This episode has listener questions about thyroid symptoms like fatigue, celiac disease and subclinical hypothyroidism.

I have had thyroid issue for years and was diagnosed with hashis about 3 years ago. I spent thousands of dollars on a naturopath and she ended up caving and told me to go ahead and just start taking thyroid medication.

I have had pretty awful symptoms over the years, all of which still constantly come and go. Some of the most bothersome include extreme sudden fatigue (I feel like I have been drugged), chills, facial flushing and intense night sweats. Are these normal symptoms? Specifically night sweats? I have talked to my doctors and no one seems to understand why I might be having night sweats.

I have had full metabolic panel blood tests done, and a stomach biopsy confirming that I do NOT have celiac.

Name withheld.

It sounds like your naturopath and you may have been trying to avoid medication which I totally understand. If she caved and told you to start taking medication, was that because your TSH stayed high? I can guess without knowing what your labs said and I would guess that maybe TSH did stay high and maybe T4 was low and T3 was normal. There may have just been a defect in your gland. This type of scenario is primary hypothyroidism where the gland just can’t produce enough hormone for the body and it is likely due to an autoimmune or Hashimoto’s issue.

Symptoms can come and go and that is just because your body is different everyday. Your extreme sudden fatigue could be due to a food allergy or sensitivity. People present with symptoms of food sensitivity differently and extreme sudden fatigue could be one. Another reason for that could be really messed up blood sugar regulation. Facial flushing can be food sensitivities or it could be peri menopause. Night sweats could be food sensitivity or perimenopause as well. I had terrible night sweats for many years and when I went gluten free, they went away completely.

I also wonder if you had a positive blood test first for celiac disease and then they did a biopsy to rule it out. The biopsy would be in the small intestine and not the stomach so I am assuming that is what you meant. It could be that you are just sensitive to gluten which is different than celiac disease and both of these things are very real with real consequences to the body.

Non Celiac Gluten Sensitivity doesn’t really have any biomarkers related to its diagnosis that are super reliable because the research on it is not that old. You can check for antibodies to gliadin which is a protein so you may have an IgG test done for anti Gliadin Antibodies and that test is positive in a little over 50% of non celiac gluten sensitive adults. Anti Gliadin Antibodies are also present in people with connective tissue disorders, IBS without a gluten sensitivity, autoimmune liver diseases and even in around 2% of healthy people. This test does not have high specificity or sensitivity but it is still used in diagnosing NCGS.

The HLADQ 2 and 8 genes which are markers for celiac disease are not an indication that you are also susceptible to NCGS.

There is a difference between a sensitivity to gluten and a wheat allergy. I had a food sensitivity test done when I first started to find a better way to live with hypothyroidism and my naturopath ran a food sensitivity panel and it showed that I was more sensitive to wheat than to gluten. I react to wheat with immediate brain fog, huge welts on my face and neck and a general terrible feeling. I ate spelt in the midst of me healing myself about 11 years ago and had zero physical reactions to it. Spelt is one of those things they say you should avoid if you avoid gluten. Just because you don’t have physical reactions doesn’t mean it isn’t causing some damage in your body. Keep that in mind.  If you have an allergy you will have IgE antibodies to whatever it is that you are allergic to with symptoms of that allergy happening from within minutes to hours. For wheat, symptoms can be any of the following: wheezing, trouble breathing, cramps, nausea, vomiting, bloating diarrhea, gas, itchy skin, hives, and of course the most severe which is anaphylaxis. A wheat allergy would be more common in an infant or toddler but can happen any time. With a wheat allergy you only have to avoid wheat. If  you are avoiding gluten you will also avoid barley, rye, spelt and a few others.

If you have celiac disease, you have an autoimmune disease, commonly occurring alongside Hashimoto’s but not always. Then you avoid all gluten. Celiac also has a high genetic predisposition with the HLA-DQ2 gene which is in 95% of Celiacs. This disease is rising in prevalence over the last 30ish years. This is not because we can diagnose it better but potentially because of things like formula use, or an introduction to gluten before 4 months of age which results in a 500% increased risk. C-sections cause an altered gut microbiome for the baby so that is also thought to be a problem. Then there are the changes in how wheat is grown. So many possibilities and no definitive answers.

