Hippocrates said, "All disease begins in the gut," and Georgia Lennard's "hellish" experience with Hashimoto's thyroiditis is no exception.
Always more easily fatigued than other children her age as a child, Georgia can't remember a time when she didn't have to push herself to keep up with the others. She didn't think anything of it until she was almost out of her college years, finishing her studies to become a nutritional therapist in London after moving there from Cape Town, South Africa.
"When I got to London I pushed myself a lot," she says. "Everything was new, I didn't know anyone, and I was only 22 years old. I didn't know how to manage stress, and I think that made me even more tired and anxious. I already suffered from anxiety and low energy and things like that. And I became really stressed out."
Hashimoto's ran in her family, but at the time she never considered that. After graduation with a degree in nutritional therapy, she went on to earn other health credentials, eventually becoming an advanced physical rehabilitation trainer.
With her husband, she opened Beyond Balance, a physical rehabilitation and training center in London, focusing on everything from rehabilitation after injury, nutrition and stress reduction to helping businesses create a workplace culture of healthy living.
She was doing all the right things herself, eating a healthy diet, eliminating gluten and dairy, focusing on nuts, seeds, fish and some lean meats along with lots of vegetables and fruits, even getting boxes of fresh produce delivered from local farms.
But over time, the sense of overall exhaustion and depression just kept building up. And then, at age 27, she got pregnant, and her symptoms went from an annoying, puzzling distraction to a raging forest fire of exhaustion, anxiety, paranoia and insomnia.
"I developed a hyperthyroid state, with an overactive thyroid, and suddenly went from being able to sleep completely normally to lying awake for the entire night for over two weeks. I was constipated and couldn't go to the bathroom. I was suddenly so anxious, it was actually paranoia. I thought people were watching me and following me. My hair was falling out, and I was freezing cold all the time, wearing huge overcoats and losing weight quite rapidly."
After the birth of her daughter, things didn't improve. Depressed and very confused, Georgia was also becoming scared and desperate.
In that mindset, Georgia was a bit more easily swayed and influenced by people criticizing the nutritional path she was following. "They'd shout, 'There's nothing wrong with gluten—it's all in your head,'" she recalls.
"And because I was in such a vulnerable space, I started thinking maybe I should stop being so strict. Maybe I was even suffering from orthorexia [an obsessive-compulsive disorder centered around eating a healthy diet]. So I just let go of everything and started eating whatever."
By November 2018, she could barely get out of bed, let alone take care of her daughter or go to work. At that point she had to come face-to-face with the hard fact that despite being a health professional herself, she was far from healthy.
"I was in so much denial because, like most women, I was living my life at 100 miles an hour and always taking care of everyone else's health," she says. "I was overworking myself, completely stressing myself out and not doing anything to handle it."
The strange thing was that Georgia didn't think to test herself, considering it too expensive and time-consuming. "And I didn't think there could be something wrong with me because I had the image that I'm so much healthier than the average person."
The first thing she did was get a comprehensive blood chemistry panel (CBC) done at a functional medicine clinic, which gave her some 37 markers, from immune markers and hormone levels to vitamin D levels. The test made her realize that her immune system was doing something very strange.
"Some of those markers were way too high," she says. "My vitamin D was low, even though I was actually taking vitamin D at the time. Vitamin D is very much associated with autoimmune diseases. I was low in a few other nutrients that are linked to low thyroid and autoimmune conditions, and I realized that I might have Hashimoto's."
Following the advice of her husband, she packed up and took her daughter back to her parent's home in Cape Town for a month of rest. There she saw an endocrinologist for thyroid tests.
"I knew not to go to a general practitioner and get my T4 and TSH tested," she says. Thyroxine, or T4, is a hormone the thyroid produces, and thyroid-stimulating hormone (TSH) is produced by the pituitary gland when the thyroid is underperforming.
"I knew I would be told, 'There's nothing wrong with you because your TSH falls within range'—because my TSH was in range.
"Actually all of my thyroid markers were in range except for my antibodies. My TPO antibodies were off the chart." TPO—thyroperoxidase—is an enzyme involved in thyroid hormone synthesis (see box, right). Antibodies are created by the body to attack what it perceives as a threat, in this case Georgia's own natural thyroid hormones.As it turned out, massive amounts of TPO antibodies were being created by Georgia's body and attacking her thyroid.
Despite the fact that her body was completely dysfunctional, the endocrinologist recommended that since the test for TSH was within range, Georgia should wait until her TSH was out of range and come back in about six month's time, at which point he would prescribe levothyroxine, a synthetic form of T4 used to treat underactive thyroid. "Basically he was saying, 'Wait six months until your thyroid burns out completely and then come back.'"
