Thyroid Autoimmunity, Stomach Acid Production and Vitamin B12 – Episode 32

In this episode, Dr. Ruscio introduces a condition called stomach autoimmunity and it’s effect on overall health and, in particular, thyroid autoimmunity. He also discusses a new treatment involving vitamin B12 shots that might be useful in the treatment of stomach autoimmunity.

If you need help with the diagnosis or treatment of thyroid autoimmunity, click here

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Topics:
Episode intro…..1:39
Autoimmunity defined…..3:32
Thyroid autoimmunity and stomach autoimmunity…..8:07
Testing for stomach autoimmunity…..10:29
Causes of stomach autoimmunity…..17:25
Treating stomach autoimmunity…..23:00
B12 therapy for stomach autoimmunity…..26:55
Episode wrap-up…..38:11

Links:

  1. (6:16) Mission Heirloom
  1. (8:07) Up to 40% of those with thyroid autoimmunity will also have autoimmunity against their stomach cells.
    1. http://www.ncbi.nlm.nih.gov/pubmed/19891010 Trusted SourcePubMedGo to source
    2. http://www.ncbi.nlm.nih.gov/pubmed/18271683 Trusted SourcePubMedGo to source
  1. (8:07) The absorption of radioactive vitamin B12 and the secretion of hydrochloric acid in patients with atrophic gastritis – http://www.ncbi.nlm.nih.gov/pubmed/14218551 Trusted SourcePubMedGo to source
  1. (8:07) It has been shown that elevation of these antibodies predicts stomach dysfunction years later – http://www.ncbi.nlm.nih.gov/pubmed/20696284 Trusted SourcePubMedGo to source
  1. (8:07) Some evidence suggest that as much as roughly 40% of people may have a condition known as atrophic gastritis – http://www.ncbi.nlm.nih.gov/pubmed/19037166 Trusted SourcePubMedGo to source
  1. (23:00) A clinic trial has shown that after eradicating an H. Pylori infection this stomach autoimmunity can reverse itself and disappear – http://www.ncbi.nlm.nih.gov/pubmed/10337662 Trusted SourcePubMedGo to source
  1. (23:00) Interestingly, some evidence has shown Epstein-Barr virus is associated with same type of stomach damage – http://www.ncbi.nlm.nih.gov/pubmed/9211523 Trusted SourcePubMedGo to source
  1. (23:00) Like many things in science and medicine, not all the data agree and some studies show no relationship between infections, like H. Pylori, and this stomach damage.
    1. http://www.ncbi.nlm.nih.gov/pubmed/21796548 Trusted SourcePubMedGo to source
    2. http://www.ncbi.nlm.nih.gov/pubmed/8284633 Trusted SourcePubMedGo to source
  1. (23:00) Like many things in science and medicine, not all the data agree and some studies show no relationship between infections, like H. Pylori, and this stomach damage.
    1. http://www.ncbi.nlm.nih.gov/pubmed/21796548 Trusted SourcePubMedGo to source
    2. http://www.ncbi.nlm.nih.gov/pubmed/8284633 Trusted SourcePubMedGo to source10. (23:31) Two placebo-controlled trials performed in the 80s showed a gluten-free diet had no effect on stomach autoimmunity.
      1. http://www.ncbi.nlm.nih.gov/pubmed/3992162 Trusted SourcePubMedGo to source
      2. http://www.ncbi.nlm.nih.gov/pubmed/6469705
        11.

        1. (25:08) The contribution of specific immunoglobulin M antibodies to the diagnosis of Helicobacter pylori infection in children – http://www.ncbi.nlm.nih.gov/pubmed?term=8590145 Trusted SourcePubMedGo to source
        2. (26:55) B12 injections – emerging concept that might be useful – http://www.ncbi.nlm.nih.gov/pubmed/20659263 Trusted SourcePubMedGo to source

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Thyroid Autoimmunity, Stomach Acid Production & Vitamin B12

Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.

Now, let’s head to the show!

Susan McCauley: Hey, Dr. Ruscio. How are you doing?

Dr. Michael Ruscio: Hey, I am good. How are you?

SM: I am hanging in there. I am feeling very productive this morning. One of my two New Year’s intentions, I guess – I don’t like to call them resolutions, was to walk more and to write more. So, I combined them and got my backpack and my laptop, and walked down 30 minutes to the coffee shop, wrote for two hours, and then walked back.

DR: Awesome. That’s kind of funny you say that. It sounds like we are in sync. I’ve been kind of into my morning routine. Instead of just working from my home office, I’ve been walking down to a little coffee shop, working there for a little bit, and then coming home. It feels good. I am in step with you there.

SM: Yeah, it just makes you feel a little bit more productive. Sometimes my husband works from home, and so, he can be a little distracting.

DR: Right.

SM: The television can be very alluring. So, I like to get out of the house.

DR: I hear you. Well, cool.

