"A Vitalist Case Study in Hashimoto's"
by Clinical Herbalist, Stephanie Carrillo
I remember the feeling that washed over me when I was presented with Mrs. T’s intake form before we first met. Can I really help someone who’s had a life-long autoimmune condition? In the moments before our interview, I was reminded that supporting health and restoring balance are the primary tasks of the healer. I knew that I would do my best to accomplish this by promoting a fundamental Vitalist approach of treating the whole body and not just the symptom. One of the principles in Vitalism is to support and invigorate the Vital Force that’s inherent in all beings, meaning, the life force which animates our cells and is present in all tissues in the body as well as the mind, heart, and spirit.
This case follows the progression of a 46-year-old female who weighs 225 lb and has a height of 5'5". She was diagnosed with Hashimoto’s when she was just fourteen years old and has been on two thyroid medications ever since. Due to this condition, she tends to have dry skin and has difficulty regulating her body temperature. Mrs. T spent many years of her life as a vegetarian, during which her diet consisted largely of glutinous grains, soy, dairy, etc. It wasn’t until around nine years ago that she made radical shifts in the way she ate and took care of herself. She knew she had to do a complete overhaul of her life and develop healthier habits. Since then she’s prioritized making healthy home cooked meals and does her best to get enough sleep and drink sufficient water. Despite her efforts, she consistently felt low-grade “crappy.”
"She knew she had to do a complete overhaul of her life and develop healthier habits"
When she arrived at the clinic seeking help, her primary complaint was related to Hashimoto's disease. Mrs. T complained of a general sense that her immune system was not working optimally. She had a history of chronic infections since infancy. A few months before she came to the clinic she had back-to-back middle ear, outer ear, and sinus infections for which she required two rounds of antibiotics. She had tried various treatments recommended to her by a naturopathic doctor and a functional medicine practitioner which included herbal remedies, medications for possible mold toxicity and supplements for high histamine levels. Among the list of recommendations given to her was to refine her diet (the details of this were not disclosed). She noticed a slight improvement in her health when she implemented the diet change, though she stopped all the other protocols when she felt she was being led astray with diagnoses that didn’t seem like legitimate causes of her symptoms.
The client's secondary complaint was indigestion, which she had been suffering from for many years. To address her digestive issues, she took probiotics for thirty days. This brought some relief, however, indigestion still occurred every day and was most severe in the mornings. Her breakfast was typically a cup of coffee with eggs, avocado, and sometimes chicken sausage, on a slice of gluten-free sourdough she made herself with a side of fruit. For lunch, she would eat any of the following: a protein bar, salad with veggies and chicken, and occasionally dinner leftovers. On her “worst days” she ate any of the gluten free Amy’s® frozen meals. Her dinners usually consisted of chicken, ground beef once a week, beans, rice, brown rice (GF) pasta, one or two veggies, and a glass of wine. Occasionally she would eat a vegan and GF pizza for dinner. At this point in her life, Mrs. T knew she had an intolerance to gluten, soy, and dairy. She was aware that she needed to take extra care with her diet to avoid these allergens; though each of them were still present to some extent in her diet.
In addition to her specific complaints, the client displayed various symptoms that may be related to broader nutritional deficiencies and lifestyle factors. These include: anxiety, fatigue, poor assimilation, weakened immune function, GI symptoms such as indigestion and abdominal cramping, brain fog, achy and sore joints, inflammation, dry skin, cognitive dysfunction, and sleep disturbances.
“Digestion is the root to healing all the tissues in the body”
~ Paul Bergner
After reviewing all the factors associated with Mrs. T’s case, I felt that I had to start with healing her digestive tract. “Digestion is the root to healing all the tissues in the body” (Paul Bergner). Strengthening the integrity of her G.I. tissue would require increasing her nutrient intake by improving assimilation in the gut. It’s important for those nutrients to be well-digested, and this absorption process is determined by the ecology of the digestive tract (Bergner). First step, lower inflammation. The client initially started taking magnesium in the morning and evening. This was to address her deficiency and inflammation in her body. Magnesium deficiency can manifest as joint pain, anxiety, sore muscles, insomnia, and fatigue. The client's vitamin D3 levels were also found to be low according to recent bloodwork, so she was advised to increase her intake as having enough vitamin D3 is crucial for individuals with Hashimoto’s.
