In my experience, the most effective thing for someone who is struggling with hypothyroid and/or hypothyroid symptoms is to improve their gut health. I see so many patients who have been barking up the wrong tree, their thyroid. Doing fancy thyroid tests, trying all sorts of medications and supplements – only for lackluster results. When they come into my office, we often find a gut problem, fix it, and then the person finally sees their symptoms improve. So, it’s no surprise a recent study found that one of the greatest risk factors for developing SIBO (small intestinal bacterial overgrowth) was being hypothyroid or being on thyroid medication. Let’s discuss how you can fix your gut to fix your thyroid.
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Dr. Michael Ruscio: Fix your gut to fix your thyroid. Hi, this is Dr. Ruscio. And let’s discuss a very interesting study that was recently published that shows that for many people suffering with hypothyroidism, SIBO, or small intestinal bacterial overgrowth, might be a key factor contributing to the symptoms that have not yet resolved.
So I’ll put the study abstract up here on the screen. But essentially a group of researchers studied 1,809 people and they tried to see what factors were associated with small intestinal bacterial overgrowth, or SIBO. This is an overgrowth of bacteria in the small intestine that can cause a number of symptoms, including gas, bloating, loose stool, diarrhea, constipation, abdominal pain, but also symptoms outside of the intestines, like insomnia, rosacea, problems with skin, potentially depression, weight gain, and so on and so forth.
So in looking at this group of patients, they found that levothyroxine medication use or being hypothyroid were two of the greatest risk factors for someone to have this SIBO or small intestinal bacteria overgrowth. In fact, being on levothyroxine or being hypothyroid may have even been a stronger risk factor than prior intestinal surgery or even being on immunosuppressive drugs. So pretty significant stuff there.
Now, why this matters is because—and just to share what I’ve seen in the clinic here for many years—is patients come into the office thinking they have a thyroid problem. And they were diagnosed with hypothyroid, they’ve been on levothyroxine, or maybe they’ve tried Nature-Throid instead or WP Thyroid, or they’re trying levothyroxine or Cytomel trying to balance out their T4 or T3 ratios, and they’re in this game of never being able to get their “thyroid symptoms” under control.
But the challenge is many of the symptoms of hypothyroidism and many of the symptoms of SIBO can be the same because the symptoms can be nonspecific, especially the extraintestinal, or the outside of the intestines, symptoms that SIBO can manifest as.
So why this matters is because there may be a lot of patients out there—and certainly my clinical experience reflects this—that their thyroid medication dose is just fine, but the reason why they still have hypothyroid-like symptoms is because of an overlooked problem in the gut. And this study is a beautiful example of that.
So what you should do, if you’re being treated for hypothyroid and you don’t feel like you’re responding, you should have a thorough gut evaluation. This is more than just a stool test. This is more than even just a comprehensive stool test. I would highly advise you to work with a clinician who is highly skilled in the gut to make sure they can identify any underlying gut problems. Stool testing can be helpful. Breath testing is how we test SIBO. But not all tests are the same, and the interpretation of a test can be pretty important. And blood and urine testing can also be used.
So it’s not to say just a stool test and you can find everything, but work with a good clinician who’s highly skilled in the gut to try to get to the bottom of and optimize your gut health, and that may be the missing factor that allows you to overcome these hypothyroid-like symptoms you’ve been chasing around with different doctors and different types of thyroid hormone medication or ratios or what have you.
And, again, why this is so important and why the gut is so important is because by improving your gut health, you can improve thyroid autoimmunity. We talked about that in the past. There’s some preliminary research that substantiates that. You can improve thyroid medication absorption, so you may need less of a dose, or you may see the dose needed stabilize because you’re absorbing it more consistently, and you’re absorbing it more once you’ve improved the health of your gut, of course.
And then finally, improvements in gut health can help with thyroid hormone conversion. So let’s say you’re taking a T4 thyroid hormone like levothyroxine, and it’s important that you have adequate conversion to T3. Optimizing your gut health may be a key way to allow your body to naturally do that and not have to take additional T3.
So I can’t emphasize how important this is. I study very closely and in the clinic work very closely both with the gut and the thyroid. But over several years, the gut has really continued to become my primary focus because it just seems to produce overall the most results, including in the other area of my focus, which is thyroid. So many patients who think they have a thyroid problem or have found a thyroid problem like hypothyroidism and are on medication being adequately treated still suffer from symptoms because an overlooked problem in the gut is present.
Now, remember, don’t be tripped up by thinking that you have to have gastrointestinal symptoms like bloating or constipation to signify that you have a gut problem. Sometimes problems in the gut manifest solely as problems elsewhere in the body. And this has also been documented in the research literature.
So, again, if you’re someone out there who is suffering with hypothyroidism or hypothyroidism-like symptoms, have a good thorough gut evaluation with a clinician who has a high amount of focus into gut health. And I think you’ll have a very high probability that you will come out on top.
This is Dr. Ruscio. And I hope this information helps you get healthy and get back to your life. Thanks.
If you need help with hypothyroid symptoms, click here.
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