Episode intro

SM: So, you’ve got some thyroid stuff to talk about today?

DR: Yeah. I wanted to talk about something that I think is really, really exciting, which is this association between thyroid autoimmunity and stomach autoimmunity, and talk about a few different ways people can approach that. But, the thing think I am really excited about is this emerging therapy that might be able to shut off the stomach autoimmunity that accompanies thyroid autoimmunity.

SM: So, Dr. Ruscio. This sounds a little complicated – autoimmunity, thyroid…tell us more.

(laughter)

DR: Yes, and these things often are complicated. So, what I want to do is cover some of the relevant background information so that people know what context this falls into, right? Because I think one for the things that can be challenging for the educational healthcare consumer is, what do you do with the information, right? Is it one of the first things you should do? Is it one of the last things you should do? Who is it relevant for? Who could it help?

So, I want try to paint the context. So,in that regard, hypothyroidism – a very common condition – the most common cause of hypothyroidism in most Westernized countries is autoimmunity, thyroid autoimmunity, or also known as Hashimoto’s, right? So, by far and away the most common cause of hypothyroidism is going to be thyoid autoimmunity, which, typically, can be diagnosed via a blood test somewhat easily. And, the two most commonly run antibodies are TPO, thyroid peroxidase, and thyroglobulin. So, that’s kind of how you diagnosis.

Maybe I should start…sorry I am a little short of breath. I was running around right before we got on the call, so I am still trying to catch my breath here.

(laughter)

Autoimmunity defined

SM: Why don’t we back up a little bit and just explain briefly what autoimmunity is? You hear it all over the news, but what is autoimmunity?

DR: OK. So, thank you for reminding me to give that primer. Autoimmunity is essentially when your immune system starts attacking a gland of your body, or a tissue of your body, or a part of your body. Although autoimmunity has been really this hot topic in Functional Medicine and alternative medicine – and rightfully so, it is definitely important- there also is this piece that some autoimmunity is actually helpful. It helps to preform housekeeping functions. It helps to clean up dead or deranged or malfunctioning cells.

There was a paper published a couple years ago that reviewed the other side of autoimmunity, which is some autoimmunity is necessary for critical housekeeping functions. I say that because, unfortunately, I’ve seen a kind of over-zealous narrative about autoimmunity in some of the online health community, where people are scaring people unnecessarily about autoimmunity. And I think it’s important that people don’t go to that extreme point of thinking that any autoimmunity is a death sentence, is a terminal thing they are going to really have to struggle to manage with. Certainly, some autoimmune conditions can be, but they don’t all have to be quite so dramatic, I guess.

Again, autoimmunity is just when your immune system starts attacking certain cells of your body.

SM: So, thyroid autoimmunity would be the cells attacking the thyroid?

DR: Right. So, thyroid autoimmunity is one type; rheumatoid arthritis would be where the immune system would be where the immune system is attacking your joint tissue; multiple scorosis, (attacking) neurological tissue; psoriasis or eczema, (attacking) skin tissue. So, if you run the numbers, autoimmunity is slightly more common than cancer, and almost as common as heart disease.

SM: Wow.

DR: Which would put it at about…heart disease is the most common disease in most Westernized countries, cancer is second-most. So, if you look at all autoimmune conditions together as one category, they are right in between the first and the second in terms of prevalence. So, there is certainly a common condition.

SM: Uh-hum. That’s amazing that it’s so many. I was just up at Mission Heirloom (1a); I don’t know if you’ve been there yet. It’s a restaurant….

DR: Uh-hum, right.

SM: …in Berkeley. And almost every dish that they serve could made in what we call the autoimmune protocol. We had a group dinner up there, and it was just awesome. There was like 50 people, all with a common autoimmune disease. So, it is very prevalent.

DR: Right. And I love Mission Heirloom – great ownership, great people. Chris Kresser and I went and checked out that operation a few months ago, and it was great to kind of get a tour. I love what they are doing over there, absolutely.

So, that’s a good segue point to (go into) why the autoimmunity matters. We talked about, in the case of thyroid, that it’s the most common cause of hypothyroidism. And a quick aside is that autoimmunity can also cause hyperthyroidism, as in Graves’ disease. That’s a different discussion entirely – but just in case people are confused about that.

So, there are many symptoms that people complain about, even after being put on thyroid medication, right? It’s common that people will go on thyroid medication, and then all of their symptoms will go away. In fact, I would say in my experience, that’s rare. Now, of course, I have an extremely biased sample, because I don’t see the people that…

SM: You get the sick ones.

DR: Right, so I don’t see those people. But, that being said, there are many symptoms that seem to persist when someone is administered thyroid medication. Two of them could be energy and digestive problems.