"Omega-3s reduce inflammation, support the immune system, improve cognitive brain function, moisten the tissues, promote heart health and more"
Over the next couple visits, Mrs. T was recommended to start taking high quality, third-party tested omega-3 supplements that have balanced ratios of EPA and DHA essential fatty-acids. Omega-3s reduce inflammation, support the immune system, improve cognitive brain function, moisten the tissues, promote heart health and more. Additionally, the client was advised to switch to a high-quality multivitamin, including B complex vitamins. This is to supplement the diet with necessary nutrients and co-factors that the body needs in order to function optimally and support natural detoxification processes.
Mrs. T was also showing signs of protein deficiency. This can manifest as energy crashes, brain fog, immune deficiency, carb cravings, inability to cope with stress, and depression to name some. She was encouraged to increase her protein intake at every meal, reaching a minimum of 112g of animal protein every day; grass fed and grass finished/free range/wild caught when possible. The Vital Force requires a diet abundant with all essential nutrients in order to fully express, and these building blocks for health must be present in the tissues of the body.
"The Vital Force requires a diet abundant with all essential nutrients in order to fully express, and these building blocks for health must be present in the tissues of the body"
Furthermore, Mrs. T was provided with an herbal sleep formula specifically created to help her fall asleep in place of her melatonin. For years, the client had been using melatonin and Valerian to help with sleep. However, she started weaning off melatonin and planned to try the sleep formula created for her. The goal was to improve her sleep quality and address any sleep disturbances that may be contributing to her fatigue and brain fog. Her intention was to gradually reduce and then completely eliminate her reliance on melatonin. I recommended that she also stop taking the Valerian since it can cause symptoms of anxiety and restlessness when used habitually. The client requested an herbal formula for anxiety, and a honey paste was agreed upon. She found this formula helpful and enjoyed its deeply relaxing effects. Similarly, the client was provided with a tea formula to support healthy connective tissue function, lower inflammation, increase mineral intake, improve digestion, and feed the beneficial gut flora. She enjoyed this tea and made it a daily ritual to prepare a pot of it in the morning and to drink throughout the day.
Lifestyle recommendations included going to bed 30 minutes earlier, incorporating daily walks in nature, and maintaining a consistent meal schedule. These changes were suggested to support overall well-being and improve fatigue and brain fog symptoms. Critical changes in formulas that developed over time included adjusting the magnesium dosage and timing, increasing the vitamin D dose and protein intake.
Evolution of the Case
After her second visit, Mrs. T was consistently adhering to the following protocol: taking magnesium, vitamin D3, omega-3s, nutritive tea, nervine honey paste, and going to bed earlier. She noticed positive changes with regard to her indigestion, sleep, and anxiety. During this visit, we discussed the importance of consuming high protein meals with veggies and/or leafy greens in place of foods predominantly rich in carbs. I also educated her on food sensitivities and how crucial it is to practice strict elimination of food allergens in order for her body to heal. She agreed that she would work on implementing these dietary changes as best she could while maintaining a full-time job and having a young child in the household.
When we met for our third visit, her symptom scores were already dropping significantly, and her fatigue was almost completely resolved. She noticed that the only times she experienced fatigue was on the days where she wasn’t eating high protein meals for breakfast and lunch. For example, she felt fatigue and brain fog when she ate GF oatmeal for breakfast or had GF toast with eggs and avocado. It was a pivotal moment for her being able to distinguish how much better she feels when she gives her body what it needs. She still ate carbohydrates, but had them in balance with larger amounts of protein and leafy greens. She also stuck with healthier carbs like low-glycemic veggies and started consuming less grains.
"When we met for our third visit, her symptom scores were already dropping significantly, and her fatigue was almost completely resolved"
Over the next couple of weeks, she continued to follow all of the protocols that we agreed on with one exception - she had not yet committed to eliminating her food allergens from her diet. She found that she was able to use the herbal sleep powder in conjunction with her melatonin to fall asleep. She stopped taking the Valerian (which improved her anxiety), and was able to get down to just 3mg of melatonin whereas before she was taking 9-12mg for several years. Mrs. T attempted to completely cut out the melatonin one night and didn’t have success. Given her high-stress job as a school teacher, she felt she couldn’t risk losing another night of rest so she decided to quit taking melatonin over her Summer break. The only other issue she had was with the multi-vitamin she started taking. After a few weeks of monitoring symptoms, she found that the multi-vitamin was giving her some indigestion. She decided to lower the dose until she finished the bottle, and I recommended a better brand.
