Digestion

Hashimoto’s is an autoimmune condition that primarily affects the thyroid gland and has been correlated with autism in the offspring of mothers with the condition. Without intervention, the result is immune destruction to the mother’s thyroid, often with a need for medication.

There is somewhat of a “myth” in mainstream medicine that leads some doctors to the conclusion that once the thyroid is completely destroyed and proper medication dosage has been achieved the disease is managed, without concern for further organ involvement.

Unfortunately, there are many sequelae that accompany Hashimoto’s, including the risk of developing multiple other autoimmune diseases. In fact, once you have one autoimmune condition, it is highly likely you will develop another.

Several studies have identified correlations between mothers with autoimmune disease and an increase incidence of autism in their offspring. Conditions such as Hashimoto’s, type 1 diabetes, inflammatory bowel disease and celiac disease have all be correlated with an increased risk of autism.

In a recent study, infants of mothers who tested positive for Anti-TPO antibodies (the primary antibodies found in Hashimoto’s) during pregnancy saw an increased odds of autism by nearly 80%.  I don’t know about you, but to me, 80% is a reason to pause and reconsider how we are approaching autoimmunity, especially in our mothers.

Register for the free upcoming Autism Intensive Summit. 

In a recent review regarding autoimmunity and thyroid disease, it was concluded that autoimmunity developed during pregnancy and thyroid disease were both associated with autism risk in baby. Furthermore, they concluded that mom’s autoimmune disease is likely an independent risk factor in the development of autism in their child, with an estimated 30% increased risk.

What role does Mom’s autoimmunity have in autism development?

There are two main theories as to how maternal autoimmunity influences the development of autism in her baby.

Immune Modification: The dysfunction in mom’s immune system during fetal development is thought to alter baby’s immune system at the genetic level.

Fetal Brain Development: Mom’s immune mediators, including cytokines, T cells and autoanitbodies pass through the placenta into baby’s brain leading to activation of microglia, the main immune system defense of the brain. The activation of microglial cells leads to inflammation in baby’s brain, which inhibits proper development.

Much more research and understanding is needed to fully grasp the role of mom’s autoimmunity during pregnancy and the long term affects on fetal brain development. But I understand that reading this may feel a little overwhelming or even a bit defeating if you currently have an autoimmune disease. But there are many steps you can take to bring your immune system back into balance prior to conception.

In a recent interview for the Autism Intensive, I shared approaches to preconception that improve both the health of mom and baby. You can register to watch the interview here.

Autoimmune Management as Part of Preconception Care

As a Functional Medicine and Naturopathic Physician, I take a holistic approach to caring for my patients. Autoimmune diseases, like Hashimoto’s can make conception much more difficult, increases the risk of miscarriage and other complications in pregnancy, and has been correlated with higher incidences of postpartum complications, like depression.

These 7 Steps are important for all women wishing to conceive, bust especially those with Hashimoto’s.

Get Tested: Work with a qualified healthcare practitioner to determine appropriate testing for you. You should have a complete thyroid panel prior to conception, as well as testing to determine your gut health. Because many Hashimoto’s patients have nutrient deficiencies, screening for these is also important. Download my list of pre-pregnancy lab testing for Hashimoto’s.

Vitamin D: Check your levels and supplement appropriately. Low vitamin D has been associated with chronic disease and has a large role to play in balancing your immune system.

Eat Your Omegas: Omega-3 fatty acids, like those found in cold water fish, reduce inflammation, improve brain health and are beneficial in immune system regulation. Don’t like fish? You can find these omega-3 fatty acids in fish oil supplements. Aim for 1,000-3,000 total omega-3 daily and always be sure to purchase from a company that uses third party testing and screens for heavy metals.

Remove Food Sensitivities: At minimum, I tell my patients to ditch gluten. An elimination diet is one of the best ways to determine if you have other food sensitivities. Food sensitivities can perpetuate autoantibodies in your system.

Fix Your Gut: It houses the majority of your immune system. If you have an immune problem, you need to look to your gut to fix it. In my practice I’ve seen countless patients significantly improve their autoimmune condition after discovering and treating their SIBO, chronic yeast, bacterial overgrowth, parasites and/or intestinal permeability.  And it is worth noting that what your grow in your gut will have a direct impact on baby’s.

Manage Your Stress: Stress is a constant in our lives and can drive your autoimmunity full steam ahead. The good news is that how your respond to and manage your stress can have a significant impact on your immune system and your entire well being.

