Keeping your immune system armed against viruses with Hashimoto’s & Graves’
With a new virus never seen before in humans spreading through the world it’s vital your body’s immune system is fully charged ready to do its job of defending you by fighting off infections.
Your immune system needs to marshal enough energy and resources to prevent pathogens entry plus recognise, destroy and remove viruses once they’re in.
Unfortunately, the reality of having an autoimmune condition is the immune system is already locked and loaded attacking the body. In the case of Hashimoto’s thyroiditis (the most common cause of hypothyroidism) or Graves’ disease (the most common cause of hyperthyroidism), the immune system is firing its weapons at the thyroid.
For some thyroid-y types, this means they seem to pick up every little infection but I do come across others who almost never get sick. What type are you?
I was the gal who caught every bug going around. This was the first sign, a decade before I was diagnosed with Hashimoto’s, that something was wonky with my immune system. I used to be ill with a cough, a cold, an infection or a tummy bug literally every month for years.
Happily, I’ve changed that miserable reality of poor immunity, and, for the past 5 years, I’ve rarely been ill. Considering the number of people I meet any ordinary day coughing and sneezing in a suburban medical practice where I work - my immune system is strong and resilient! With daily updates on the rapid spread and deadly potential of the Corona Virus, it’s time to talk immune health with my thyroid sisters and brothers. This is what I did in my own body all those years ago to arm myself against infections. I am an ‘evidence-based’ practitioner so I’ll share the scientific research through the discussion and you can make up your own mind. COVID 19 is simply just too new to have specific evidence on any anti-viral properties known to fight it so my approach is one of informed prevention rather than cure.
The goal of immune health when exposed to a virus is a call to A.R.M.S. to encourage your body to work the way it should be when healthy: Add the nutrients your defence needs to be strong and healthy. Recognise factors weakening your defence forces. Manage and mitigate exposure to the virus in the first place. Soothe the autoimmune attack on your body to free up energy and resources to fight a virus.
Strategy 1 of Immune ARMS
ADD the nutrients needed by the immune system.
Vitamin D3
What it does:
• Helps regulate the immune system (1).
• Protects against the flu and respiratory tract infections (2).
Where do you get it:
• Daily safe sunshine exposure (for more information on sun exposure to make Vitamin D check this out https://www.cancer.org.au/preventing-cancer/sun-protection/vitamin- d/ ).
• While sunshine exposure is the ideal way to make your own Vitamin D when there is Hashimoto’s or Graves’ often it is not possible for the body to manufacture enough Vitamin D to be helpful (3).
• Supplement with Vitamin D3 plus K2 in a capsule or emulsified liquid with vitamin D3 (and vitamins K1 and K2).
• Cod liver oil which has Vitamin D, as well as thyroid and immune essential Vitamin A. Cod liver oil, is such a powerhouse of goodness for thyroid and autoimmunity which is why it is one of my very favourite helpers in my clinic.
• Food sources include fatty fish: salmon, mackerel, sardines.
How much do you need:
The Vitamin D Council recommends 5,000 IU for adults on days you don’t sunbathe. Obese adults should consider a higher dose but do not exceed 10,000 IU without trained supervision.
Caution: If you are taking a dose higher than 2,000 IU daily then it is wise to retest after 3 months of supplementation to monitor your levels and then as often as your doctor recommends (4).
The Hashimoto’s & Graves’ Vitamin D Story
Supplementing Vitamin D when levels were low in Hashimoto’s was found to actually help reduce thyroid antibodies. That’s right! Vitamin D may help not only fight a virus but also calm and soothe a cranky immune system in thyroid-y types (5, 6).
Vitamin A
What it does:
• Necessary for immune function. In fact, if your vitamin A level is low it’s considered an acquired immunodeficiency disease (8)!
• Virus protection. In studies on the measles virus children who were mildly deficient in vitamin A had a higher rate of mortality, diarrhoea, and respiratory complications compared to children eating adequate amounts of vitamin A (9). Where do you get it:
• It’s best taken in food-based fats and oils like egg yolks, chicken fat, cod liver oil and grass-fed butter.