Thyroid autoimmunity and stomach autoimmunity

DR: This links together – this thyroid autoimmunity with gut autoimmunity. In up to 40 percent of patients with thyroid autoimmunity, they will also have autoimmunity against their stomach cells that help produce hydrochloric acid and intrinsic factor (2a) Trusted SourcePubMedGo to source (2b Trusted SourcePubMedGo to source) (3a Trusted SourcePubMedGo to source) (4a Trusted SourcePubMedGo to source) (5a Trusted SourcePubMedGo to source). That can ultimately end up causing enemas of vitamin B12, which can cause fatigue and poor circulation; and the low hydrochloric acid levels can leave you more susceptible to bacterial infections, like H. Pylori – which also ties into this conversation; and small intestinal bacterial overgrowth, or SIBO, candida, or any kind of just pathogenic infection.

So, that’s how these two tie together.

SM: Which one do you think comes first? Or, do we not know?

DR: Well, that’s a good question. I haven’t seen any data that suggests one happens before the other. But, what the data does show is that when someone has one autoimmune condition, they are at higher risk for others. So,
we know there is an associative risk – where, if you Hashimoto’s autoimmune thyroid, you’re at higher risk for autoimmune diabetes, or an autoimmune skin condition of some sort, or in this case, autoimmunity to your stomach.

But I don’t think there is, necessarily, a one-causes-the-other (relationship). What it may be is just a symptom of your underlying predisposition to autoimmunity. And so, the groundwork that allows these to happen is probably laid really, really early in life. And then, as time and environmental factors go on, they probably just onsets. So, that’s a great question. I just wish there was a more direct answer to that.

SM: Yeah, definitely. But, with all of these things, sometimes we just don’t know. So, we just proceed.

DR: Right, right. That’s why I think it’s important to have a practical way of approaching these things. When we get it on to the treatment options that people have for this, I think we will lay out some simple, practical ways of approaching this. And it doesn’t really matter which one happened first when you come down to how do you treat it.

Testing for stomach autoimmunity

SM: So, before we talk about how we treat it, how do you test?

DR: OK, so. Regarding testing, there…well, what I do…here is what I do; it’s probably the easiest way to bridge this. If someone test positive for thyroid autoimmunity, then I will order a follow-up round of lab work that will look for the stomach autoimmunity.

SM: So, you automatically always test for the stomach autoimmunity? If they have Hashimoto’s?

DR: Yes, yes. Only if they have Hashimoto’s, exactly.

SM: OK.

DR: Exactly. And the reason for that is, it’s only found in 20-40 percent of the Hashimoto’s population. So, I think it’s something that needs to be screened for for everyone. And, there are so many things that you can test. You really have to have a linear process, or some kind of algorithm, to know when to test what. If not, you run into the thing I criticized openly, and I am hoping the Functional Medicine community can amend and improve, which is this thousands and thousands and thousands of dollars of lab work on Day 1 that may not really translate the benefit to the patient. It’s interesting information to have. But, in my opinion, a lot of it is unnecessary. That’s why I like having these algorithms that I use. It helps you be more conservative in your testing and less wasteful.

SM: Kind of like an if/then…If this, then this, instead of testing for 20 different types of antibodies, and then looking to see what falls out.

DR: Exactly.

SM: That makes a ton of sense. I am sure a lot of people listening will have wished they heard this before they spent the thousands of dollars on tests, unfortunately.

DR: Right. And I’ve seen a number of those patients that got those results. And the particular practitioner – now I am just painting a hypothetical; I’m not speaking about…

SM: Right.

DR: …but, they spent so much time testing that they didn’t get too deep into the treatment part, right? If your treatment – again, a number of practitioners will recommend a gluten-free diet; gluten-free, dairy-free, soy-free, let’s say, and then maybe some antioxidants and glutathione boosters – if that’s going to be your treatment no matter what you find…

SM: Use that first!

DR: Yeah. You don’t really need to do the $1,000-worth of auto-antibody profiles, exactly. It’s definitely something I’ve learned. I plan on doing another podcast on this soon – that the more experienced the clinician is, in my experience, the less testing they have to do. Because, they’ve just learned where the waste is. That is something I am always doing myself. I am always asking, “Is this necessary? How can I get equivalent results by doing less?”

Unfortunately, I think sometimes in this community, there is this complexity for the sake of complexity, right? The person who does the most lab work is the smartest or the best. I am hoping that the pendulum is starting to swing, where people are starting to realize that just because you can check off every box on the lab or position form doesn’t mean you are the best provider. In fact, it may mean that you’re doing things a little bit in a wasteful matter. Because, again, in my experience, when you’ve run test after test after test after test on patient after patient, you start to figure out, ‘You know what? This doesn’t really make a whole lot of difference…

SM: Yeah, you start to see the patterns.

DR: Exactly.

SM: Yeah, I feel that way a lot sometimes about the food sensitivity testing. It’s so expensive, and what does it really tell you when you can do an elimination diet that sill really tell you. I’ve done the food sensitivity testing. It’s told me that dairy and wheat work for me, and I know for a fact that dairy and wheat do not work for me.

