So many women are led to believe that their thyroid symptoms are in their heads! Well, guess what, ladies, it’s not in your head – but your thyroid troubles could be starting in your gut!

Let me tell you about one of my patients.

Karen had a life-long history of terrible bloating and constipation. Aside from this, she’d always been happy and energetic.

Soon after she turned 36, everything changed.

She started feeling exhausted all the time and became so depressed that some days she barely had enough energy and motivation to take care of her kids or make it though a whole workday. In fact, she had to switch her job to part-time just to cope, but this had an impact on her income and self-esteem, which only added to her depression.

Karen sent me a photograph of her belly when it was bloated. She was often asked if she was pregnant and indeed, I’d have thought she was 7 months pregnant from the photo – her distended belly stood out in start contrast to her otherwise tall, slim figure.

She came in for an appointment.

Given her fatigue, I ran tests for thyroid problems. Her results clearly showed Hashimoto’s disease, an autoimmune hypothyroid disorder responsible for 80% of all hypothyroid cases in the US.

But this is not the only thing testing revealed. An endoscopy revealed celiac disease.

Karen immediately removed all gluten from her diet, and within just a few weeks began noticing improvements in her digestion, energy, and mood. She decided to continue working on her diet and healing her gut and systemic inflammation before starting thyroid medication. About 2 months later, her TSH had almost normalized, and her thyroid antibodies were coming down. Her energy continued to improve, as did her mood.

Karen has remained strictly gluten free. Her thyroid function completely normalized – and here’s the amazing thing: she never did start thyroid medication.

What is the Gut –Thyroid Connection?

Hashimoto’s disease is an organ specific autoimmune disease – meaning it affects the thyroid. But at its core, it is rooted in inflammation that may begin outside of the thyroid in a substantial number of cases . One of the most common sources of inflammation that eventually leads to autoimmune conditions is intestinal hyperpermeability, or “leaky gut.”

The main job of the intestinal mucosa (the lining of the intestine) is to act as like customs officer at a border crossing. It allows nutrients from our food to pass into the submucosa where it can be assimilated for our benefit, while keeping potentially harmful proteins from our food and fragments of both healthy and harmful bacteria out of the submucosa where they can trigger inflammatory and immune reactions. Over time, persistent exposure of the submucosa to inflammatory and immune triggers causes the body to produce antibodies, special proteins that recognize and fight viruses and bacteria. These antibodies can also start to recognize and attack your body tissue, including your thyroid tissue, and sabotage your thyroid’s ability to produce or use thyroid hormones, resulting in Hashimoto’s disease.

Further, the health of the intestinal microbiome regulates overall inflammation in your body by inhibiting the production of pro-inflammatory cytokines including tumor-necrosis factor (TNF), interleukin 6 (IL-6), and nuclear factor-kappa B (NF-KB), while promoting anti-inflammatory cytokines like interleukin-10 (IL-10).

New research also suggests that there is direct cross-talk between proteins and hormones in the gut and the hypothalamic-pituitary-thyroid axis (HPT), adding yet another layer of the connection to what goes on in the gut and the health of the thyroid.

Antibiotic use, frequent use of NSAIDS (ibuprofen, Aleve, Motrin, etc.), a diet high in sugar and low in a wide variety of vegetables, over-exercise and chronic stress, all affect the health of the intestinal mucosa and the microbiome, and can determine whether you develop hypothyroidism.

Celiac disease, as in Karen’s case, creates an extreme set-up for leaky gut. In fact, as many as 10% of patients with celiac disease have hypothyroidism. But much milder forms of leaky gut and dysbiosis – which affect millions more people that has previously been recognized – can also create the environment for Hashimoto’s to develop.

The tricky thing is that not not everyone with gut problems has classic digestive symptoms. Sometimes the only symptom of gut problems is an autoimmune disease! So if you have Hashimoto’s disease, it is worth including gut healing as part of your plan.

The Core Solution: Healing the Gut-Thyroid Connection

While the gut is not the only source of autoimmune hypothyroidism, healing the gut is one of the core solutions for preventing and healing from Hashimoto’s in many cases, and can prevent further autoimmune disease from starting.