• The pre-curser to Vitamin A is found in many brightly coloured fruits and vegetables but you do need to eat them with a fat or oil to absorb Vitamin A fully. Add a slosh of olive oil or a handful of walnuts and you are getting the full bang for your Vitamin A buck from sweet potato, carrots, spinach, butternut pumpkin/squash, pumpkin.
Cautions:
• Vitamin A in high amounts can lead to headaches, dry skin, and other symptoms of toxicity.
• If you’re considering using higher than 10,000 IU of vitamin A in adults or supplementing for longer than 1 week please consult a trained nutritionist or medical professional first.
• Retinyl palmitate and other forms of pre-formed vitamin A should not be taken in high dosages if you are trying to conceive or are pregnant.
Hashimoto’s & Graves’ Vitamin A Story
If you are low in Vitamin A you will more than likely feel worse if you have Hashimoto’s and/or hypothyroidism. So linked is Vitamin A to thyroid health that supplementing Vitamin A, when it is deficient, has been found to relieve hypothyroidism (10)!
But Vitamin A does not work alone. Low levels of the mineral zinc, common in Hashimoto’s hypothyroidism, has been shown to interfere with vitamin A metabolism (11).
Zinc
What it does:
• Zinc is essential for immune function (12).
• When zinc is low there is an increased susceptibility to infections and a decreased capacity for the immune system to combat illness (13). This is not a state you want to find yourself in 2020.
• The impact of taking zinc once sick is still mixed. Some studies found zinc lozenges haven’t been all that effective for the common cold, however, some concluded taking zinc within the first 24 hours of cold symptoms reduced the severity and duration (14). Other studies found zinc was most effective for adults in the fight against upper respiratory tract viruses (15).
Where do you get it:
• Oysters, beef, turkey, pine nuts, cashews, and chickpeas. But you do need to have a strong digestive fire to extract zinc out of foods so squeeze a lemon or add apple cider vinegar to these foods to potentially help your stomach acid work more effectively.
How much do you need:
For Adults, consider 25 mg 1-2 times daily with food.
Caution:
• It is generally recommended to use zinc for the duration of symptoms and discontinue 2 days after symptoms have resolved.
• Zinc should not be used long term without regular checkups and guidance.
The Hashimoto’s & Graves’ Zinc Story
Zinc is a common deficiency in both hypothyroidism and hyperthyroidism (16, 17). Having low levels of zinc in both hypothyroidism and hyperthyroidism may contribute to a worsening symptoms (18) like hair loss (19).
The impact of correcting low zinc levels can be profound. One study on targeted zinc supplementation in hyperthyroid populations found the symptoms of hyperthyroidism improved (20).
Vitamin C
What is does:
• Contributes to the defence of your body from pathogens by supporting both the front line (innate) immunity and the part of your immune system that remembers what to fight (adaptive).
• Supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections (21).
• Currently, early use of large dose antioxidants, especially vitamin C is playing a key role in the management of Coronavirus patients in China. However, some of this supplementation is via massive doses intravenously not orally (22). Where is it found:
• Fresh, raw fruits and vegetables contain Vitamin C and the more brightly coloured the better so choose strawberries, red capsicum, broccoli and oranges for the win. How much:
• Vitamin C gets burnt up pretty quickly so the more fresh, brightly coloured, raw veggies the better.
• When supplementing a preventative dose of vitamin C may be small at 100–200 mg/day if you are feeling well and energetic.
• In contrast, treatment of established infections requires significantly higher (gram) doses of vitamin C to compensate for the increased inflammatory response and metabolic demand.
• Thankfully, there is currently a research trial underway to investigate vitamin C infusions for the treatment of severe Corona Virus-infected pneumonia where patients in the treatment group will receive 24 grams of Vitamin C daily for 7 days (23).
Caution:
Those with kidney diseases and prone to kidney stones or a family history of kidney stones should only take a vitamin C supplement with advice from a trained professional.
The Hashimoto’s & Graves’ Vitamin C Story
Lower level of Vitamin C have been found in those with thyroid disorders so make sure you are turbocharging your raw veg consumption or start eyeballing a good quality supplement (24).