DR: Absolutely. And I can’t tell you how many patients that I’ve noticed the same thing. They’ve done their food sensitivity testing, and it doesn’t agree with their real world experience. And so, in time, they just end up reverting back to what they notice on a day-to-day.

SM: Yeah.

DR: Meaning, if the labs say you can eat dairy, like you were saying, but you notice you don’t feel well…

SM: I’m congested and I am constantly clearing my throat. And wheat, that’s a whole other story. I can name 10 different symptoms…it’s just, like, TMI that we don’t need to talk about.

DR: Right. Yeah, and I am really happy you made that point, because that’s another – and not to get too far off our core topic, but I think it’s really an important thing to mention. Which is, these tests, I think in a lot of cases, are very wasteful, because what I have found is that, ultimately, people are going to end up eating the way in which they feel the best.

SM: Uh-hum.

DR: And, the piece of paper will give you short-term compliance, yes. But if, when someone goes out and tests that finding in the lab work, and they have no repercussion, they are going to, in a lot of cases, eventually drift back to eating that way.

SM: Yeah, they will. I think a lot of these patients are just very sick, and they want answers, so they think that, somehow, all of these tests, will give them the magic answer that’s going to fix them, unfortunately.

DR: Right, and…

SM: It’s a process.

DR: I also think, unfortunately, sometimes certain people exploit that chronic sickness in people, and they use it to get people to agree to do extensive testing that’s not always necessary. I don’t think it’s the practitioner’s fault. I think it’s some of the education’s fault. I think some of the educational values has mislead people onto thinking that really exorbitant testing is necessary, and it’s not. The only person who really loses in that scenario is the patient.

SM: Yeah, I’ve been to some trainings where they recommend some of these extensive tests. Like you said, is it all really necessary?

DR: Right, right.

SM: So, back to the topic.

DR: Yeah. And we are going to do a podcast about this specifically, this testing – being conservative and effective. But, as you can tell, we are both passionate about it. So, that should be a good episode in and of itself.

SM: Yeah.

(laughter)

DR: So, back to the testing – you can test for the antiparietal cell antibodies and the intrinsic factor antibodies, or intrinsic factor-blocking antibodies. And those are both available through LabCorp (and) Quest, cover-able by a patient’s insurance, not something you have to go spend $300 to do through a specialty lab – it can be done routinely through LabCorp and Quest.

SM: OK.

Causes of stomach autoimmunity

DR: So, that’s the testing for the stomach autoimmunity. The other piece I think we should add into this is what causes the autoimmunity? We haven’t really talked about that. We discussed the association to Hashimoto’s, but we didn’t really talk about causes.

So, of course, it’s autoimmune. One of the best-known associative causes is actually H. Pylori – or Helicobacter Pylori infection, which is a bacteria that usually colonizes the stomach. Of course, it makes a lot of sense that if this bacteria is colonizing the stomach, that’s going to cause the immune system to try to attack this bacteria. In the process of attacking this bacteria, it seems to potentially cause some bystander damage to the cells of the stomach that, again, are needed for releasing hydrochloric acid and intrinsic factor.

SM: Right, yeah. H. Pylori is a tricky little guy – (it) likes to cover itself up in the cells of your stomach. In doing that, it does the damage.

DR: Yes. And I hate to keep referencing future podcasts, but that’s another podcast that I want to do. I plan on doing (it) – it’s on my list, regarding H. Pylori, because it’s a very interesting topic, because it can prevent autoimmunity, it can cause autoimmunity, it can cause high stomach acid, it can cause low stomach acid, it can protect from stomach cancer, it can cause stomach cancer.

SM: Right. Doesn’t it depend on when you are infected with it?

DR: When you are infected, where you are infected -meaning, which part of the stomach it infects- and then the strain that you have.

SM: Um-hum.

DR: Yeah, so it’s an interesting topic, and I’d like to, hopefully, outline that for people so that they have a little bit of clarity – because people will hear conflicting things about H. Pylori out there, and I think through a discussion we’ll have, they’ll understand why there is conflicting things; people are just referencing individual pieces of the H. Pylori picture, and we will, hopefully, put all those pieces together so that people will understand the whole topic.

SM: Cool. So stay tuned for the H. Pylori episode.

DR: Yes, and sorry for all of the cliffhangers here, guys.

(laughter)

SM: I like cliffhangers.

DR: Right.

SM: It keeps me tuned in.

DR: So, autoimmunity is…of course, the chief cause of this stomach autoimmunity is, of course, autoimmunity. One of the things that can cause that autoimmunity, like we just talked about, is H. Pylori.

Now, it can also be initiated by irritation. So, the two most common factors that can cause irritation are the use of non-steroidal anti inflammatories – like Bayer, Bufferin, Excedrin, Advil, Motrin, Aleve – and also, alcohol consumption.

SM: Ah. My favorite.

