Episode - Food Triggers and Graves’ Disease


There are numerous factors which can trigger Graves’ disease, and food is one of these triggers. While food isn’t a trigger in everyone, when it is a trigger you of course need to remove the food in order to restore your health. In this episode Dr. Eric will discuss some of the common food triggers, as well as how to identify them.

During this episode you’ll learn:

  • The common food triggers of Graves’ disease
  • How to find food triggers
  • 5 reasons to avoid gluten
  • Why nightshades should be avoided
  • The concerns with a high salt diet
  • Whether caffeine should be avoided

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Here is the transcript for this episode:

Welcome back to the Save My Thyroid podcast. This is Dr. Eric Osansky, and in this episode, I’m going to discuss food triggers and Graves’ Disease. Let’s go ahead and discuss some of the common food triggers.

Of course, there is gluten as well as dairy. Corn is also a potential trigger as well as soy and salt. I’ll be discussing all of these a little bit later.

How about sugar, eggs, nightshades, and caffeine? Are these considered to be triggers? I don’t think they are direct triggers of autoimmune conditions such as Graves’. Without question, sugar can cause a lot of problems. Nightshades can be inflammatory in some people. Eggs can also be problematic in some people. Some people also have issues with caffeine. Once again, I’ll talk more about these foods a bit later.

How do you find food triggers? I recommend an elimination/reintroduction diet. The AIP diet, which is the Autoimmune Paleo diet, serves as an elimination diet. Essentially, you want to eliminate the common allergens, but even some of these other foods I mentioned such as nightshades and eggs. Then you would slowly reintroduce them back one at a time. You would eliminate them for a period of 30-90 days and then reintroduce certain foods one at a time.

Some practitioners will recommend food sensitivity testing instead of an elimination diet. Food sensitivity is an option. It’s just not completely accurate. Without question, there are some labs that are better than other labs. Still, I have gone with an elimination diet for years. Food sensitivity testing, I can’t say I never do it. Let’s say if an elimination diet doesn’t reveal the food triggers, then I might turn to food sensitivity testing.

Just keep in mind that food isn’t a trigger in everyone. Food is important. You need to eat an anti-inflammatory diet consisting of whole healthy foods. This doesn’t mean that food is a trigger in every single person with Graves’.

Also, keep in mind that not all food sensitivities are food triggers. By this, I mean that just because someone has a negative reaction to a certain food doesn’t mean that it will trigger a condition such as Graves’. That being said, such a food potentially can cause gut inflammation and might prevent someone from healing.

I want to briefly mention five reasons why gluten should be avoided, especially while restoring your health.

Reason #1 is because gluten is a common allergen.

Reason #2: Gluten is a potential trigger of autoimmunity.

Reason #3: Gluten cannot be completely digested.

Reason #4: Gluten causes an increase in intestinal permeability in everyone. Once again, an increase in intestinal permeability is also known as a leaky gut. This is based in research done in 2015 that showed that gluten can cause a leaky gut in everyone. It’s not just a concern in people with Graves’ Disease.

Reason #5: You should focus on eating whole healthy foods.

Some might wonder “can you reintroduce gluten later on after someone has restored their health?” This really is up to the person. This is something I could discuss in future episodes. I will say since being in remission—I have been in remission from Graves’ since 2009—for the most part, I avoid gluten. But I can’t say that I have avoided gluten 100% since 2009. It is something that I do make an effort to avoid most of the time.

One question you might have is can eating a small amount of gluten cause inflammation or a leaky gut or both? What some people will wonder is if they could have some gluten every now and then, even when restoring their health. After restoring your health, it’s a bit of a different story, and it depends on the person. Everybody, while trying to restore their health, really wants to be strict with gluten because in some people, the answer is yes, sometimes eating a small amount of gluten can cause inflammation or a leaky gut.

Let’s briefly discuss some of the testing options for gluten. You could test for gliadin antibodies, which you could do at most labs like Quest Diagnostics or LabCorp. You could also do a full Celiac panel. So if you do a test for gliadin and if it’s positive, that doesn’t confirm Celiac disease. There are other markers related to Celiac such as transglutaminase and endomysial antibodies. There are some practitioners who believe that everyone with an autoimmune condition should test for Celiac if they are eating gluten.

If you are not eating gluten, the test should come back negative. If you have avoided gluten for a prolonged period of time, then you should expect a negative result. If someone is eating gluten, some practitioners will recommend for everyone with an autoimmune condition to test for Celiac disease, just because someone with an autoimmune condition is more likely to develop a different autoimmune condition, such as Celiac.