Preconception Detox: Daily detoxification is a must for your health and baby’s. I find many of my autoimmune patients have either issues with the way their body eliminates waste or have a build up of toxins, including heavy metals and endocrine disruptors, in their system. Detoxing a good 6-12 months prior to conception can alleviate your symptoms, decrease your autoimmunity, improve thyroid function and make conception so much easier.

I’m a strong advocate for the management of autoimmunity prior to conception and as such, I have put together a comprehensive program that focuses on preconception care for women with Hashimoto’s. As a mother and a doctor with Hashimoto’s, it is my mission to help women with Hashimoto’s have the most optimal pregnancy outcomes.

Join my mailing list now to receive exclusive offers and special pricing on my Hashimoto’s Preconception Program opening in 2016.

And don’t forget to sign up for the Free Autism Intensive airing in January 2016.

Awhile back, I attended a school event with my son and through a series of events I came to realize there’s a whole lot people do not understand about celiac disease.

I’ve written about my son’s food sensitivities before (there’s a long list here), but it just so happens that there is girl in his class that shares the big ones with him — dairy, eggs, and gluten. But her issue with gluten isn’t a sensitivity; she’s been diagnosed with celiac disease.

Because of my knowledge of food sensitivities and because these two lovelies share the big ones, I was asked to be responsible for taking them around the festival. And I take this responsibility very seriously (imagine me as a food ninja, back flips and all).

Each booth was the theme of a continent and there was food and a craft representing each region of the world. Sounds awesome until you roll up on a bowl full of couscous or the cheesecake table or Brazilian cheese balls (which are gluten free, but made with cheese and eggs).

I had prepped a bunch of food that met the requirements and matched what they were serving for my son. I also brought extra in the event other kids needed alternatives too. They had plenty to eat and were happy, but that’s not why I’m writing this post. I just want you to know that no one was deprived that day.

Oh and if at this point you’re thinking, “um, why not just bail?” Let me assure you that it did cross my mind, but I don’t believe that children should have to forgo fun on account of having food related health issues.

Anyhow, we ended up at a booth with wonderful glutenous snacks to engage in their designated craft. As anyone can imagine, managing two toddlers in a field of chaos is not free from a bit of struggle. Now here’s the classic mom line — “I turned my back for 2 seconds and…” Yup, literally 2 seconds and I look back to see a well meaning parent handing this little girl a bowl of gluten. (Spoiler: NO ONE DIED!) But you may have thought someone was about to die the way I yelled, “NO!” and whisked her away.

I politely told the other parent that she could not have that. And of course, I was asked, “Does she have an allergy?” (Totally legitimate question, by the way.) My answer was, “She has celiac disease.” What came next just about floored me and the look on my face totally revealed how concerned I was by this statement. “Oh, well she’d just have a little tummy ache.”

First thing, let’s not hate on this person or feel compelled to shame them (because if you’re reading this and have celiac disease you may very well feel that way), but instead let’s break down some fundamental flaws of that statement.

1. Celiac Disease + Gluten Consumption does NOT equal “just a little tummy ache.” I’ll get to what goes down in a bit.
2. You just insinuated that this disease is no big deal … to a toddler.
3. You just undermined everything her parents have been teaching her to keep her safe.
4. And you just dismissed the inappropriateness of your action.

Ok, number 4 is going to upset some people, but I’m going to dive in because it is that important.

As an adult, you MUST ALWAYS ask permission before giving a child food. I know food is awesome. The self proclaimed foodie writing this loves food and loves making food and loves sharing food. But we can not ignore the fact that food sensitivities, food allergies and conditions like celiac disease exist. The only way to be sure is to ask.

I know that no one wants to hurt a child — this parent was coming from a place of joy and generosity. And I know that food being harmful is a difficult concept, so let’s break down what celiac disease is and what happens to a child (or adult) who is given gluten.

What is Celiac disease?

Celiac disease is a hereditary condition in which the immune system attacks the gut lining in response to the gluten protein found in wheat, barley, rye, and other related grains. It is estimated that about 1% of the population has celiac disease, although lack of screening may mean more people actually have the condition.

It is not an allergy, which involves IgE antibodies, but it is just as serious.

What Happens When Someone with Celiac Disease Eats Gluten?