Summary of Strategy 1: ADDing nutrients your immune system needs
For my Hashimoto’s & Graves’ clients:
• 1 x Cod liver oil capsule (Vitamin D and Vitamin A) taken with each meal
• 1 x highly absorbable Zinc to the dose of 25-50mg at night with food
• 1 x Scoop of yummy vitamin C powder added to their bottle of water in the morning and sipped all day.
If you are not my client I cannot provide you with specific advice. Use my recommendations as a basis for a conversation with your own trained nutritionist/naturopath. If you want more child-specific information and dosages check out Dr. Elisa Song’s blog.
Strategy 2 of ARMS
Recognise factors weakening your immune system in Hashimoto’s & Graves’
Sugar, stress and sleep are some of the most common reasons our immune system loses its vigour and gets lazy.
Sugar
Hypothyroidism appears to change the way the body uses sugar with an increased risk of developing type 2 diabetes mellitus (30) and gestational diabetes when pregnant (31).
Sugar in all its forms is a siren song luring those with hypothyroidism and Hashimoto’s into its dangerous arms. It’s no mystery to me why we Hashi’s peeps tend to be jonesing for sugar. The simple truth is sugar promises energy. Let’s face it when you are hypothyroid you become enamoured of anything that could possibly boost your energy. But sugar is like fool’s gold - promising rich energy but delivering only worsened fatigue, cravings, weight issues and muscle aches and pains.
Worse still every teaspoon of sugar dials down your immune system leaving you more vulnerable to infections (25). A sluggish immune system means a body with poor defences - you do not want this to be your reality.
Use this time of increased awareness of immune health as a trigger to face your relationship with sugar. It’s hard but it’s worth it!
Stress
Stress can sabotage your immune system, in fact, the link between autoimmunity, thyroid disorders and stress has been proven in research (32). It’s time to take your self-care seriously and create a routine that supports not only your immune system now but for the rest of your life. Strategies called ‘active relaxation’ help you manage the real impacts of stress on your body.
My clients’ favourite picks include:
• Deep belly breathing - check out this YouTube by me on how to do deep belly breathing.
• Gentle yoga - my current favourite is Yoga by Adriene on YouTube.
Sleep
Consistent, great quality sleep helps support a strong healthy immune system. If you tend to stay up late, you might want to make some modifications in the coming weeks. Here are some tips to help improve your sleep:
Use the hour before bed to wind down with a routine of gentle stretches, journalling and sip relaxing chamomile or passionflower tea. If you enjoy baths an Epsom salts bath boosts magnesium absorption and helps soothe jangled nervous systems.
Turn off screens and TVs, light candles or consider blue light blocking glasses in the evening.
Avoid eating 2 hours before bed unless otherwise advised.
Avoid alcohol, coffee or sugar in the evening.
Sleep in a cool and dark room.
Summary of Strategy 2: Recognise factors weakening your immune system in Hashimoto’s & Graves’
Use the Corona Virus as an excuse to break-up with sugar, explore stress management techniques and get on top of a great sleep routine.
Strategy 3 of ARMS
Manage and mitigate exposure to the virus in the first place.
I’m a huge fan of prevention rather than cure so if you can prevent a virus from entering into your body in the first place to me that is ideal.
• Wash Your Hands and sing the “Happy Birthday to You” song so you wash for 20 seconds continuously, long enough to have an impact. As you’re standing there at the basin lather the soap between your fingers, top & bottom, front & back of your hands and into your nail beds and remember to show your thumb some soapy love.
• Cough/sneeze into a disposable tissue and throw it away before you touch anything. Then go wash your hands for 20 seconds continuously. Help others to do the same.
• Stay up to date on the latest reputable information so you can respond quickly: Coronavirus(CoVid19) health alert.
Strategy 4 of ARMS
Soothe the immune attack on your body to free up energy and resources to fight a virus.
Selenium
Your thyroid and your thyroid hormones love selenium. Selenium is a mineral found in foods like Brazil nuts, asparagus and eggs. Selenium is being actively researched with exciting findings on its ability to protect the thyroid gland from immune attack and regulate the amount of active thyroid hormone (T3) in cells.
When selenium was given as a supplement to people with Hashimoto’s hypothyroidism it calmed their immune system and left them feeling better. Specifically, anti-TPO antibody levels were reduced after 3 months, with improvement in mood and/or general well-being (26).