Another example of a test is Cyrex Labs’ Array #3, which is also called their wheat gluten Proteome reactivity and autoimmunity panel. It’s a really good test. Probably the most comprehensive test out there for gluten that I know of. It is kind of pricey though. I usually just tell people to avoid gluten. If someone is eating gluten, then you might want to start with a Celiac panel. I can’t say that everyone needs to do the Cyrex Labs testing. Honestly, most of my patients don’t do this test.

Is the problem really with gluten? First of all, someone might have a wheat allergy, which is not exactly the same as a gluten sensitivity. I don’t want to get too complex here, but an allergy is IGE-mediated whereas a sensitivity is IgG-mediated. IGE typically involves an immediate response, usually within a few seconds or minutes. A sensitivity is frequently a delayed response. It can be hours and sometimes a few days. It is possible for someone to have a wheat allergy, but they might be fine with other sources of gluten such as rye and barley.

There are some people who need to avoid grains altogether. It might not be a gluten problem; it might be a grain problem. There are some practitioners who will recommend for everyone with an autoimmune condition, not only Graves’, to avoid grains. If you’re following a strict AIP diet, then you will be avoiding grains because grains are not a part of this diet. Grains also are not a part of the regular Paleo diet.

Grains are also high-FODMAP foods, which can also be a problem. It might not be the problem with gluten, but it might be because the high FODMAP is giving someone problems, especially with people who have SIBO (small intestinal bacterial overgrowth).

Some wonder if their problem is not with gluten, but with glyphosate because at least in the United States, the crops are sprayed with wheat. Glyphosate can cause a lot of problems. I will cover glyphosate in a different episode. There are some people who will go to a different country, eat wheat and gluten, and do perfectly fine. When they eat wheat in the United States, or another type of gluten, they have problems.

That brings up the question: Is it a problem with the wheat, or is it with the gluten, or is it the glyphosate? There are other theories like hybridization, which I’m not going to get into here.

Glyphosate is a big problem. You want to do both honestly. Try to minimize or completely avoid gluten while you’re restoring your health at least. Also try to minimize your exposure to glyphosate. You could accomplish this by eating mostly organic. That doesn’t mean you will 100% eliminate the glyphosate, but it will greatly reduce your exposure.

Why should dairy be avoided? Like gluten, dairy is a common allergen. Casein, which is a protein of dairy, cross-reacts with gluten and can result in the gliadin antibodies I discussed earlier. Essentially, dairy can cause gluten antibodies. This includes not only milk but also yogurt, cheese, kefir, and whey.

How about butter and ghee? They don’t have a lot of casein, especially ghee. Many people do fine with butter and/or ghee. If someone is following a strict AIP diet or a Paleo diet, I would say to take a break from dairy. It doesn’t mean you can’t potentially reintroduce diary in the future. That’s up to the person.

Some practitioners, just like they recommend to avoid gluten permanently, will say that all of their autoimmune patients should avoid dairy as well on a permanent basis. I have been in remission since 2009, and I can’t say that I have completely avoided dairy, especially when I have pizza. When I have pizza, it’s usually a gluten-free pizza, but I can’t say it’s a dairy-free pizza, even though there are options like daiya cheese. So just to be transparent, I usually don’t have dairy-free pizza when I have pizza.

Four additional reasons to avoid conventional cow’s milk. First of all, growth hormone is commonly added to cow’s milk. Cow’s milk also can contain estrogens as well. Heating of the milk, known as pasteurization, decreases many of the nutrients, such as Vitamin B1, B2, folate, Vitamin B12, Vitamin C, and Vitamin E. Homogenization changes the physical structure of milk fat. Because of this, it might also alter the health properties of milk. Cow’s milk, along with other types of dairy, has a high insulin index, which means that it causes a high insulin response. These are four reasons why you want to avoid dairy, especially cow’s milk.

How about other types of dairy? Some will ask is it okay to drink raw milk? Or is it okay to drink milk from another animal such as a goat or a sheep? Many people do fine with raw milk as well as other types of milk, but it does depend on the person. If you’re following a strict paleo or AIP diet, I would say all dairy should be avoided, even if it’s raw milk or milk from a goat or sheep or camel or another animal. The problem is there hasn’t been as much research on these types of milk although it does appear the insulin index is similar to cow’s milk. The insulin index is similar or the same. If you do decide to eliminate dairy and then eventually reintroduce it, these other types of milk are healthier, like raw milk, which I know you can’t get in every single state. Raw milk is something to consider. Milk from a goat or a sheep as well.

