In addition to a smartly designed dietary protocol, supplements may aid in your Hashimoto’s healing journey, especially if your digestion is severely impaired, which prevents you from extracting sufficient nutrients from food.
You may be able to discontinue most supplements once your digestion is fixed and you have adopted a well-balanced diet.
“Start Low and Go Slow”
Supplements should be started at a low dose, one at a time.
Vitamins and herbs are certainly not without risks, even if they are “naturally derived” (Remember, arsenic is also a natural substance!)
You want to make sure to start a low dose of one supplement one at a time, rather than starting the full dose of six different supplements at once.
For example, you may add selenium at 200 mcg and see how you tolerate it for a few days before you decide to increase it to 400 mcg.
Once you’ve found that you tolerate the 400 mcg dose for a few days, you can add a second supplement.
This approach increases the likelihood of catching adverse events before they get too far, and it will help you pinpoint the substance causing the adverse effect without having to stop all of your other supplements and delay your progress.
Not All Supplements Are Created Equally
Vitamin and supplement companies are not required to adhere to the same strict rules as medications in their manufacturing and labeling requirements.
This leads to some supplements not having the ingredients stated on their labels or having them in doses that are either too high or too low.
In some cases, they may contain substances not even listed on the label.
Additionally, many of the excipients used in drug store brands can cause hypersensitivity reactions as well as preventing the proper absorption of the supplement.
Reports of toxicity from poorly regulated supplements pop up every so often, and many brands are simply not worth spending your money on or risking your health over.
Various formulations exist for mineral supplements. For example, zinc is available as zinc oxide, zinc citrate, zinc gluconate, and zinc picolinate.
The picolinate formulation is the most bioavailable for zinc and chromium supplements.
Taking zinc with food (after a meal) and with vitamin C increases its absorption as well.
The same is true of ferritin, which should also be taken after meals with vitamin C.
We have researched and tried a variety of brands and the following are the brands we recommend and use personally.
- Future Kind: Vegan supplement company with an ethical, eco-friendly consciousness. They use only natural, organic ingredients; all their formulations are approved by dieticians, made in the USA & 3rd party tested.
- LYFE Fuel: Headquartered in Southern California, this whole food nutrition company produces small batches of organic & non-GMO dietary supplements, without the use of any fillers, binders or harmful synthetic additives. They offer great tasting protein supplements and whole food-based meal replacements that are easy to digest and soy-free, dairy-free and keto-friendly.
- Global Healing: Whole-food based brand that uses only organic and ethically sourced natural ingredients without harmful additives or fillers. All their products are vegan and gluten-free and undergo rigorous quality control tests at every step of the growing and manufacturing process.
- CLE Holistic Health: Headquartered in Vancouver, British Columbia and established by Dr. Stacey Miller, ND, this professional-grade supplement company offers whole-food based formulas and standalone vitamins and minerals. Their supplements focus heavily on blood glucose regulation, immune support, blood pressure control, depression and anxiety.
- Microbiome Plus: Clinically tested probiotic supplements, digestive enzymes and colon formulas that are used extensively by healthcare professionals across the US. Their patented probiotic NCIMB 30242 has been used in several clinical trials and proven to lower LDL cholesterol by 11.64% and increase Vitamin D by 25.5%. All their products go through rigorous research and third party testing for safety and effectiveness. We like to use the Lactobacillus Reuteri NCIMB 30242 probiotic by this manufacturer.
When beginning using supplements, the ideal approach is to always “start low and slow”.
This is especially true with probiotics as they can cause significant die-off symptoms.
This can cause further inflammation and autoimmune damage from endotoxins being released from the dying pathogenic flora as they are displaced by the beneficial bacteria in probiotics.
Since people with Hashimoto’s usually have low levels of alkaline phosphatase to begin with, they are unable to keep up with the daily endotoxin release from the normal life cycle of pathogenic bacteria, let alone the massive amounts released when bacteria start dying off at a fast rate.
That said, most probiotics in health food stores have maintenance doses of beneficial bacteria- doses that are too low to heal and make an impact on intestinal flora.
A super-extensive high-potency probiotic may contain 10 billion CFUs per capsule, while the minimal therapeutic dose for changing the gut flora is 60 billion CFUs.
For adults, we advise starting with a 10 billion CFU dose and increasing every few days until die-off is seen.
We have tried a variety of different probiotics, and some were a waste of money.