Complete gut healing can take time – even a year – but it’s not too complicated with this simple plan of action. Results often start to happen quickly, so you can feel improvement in your digestion, energy, mental clarity, and so many other areas of your life in as short as 10-30 days if you’re on the right track. I’ve seen this happen for my patients time and again.

As your overall inflammation starts to go down, your thyroid antibody numbers will also decrease. It takes at least several months and even a year to see a substantial change in antibody levels, but if you’re getting to the root of the problem, you should see a change.

Now not everyone who has Hashimoto’s can avoid or go off of thyroid medication – sometimes it remains necessary – but taking the approach of healing the underlying gut problem will prevent further health problems from arising, relieves many general symptoms, and may allow you to eventually reduce your thyroid medication dose. As inflammation resolves, so will weight loss, brain fog, sleep problems, and many other chronic symptoms many of us just assume are normal and live with.

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4 Steps for Breaking the Gut-Thyroid Autoimmunity Cycle

Healing the gut is a 4-part process. I generally recommend doing these 4 steps at the same time, but they can be done sequentially, in the order they appear here:

 

  1. Remove leaky gut triggers: The most common leaky gut triggers are gluten containing foods, gluten cross reactive foods (corn, coffee) and dairy products, as well as antibiotics, proton pump inhibitors (i.e., Prilosec and many other medications for reflux, and ibuprofen and other NSAIDS including Aleve, Motrin, etc.). To truly heal your gut enough to have an impact on Hashimoto’s, you will want to remove these food triggers for at least 6 months. If there’s even a hint that you are gluten intolerant, then remove gluten and gluten cross-reactive foods permanently. Speak with your doctor about whether you must be on the above medications, and whether alternatives might be possible. The same herbal supplements that help remove inflammation in the digestive system, for example, ginger and turmeric, are effective for pain, and DGL licorice has been used effectively for acid reflux, along with avoiding reflux dietary triggers and eating too close to going to bed.
  2. Replace: Take a digestive enzyme (usually 1-2 capsules with each meal) and betaine HCl (check with your doctor first if you have ulcers, a usual dose is 1-4 capsules with meals, depending on the product)) with each meal to help your body break down proteins more completely so they don’t continue to act as an immune trigger.
  3. Re-inoculate: Take a daily probiotic that includes Saccharomyces boulardii, as well as a variety of Lactobacillus and Bifidobacterium strains. Start with a low dose, usually 1 capsule per day, and increase up to 2-4 caspules per day, depending on the package instructions for the brand you purchase. And add lacto-fermented vegetables to your daily diet. If you have a major problem with gas, bloating, or a history of constipation or diarrhea, or if you notice that your digestive symptoms worsen when you start taking the probiotic, either back down on the dose or treat dysbiosis first. You may need additional help clearing out overgrowth of problematic gut flora by taking an herbal combination that contains garlic, oregano oil, or other antimicrobial herbs, for example, those that contain the ingredient berberine, like goldenseal and goldthread. Para-Shield by Gaia Herbs, Candibactin-AR and Candibactin-BR by Metagenics are examples of products that are effective for this.
  4. Repair: A number of herbs and supplements are beneficial for relieving inflammation in your gut lining, while healing the intestinal tissue. These include a daily combination of the following for 3-12 months: curcumin (1000 mg twice daily), ginger root (500-1000 mg twice daily), zinc carnosine (30 mg 1-2 times daily), L-glutamine (up to 5 gm twice daily), and marshmallow root herb, chamomile, and others which can be found in products such as Intestinal Soother or Inflamma Response by Herb Pharm. GI Benefits from DaVinci Laboratories also includes many of the ingredients in this repair section, all in one product, though it does contain stevia which I’m not a huge fan of and fruit powders for flavor which might be a trigger for gas and bloating if you have fructose intolerance.

I hope this article gives you peace of mind and freedom from thyroid troubles!