Caution:
Selenium should not be supplemented long term nor should more than 200 mcg/day be taken as in excess it is toxic in large amounts.
Gluten Free or Not
A 2019 published study found removing gluten from women with Hashimoto’s hypothyroidism, who did not have coeliac disease, reduced thyroid antibodies and improved thyroid hormone levels (27). Remember lowered thyroid antibodies means fewer symptoms and a calmer immune system (28).
Possibly a gluten free diet may be a good idea when any autoimmunity is present regardless of the specific disease (29).
The Simple Way to Arm your Immune System
A diet rich in fruit and veggies, high-quality proteins yet low in sugar and processed foods hits all the nutritional high spots for arming your immune system. If your antibody count is high or you feel like you need a top up I’ve listed in this article the nutrients Hashimoto’s and Graves’ should explore first.
Manage your stress and get lots of restorative sleep. Whilst these two almost seem like no-brainers you might be surprised to hear that most people struggle with them on a daily basis.
Whilst it might feel that all that matters is stockpiling enough toilet paper, make sure you wash your hands and eat your veggies ;)
Stay safe my thyroid brothers and sisters.
With love, Sonia x
Remember whilst I am a qualified naturopath, nutritionist and herbalist I am not your practitioner so any information provided here should only be used to arm you for a discussion with your qualified nutrition professional.
References:
1. Wang H, Chen W, Li D, et al. (2017). Vitamin D and Chronic Diseases. Aging Dis. 8(3), 346–353.
2. Mitsuyoshi Urashima, Takaaki Segawa, Minoru Okazaki, Mana Kurihara, Yasuyuki Wada, Hiroyuki Ida, (2010). Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren, The American Journal of Clinical Nutrition, 9(5),255–1260.
3. Wang, J., Lv, S., Chen, G., Gao, C., He, J., Zhong, H., & Xu, Y. (2015). Meta-analysis of the association between vitamin D and autoimmune thyroid disease. Nutrients, 7(4), 2485-2498
4. Sadat-Ali, M., Al-Anii, F. M., Al-Turki, H. A., AlBadran, A. A., & AlShammari, S. A. M. (2018). Maintenance Dose of Vitamin D: How Much Is Enough?. Journal of Bone Metabolism, 25(3), 161-164.
5. Chaudhary, S., Dutta, D., Kumar, M., Saha, S., Mondal, S. A., Kumar, A., & Mukhopadhyay, S. (2016). Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease: An open-labelled randomized controlled trial. Indian journal of endocrinology and metabolism, 20(3), 391.
6. Wang, J., Lv, S., Chen, G., Gao, C., He, J., Zhong, H., & Xu, Y. (2015). A meta-analysis of the association between vitamin D and autoimmune thyroid disease. Nutrients, 7(4), 2485-2498.
7. Uysal, H. B., & Ayhan, M. (2016). Autoimmunity affects health-related quality of life in patients with Hashimoto’s thyroiditis. The Kaohsiung Journal of Medical Sciences, 32(8), 427-433.
8. Semba RD. (1997). Vitamin A and human immunodeficiency virus infection. Proceedings of the Nutrition Society, 56(1B), 459-469.
9. Field CJ, Johnson IR, Schley PD. (2002). Nutrients and their role in host resistance to infection. Journal of Leukocyte Biology, 71(1), 16-32.
10. Farhangi, M. A., Keshavarz, S. A., Eshraghian, M., Ostadrahimi, A., & Saboor-Yaraghi, A. A. (2012). The effect of vitamin A supplementation on thyroid function in premenopausal women. Journal of the American College of Nutrition, 31(4), 268-274.
11. Christian P, West KP, Jr. (1998). Interactions between zinc and vitamin A: an update. American Journal of Clinical Nutrition, 68(2 Suppl):435S-441S.
12. Baum MK, Shor-Posner G, Campa A. (2000). Zinc status in human immunodeficiency virus infection. Journal of Nutrition, 130(5S Suppl),1421S-1423S.
13. Maares M, Haase H. (2016). Zinc and immunity: An essential interrelation. Archives of Biochemistry and Biophysics, 611, 58-65.