DR: Now, that doesn’t mean that you can’t have a couple glasses of wine a week. It’s all about degrees, right? So, if you are severe in your alcohol consumption, then you may run a risk for this.

Now, some other things that I think are really important to mention: this is associated with a thyroid condition. Can you treat this by taking more thyroid hormone? And the answer, as far as I’ve seen, is no, right? There are many things involving thyroid that can’t be remedied by taking more thyroid hormone. I think that’s important to mention because sometimes there is this feeling that you just need more thyroid hormone, or just need your thyroid hormone to be in the right levels. I think, sometimes people get very frustrated by trying to figure what are the ideal levels? What are my ideal levels? Should I be on T4? Should I be on T4 andT3? And all this…

Certainly there is merit to that. But there are some conditions associated with hypothyroidism that aren’t thyroid-hormone specific. This is one of those.

SM: I think that’s a really good point. I think that’s a really good point.

DR: Thank you. So, this is one of those.

The other thing I should mention is that – and I am sure people are privy to this – but, the gastrointestinal tract is very, very important for thyroid conditions, because thyroid hormone conversion…maybe 20-ish percent of thyroid hormone conversion, or at least the estimate is, takes place in the gut. So, if there are a lot of problems in the gut, you may have poor T4/T3 conversion. Also, inflammation can derange the conversion of T4 to T3. And, one of the primary sources of inflammation, arguably, is going to be the gut.

SM: And the diet, yes.

DR: Right, yeah. So, things that affect the gut, like the diet. Absolutely. So, it’s a really important part of this.

Additionally, certain infections in the guts can affect autoimmunity. And one that we’ve talked about already – H. Pylori – is known to also directly affect thyroid autoimmunity. And some interventional studies have shown that after treating H. Pylori in patients which also have Hashimoto’s, or thyroid autoimmunity, their autoimmunity starts to dampen or turn off. So, with thyroid, oftentimes, in my experience, it’s all this other stuff – it’s not thyroid hormone-specific that really needs to be addressed to get the thyroid balance back out.

SM: OK

Treating stomach autoimmunity

SM: So, you’ve tested for autoimmunity, you’ve tested for H. Pylori…so, do you go straight to treating the H. Pylori first and then go to the gut autoimmunity (6a Trusted SourcePubMedGo to source) (7a Trusted SourcePubMedGo to source) (8a Trusted SourcePubMedGo to source) (8b Trusted SourcePubMedGo to source) (9a Trusted SourcePubMedGo to source) (9b Trusted SourcePubMedGo to source) ? What’s the process?

DR: Well, the first thing I think people would want to start with is making sure they’re not consuming a lot of the non-steroidal anti inflammatories, right?

SM: Um-hum.

DR: That’s pretty simple. Not over-consuming alcohol, eating a healthy diet – preferably paleo; maybe even give autoimmune paleo protocol a try, and then go through food re-introduction to figure out what works for you.

So, another thing I should mention relevant to this initial therapy dialog – gluten-free has not been shown to be effective for this.

SM: Really?

DR: There were two randomized control trials (10a Trusted SourcePubMedGo to source) (10b Trusted SourcePubMedGo to source), and I will provide the links – the references for these – in the show notes. So, yes, there were two randomized trials that looked at the potential ability of a gluten-free diet to affect this stomach autoimmunity.

SM: Oh, stomach autoimmunity.

DR: Yeah, I’m not talking about thyroid autoimmunity. Clearly, there is some very compelling evidence that gluten-free for thyroid autoimmunity is helpful. All right? But I believe in being somewhat pragmatic and definitely ensconced evidence-based (medicine). So, the best available evidence we have regarding dietary therapies for the stomach autoimmunity show that gluten-free diets have no benefit.

Does that mean you should start eating a bunch of gluten?

(laughter)

No, but I am just trying to let people know what the evidence says, right?

SM: Right.

DR: So, then after you’ve gone through this dietary and lifestyle changes like we discussed, then I would also screen for H. Pylori. And, if they have H. Pylori, treat it. Now, the way I like to screen is I will do the H. Pylori breathe test (there is a SIBO breathe test, there are multiple breathe tests, but this one is specifically be the one that’s for H. Pylori), a stool test, a stool antigen test, and then I usually run a blood profile of IGG and IGA (12a Trusted SourcePubMedGo to source).

For those out there whom are clinicians or pretty savvy with this, it doesn’t appear that IGM is a good marker of acute or current infection for H. Pylori, which might be a little counter-intuitive for some because IGM is classically known to be the marker you look for to signify active infection.

SM: Right, right. That’s what I was going to say. Because, if you have IGM (antibodies), you just usually think, ‘That’s the active infection.’

DR: Exactly. But that doesn’t seem to be the case for H. Pylori.

So, we have a few different windows – we have the breathe, we have the stool, and we have some antibodies. It’s just that IGM doesn’t seem to be a reliable one.

SM: Great.