Worse, levothyroxine does nothing to help heal Hashimoto's disease. "You see a lot of women taking thyroxine and they still have symptoms," says Georgia.
Beyond standard of care
Health and lifestyle expert Kristin Grayce McGary, LAc, MAc, CLP, an internationally recognized authority on autoimmunity, functional blood chemistry analysis, thyroid and gut health and author of Holistic Keto for Gut Health: A Program for Resetting your Metabolism, says Georgia's story is all too typical.
When it comes to Hashimoto's and other autoimmune disorders, narrow, traditional 'standard of care' regulations and recommendations make getting diagnosed and receiving appropriate treatment extremely difficult.
"No one is talking about regulating the immune system—which would halt the autoimmune attack—through gut repair and other lifestyle and nutritional changes," says McGary.
"You can halt the autoimmune situation and begin to heal, but there are very few doctors in the Western medical world talking about that."
She says Hashimoto's is going undiagnosed or misdiagnosed because most doctors and endocrinologists are not ordering a full thyroid panel. "In my world of functional medicine, a full thyroid panel is eight thyroid markers and two antibodies at least—that's 10 markers.
"But it's difficult to get an endocrinologist to order that, and even if they do, they don't understand fully how to interpret those tests because they're not used to ordering them.
"In the standard of care in Western medicine, if your TSH is off, there is no inquiry about why it's off," McGary continues. "Are you having a conversion problem from T4 to T3? Is your body not converting that hormone? If so, is that because of a gut issue or a liver issue? Because that's where conversion happens. Is it because you're having high cortisol because of stress, or something else?"
In addition to the CBC and thyroid antibody test, Georgia says she also took a stool test to discover which gut microbial strains she had present, including the strains that are linked to autoimmune disorders, and in what percentages.
"Then I was able to target what I needed for my digestive system and get the right products, like Designs for Health GI Revive (catalog.designsforhealth.com), to heal my leaky gut. I also discovered that I needed to take digestive enzymes with every meal because my hydrochloric acid level was too low."
She had already gone back to her original gluten-free, dairy-free diet and was now also sugar-free and eating "masses" of vegetables to create the short-chain fatty acids needed to help damp down the inflammation in her body. Step-by-step, she says, she began to sort herself out.
Within four weeks, the turnaround in her health was dramatic. She actually felt functional for the first time in years and was able to go back to work.
"I was shocked," she says. "I wouldn't say I felt amazing, but from not functioning at all to being able to go back to work was really incredible. And with every week and every month I'm getting better and better."
Aside from diet, Georgia says the most important thing she did was get a handle on her stress levels—the very thing that seemed the most likely cause of her Hashimoto's in the first place.
"If I start getting really stressed out about something, I let it go because it's not worth it. And if I don't achieve things as quickly as I thought I should in the past, that just doesn't matter."
Part of her letting go of stress has centered on her attitudes around food. For years she restricted her diet, especially carbohydrates, to the extreme. As a result, she says, she thought about food way too much, becoming obsessed with being "good" during the week, then binging on weekends.
Exercise is also crucial to keeping her Hashimoto's in remission, but she's had to shift from lifting heavy weights four times per week to more bodyweight circuits and cardio-based (high heart rate, high sweat) exercise programs.
"Research suggests that weight training might put too much of a burden on the mitochondria (energy producing part of the cells) in the body, and recovering from this style of training might be tricky for Hashimoto's sufferers," she says. "I've felt much better doing circuits and cardio."
She's also been working on turning her analytical and frequently "cynical" mindset into a vehicle more built on faith and a belief in the unseen. It's taken her five years to let go and realize she cannot control everything.
"I cannot begin to explain how different I feel. I've suddenly got my clear mind back and handle stress head on. My confidence is back too—I feel like a new woman!"
WHAT IS HASHIMOTO'S THYROIDITIS?
The thyroid gland is a butterfly-shaped endocrine gland located below the Adam's apple on either side of the lower neck.
Its main role is to produce the hormone thyroxine (T4), which the body converts into triiodothyronine (T3), the functional version of the hormone that passes into the bloodstream and circulates throughout the body.
These two hormones help regulate metabolism (determining the way the body uses fats and carbohydrates), protein production, heart rate and body temperature.
The thyroid gland also produces a hormone called calcitonin that helps control the amount of calcium in the bloodstream.
Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is an autoimmune disorder where the body's immune system produces antibodies that attack the thyroid gland and other tissues in the body.
This inflammatory process damages the thyroid, resulting in insufficient hormone production in the gland.