14. Hulisz, D. (2004). Efficacy of zinc against common cold viruses: an overview. Journal of the American Pharmacists Association, 44(5), 594-603.
15. Johnstone, J., Roth, D. E., Guyatt, G., & Loeb, M. (2012). Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials. Canadian Medical Association Journal, 184(10), E551-E561.
16. Al-Juboori, I., Al-Rawi, R., & Hussein, A. (2009). Estimation of serum copper, manganese, selenium, and zinc in hypothyroidism patients. European Journal of Biology, 68(2), 121-126.
17. Sinha, S., Kar, K., Dasgupta, A., Basu, S., & Sen, S. (2016). Correlation of Serum zinc with TSH in hyperthyroidism. Asian Journal of Medical Sciences, 7(1), 66-69.
18. Napolitano, G., Palka, G., Lio, S., Bucci, I., De, P. R., Stuppia, L., & Monaco, F. (1990). Is zinc deficiency a cause of subclinical hypothyroidism in Down syndrome?. In Annales de Genetique, 33(1), 9-15.
19. Betsy, A., Binitha, M. P., & Sarita, S. (2013). Zinc deficiency associated with hypothyroidism: An overlooked cause of severe alopecia. International Journal of Trichology, 5(1), 40.
20. Sinha, S., Kar, K., Dasgupta, A., Basu, S., & Sen, S. (2016). Correlation of Serum zinc with TSH in hyperthyroidism. Asian Journal of Medical Sciences, 7(1), 66-69.
21. Carr, A. C., & Maggini, S. (2017). Vitamin C and immune function. Nutrients, 9(11), 1211.
22. Cheng, R. Z., Shi, H., Yanagisawa, A., Levy, T., & Saul, A. Early Large Dose Intravenous Vitamin C is the Treatment of Choice for 2019-nCov Pneumonia.
23. https://clinicaltrials.gov/ct2/show/NCT04264533
24. Reddy, V. S., Gouroju, S., Suchitra, M. M., Suresh, V., Sachan, A., Rao, P. S., & Bitla, A. R. (2013). Antioxidant defence in overt and subclinical hypothyroidism. Hormone and Metabolic Research, 45(10), 754- 758.
25. Janjua, H. U., Akhtar, M., & Hussain, F. (2016). Effects of sugar, salt and distilled water on white blood cells and platelet cells: A review. Journal of Tumor, 4(1), 354-358.
26. Toulis, K.A., Anastasilakis, A.D., Tzellos, T.G., Goulis, D.G. & Kouvelas, D.(2010). Selenium supplementation in the treatment of Hashimoto's Thyroiditis: A systematic review and a meta-analysis. Thyroid. 20(10): 1163-1173. doi:10.1089/thy.2009.0351.
27. Krysiak, R., Szkróbka, W., & Okopień, B. (2019). The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Experimental and Clinical Endocrinology & Diabetes, 127(07), 417-422.
28. Ott, J., Promberger, R., Kober, F., Neuhold, N., Tea, M., Huber, J. C., & Hermann, M. (2011). Hashimoto’s thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: A prospective case–control study in women undergoing thyroidectomy for benign goitre. Thyroid, 21(2), 161-167. doi:10.1089/thy. 2010.0191.
29. Lundin, K. E., & Wijmenga, C. (2015). Coeliac disease and autoimmune disease—genetic overlap and screening. Nature reviews Gastroenterology & hepatology, 12(9), 507.
30. Gronich, N., Deftereos, S. N., Lavi, I., Persidis, A. S., Abernethy, D. R., & Rennert, G. (2015). Hypothyroidism is a risk factor for new-onset diabetes: a cohort study. Diabetes Care, 38(9), 1657-1664.
31. Gong, L. L., Liu, H., & Liu, L. H. (2016). Relationship between hypothyroidism and the incidence of gestational diabetes: A meta-analysis. Taiwanese Journal of Obstetrics and Gynecology, 55(2), 171-175.
32. Mizokami, Tetsuya, Audrey Wu Li, Samer El-Kaissi, and Jack R. Wall. " Stress and thyroid autoimmunity. & Thyroid 14, no. 12 (2004): 1047-1055.