There is beta casein A1 versus A2. Cow’s milk both consists of casein and whey protein. Cow’s milk consists of approximately 80% casein. There is a lot of casein. There are different types of casein in dairy cows. The most common form is a beta casein, A1 and A2. Beta casein variant A1 yields the bioactive peptide called betacasomorphin seven or BCM7. This may play a role in the development of certain chronic health conditions. Some people react to beta casein A1 but do fine with beta casein A2. That’s why some health food stores will sell A2 milk. Some people do perfectly fine on this. Once again, if you’re following a strict paleo or AIP diet, I would say to avoid all dairy, including A2 dairy.

Now let’s discuss some other foods to potentially avoid, starting with corn. Eating corn can cause a similar response as gluten. Research has shown that a protein from corn can potentially cause a Celiac-like immune response. Anyone who eats processed foods regularly most likely is being exposed to corn. It seems like it’s everywhere. Some different names, it’s not always listed as corn on ingredients. Confectioner’s sugar, hydrolyzed vegetable protein. Maltodextrin is commonly corn-based. There are other types like tapioca-based. But if it just says maltodextrin, it’s probably corn-based. Modified food starch. Xanthan gum.

Another thing to keep in mind is that most corn in the United States is genetically modified. If you eliminate corn and eventually reintroduce it, you want to try to make sure you are eating organic corn.

How about soy? Once again, most soy is also genetically modified. Many people are sensitive to soy. Just like corn, many packaged foods include soy ingredients. You definitely want to read the ingredients carefully. A few studies have shown that soy has goitrogenic properties. Goitrogenic means that it can potentially inhibit thyroid activity. If someone has hyperthyroidism, they might think that’s good. For the other reasons, I wouldn’t say to load up on soy. Even if soy were to help to lower thyroid hormone levels, and there is no evidence I have seen where it helps with hyperthyroidism, because of the other reasons I am discussing, I would still avoid soy.

Phytic acid is an anti-nutrient that is found in grains, nuts, seeds, and legumes, including soybeans. Studies show that the phytates in soy can lead to a decrease in iron and calcium absorption, which is not a good thing.

However, I will say that soaking and fermenting soy can significantly decrease the levels of phytic acid. This brings up the question if eating organic fermented soy is okay, such as miso, tempeh, natto. While restoring your health, I would say to refrain from consuming soy. Once someone is in a state of remission, I can’t say that they absolutely need to avoid soy forever. Fermented soy does have health benefits. Soaking and fermenting soy can significantly cause a decrease in levels of phytic acid. So in the future, maybe. But while restoring your health, I would say no, especially if someone has a known soy allergy or sensitivity. The problem is you don’t always know. If you have a soy allergy or sensitivity and you know it, even organic fermented soy should be avoided.

Once again, the problem with these foods is with sensitivities, you don’t always experience symptoms. Sometimes that elimination and reintroduction diet will bring out some symptoms. Someone might be eating a certain food, and it might feel fine, be it gluten, dairy, corn, soy. Then they eliminate the food for 1-3 months, let’s say. Then they reintroduce foods one at a time. Certain foods they realize cause problems. It’s not that the elimination process made them sensitive to that food. They were sensitive all along, but their body was so inflamed they weren’t reacting. Once they eliminated that food and the inflammation reduced and then they reintroduced the food, then the symptoms became more prominent and noticeable. In some cases, they weren’t noticeable to begin with in the past.

Let’s discuss nightshades. These include tomatoes, eggplant, white potatoes, most types of peppers. These foods contain compounds that can negatively affect the health of the gut. Yes, they of course do have some health benefits, too. Ideally, while trying to restore your health, at least initially, I would say avoid these foods. If you are following an AIP diet, especially.

As far as some of these compounds, they include lectins, alkaloids, glycoalkaloids. You might wonder does everyone need to avoid nightshades? As I just mentioned, if someone is following a strict AIP diet, I would say yes. It doesn’t mean everyone is going to have a negative reaction to nightshades. On the safe side, avoid these foods. The same could be said with anything we’re discussing. Some people might be fine with dairy, corn, or even gluten. Try to take a break from nightshades. Doesn’t mean you need to avoid them permanently.

As far as when nightshades can be introduced, Sarah Ballantyne has different stages of reintroduction. Nightshades are definitely not in the earlier stages as far as when they should be reintroduced. Of course, everyone is different. Some people will choose to reintroduce them sooner. I would say certain foods like tomatoes, eggplant, peppers, white potatoes, reintroduce them later and focus on other foods.

How about sugar? Although sugar doesn’t directly trigger thyroid autoimmunity, eating a lot of sugar frequently can cause blood sugar imbalances. You should avoid refined sugars once restoring your health. Once in remission, you should still minimize your consumption of refined sugar.

