Is finding your root cause really enough?

If you have Hashimoto’s, you must have heard that the key to getting better is finding and eliminating the ‘root causes’ of your condition. This is true by all means, but sometimes it may not be enough.

One of the common root causes contributing to Hashi is non-coeliac gluten sensitivity (NCGS) or Coeliac disease (CD).

Eating gluten containing foods (or foods contaminated with gluten) is a trigger for people with NCGS & CD. It triggers a sequence of events within the body, with one consequence being the destruction of your thyroid gland (due to a mechanism called molecular mimicry). The destruction of the thyroid tissue by your immune system is the primary mechanism in Hashimoto’s disease and ultimately leads to hypothyroidism (=not enough thyroid hormones). Avoiding the trigger is definitely necessary for recovery in Hashi, if you have NCGS or CD, but it may not be enough. Why is that?

Both NCGS and CD cause a degree of damage to you gut and you may need to take some steps to help fix this damage. Depending on how much damage has taken place, a short and simple or a complex and long term intervention (diet, lifestyle changes, supplements, etc.) may be needed. CD can have a truly devastating effect on the gut and leaves you with a host of nutrient deficiencies. So the minimum you need to do is avoid gluten, rapier the gut wall, and correct the nutrient deficiencies. Simply avoiding gluten is often not enough. You must deal with the downstream effects too.

Gluten causes the wall of your gut to become leaky, hence the term ‘leaky gut’. By gut we mean the small intestine here – the part between your stomach and your large intestine. The small intestine is where most nutrients are being absorbed into the blood to nourish your whole body. What leaks out of the gut can vary substantially between people and depends on what is happening higher up and lower down in your digestive tract.

For instance, some people don’t digest their foods properly due to low levels of stomach acid. In this case, partially digested proteins (amino-acid sequences instead of separate amino-acids) leak out of the gut into the blood circulation. This has a set of consequences (eg. molecular mimicry – a mechanism involved in autoimmunity).

Some people have a degree of gut dysbiosis. Your digestive tract is inhabited by an insane number of microbes (from different families, species), collectively referred to as gut microbiome. When the microbiome becomes imbalanced (some species proliferate too much and others become depleted) we talk about dysbiosis. The dysbiosis can affect your large intestine only or can spread up your ‘plumbing system’ into the small bowel (= intestine). We call this SIBO (small intestinal bacterial overgrowth). In this case, the toxic metabolites (= products) of the unwanted bacteria leak out of the small intestine into the blood circulation (we call this metabolic endotoxemia). This has a different set of consequences (eg. systemic inflammation = whole body inflammation).

Some people have both – low stomach acid and protein maldigestion as well as SIBO. In this case what leaks out into the blood are partially digested proteins and the toxic bacterial metabolites. You now have to deal with the consequences of molecular mimicry and systemic inflammation and whatever downstream effects these might have caused too.

Furthermore, in response to gluten ingestion, your immune system can launch an attack on your brain (cerebellum, specifically) as well as your thyroid. This has a set of unique consequences and avoiding gluten may not be enough to ‘save your brain’. Once inflammation starts raging through the brain, it can be difficult to control. It’s another example of a downstream effect you might need to deal with.

Imagine you’re on a lovely bike ride and all of a sudden you ride over a nail and you get a flat tire. Removing the nail (=the trigger) is not enough to solve your problems. You must fix the puncture (=downstream effect) to be able to keep going. 

All this can be a bit hard to navigate, especially if you’re trying to fix it all on your own. I often see people identify their root cause (in this example NCGS or CD) and eliminate their trigger (gluten) but continue to struggle rather than recover. This is because apart from identifying the root cause and eliminating the trigger, you need to deal with all of the downstream effects the root causes/triggers have lead to. Basically, it’s all a complex domino (or a giant snowball) and although the body has an amazing ability to heal itself, sometimes it may struggle to re-boot.

To summarise, starring in our example we have the following:

• NCGS/CD as the root cause
• Gluten as the trigger
• Leaky gut as the key mechanism
• Molecular mimicry, systemic inflammation and neuroinflammation (=brain inflammation) as the downstream effects (=mechanisms) we also need to address to start getting better.

I hope this sheds some light on the complexity of things in Hashimoto’s – it’s important to know what you’re dealing with. It’s also important to remember that although autoimmune disease tends to have a complicated matrix, simple diet and lifestyle habits can have a profound effect on your wellbeing. Just remember, there’s a lot you might need to take into account while putting together a recovery plan for yourself.

Other factors (root causes/ triggers) linked to Hashi involve:

• Foods that cross-react with gluten
• Other food sensitivities and allergies
• Excess iodine
• Excess sodium in diet
• Poor diversity of plant foods in diet
• Chemicals (eg. pollutants, BPA)
• Hidden infections
• Sedentary lifestyle or overtraining
• Not enough sleep/rest
• Bad relationships
• Stress

Which ones are you dealing with?

Ps. This article was not written to discuss NCGS/CD but if you’ve been diagnosed with or suspect having one of these conditions, apart from removing gluten out of your diet, you’ll likely need to heal and ‘seal’ your gut, correct your nutrient deficiencies and address your individual downstream effects. Avoiding gluten may not be enough.