Hashimoto's runs in families and occurs mostly in middle-aged women. In fact, Hashimoto's and other autoimmune disorders occur about twice as frequently in women as men.
The risk increases with age and is greatest for people over 50. However, anyone at any age can be affected.
Symptoms are not always clear because Hashimoto's shares some symptoms common to other autoimmune disorders.
But most Hashimoto's sufferers report experiencing debilitating fatigue, weight gain, muscle aches and pain, constipation, increased sensitivity to cold, dry skin, irregular and/or difficult menstruation, severe depression and anxiety. The slow cell damage to the thyroid can sometimes lead to a person developing a goiter (enlarged thyroid), which is a symptom of hypothyroidism in general.
The clearest indicator for Hashimoto's is the presence of elevated thyroid peroxidase (also called thyroperoxidase or TPO) antibodies in the bloodstream, indicating an autoimmune condition where the body is attacking the thyroid. TPO is an enzyme involved in thyroid hormone synthesis.
Nonetheless, antibody testing is not part of the standard of care in either the US or UK, and the vast majority of doctors never order it.
Instead, they rely on thyroid tests that focus on the amount of T4 and T3 hormones in the bloodstream, as well as the amount of thyroid-stimulating hormone (TSH).
TSH is a hormone normally released by the pituitary gland in response to changing levels of T3 and T4 in the bloodstream.
Unfortunately, while an elevated TSH reading is effective for diagnosing hypothyroidism, it is not necessarily an indicator of Hashimoto's. Tests for T4 and T3 are also poor indicators of Hashimoto's.
CAUSES OF HASHIMOTO'S DISEASE
Most mainstream doctors aren't sure what causes Hashimoto's. But studies are beginning to get to its roots
Poor gut health and imbalances in the microbiota of the intestinal tract have been linked to the development of many autoimmune diseases including inflammatory bowel disease (IBS), rheumatoid arthritis, lupus, multiple sclerosis and even type 1 diabetes.1 So far, few studies have looked at gut health and Hashimoto's thyroiditis, which is also an autoimmune disorder, but the evidence to date shows a connection between the two.2 Compared to healthy controls, patients with Hashimoto's had different relative amounts of various species of gut bacteria, and the extent of those differences correlated with the severity of their symptoms.3
The Western diet, characterized by the consumption of high-fat, high-cholesterol, high-protein, high-sugar, high-sodium, processed and fast foods, can play a large role in inflammatory autoimmune conditions.4 Leaky gut—a condition where poor diet and nutrition lead the walls and junctions in the intestines to become permeable, releasing toxic waste material into the bloodstream—has been linked to autoimmune disorders,5 and high consumption of sugar substitutes has also been identified as a possible cause of Hashimoto's disease.6
Gluten is the number one culprit in autoimmune disorders. It negatively impacts the gut microbiome and increases intestinal permeability leading to a leaky gut.7 A gluten-free diet has been shown to mitigate the symptoms of Hashimoto's.8 Other inflammatory foods such as dairy can also trigger autoimmune issues, as can alcohol consumption.
Stress is a startlingly clear cause of Hashimoto's and other autoimmune disorders. Emotional stress triggers the production of hormones, which in turn impact the release of cytokines—chemical messengers secreted by certain cells of the immune system that regulate inflammation. This results in immune dysregulation and eventually autoimmune disease.9
Stress also contributes to hormone imbalances that change the rate at which the thyroid hormone T4 (thyroxine) is converted into its 'usable' form, T3 (triiodothyronine). Hashimoto's causes changes in the brain that amplify the stress reaction, and sufferers are far more likely than the general population to experience anxiety or depression,10 creating a vicious stress cycle that, unless addressed, gets progressively worse.
Vitamin D deficiency has been linked to Hashimoto's disease, and vitamin D therapy can mitigate the autoimmune response.11 Pregnancy also impacts thyroid hormones, and some women develop antibodies to their own thyroid during or after pregnancy.12
Epstein-Barr virus (EBV), alternately known as human herpesvirus 4, has been linked to autoimmune disorders of the thyroid,13 and smoking cigarettes is another causative factor, with a number of studies showing correlations between smoking and thyroid dysfunction.14
If you suspect Hashimoto's...
Fatigue, anxiety, constipation, weight gain, muscle aches, dry skin, cold all the time ... if this sounds like you, there are several things you can do to find out if you have Hashimoto's, mitigate the symptoms and help your body heal.
Step 1: Get the right test
Georgia Lennard, nutritionist and advanced physical rehabilitation trainer at Beyond Balance in London, recommends you seek out a functional medicine clinic and get certain lab tests done, including:
Antithyroid antibodies test.