It’s not just blood sugar imbalances. Eating a lot of sugar can also be a factor in the overgrowth of candida. It’s normal in our body. We just don’t want too much. Sugar will feed the candida. Another reason to minimize sugar. Not just refined sugar. Even healthier sugars you can overdo. When you’re restoring your health, try to completely avoid refined sugars. Maybe minimal healthier sugars, natural sugars like honey, 100% maple syrup in small amounts.

I should also mention fruit as well. Everybody is different. I wouldn’t overdo it with fruit. Sometimes I will see people eat four or five servings of fruit per day. I would focus on eating more vegetables than fruits. Have a couple servings at the most of fruit per day.

Let’s talk about salt. A high salt diet increases Th17 cells, which are associated with autoimmunity. The key here is moderation. If someone is eating a lot of packaged and processed foods, then there is a good chance they are consuming high amounts of sodium chloride, which can potentially cause problems. If someone eats mostly whole foods, and they add some high-quality sea salt to their food, not adding too much but maybe a half teaspoon to teaspoon per day, this shouldn’t trigger autoimmunity or exacerbate the autoimmune response. But if someone is eating a lot of packaged foods, even if it’s healthier packaged foods like organic, gluten-free, it still most likely has a good amount of sodium in the food. Of course, you could read the label and see. Butifyou are adding some sea salt, in most cases, especially a Celtic Sea salt, for most people, that would be okay.

Let’s go ahead and discuss caffeine. The good news is that caffeine has been reported to decrease the production of both Th1 and Th2 cytokines. These have been associated with autoimmunity. However, most people who I work with have adrenal problems. I certainly had my share of adrenal problems when I dealt with Graves’. Caffeine can have a negative impact on adrenal health. Many people are eventually able to reintroduce coffee sooner than later. Of course, there are other sources, but a lot of people who listen to this are focused on the coffee. They don’t want to give up their coffee. There are some people who when following AIP, they have no problems avoiding gluten and dairy. It’s the coffee that’s the struggle.

If you happen to be a slow metabolizer of caffeine, which means you break down and excrete caffeine slowly, then it’s a good idea to minimize your consumption of caffeine permanently. You might know by symptoms. If you feel wired when you have caffeine, that’s a good indication that you’re a slow metabolizer. You could also do some genetic testing. According to the research, slow metabolizers of caffeine have an increased risk of having a heart attack, an impaired fasting glucose. Another reason to be cautious about consuming caffeine, especially in larger amounts.

Let’s discuss eggs. Even though eggs are nutrient-dense, they also are a common allergen. Having an IgG sensitivity to eggs is more common than having a true allergy. I mentioned earlier that an IgG sensitivity means you’re having more of a delayed response, where with a true allergy, you’re having an immediate reaction. Compounds in egg whites can have a negative effect on gut health, especially lysozyme. Some people as a result might have problems eating egg whites but might do okay eating egg yolks. As a result, as far as eliminating eggs, I recommend avoiding eating eggs altogether for at least one month. Three months is even better. If you want to reintroduce eggs, first start out with eating egg yolks, then move on to egg whites.

Let’s go ahead and summarize what I discussed here. Common food triggers such as gluten, dairy, corn, soy should be avoided when trying to restore your health.

Too much salt can increase Th17 cells. I mentioned that some natural sea salt such as Celtic Sea salt should be okay with most people. If you are eating a lot of packaged and processed foods, you very well might be getting too much salt, which can make it difficult to recover.

In order to find food triggers, I would recommend an elimination diet. You will eventually reintroduce the foods you eliminate. Some practitioners recommend food sensitivity testing. I stick with the elimination diet. Every now and then, I will do the testing. I can’t say I never do it. That’s the approach I take.

Eating a small amount of gluten can in some people cause inflammation. Some people might be able to get away with eating a small amount of gluten. I wouldn’t take the chance. While restoring your health, give it up completely.

I mentioned gluten versus glyphosate. The problem could be more with glyphosate. I recommend avoiding both when restoring your health. Try your best to avoid glyphosate; eat organic whenever you can.

Nightshades contain compounds that can negatively affect gut health and cause inflammation not just in the gut but in general.

Caffeine can have a negative affect on adrenal health. You might want to take a break from drinking coffee while trying to restore your health. Sometimes we have to negotiate. I can’t say 100% of my patients give up coffee. Ideally you want to do this though.

Compounds in egg whites can have a negative effect on gut health, specifically lysozyme. That’s why when you reintroduce eggs, if you eliminated them, you want to ideally start with the egg yolk. Of course, this is assuming you eliminated eggs for 1-3 months. If all goes well, then you could try reintroducing the whole egg.

That is all I want to discuss with regards to food triggers and Graves’. I hope you found the information to be valuable. I look forward to catching you in the next episode.