With love,

AJR-Sig

 

 

 

 

References

Counsell, CE et al. Coeliac disease and autoimmune thyroid disease. Gut. 1994;35:844-846

Emami, A. et al. Is association between thyroid hormones and gut peptides, ghrelin and obestatin, able to suggest new regulatory relation between the HPT axis and gut? Regulatory Peptides. 2014;189: 17-21.

Hays, MT. Thyroid Hormone and the Gut. 1988, Vol. 14, No. 2-3: 203-224

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85 Comments

  1. Thank you for such an informative article! As a nursing mother, is it safe to take the supplements you recommend to “repair” your gut?

    • The ones in this article are safe, except for the products that contain concentrated essential oils i.e. candibactin products which I generally don’t recommend while nursing unless under a physician’s guidance.

  2. Hi Aviva,

    Thanks for this great article! I’m wondering, in your experience with using digestive enzymes and HCl with patients, do you find that the body starts to downregulate production of endogenous enzymes and HCl over time with supplemental use? I am sometimes torn between the use of bitters to stimulate the body’s own production of these versus supplementation — I lean toward use of bitters with my clients for concern with the possibility of downregulation of endogenous production, so since this is something you recommend, I’m really curious about your experience with this. Are there particular scenarios you’d be more likely to use bitters for this versus enzymes/HCl (aside from obvious HCl contraindications)?

    Many thanks!
    Lena

  3. Thank u for a great article…i suffer wth low thyroid n gut…so wil try some of the advice…..i lov natural meds n advice.. .bless u….Rashida…cape town …s.a.

  4. Thank you, Aviva! This is very timely information. I had followed similar dietary guidelines in order to clear up symptoms that had developed from an extended time on antibiotics for Lyme, and the results were largely successful. But then I fell off the bandwagon – mainly due to pregnancy and the fact that vegetables and all the healthy food I was eating were suddenly utterly repulsive!! But I need to start addressing these issues again, so thanks for the well-researched nudge.

    Here is a question I have: you mentioned that you are not a huge fan of stevia. Do you mind sharing (at some point) why not? Stevia is something I use a lot and this is the first time I have come across stevia wearing a red flag.

    And thank you so, so much for sharing your vast knowledge and sweet, caring spirit with us!!

    • just as a note to the lady that was on antibotics for lyme disease .. if you are still having problems with lyme .. look up Dr Ernie Murakami .. he is a leading Dr regarding lyme and its treatment .. other than antibiotics .. just thought id share 🙂

  5. Hi Aviva….Thank you for the great blog. I have had similar experience with Hashimoto’s. I no longer take thyroid medication & the last time I was tested, my thyroid antibodies were still elevated, but approaching normal.

  6. Another great discovery to avoid taking medication! Our bodies are self healing if we give them the right medicine; healthy food!! Great read! I am wondering if there is any gut-thyroid connection for myself, I have Grave’s Disease; hyperthyroidism. I am currently on medication and would love to find a holistic approach to be in remission. have you read anything in regards to hyperthyroidism and a connection?

    Thanks!

  7. Hey Aviva! Thank you for the article! I was wondering if you could say more about gluten cross reactive foods. When I search online I find various thoughts and list for foods that potential gluten cross reactive foods. I am seeking some concise information on the matter and the foods involved!

    Thanks!!!!!!!!
    Jahan

      • Give up all dairy? Really? Even for a 100 pound lady trying to get pregnant? Who hardly eats red meat and eats much healthier than most folks?

        • Of course you have to personalize all recommendations to your own situation. Of note, women who eat full fat dairy are more likely to conceive than those who eat low fat. But yes, if one is having a thyroid problem, I do recommend other sources of fat and calcium generally than dairy. at least while trying to establish whether the dairy is a trigger for that woman’s immune response or gut.

  8. Aviva, thanks for this information. I was diagnosed with Hashimoto’s 10 y ago after having elevated
    antibodies and slightly elevated TSH. My mother and sisters were all diagnosed with H at a young age. Two of them developed thyroid cancer, so I took the diagnosis seriously. I went gluten free soon after my diagnosis and within the last year added probiotic and fermented foods to my diet. I was recently tested and my thyroid antibodies were non-detectable! Just wondered after taking thyroid replacement for 10 years if it is possible to now taper off them?