DR: So, they would want to address the infection, should it be present. And that’s kind of a whole other conversation. But there is triple-drug therapy, and there are also natural therapies, that can be very effective in clearing H. Pylori. I prefer the natural therapies, and I usually will administer N-acetyl cysteine along with a given antimicrobial, because some studies have shown that N-acetyl cysteine can break down protective bile films that protect H. Pylori. When the N-acetyl cysteine was used in conjunction with agents that kill the H. Pylori, the irradiation rate went up significantly. So usually I will administer N-acetyl cysteine along with it. Again, you need to run these things by your doctor, but this is just some information that people may want to be aware of.

SM: And then we will get into much more detail during the H. Pylori podcast.

DR: Right, right.

B12 therapy for stomach autoimmunity

DR: Here is the final piece that I’m really excited about. A group of researchers in Japan were studying a condition called oral lichen planus – it’s essentially an oral disorder that can cause lesioning in the mouth, among other things (12a Trusted SourcePubMedGo to source).

They were trying to see what kind of therapies would be helpful in managing this oral autoimmune condition. They administered B12 along with an immune modulating medication, or just the immune modulating medication alone. They weren’t necessarily looking or expecting to find this, but what they found was when they administered the B12 – it was only in the patient groups that received the B12, the antiparietal cell antibodies, or these stomach antibodies, eventually shut off and went to normal.

SM: Wow.

DR: And this is the first study that I know of this kind. I actually was in correspondence with the researcher, and he wasn’t really able to point me in direction of any other preexisting studies. So, this may be the first study of it’s kind that has found this.

Why this is important? Why is this relevant? Because, by administering something very cheap and simple – a vitamin B12 injection – they were effectively able to shut off autoimmunity. What I think this could translate to people is, if you catch this early, and you go through the vitamin B12 injections, you could shut off the autoimmunity and retain a robust ability to secrete hydrochloric acid. At the end of the day, what you would be looking at, in terms of maintenance, is one tinny, tiny subcutaneous inject of B12 per month – the subcutaneous injections are just tiny, tiny, tiny little needles that anyone can do on their own…

(laughter)

DR: …once a month; compared to taking hydrochloric acid pills with every meal, every day for the rest of your life.

SM: Right. Me, personally, I have stopped taking them because I never felt the warming sensation that you are suppose to feel. And then, to go on a trip, you have to take so many pills with you, and then it just becomes, ‘You know what? I’m done with this.” I think compliance is an issue with taking the hydrochloric acid.

DR: Right, and I also think that not everyone is going to need hydrochloric acid. Maybe that’s a good point to insert some of the keynote symptoms of low hydrochloric acid – if people feel excessively full after meals; if they burp or belch a lot – that’s kind of a keynote symptom; some people that have reflux will have low acid; and also people who are prone to have loose stools, food particles in their stools – certainly, it’s not the only cause of loose stools, and food particles in stool, but it’s one; and people who seem to have recalcitrant or chronically relapsing fungal or bacterial infections, are some of the keynote symptoms.

What I like to do is, we go through our phase of therapy with a patient. Once someone is healthy and feeling good for two-to-four months, I try to slowly curtail them off of everything they’ve been taking.

SM: Um-hum.

DR: What I try to do is find the minimum tolerable dose for everything we had the person on. I think that’s a key point because, in my experience, lots of patients will be able to be on little to nothing in the long term. But, unless you set that as an objective, people just stay taking a ton of stuff indefinitely. I think that’s really problematic and wasteful.

SM: Yeah, like I said, carting your supplements around, taking them. I know I’ve been at different functions, and everyone pulls out their supplement-little jar…

DR: Right.

SM: …and we’re all taking them. It’s like, when does it end? Because, you know, in the end, a really solid paleo-style diet should give you all of the nutrition that you need. You shouldn’t really have to. You know, the goal is to be on no supplements. You know, in the end.

DR: I agree. I think the supplements are best used to achieve a therapeutic endpoint, and then allow the body to not really need them in the long term. Yeah, absolutely. I agree, I agree.

So, coming back to that B12 therapy: if people try this…well, first of all, I’d recommend that you speak to your doctor, do it under their supervision. What the paper did is they used sanal cabelwin – which, I am not a huge fan of that form of cabel…

SM: Right.

DR: …B12. And they did an intramuscular injection, which is a significantly larger needle, and it is significantly more uncomfortable. If you’ve gone to the doctor and gotten a shot in the arm, that’s an intramuscular injection.

SM: Or, in your glute. I will put it that way.

DR: Right, in the other place, right. Now, what we are doing is we’re administering a subcutaneous injection, and we’ve done 2,500 micrograms twice per week.

SM: Of methylcobalamin?

DR: I am sorry. Of methylcobalamin…

SM: OK.

