While immune system genes influence the severity of the autoimmune response and dictate what antigens one will react to, environmental factors trigger this response. Environmental influences, particularly stress, iodine, infectious agents, heat shock proteins and hormones, cause immune system changes that may induce or exacerbate (worsen) symptoms. Besides environmental influences, the nutrient deficiencies associated with GD can cause their own cornucopia of symptoms.
Nutrient deficiencies are caused by an increased metabolism and diminished nutrient absorption. The body's constant demand for energy in GD puts all systems in overdrive, and each metabolic process requires nutrients. Also, food is digested so quickly that nutrients aren't properly absorbed. This leads to a condition known as malabsorption, which is associated with an increased passage of food through the intestines, and increased defecation. Food does not stay in the gut long enough for normal nutrient absorption.
Furthermore, patients with GD are more likely to have gluten sensitivity enteropathy (GSE or celiac disease) than normal individuals. Symptoms of GSE may be mild, merely causing bloating or constipation, or they may be more pronounced, causing diarrhea. Patients with GSE react to gluten, the protein found in wheat, rye, barley and oats. GSE, which also causes malabsorption, may lead to destruction of villi in the stomach and eventual lymphoma. Recent studies indicate that six months on a gluten-free diet reduces the levels of gliadin antibodies associated with GSE and also thyroid antibodies in patients who have concomitant autoimmune thyroid disorders, including GD. Patients with GD are also typically deficient in essential fatty acids, as well as vitamins A, B1, B2, C, D and E and also the minerals copper, magnesium, potassium and manganese.
Symptoms in GD may also be influenced by diet. Excess dietary iodine generally has an adverse effect. The incidence of GD is known to increase in countries which introduce iodine supplementation programs. On the other hand, the addition of goitrogens to one's diet can reduce symptoms. Goitrogens, foods that interfere with iodine uptake and thyroid hormone production, include raw cauliflower, broccoli, cabbage, almonds, peaches, pears, kohlrabi, grapes, grapefruit, peanuts and several others. Soy has a similar effect and also interferes with the enzyme needed for thyroid hormone production. Excess sugar and saturated fat both cause immune system changes that, in turn, cause an exacerbation of symptoms.
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