For those with celiac disease, eating gluten triggers an immune attack on the intestine causing tissue destruction and inflammation. The villi, finger-like projections of the small intestine, are destroyed. Because we rely on our villi for important enzymes and absorption of nutrients, their destruction results in malabsorption.

It’s important to note that some people with the condition never have digestive symptoms. Instead, some people present with symptoms like muscle and joint aches, brain fog, and other mental ailments.

Symptoms & Long Term Health Conditions Associated with Celiac Disease:

Abdominal Bloating & Pain
Constipation
Dental Enamel Defects
Steatorrhea: Floating stools or the appearance of oil in the toilet due to fat malabsorption.
Vitamin and Mineral Deficiencies
Fatigue
Irritability (especially in children)
Canker Sores
Weight Loss
Developmental Delays
Delayed Puberty
Depression/ Anxiety
Numbness in Hands or Feet
Short Stature
Skin Rashes
Arthritis
Liver Disease
Bone Disease
Headache or Migraine
Dementia
Infertility
ADHD
Iron Deficiency Anemia
Cerebellar Ataxia: May present as walking abnormally or having an abnormal posture, vomiting, strange eye movements, loss of fine motor skills.

With a gluten free diet, the gut is allowed to heal and function will be restored. If the disease is caught early, many of these symptoms are reversed or prevented altogether.

Other Diseases Associated with Celiac Disease:

Dermatitis Herpetiformis: Itchy vesicles on the elbows, knees, face, neck, torso, buttocks (sometimes the mouth) that rupture and scar.

Type 1 Diabetes: An autoimmune condition in which the body stops producing insulin as a result of extensive destruction of pancreatic beta cells. It is estimated that 3.5% of children with celiac disease have a parent with Type 1 diabetes. One study found that Type 1 diabetes may be correlated with duration of gluten consumption.

Hashimoto’s Thyroiditis: Autoimmune thyroid disease in which antibodies attack the thyroid and the patient is no longer able to produce thyroid hormone in later stages of the disease. Approximately 20% of people with celiac disease also have autoimmune thyroid disease. About 5% with autoimmune thyroid develop celiac disease.

Cancer: Gastrointestinal cancers and non-Hodgkin lymphoma are associated with celiac disease in adults. Eliminating exposure to gluten decreases the risk.

Liver Disease: Acute and chronic hepatitis, autoimmune hepatitis, and primary biliary cirrhosis have all been associated with celiac. Liver disease and cirrhosis have been found in children with celiac disease, but it is unclear if celiac was the cause.

Other Autoimmune Disease: In addition to the other conditions listed, having celiac disease is associated with an increased risk of developing Addison’s disease, Crohn’s disease, multiple sclerosis, psoriasis, ulcerative colitis, and many others.

Testing For Celiac Disease

The following blood tests can suggest the possibility of celiac disease. Biopsy of the small intestine is necessary to confirm the diagnosis as it is possible to have a false positive blood test. If you are concerned you may have celiac disease, please talk to your doctor about having the following tests done:

YOU MUST BE CURRENTLY EATING GLUTEN TO HAVE ACCURATE RESULTS.

• Tissue Transglutaminase Antibodies (tTG-IgA)
• IgA Endoymsial antibody (EMA)
• Total serum IgA
• Deamidated gliadin peptide (DGP IgA and IgG)
• Genetic testing: HLA DR3-DQ2 and DR4-DQ8 – 99% of those with celiac disease have either one or both of these genes.

Celiac disease is triggered by gluten containing products, but the symptoms and progression of the disease can be avoided by eliminating gluten from the diet. In my clinic, I recommend that patients also remove gluten containing personal care products from their home, especially with children in the house.

Download our complimentary Gluten Free Guide Here.

Oh and to finish my story. I explained everything in this post to the parent, who responded, “I had no idea.” But now they do and it was a total GI Joe moment: “Knowing is half the battle.”

If you’re reading this and have celiac disease or a food sensitivity, remember that we need to educate and create allies. I’m not saying you should go out and tell everyone about your condition, but instead, when an opportunity arises don’t shy away from sharing some facts. People are curious and I find that parents genuinely want to know. After all, we all want what is best for our kids.

If you’ve made it this far and you don’t have celiac disease or food sensitivities — congratulations! You’re an awesome human for putting this much time into educating yourself. Gold star, indeed!

If you think you may be suffering from celiac disease or gluten sensitivity, I encourage you to speak a qualified medical practitioner about testing.