DR: So, we’ve done methylcobalamin, administered subcutaneously at 2,500 micrograms, twice per week. And, I suppose to be the most scientific, we would be replicated exactly what they did the study. I just think compliance is going to be too large of an issue there. So, I’ve been doing this with patients. We’ve been tracking it. I don’t really have anything exciting to report yet, because there is just not a ton of these patients walking around. Or, at least there haven’t been a ton of these patients that we’ve sniffed out in the clinic. But, we are tracking the numbers, and I am hoping at some point at least to be able to report what we found. I am hoping we are going to see the same thing happen with the patient population that we are working with. And if people try this – again, under the supervision of their doctor – and they have a good result, or see no result, please let me know. Because I am really trying to get a ‘real world’ sense of, ‘Is this finding from this group in Japan something that’s able to be replicated?’ If so, I think it could be a really novel preventative strategy for maintaining stomach health in the Hashimoto’s population.

SM: So, say you take the B12, and it restores your parietal cells. And you can make your hydrochloric acid, and it restores your gut health. How does that help your Hashimoto’s?

DR: Well, we don’t know.

SM: OK.

DR: We don’t know, specifically, how helps your Hashimoto’s directly. But, indirectly, if you have an anemia, it’s certainly going to help your anemia, it’s going to help your energy.

SM: Oh, our energy, for sure.

DR: If you have digestive problems that….well, what you may do is prevent further progression, or further digestive problems in the future, because you will stop a process that is damaging your ability to make hydrochloric acid, which protects you from SIBO, protects you from candida…

SM: Ah. OK.

DR: …and those things can interfere with thyroid hormone conversion. And they can also propagate thyroid autoimmunity. So, nothing directly, but through affecting autoimmunity – that will affect your thyroid, affect your conversion and through affecting anemia and digestive competency. So, will it have a direct effect on thyroid autoimmunity? It may. But, I think it’s going to be more so thyroid hormone metabolism that is most benefited from this.

SM: It’s just getting more healthy, so then you can…your thyroid can do a better job.

DR: Exactly. Because remember, like we mentioned before, there are symptoms that are associated with hypothyroidism that the answer to those symptoms is not just found in the thyroid itself – there other systems in the body that need to be corrected. That’s really what I think this would benefit. Also, because it may prevent people from needing hydrocholic acid supplementation.

I should mention really quick here that usually they saw in between two-to-six months, the antibodies would normalize. And once those antibodies normalized, they reverted from their normal once-weekly injection – or, in our case, we are doing two injections per week – to once per month. So, what they did in the study was they did an injection once per week, a larger injection – we are doing two smaller injections per week during the active treatment phase; once someone’s antibodies are within normal limits, then we are reverting to a once-per-month followup. That’s where I think it’s exciting for people, because doing a once-per-month vitamin B12 injection subcue is nothing. And, there is potentially a nice upside here. So, to be determined, but hopefully people will tinker with that – again, under the supervision of their doctor – and report back some information to us that we can tell everyone else about.

SM: I think it’s exciting stuff. It really is. Because, sometimes, like you said about the thyroid tests, maybe you are in the lab-ranges, but you still have thyroid symptoms. So, the fatigue and the energy is one of the huge, huge ones. So, if you can alleviate so of those energy issues, and just make your gut healthier, it’s a win-win.

DR: Absolutely. The gut-health piece is so important. Just a couple weeks ago, I sat down with a patient. The video went out in our weekly newsletter, and she was able to cut her dose of thyroid in half after we treated her for SIBO.

SM: Wow, that is huge.

DR: She cut her thyroid hormone dose in half. And the reason why this happened is she became hyperthyroid, right?

SM: Um-hum.

DR: The dose she was on before now was too much for her body, because her body was healthier. We sent her back to her prescribing, prescribing, maybe, the appropriate dose adjustment. She cut her dose in half, and lost weight as part of that process. So yes, to get the thyroid straightened out, it’s not always a thyroid issue. If definitely can be a thyroid issue, but sometimes there are other systems in the body that are having a negative feed-in into the thyroid.

SM: Yeah, I’ve heard that to look at thyroid autoimmunity not as a thyroid issue, but as immune system issue.

DR: Exactly.

SM: So, instead of treating the thyroid with thyroid hormone, it’s a much bigger picture.

DR: Exactly. And, I think people are starting to become privy to that, and, hopefully, our discussion today has kind of helped them see a little bit more of that whole context.

SM: Yeah, OK.

Episode wrap-up

SM: Well, is there anything else that you need to add to all of this fascinating information?

DR: I think we’ve pretty much covered it all. Sorry for Susan and myself getting on our soapboxes a little bit, talking about the excessive testing. But, other than that, hopefully people got something good out of this. And, hopefully, people are enjoying the podcast. Please provide us with your feedback or questions on the website portal or Facebook page, because I am really trying to make this something that is not just me spewing rhetoric – I am trying…

(laughter)

SM: You want it to be useful?

DR: Yeah, I hope my rhetoric is useful as is, but I really want to know what it is people are curious about, and try to meet them where they are. And help them.