The biggest symptoms to celiac disease are diarrhea, fatigue, gurgling, pain, weight loss, distended belly, gas. Less common symptoms are bone loss, poor liver function, vomiting, iron deficiency anemia, constipation, nausea and dermatitis herpetiformis which is a rash appearing typically on elbows, knees, back and butt. Some people will have no symptoms at all.

The autoimmune damage occurring with this disease is damage to the lining of your small intestines. Those little microvilli that absorb your nutrients should be like a shag carpet and in determining CD there are different stages of damage to the villi.

A small bowel biopsy, which is what I think you meant by stomach biopsy is the gold standard for diagnosis both while consuming gluten and then again while on a gluten free diet and improvement in the biopsy tissue is seen. These changes in microvilli length are graded by something called the Marsh criteria. It grades damage from 1, 2, 3a, 3b, 3c with 3c having the most damage and the most severe symptoms. Gluten should be eaten daily at least 6 weeks before doing this kind of test.

There is another test called the Biocard Celiac Test from labsystems diagnostics that is a finger prick and is pretty accurate but it looks like a doctor has to order it and it is not available in the US from what I can tell. The antigliadin antibody test is better to be done with other celiac testing as it isn’t as good on it’s own as a diagnostic tool.

Nutrient deficiencies are common in celiac because the damaged microvilli just can’t take up nutrients so you end up with protein deficiencies as well as vitamin and mineral deficiencies. To be on the safe side I would make sure you are not eating gluten at all and you should see some improvements.

Without knowing more about your labs it is hard to say much more but I hope this was helpful.

Next question.

Hi, I have hashimotos and “sub clinical hypothyroidism” my symptoms seem to be getting better with the elimination of gluten and dairy but i have since found out via my Elisa 96 food panel(from alletess labs) that I am only mildly sensitive to beef and green peas among other things. My question is can I not have any protein powder in any form? Most protein powders are made with whey or pea protein or some beef version...if you u can help thanks

Marcie

A food sensitivity panel can often pick up foods that you are eating a lot of during the test. If you are only mildly sensitive to beef and peas I would say, work on healing your gut for a couple of months and then you can reintroduce those foods and see if you have any physical reaction of any kind. Wait at least 4 days in between reintroductions to give your body time to react. That said, if everything on the test was coming up mildly sensitive and you still eat those things minus gluten and dairy, just be mindful of not eating the same things all the time.

Let’s dive in to why you feel you need a protein powder. Do you rely on them for a meal replacement? Do you use one to make sure you are getting enough protein in each day? A few weeks ago I shared a graphic with my newsletter subscribers on ways to get more protein in. I would try for food first and then powders if you are struggling. And once your gut is healed you can reintroduce and retest. And again, the more varied your diet is the better - it helps you avoid food sensitivities.

Another question from an unnamed person.

I wondered if you could explain why someone would have high TPO Antibodies but normal thyroid hormones? And why is thyroid medication prescribed in this situation if hormones are normal? 

High antibodies with all normal thyroid hormones probably means there is some autoimmunity and potential destruction of thyroid gland tissue but it just has not yet affected the glands ability to put out enough hormone. The destruction usually starts before symptoms are felt and can take years before symptoms appear and at this point it would be too late to fix the gland and then medication is needed. There really should be no reason that I know of to be on medication with normal labs and high antibodies. Your body doesn’t need hormone, it needs your immune system to calm down and that starts with diet and lifestyle changes and having a look at your blood work to see what is deficient. So a complete blood count with a differential, a lipid panel, full iron panel with reticulocytes, inflammatory markers, LDH, GGT, a comprehensive metabolic panel  and I think that is a good place to start. That will give us a lot of information and then after getting to know you and your health and life history a bit we can work on making some changes to diet and lifestyle. Then if you still don’t improve, further testing may be needed.

Okay. That is it for this episode.