  9. I had my thyroid out (parathyroid adenoma that grew into it), but the endocrinologist did say I had the beginnings of hashimotos at the time. With the thyroid gone, will other organs be attacked next, if I don’t heal my leaky gut?

  10. Thank you so very much for your informative article, densely packed with helpful tools! May I ask why you don’t like Stevia? I currently recommend it to my Health Coaching Clients so if there is anything negative about consuming it I’d like to know so I can change my recommendation. Thank you!

  11. I didn’t think there was connection between thyroid problems and gut. Two years ago, I was told by my doctor that my thyroid isn’t working properly /hypothyroid/, which finally explained why I was feeling tired, depressed and lethargic all the time. I refused to take any medication, instead I started to take kelp in powder form and changed my diet /got off the sugars, carbohydrates completely and added good fat/. Then I came across Gaps diet, which is pretty much gluten free diet plus adding fermented food. Year later, my thyroid was back to normal. Before reading your article, I thought that taking the kelp did the trick. After reading your article, I can connect the dots and I believe that it was the diet that probably helped. Why didn’t I think of that? Thank you for your article, Aviva!
    PS: why don’t you like stevia?

    • I’m concerned that unless one is getting raw stevia, that there is processing involved that makes it less than natural; also, it’s not clear to me that it doesn’t contribute to sugar addiction by keeping us acclimated to a sweet taste — it’s added to so many products now — jading our tastes for “real food” and healthier choices. Awesome on getting your thyroid back to normal!!! 🙂

    • how do “normal” people do the GAPS diet? i have no idea how to make my own chicken stock and that’s only step #1.

  12. this is ME!!!! Can you tell me why you are not a fan of stevia? Also I drink one cup of bulletproof coffee which doesn’t have any mold or toxins, do I need to give that up? Thank you so much for your article!

    • Hi Julie
      Totally personal choice on the coffee. As for stevia, sweet taste, even if from a healthier source, tells the body to pump out insulin and can elevate blood sugar. Also, I do believe that unless in the form of the raw powder or leaf, some processing is required so not sure it’s a totally natural product….

  13. Aviva,

    This has been the most clearly written article on the subject that I have yet to come across. The break-down of the four steps to take plus the appropriate supplements was the perfect amount of information to take in. Can’t wait to share this gem on my Facebook. Thanks Aviva!

  14. This is a very informative article! I have many of the symptoms of thyroid issues and all of my tests come back normal. I have a pituitary adenoma and chronic bowel/gut problems. I have gone to my doctor and they can not figure out my issue.

    • Amber, find a good endocrinologist & don’t put up with doctors that tell you they don’t know what is wrong with you. leave them and look elsewhere for help. They still charge you for your doctors visit though and waste your time in getting better. Research specialists in the field, also gastroenterology would be a good start as well for your gut issues. Hope you find the answers to your health soon.

  15. Thanks Aviva.
    I have Hashimoto’s and I tried going totally gluten free for 2 months. I really didn’t notice a difference so I went back on gluten and again didn’t notice any difference again. I live an otherwise healthy lifestyle and take a slew of supplements recommended by my naturopath. I am also on levothyroxine, which does seem to help. I tried reducing my dosage but the symptoms starting coming back and the bloodtests confirmed it.

    • Hi! Yes, not everyone who develops Hashimoto’s does so as a result of gut issues or gluten. Other factors such as certain hormonal changes (i.e. postpartum), environmental toxins (including fluoride in water!), and even infections like Epstein Barr virus can cause it. So can chronic stress affecting the adrenals and systemic inflammation. Medication can be super helpful and some women do need to be and stay on it to maintain optimal metabolism, cognitive clarity, and hormone balance. Sounds like you’re making good choices!

  16. Great article! While probiotics do help with digestion, in my case they cause painful cystic acne. Are some probiotics less risky than others?

    • Hi Elizabeth, There are a variety of probiotic strains so it might be about finding the one that’s right for you will be the solution and getting to the root of the digestive issue if there is one.