To significantly change gut flora, we recommend only two probiotic companies:
This is a good start but may be insufficient, depending on the degree of gut dysbiosis.
In severe cases of dysbiosis, a > 50 billion dose may be necessary.
2) VSL#3 is a therapeutic-dose, multiple-strain, pharmaceutical-grade probiotic from Sigma-Tau Pharmaceuticals, which has been studied in the context of improving bacterial flora and disease outcomes in ulcerative colitis and IBS.
VSL#3 contains 450 billion CFUs per dose.
You would need to take forty-five capsules of the brand sold in health food stores to equal one dose of VSL#3! (At $50 for sixty capsules, you would be spending $150 every four days!)
Sometimes we may even need to supplement in the trillions of CFUs.
This makes sense as the gut is home to 100 trillion bacteria, yeasts, and other microbes.
For a properly functioning immune system, we need a balance of approximately 85 percent beneficial to 15 percent of potentially pathogenic bacteria.
The human intestines have been found to host between 7 and 50 percent of gram-negative bacteria.
It is unclear how many CFUs of beneficial bacteria it takes to displace one CFU of pathogenic bacteria.
Providing one trillion CFUs of beneficial bacteria seems like a lot, however, it may pale in comparison with the 16-50 trillion pathogenic bacteria that may be present in gut dysbiosis.
Probiotic supplements do not seem to take up residence in our intestines permanently and are described as transitional, meaning they do not grow in the intestines.
VSL#3 strains, for example, live up to three weeks in the intestines before reinforcements – in the form of additional probiotics – need to be sent it.
Caution: Many probiotics use gluten, dairy, or soy in their manufacturing process.
Beneficial bacterial species found on raw lacto-fermented vegetables reportedly contain trillions of CFUs per dose.
Although not technically supplements, they really are the superstars for overcoming dysbiosis and should be included in the healing plan above all else.
How to Get the Most Healing From Your Supplements
As healthcare professionals, we know that adherence to a medication / supplement regimen can often be difficult.
Adherence studies have found that even when we know how to treat a condition perfectly well, in many cases when a product is recommended by a health care professional, it does not help the patient for a variety of reasons- most of them having to do with the lack of information the patient received.
- The patient never gets the product.
- The patient gets the wrong product, wrong dose, or wrong type of medication or supplement.
- The patient gets the correct product but uses it incorrectly.
- The patient gets the product and knows how to use it but forgets to take it and uses the product only sporadically.
There is an old doctor’s joke about a man who goes to the doctor and says the suppositories the doctor prescribed are not working for his constipation.
Puzzled, the doctor asks, “How have you been using them?”
The patient replies, “Well, I swallow them, of course- what else would you do with them?”
You can spend hundreds of dollars on really great products, but if you don’t use them correctly (or at all), you might as well be throwing your money away!
Some medications and supplements cannot be absorbed in combination with other supplements or when food is present.
Others absorb better with food or other supplements.
Still others may need to be taken at different times of the day due to their propensity to cause tiredness or alertness.
Thyroid hormones in particular have a lot of restrictions.
They need to be taken on an empty stomach, thirty minutes prior to meals, and at least four hours apart from iron, calcium, and magnesium (which can lower the absorption of the hormone).
During the transition period, you may take multiple supplements.
Sometimes, it’s challenging to keep them all straight. We highly recommend purchasing a pill planner.
Stackable pill planners can be very useful as they can be thrown in your purse or pocket when you need to take supplements to work or on the road.
Attaching the supplements to a habit you already have (like brushing your teeth or making tea) may help, too.
Pill reminders can be sent to your smartphone using free apps courtesy of pharmaceutical companies (i.e., MyMedSchedule Plus).
Sample Supplement Protocol
Morning Supplements (best on an empty stomach)
Bathroom (next to your toothbrush; take right before you brush your teeth)
- Thyroid Hormone (ideally wait 60 minutes before eating for maximum absorption)
- Selenium 200-400 mcg
- Adrenal Glandular
- Vitamin E 400 IU
- Licorice drops (do not take if you have high blood pressure)
- Thyroid Glandular (may be used as a natural substitute for thyroid medication. Take only if you are not on medication yet or tapering off)
- Adrenal Adaptogens
Fridge (next to your breakfast foods)
Breakfast (next to your tea kettle)
- Betaine with pepsin (after protein meal)
- Glutamine powder: 5 grams in tea (it is flavorless)
Lunchtime Supplements (best with meals)
Put supplements in your lunch bag.