The antithyroid antibodies (ATA) test, also known as the TPO test, is the best test for determining whether or not you have Hashimoto's thyroiditis. Over 90 percent of people with Hashimoto's have high levels of antibodies because Hashimoto's thyroiditis is an autoimmune disorder, which means immune cells are producing the antibodies to attack your thyroid gland. ATA tests detect the presence of these antibodies and measure their levels.
Thyroid-stimulating hormone test. Thyroid-stimulating hormone (TSH) is produced by the pituitary gland when the brain registers low levels of thyroid hormone production. This is the test for determining hypothyroidism (an underperforming thyroid).
Though commonly used as a test for Hashimoto's, it is not an accurate test because Hashimoto's is an autoimmune dysfunction that triggers hypothyroidism as a side-effect. Having high (or low) levels of TSH does not necessarily mean you have Hashimoto's.
T3 & T4 tests. The common thyroid tests the vast majority of general practitioners and endocrinologists prescribe and are familiar with as their 'standard of care,' these measure the levels of triiodothyronine (T3), the main thyroid hormone that enters the blood stream, and its precursor thyroxine (T4).
T4 and T3 readings can be totally within normal ranges, and you can still have Hashimoto's. Similarly, neither elevated levels nor low levels of either or both hormones are an accurate indicator of Hashimoto's. Unfortunately, this is the test the vast majority of doctors use for diagnosis.
Step 2: Use food as medicine
Although every body is unique and no two people will react to the exact same foods and combinations, there are some excellent general guidelines for preventing, managing and healing Hashimoto's.
The top foods to avoid are gluten, dairy, soy, sugar, alcohol, coffee, processed foods and usually all grains.
"For certain people who have autoimmune disease, gluten is a poison, even a tiny amount," says Kristin McGary, LAc, MAc, CLP. "You would never drink a little chlorine or gasoline, would you?
"You might not feel anything when you eat gluten. But then you don't feel anything when you have decay in your mouth either, until it's caused enough damage to cause a cavity.
"Gluten is the same way—it's creating inflammation in the body, in the gut and even in your brain for months and years before you get a symptom."
Remember, not all foods are good for all people. For example, legumes are healthy, but Georgia Lennard says that her body just can't handle them.
Trust how your body feels when you eat a certain food, and get tested for food allergens and sensitivities. Here are some of the top foods to start the healing process:
Fresh vegetables and fruit. Fiber is what feeds the gut microbiota, which then convert the fiber to short-chain fatty acids that are the main source of nutrition for the cells of the colon. They also reduce inflammation, prevent heart disease and other conditions, help with digestion and balance blood sugar levels.
Wild-caught salmon and other fish. Great sources of omega-3 fatty acids, essential for hormone balance and thyroid function.
Probiotics. Organic yogurt and kefir, sauerkraut, kimchi and other fermented foods supply beneficial bacteria to the gut.
Avocado and coconut oils. Avocado oil supplies oleic acid, a mono-unsaturated omega-9 fatty acid that, like omega-3 and omega-6 fats, increases 'good' HDL cholesterol, lowering blood pressure and preventing arterial plaques. Coconut oil provides medium-chain fatty acids, boosting energy and supporting a good metabolism.
Sprouted seeds and beans/legumes. These are high in fiber and minerals.
Bone broth. High in nutrients and minerals, it helps heal the gut lining.
Step 3: Manage your stress
"Stress is a huge part of Hashimoto's," says Georgia. "Obviously stress can cause inflammation within your body.
"It causes cytokines to be released and a whole cascade of autoimmune reactions to kick off, and that in itself can cause your gut junctions to widen, so then you get a permeable gut and ultimately an autoimmune condition."
Here are some recommended ways to handle stress and feelings of overwhelm:
EMDR. Eye movement desensitization and reprocessing, or EMDR, is a rapid, nontraditional type of psychotherapy that enables people to heal from emotional distress and trauma.
EFT. The Emotional Freedom Technique (EFT) is a self-help technique that employs tapping a specific series of acupuncture points on certain energy meridians to lower the body's stress response and promote relaxation.
Meditation, including mindful breathing and other relaxation techniques such as yoga, tai chi and qigong, has been proven to reduce stress and help manage emotions.
Earthing and getting out in nature. Studies on earthing (also known as grounding) show that walking barefoot or otherwise connecting your body to the earth's natural electromagnetic field of energy for 20 minutes a day is a tremendous stress-buster. It introduces electrons into the body, reducing free radicals and inflammation, combatting insomnia, lowering pain levels and more.