  17. Dr. Aviva,
    Thank you so much for this simple, easy-to-understand article. As a young person with a family history of thyroid issues, this is helpful from a preventative standpoint. I am wondering, since I have the aforementioned family members with thyroid issues, in referring them to this article, do the same healing practices work for women AND men? This probably a silly question but since you mainly deal with women and children, I want to make sure that I am helping and not hurting the men in my family by encouraging them to take these steps.
    Thank you for your time and your refreshing contribution to natural healing and wellness!

  18. I was diagnosed with Crohn’s disease 19 years ago at age 28 when I had my first surgery for bowel obstruction. After years & years, I finally went into remission and became pregnant with a healthy son. Shortly after my son was born I was told that I have Hashimoto’s and have been suffering with both autoimmune diseases ever since! I am tired of feeling sick (and tired!) and have had it with taking more prescriptions just to feel well enough to get out of bed. I am going to try the tips mentioned in your blog. Thank you in advance.

  19. I had not heard of hashimotos until recently and now I seem to read about it everywhere. This article really reminded me of a book I read by Dr. Joni Labbe “Is Mid-Life Mooching your Mojo?” (http://mojogirlfriends.com/). The author was diagnosed with hashimotos and celiac disease and is living proof that you can live well with these thyroid issues. She has helped many women battle fatigue, insomnia, hot flashes, and more with her nutritional expertise and through functional neurology. The book is also written in a way that is easy to understand and implement in your daily life. This is for anyone who has tried just about everything from medication to supplements and is ready for a change. I really think you and your readers would benefit from her book and website. I hope you will check it out

  20. Dr. Aviva,

    Could you clarify the dosage for L-Glutamine. 5mg is lower than most supplements offer.
    Do you mean 5grams?
    Thank you.

  21. Is this plan safe to do if you’re breastfeeding? I’m 10 months postpartum, and my TSH has swung from way low (less than .02) to high (5), and I have antibodies. So, want to address whatever is happening on the autoimmune level, but am not sure if I should wait until I’m done nursing, which might be awhile. Thanks for all your thyroid posts. They are really helpful.

  22. Thank you for your informative article. I’ve been gluten free for years now but I still have a thyroid issue. I also don’t have dairy and limit my sugar. Any other ideas? And I have digestive issues too. Thanks!!

  23. I enjoyed your article but am concerned with the suggestion of taking L-Glutamine. Personally I have been suffering from msg sensitivity and this substance will convert to glutamic acid & could cause reactions that are the very ones you mention in your article ie headaches, nausea, fatigue depression etc I experienced this first hand w/Vega sport protein powder which contains L-glutamine

  24. Hi Aviva,

    Thanks so much for this very clear and informative guide. You are (possibly literally..?!) a life-saver.

    Just wanted to ask if it would be wise to avoid any of the above supplements/herbs during pregnancy to be on the safe side? (And would you recommend any substitutions)?

    Thanks in advance! Really appreciate your blog.

    • Yes, other than supplements recommended in my pregnancy blogs, articles, and book, I generally recommending avoiding herbs in pregnancy unless under the care of someone experienced in using them medicinally, or of course, if you have the knowledge to do so safely.And you are so welcome — thank you for writing! 🙂

    • Bloating can be caused by so many things; most usually it is diet or gut dysbiosis (I have several blogs on this topic) — but if you have no thyroid getting the right medication dose can also sometimes help if you’re levels are low and affecting digestion.

  25. Hi. Thank you for a very interesting and informative article. And a possible alternative to PALEO is welcome! A couple of questions please 🙂 is all dairy bad for Hashimotos? Someone told me butter is fine (I gave up gluten over a year ago after getting the antibodies test results, but have just recently cut out milk and cheese…). I also still take milk kefir… Again I heard that as all the lactose is eaten by the bacteria, that it is ok. I now have water kefir too, so if I have to I will regrettably give up the milk kefir! I hoped just gluten would be enough… But I definitely notice a tummy ache if I have for example a pure milk hot chocolate which got me to considering the dairy too (a bit gutted to be honest). Can anything be reintroduced once the gut is healed?