- Zinc Picolinate 25-50 mg
- N-acetyl cysteine (NAC) 1.8 grams
- Betaine with pepsin
- Fish oil
- Biotin 5,000 mcg
- Vitamin D3 5,000 IU
Note: Take NAC after you eat, as it will cause a stomachache without food.
Dinnertime (best with meals)
- Betaine with pepsin. If you are vegan you can use a product like HCL Breakthrough, as pepsin is derived from the stomachs of animals.
If you forgot to take your lunch supplements, you can take them at dinner, but note the B vitamins may be stimulating.
Bedtime (may be sedating)
Note: These statements have not been evaluated by the Food and Drug Administration. The products discussed are not intended to diagnose, treat, cure, or prevent any disease.
|Adrenal Adaptogens||Help support adrenal function||Multiple formulations exist; cross-check ingredients for sensitivites|
|B12||Proper development of villi, protein digestion, many other benefits||Bright yellow urine||Sublingual B12 may be better absorbed, especially with GI issues|
|Betaine with Pepsin||Helps digest proteins||Burning in throat; not to be used with ulcers!||Take with meals containing protein|
|Chromium||Required nutrient for thyroid function||May cause drowsiness|
|Curcumin||Reduces inflammation||Can alter liver enzymes, thin the blood, and change kidney function||Look for absorbable formulations with piperine, such as Curcumin Plus|
|Vitamin D 5,000 IU||Reduces inflammation, autoimmune symptoms||Ideally, you should get it from the sun, but supplements can be a secondary option; can measure levels|
|Vitamin E 400 IU||Antioxidant, works synergistically with selenium, improves skin||Can have blood-thinning effects|
|Glutamine||Helps repair the intestinal lining||Agitation||Discontinue if experiencing agitation|
|N-Acetyl-Cysteine||Helps restore the gut lining; powerful antioxidant; supports liver function; helps eliminate pathogenic bacteria||Stomach pain if taken on empty stomach||Take with food!|
|Licorice||Antiviral properties; helps stretch cortisol levels in cases of adrenal fatigue / exhaustion||May increase blood pressure; avoid if already have high blood pressure|
|Magnesium||Helps restore DHEA levels||Diarrhea, sleepiness||Depleted by fluoride; most people show deficiency|
|Omega-3 or Cod Liver Oil||Reduces inflammation; improves skin condition||Can have blood-thinning effects||Look for formulations free of mercury|
|Probiotics or VSL#3||Lactobacillus deficiency; LB creates enzymes that aid digestion and absorption, help impove immune function, and help balance out pathogenic flora||Nausea, vomiting, die-off reaction||Probiotic levels can be measured by stool tests (CDSA, GI Effects)|
|Proteolytic enzymes||Reduce circulating immune complexes of proteins that may become antigenic||Take between meals|
|Saccharomyces boulardii||Increases SIgA; helps clear out pathogenic bacteria from the body||Combine with other probiotics; dosages higher than stated on the package may need to be taken|
|Selenium 200 mcg||Antioxidant; reduces TPO antibodies; helps convert T4 to T3.|
Will not be absorbed properly from multivitamin or Brazil nuts
|Toxicity reported at excessive doses, garlic smell sign of excessive dose||Make sure to rule out iodine deficiency; can make hypothyroidism worse if selenium is given in overt iodine deficiency|
Take on an empty stomach along with vitamin E
|Thyroid Glandular (protomorphogen)||Reduces antibodies; helps rebuild thyroid.|
Natural and effective alternative to thyroid medication if it’s not well tolerated
|Hyperthyroid symptoms||Start with 1 capsule and increase gradually; recheck antibodies after starting|
|Zinc||Required for T4 to T3 conversion.|
Deficiency due to impaired absorption with Hashimoto’s, Celiac; seen as low alkaline phosphatase on CBC
|May cause copper deficiency in doses >30 mg/day||Liquid deficiency test: swish around mouth|
Picolinate version is absorbed best. Take with liposomal vitamin C and food.
PS. If you haven’t already, you may check out our Recommendations List for high-quality supplements, health products and services you can trust. There is probably nothing health-related you won’t find there + special discount codes are waiting for you.
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About George Kelly
George Kelly M.Sc. is a Registered Dietitian Nutritionist that specializes in chronic and autoimmune conditions. He is the CEO and lead author of Metabolic Body.
This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Metabolic Body nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.