As a Naturopathic Physician, I treat a wide variety of conditions, specializing in autoimmune diseases like celiac. You can schedule a complimentary 10-minute phone consultation here to learn more about our patient centered approach to celiac disease.

Download Our Complimentary Gluten Free Guide

Navigating the food world can be tough. Please take advantage of our free guide to help you steer clear of gluten containing products.

Sources:

Accuracy of serologic tests and HLA-DQ typing for diagnosing celiac disease. Hadithi M, von Blomberg BM, Crusius JB, Bloemena E, Kostense PJ, Meijer JW, Mulder CJ, Stehouwer CD, Peña AS Ann Intern Med. 2007;147(5):294.

Autoantibodies to human tissue transglutaminase identify silent coeliac disease in Type I diabetes. Seissler J, Schott M, Boms S, Wohlrab U, Ostendorf B, Morgenthaler NG, Scherbaum WA.  Diabetologia. 1999;42(12):1440.

Celiac disease in children, adolescents, and young adults with autoimmune thyroid disease. Sattar N, Lazare F, Kacer M, Aguayo-Figueroa L, Desikan V, Garcia M, Lane A, Chawla A, Wilson T. J Pediatr. 2011;158(2):272.

Development of celiac disease-associated antibodies in offspring of parents with type I diabetes. Hummel M, Bonifacio E, Stern M, Dittler J, Schimmel A, Ziegler AG Diabetologia. 2000;43(8):1005

Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Ventura A, MagazzùG, Greco L. Gastroenterology. 1999;117(2):297.

Prevalence of autoimmune thyroiditis in children with celiac disease and effect of gluten withdrawal. Meloni A, Mandas C, Jores RD, Congia M. J Pediatr. 2009

Range of neurologic disorders in patients with celiac disease. Zelnik N, Pacht A, Obeid R, Lerner A, Pediatrics. 2004;113(6):1672.

This time on the blog I want to talk about the cause of IBS, like the migrating motor complex and more. This is all sort of spiraling out of a SIBO Symposium I just attended and I wanted to share it with you.

I had the pleasure of attending the SIBO Symposium at the National College of Natural Medicine in Portland, Oregon last week. The speakers were fantastic and a lot of great information was shared regarding SIBO and IBS, all of which I’ll be sharing with you through my blog and videos on YouTube.

I will be sharing some of the pearls in treating IBS and SIBO over a series of videos. I think you’ll find them helpful.  Please be sure to subscribe to my YouTube channel so you don’t miss any.

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is estimated to affect approximately 40 million Americans, making it the most common gastrointestinal disorder. There are different forms of IBS—constipation, diarrhea, and alternating constipation and diarrhea. Stomach pain, gas, bloating, and abdominal discomfort are common in those who suffer from IBS.

For many years, conventional medicine has viewed IBS as being largely psychological. Dr. Mark Pimentel discussed the flaws in this reasoning as revealed by studies, which demonstrated an infectious component to the development of IBS.

Which brings us to the new test and the possible underlying cause for IBS—anti-CdtB antibody and anti-vinculin antibody. Let’s talk a little bit more about what is believed to be the underlying cause of IBS with diarrhea and the mechanisms so you can understand why we would test for these antibodies.

When you ingest pathogenic bacteria, they can release a toxin known as Cytolethal Distending Toxin or CDT. Bacteria such as Campylobacter, E. Coli, Shigella, and Salmonella release the toxin and, because your body is wise, it creates an antibody to CDT (anti-CdtB). However, in a process of molecular mimicry, your body can get confused and start to make antibodies to vinculin. This then results in the destruction of the interstitial cells of Cajal (ICC).

Bottom line: Some specific bacteria can indirectly trigger your immune system to attack a key component of your digestive tract resulting in IBS.

The ICC cells are the electrical pacemakers of the migrating motor complex (MCC. These stimulate a wave-like motion in the intestines. We know that in both IBS and SIBO the migrating motor complex is compromised. Meaning the sweeping of GI contents into the large intestine is inhibited.

Underlying Cause

It is now believed that IBS has an underlying autoimmune component. The anti-CdtB and anti-vinculin antibodies result in an autoimmune response and destruction to the ICC cells.

Now I know when I say autoimmune, that raises red flags, and I definitely understand that. But, what some of the research has shown is that after successful treatment, the ICC cells can regenerate in about three weeks. Which is pretty cool, because most nerves in the body take a long time to regenerate. It also tells us that the tissue destruction that takes place is not permanent, so you can actually heal your body and recover from IBS and become symptom-free.