    I have ME too, so no income to speak of. The cost of all this in one go is impossible for me. Would water kefir (with or without milk kefir) and fermented veg be a sufficient replacement for tablet probiotics?

    I definitely have dysbiosis… Years of awful wind and gut issues after time in India. Tackling that first with the suggestions above – how long should I treat that before I try the rest of the approach you have described above?

    My last question (so sorry for so many questions, and thank you thank you for your time), corn as a cross gluten contaminant – you don’t mean sweet corn or corn on the cob do you? But the kind of stuff found in corn flakes? Is that due to gluten flying ove in the wind and growing amongst the crop… For the same reason I buy gluten free oats for breakfast?

    Thank you and again sorry for so many questions. I really want to nail this… And I can’t afford the AIP PALEO diet, so this is a ray of hope for me if I can do it in stages.

  26. I cannot tell you how much this article helped me..I felt like the article was written about me..I suffer from all of the same symptoms..EXACTLY..Thank you for all this wonderful information

  27. Thank you for re-iterating the path I am currently following should give me some resolution to my problems. I have an antibiotic resistant strain of Helicobator Pylori. I also have Hashimotos Thyroiditis. After a third positive Helicobactor test in 14 years the second coinciding with Thyroid issues. I have been struggling for years. I am only two weeks into treatment of the gut, with many of your above points having been addressed and I am using a variety of supplements and dietary assistants. Hopefully I shall see and feel some changes soon – including the dreaded pregnancy belly when I am not pregnant!!

  28. Hi Aviva, once again thank you for a wonderful article. I was vegetarian for 18 years and started to eat Paleo in March 2014. I have endometriosis and infertility and thought that adding animal protein back into my diet my help my fertility. I used to struggle with episodes of hypoglycemia as a vegetarian and gave up coffee and alcohol. I have always eaten a very clean diet and exercise everyday. I had my TSH checked in Dec 2013 and it was 1.3, (typical for me) then in Dec 2014 it was 2.2, last week it was 4.2! I have been struggling with fatigue and GI issues for months, as well as palpitations. I have also noticed that with any physical activity I get very weak and shaky, even light walking for 35 minutes. 2013 was the most stressful year of my life and although I thought I dealt with it very well, I am now worried that I may have adrenal fatigue and a sluggish thyroid as a result. I am waiting for additional labs now. I started the autoimmune paleo diet on Monday and although I have not regularly consumed dairy or wheat in years, I am not 100% diligent about it. That is changing now.
    My question to you is what can I do when I have my period? I have worked very hard with a physical therapist (myofascial release) to get my menstrual pain to a place where I do not need narcotics but I have to take 800Mg of Ibuprofen every 6 hours for 48 hrs each month. Do you think it would be better for me to just use the Norco? I want to heal my gut and I know that NSAID is not going to help but I simply cannot suffer. I would not be able to function without some type of pain reliever for those first 24-48 hours.

    • Hi Lois,

      This is Megan from Dr. Aviva’s team and I wanted to chime in and thank you for sharing your story. It sounds like you have been through quite a bit, but it also sounds like you know your body REALLY well. I wanted to point you to two different articles that Dr. Aviva wrote, one specifically on endometriosis and one on managing pain more naturally . I hope these are helpful for you!

      Megan- Dr. Aviva Romm Nutritionist

  29. Oh my word. It’s like you wrote the description about me. I’ve been gluten free for 10years and mostly dairy free this year with some slip ups. But I still have the same symptoms as described above. I need to find a local doctor I guess who can walk me thru all this and not throw meds at me. (Dallas, Texas)

    • Hi karen,

      This is Megan from Dr. Aviva’s team. I wanted to let you know that Dr. Romm will be offering a thyroid course in the very near future, and if you need help finding a doctor in your area, you can look on the the Institute for Functional Medicine web page and above the search box, there is a link for finding a practitioner.