SM: Yeah, go over to Facebook…what is your Facebook page, so people can go over there and like you, and ask you questions?

DR: It’s just http://www.facebook.com/drruscio, I believe. And there is a cheesy picture of me in a white coat, so it won’t be hard to overlook.

(laughter)

And, the website has a portal where people can ask me a question – they can leave an audio message to ask a question there, too. So yeah, I think that pretty much wraps it up. Is there anything you wanted to add, Susan?

SM: No, just if you like what you hear, go over to iTunes and give us a review. It really helps move the podcast up in the ratings, so more people can find us. So, you know, if you don’t like it, you’re still more than welcome to give us a review. I don’t want to say that those who can’t say something nice, don’t say anything at all. No, I’m not going to go on that one. But, yeah, it would help us out if you can give us a review. And, we will talk to you next time.

DR: All right, sounds good. Thanks, guys, and thanks, Susan.

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRusso.com to ask a question for an upcoming podcast. Post comments for today’s show and sign-up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

If you need help with the diagnosis or treatment of thyroid autoimmunity, click here

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Discussion

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24 thoughts on “Thyroid Autoimmunity, Stomach Acid Production and Vitamin B12 – Episode 32

  1. I loved the podcast!! Very informative. I have Hashimotos and have tested negative for H pylori thru endoscopy. Could I still have stomach autoimmunity? I have also tested positive for SIBO. Would the vitamin B-12 protocol help resolve SIBO?
    Thank you for your reply.
    Madeleine.

    1. Thanks! You could still have H. Pylori and stomach autoimmunity. Vitamin B12 is not a treatment for SIBO. I would treat your SIBO and then re-evaluate your symptoms and retest SIBO. If your symptoms are gone and SIBO is cleared, great. If not, then looking into HP might be a good idea. Hope this helps!

  2. I loved the podcast!! Very informative. I have Hashimotos and have tested negative for H pylori thru endoscopy. Could I still have stomach autoimmunity? I have also tested positive for SIBO. Would the vitamin B-12 protocol help resolve SIBO?
    Thank you for your reply.
    Madeleine.

    1. Thanks! You could still have H. Pylori and stomach autoimmunity. Vitamin B12 is not a treatment for SIBO. I would treat your SIBO and then re-evaluate your symptoms and retest SIBO. If your symptoms are gone and SIBO is cleared, great. If not, then looking into HP might be a good idea. Hope this helps!

  3. Hi Dr Ruscio, just wanted to say thanks for another informative podcast. I’m a naturopath and nutritionist from Australia and I first heard you on Robb Wolf’s show and now I’m a loyal fan of your show. The information you provide is really helpful for my work and thoroughly researched. Thanks again. http://www.kellymartin.com.au

  4. Hey Dr. Ruscio,
    Thanks again for putting out these podcasts that are so informative. I’m hooked. My question: At what level of TPO or TGB antibodies does someone need to have for you to consider autoimmunity? From my experience, it seems like some clinicians may have varying opinions on this. For example, I’ve had multiple lab tests come back with TPO antibodies ranging from 35-45, but have been told this is not high enough to worry about Hashimoto’s.
    Thanks,
    Andrew

    1. Good question Andrew. I think TPO below 200-300 is a safe range, or what many healthy patients settle in at after having levels that were 700-1400. TG is not as clear, still trying to make up my mind on it.

  5. I am going to try this protocol (under the supervision of my doctor). Have you seen positive results in your patients since you’ve been doing it for a while now? Have you changed anything about the protocol since this podcast? Thank you for the great info!

      1. Thank you so much for your response, I really appreciate it! I have one more question, what do you consider normal for these antibodies?

  6. Hey Dr. Ruscio,
    Thanks again for putting out these podcasts that are so informative. I’m hooked. My question: At what level of TPO or TGB antibodies does someone need to have for you to consider autoimmunity? From my experience, it seems like some clinicians may have varying opinions on this. For example, I’ve had multiple lab tests come back with TPO antibodies ranging from 35-45, but have been told this is not high enough to worry about Hashimoto’s.
    Thanks,
    Andrew

    1. Good question Andrew. I think TPO below 200-300 is a safe range, or what many healthy patients settle in at after having levels that were 700-1400. TG is not as clear, still trying to make up my mind on it.

  7. Hi Dr Ruscio, just wanted to say thanks for another informative podcast. I’m a naturopath and nutritionist from Australia and I first heard you on Robb Wolf’s show and now I’m a loyal fan of your show. The information you provide is really helpful for my work and thoroughly researched. Thanks again. http://www.kellymartin.com.au

  8. I am going to try this protocol (under the supervision of my doctor). Have you seen positive results in your patients since you’ve been doing it for a while now? Have you changed anything about the protocol since this podcast? Thank you for the great info!

      1. Thank you so much for your response, I really appreciate it! I have one more question, what do you consider normal for these antibodies?

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