Since it is estimated that over 80% of people with IBS also have SIBO, both testing and treatment of SIBO, if present, should be part of therapy. Additionally, elevated anti-CdtB antibodies have been correlated with SIBO. This is a promising discovery. By treating the underlying cause and promoting gut and immune system healing, IBS can be reversed.

Anti-CdtB and the anti-vinculin antibodies can currently be ordered through a lab called Commonwealth. Commonwealth also offers the lactulose breath test for screening for SIBO.

I’m hoping to see more labs pick this up. For now, it’s really exciting that we can use these tests to understand the underlying cause of IBS, the prognosis, and how difficult the case may be to treat.

I hope you found this really exciting and helpful. Stay tuned for the additional video and posts where I’ll share even more about this leading-edge research and new treatment protocols for IBS and SIBO.

Sources:

1. Madnusudan, G. Role of gut pathogens in development of irritable bowel syndrome. Indian J Med Res. 2014 Jan; 139(1): 11–18.
2. Pike, B., et al. Acute Gastroenteritis and the Risk of Functional Dyspepsia: A Systematic Review and Meta-Analysis. The American Journal of Gastroenterology 108, 1558-1563 (October 2013) doi:10.1038/ajg.2013.147
3. Porter, C, et al. Pathogen-specific risk of chronic gastrointestinal disorders following bacterial causes of foodborne illness. BMC Gastroenterology 2013, 13:46

We know that bacteria are essential for a healthy gut biome, performing a number of functions that affect everything from metabolic function to immunity, to how we perceive the world. But there are instances when the same bacteria that help us with digestion and fighting off nasty infections can turn against us in a condition called SIBO.  

Small Intestinal Bacterial Overgrowth (SIBO) is a condition in which there is an increase in the number of bacteria found in the small intestine. The increase in bacteria may be an overgrowth of what is normally found in the small intestine, but more commonly, it is the result of bacteria finding their way from the large intestine into the small intestine.

Sounds harmless? It’s not.

Inhabitants of the large intestine have taken up residence in the small intestine.

SIBO has been shown to cause damage to the small intestine, resulting in nutrient malabsorption, nutrient deficiencies, inflammation, allergies, food sensitivities and leaky gut, which is involved in autoimmune conditions and other chronic disease. Because the bacteria have the ability to inactivate (deconjugate) bile, fat malabsorption and deficiencies in fat soluble vitamins can also occur. So, how do you know if you suffer from SIBO?

Common Symptoms Caused by SIBO:

• Gas/ Bloating
• Heartburn/ GERD
• Constipation
• Diarrhea
• Irritable Bowel Syndrome (IBS)
• Nausea
• Abdominal Pain/ Cramps
• Joint Pain
• Fatigue
• Anemia-B12 or Iron
• Fat Malabsorption/ Steatorrhea
• Weight Loss

It is estimated that upwards of 84% of people diagnosed with IBS test positive for SIBO.

[bctt tweet=”84% of people diagnosed with IBS test positive for SIBO.”]

Treating SIBO can be difficult because these bugs are smart.

I have a love-hate relationship with these bacteria. I love how smart they are and have a huge amount of respect for their survival tactics, but when they’re in your small intestine hijacking your food — I hate them.

You see, their objective is to create an environment in which they preferentially absorb important nutrients; for example, B vitamins and amino acids.

But how your gut functions can also make SIBO very difficult to treat.

Most people I see with SIBO have some degree of slow gut motility. What does that mean? Basically, your digestive system is a little slow in moving out waste.

If you have slow gut motility, any antimicrobial therapy, either pharmaceutical or herbal, will only be a temporary fix in symptoms until this underlying issue has been addressed.

I’ve helped many patients achieve permanent resolution of symptoms after having been frustrated with unsuccessful pharmaceutical or herbal antimicrobial therapy prescribed by other practitioners. The difference in my treatment approach is that I not only look to correct the bacteria levels and gut function, but I also look to what may have created the condition in the first place.

Risk Factors for Developing SIBO:

• Diabetes I & II
• Low Stomach Acid/ Use of Antacids
• Pancreatic Insufficiency
• Repeat Antibiotic Therapy
• Celiac Disease
• Bowel Surgery
• Crohn’s Disease
• Oral Contraceptive Pills
• Moderate to Heavy Alcohol Use
• Constipation
• Unmanaged Hypothyroidism