      Megan- Dr. Aviva Romm Nutritionist

  30. My daughter was diagnosed with Hashimoto’s just recently and she is completely off of gluten. We’re also going to a functional medicine doctor and they’re taking the approach of working on the adrenal glands. I hadn’t heard of taking these other supplements except for zinc. Any thoughts on taking the approach of working on the adrenal glands first? She’s taking Ashwagandha, Adrenal Support, Zinc, and Selenium to help with all this. She’s eating high protein, low carb. Thoughts?

  31. What if I don’t have access to the natural stuff you mention in the article? Thank you so much for sharing such beneficial information. I have been that woman you are talking about … Energetic till 38 and then a total downfall. Do you think homeopathy alone can help? I’m off the gluten – rarely I eat a piece of bread that contains wheat but I can completely get off the gluten. I have detoxed 3 times in the past year, twice on juice for one week and once on a water fast. I’m based in egypt and maybe I need to order some of the stuff you mentioned. Your recommendations please. Thanks again!

  32. Thanks for all the info. I have had Hashi’s for about 15 years and now severe adrenal fatigue. I don’t eat gluten and my diet is mostly lots of good fats, meats, veggies and some fruits, nuts and infrequent legumes. I have just reintroduced dairy (cottage cheese and greek yogurt) with no side effects. Bloating is a very occasional problem but not with the dairy. Can I stay with it? It just feels right to me and I’m looking into organic local dairy. Any thoughts?

    • Hi Shawn,

      This is Megan from Dr. Aviva’s team. Overall the concern is that unless one is getting raw stevia, that there is processing involved that makes it less than natural; also, it’s not clear that it doesn’t contribute to sugar addiction by keeping us acclimated to a sweet taste. I hope this helps!

      Megan- Dr. Aviva Romm Nutritionist

  33. What a great article! I’ve been under Dr. Boham’s care for 8 months now and have seen a huge overall improvement in my health using the principals you discussed in this article. However, it’s difficult for me to find good information about healing goiters naturally. Even though this program got to the bottom of why I was having so many health problems and is making strides towards repairing them, I have a goiter that has gone from 6cm to 9cms while doing everything you mentioned above. What else can I do? My body is telling me that I can heal it naturally without surgery but I’m at a loss how to do that. What do you recommend?

  34. Dear Aviva,
    Thank you for writing this post and including steps to heal your gut. Where do you suggest I purchase the repair supplements from? There are a lot to chose from and I’m not sure what brands are best. Thanks!

    • Hi Tara,

      Looking at a truly natural health food store will give you some good options. Best suggestion is to really read the labels and, you can always speak with the people who are working in the wellness department to help you make a decision.

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  35. Hi! My name is Adrienne
    Can glutin cause a burning feeling in your gut. I will find a Dr. in my area soon. Working on giving up Gluten first. I feel better until I eat something that caused a reaction by mistake. I have the sweating and fatigue. I do not like medications. I eat Organic foods. Will move away from Gluten Free process foods. Eating fruits and vegetables. Seafood is great and chicken. I am trying to help myself first before see a Dr. I guess I will give myself 6 months before seeing a doctor. Thank you for your help.

    • For celiac? I don’t recommend endoscopy. I recommend a gluten elimination diet, and I usually run labs – if positive labs that is definitive. If elimination diet improves symptoms, that is, too. Warmly, Aviva

  36. Just wanted to say a huge thank you for this article and so many of your others. They have been a blessing in my life. Thank you, thank you, thank you from a mom of two little ones.

    • Hi Allison,

      This is Megan from Dr. Aviva’s team! I just wanted to chime in and say thank you for the sweet message, Aviva sees each and every message and the feed back warms her heart! <3

      Megan- Dr. Aviva Romm Nutritionist

  37. Hi. Just reading through all the questions and was wondering I am receiving immunology treatment (Keytruda) for stage 4 melanoma and my thyroid is up and down and now my Dr thinks I have Hoshimoto’s disease. She had put me on levothyroxine 150mcg and now added Liothyronine 10mcg a day. She has blamed the Keytruda which attacks the immune system but at the same time I need to take the Keytruda to keep my immune system in check. Any suggestions?

    • Hi Ginny,

      This is definitely something you would want to work with either a functional or integrative Dr. on as they will help sort all the pieces of the puzzle out WITH you. We recommend looking on the website of the Institute for Functional Medicine (https://www.functionalmedicine.org/) for a practitioner in your community.

      If you are unable to find someone suitable, or would like to consult with Aviva as a physician, please check her website at http://avivaromm.wpengine.com/patients to find out about becoming her patient.

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  38. This was so informative. I use doTERRA products. Have you heard about them? I was wondering what do people replace dairy with? Almond milk? Thanks in advance!

    • Hi Denise,

      Almond milk is great to replace dairy with! If you do a search, Aviva even has a video on how to make it 🙂

      Warmly
      Megan- Aviva Romm’s executive assistant and online nutritionist

  39. Dr. Aviva,

    I am just wondering if the 4 Rs are done all at the same time? I realize that the Remove should happen first, but what is the timing of the other 3 Rs? Thanks so much!

    • Hi Alexandra,

      Yes! They can all be done at the same time. 🙂

      Warmly,
      Megan-Aviva Romm’s Executive Assistant and Online Nutrition Expert

  40. I have been on an elimination diet for 8 wks to determine any food intolerances that might help heal my Hashimotos. I am having a hard time not going too low carb since I am avoiding all grains. I do not need to lose weight. Would one serving of yams or squash every day be sufficient carbs for the day? How many fruit servings? Thx in advance for any tips on getting enough carbs while healing my gut!

    • Hi Rhonda,

      Brining in yams, squash, sweet potatoes (all those magical Autumn foods) is wonderful!! Aviva will be taking a deep dive into foods for replenishing gut health in her up an coming gut health course so please stay tuned for more!

      Warmly,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  41. I was recently diagnosed with the autoimmune disease, primary biliary cirrhosis. I am interested in trying the things you suggest to repair leaky gut, as I’m leaning towards leaky gut as the culprit for my autoimmune disease. My concern is, what do these herbs and supplements do to the liver? I don’t want to compromise it any more than it already is. Thank you for your help.

    • Hi Kristin, Oh that’s tough news to get. In your case, because herbs do get metabolized by the liver, I’d hold off and discuss with your doc, and also find someone like me (see Institute for Functional MEdicine) and work with someone knowledgable about herbs and primary biliary cirrhosis. Probiotics, digestive enzymes, and marshmallow root, slippery elm, and ginger should all be safe, but again, check with your doc to make sure you are personalizing safe choices for yourself. Best wishes, Aviva

  42. Thank Aviva for the great article. I greatly suffer from the 24/7 belly bloat looking 7 months pregnant. I have gone through many gut repair protocols and get temporarily relief until it happens again. The bloating never fully gets better. I am also an athlete at an elite level and have suffered from low heartrate and huge fatigue not being able to perform or recovery like I use to. Through all this my doctor has tested my thyroid and each year it has gone up and up. It was around 3 with symptoms and now in the last year gone from 4 to 5. And some times when my stomach is mildly better it goes down to 3 but never ever any lower and the trend goes up. I am at the point of believing that I cant get better until I treat it. But it is hard to trust that when medical doctors dont think it is the problem. One part of me worries about adrenals and if I am wrong that my system will crash. How likely is this to happen if you started on a low dose of thyroid? And can stomach bloating be fixed if the thyroid is treated and the main problem? In your experience is NDT easier to handle on the adrenals over synthroid? Thanks for all your help, would love to hear your recommendations and can email if needed. I just really want to get better as this has been going on for 8 years and I keep trying with being so healthy as far as diet, rest and stress and am not getting anywhere as I think these are essentially bandaids to the real problem.

    • Hi Nat, Complex questions here – so to answer the stomach issue – and bloating – that’s where I recommend my book because I walk readers thru a complete healing protocol of stomach issues and bloating. These can be due to or be a trigger of thyroid issues. Not quite sure what you’re asking about the adrenals and crashing…Low dose thyroid treatment doesn’t usually crash the adrenals and can really improve symptoms but it’s very individual. As for which thyroid hormone supplement – I usually start with a natural preparation except in pregnancy when I start with synthroid for reasons I discuss in my podcast on prenatal thyroid health.

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