"Some of the symptoms related to consuming one’s food allergens are systemic inflammation, connective tissue autoimmunity, digestive complaints, leaky gut, chronic fatigue, mood disorders, etc"
At our fourth visit, nearly all of her symptoms were down to a 3/10 (a score of 10/10 being severe), a 1/10, or were completely resolved. The inflammation in her ears and sinuses after her back-to-back infections had moderately improved since we started working together. This could be attributed to the fact that she was still consuming some of the foods she’s intolerant of - gluten and soy. Some of the symptoms related to consuming one’s food allergens are systemic inflammation, connective tissue autoimmunity, digestive complaints, leaky gut, chronic fatigue, mood disorders, etc.
It was during this visit that the client had expressed real interest in embarking on an elimination diet. She was feeling negative shifts in her mood and energy levels after eating certain meals and was interested in pin-pointing what it was that was triggering her. Another pivotal moment during this session was when the client expressed that she felt the need to quit her job; she had been deeply questioning the sustainability of continuing down the same path. She realized that she simply can’t reach the level of health and vitality she’s aiming for while working in such a stressful environment.
At our fifth visit, I felt as though I was speaking with a completely different person. Mrs. T had the most liveliness in her voice that I’d heard since we met. She was cheerful, chatty, and inspired. She had started her elimination diet some days before our session without my prompting. I had provided her with all the information necessary, such as a proper elimination protocol and recipes. Plus, we had spent weeks discussing the process and building her up holistically. Her focus with the elimination diet was to remove grains and soy. She could feel that there was a correlation between her lingering symptoms and those foods.
The next couple of weeks took an unexpected turn. She had contracted COVID-19 during her elimination diet and it threw her completely off course. She reported having mild symptoms and felt that this was related to her immune system feeling more resilient. However, when she was sick with COVID-19 she broke her elimination diet. She started consuming grains again; rice, GF sourdough, GF muffins, and GF oatmeal. She also stopped taking most of her supplements due to not being able to “stomach” them from the indigestion that came back, though her supplements weren’t the cause or the trigger. The challenging thing about this is that consumption of food intolerances during illness causes a major immunological set back and will exacerbate any lingering side effects of the illness. All of the client’s symptom scores went back up, she wasn’t sleeping well, and she was feeling very overwhelmed. This was coupled with the fact that things at her work intensify toward the end of the school year.
We discussed ways that she could nourish herself while recovering from COVID-19. She agreed to continue focusing on high protein, whole food meals and getting back on at least the magnesium to help lower inflammation and anxiety levels. She also was going to continue using her herbal formulas like the gut healing tea and nervine honey paste, both of which had been supporting her the entire time. Mrs. T admitted that she wasn’t going to be able to give her elimination diet another try until the school year was over and she had time to decompress. Despite feeling so low, she let me know with as much excitement as she could muster that she had quit her job and was going to be hired for a new position. This job was a big obstacle to cure, and she’d had enough. We left it open-ended to meet again in the coming weeks and she agreed to stick to all of the therapeutic protocols she learned during her time working with me. The goal was to get her back to a healthy and stable place within her being before giving an elimination diet another try.
The client and I had a total of seven visits over the course of five months. During these visits, the client reported various improvements and changes in symptoms both with her chief complaints and with symptoms that were not chief complaints, but had been plaguing her for much of her life. During the course of treatment, the client found that the nervine honey greatly helped her cope with the stress of her job. Additionally, her improved diet choices, supplement intake, herbs, increased sleep, and daily exercise had also resolved her brain fog, fatigue, and anxiety. Her chief complaint of indigestion completely resolved when she was consistently consuming a protein-rich whole food diet, avoiding offending foods, and consuming the nutritive tea I formulated for her. The inflammation in her ears and sinuses had gotten a bit better, but along with all her other symptoms, it subsequently worsened when she became sick and reintroduced her food allergens into her diet. Overall, she expressed that her immune system felt much stronger, and she was excited about the new improvements with her health.
"Her chief complaint of indigestion completely resolved when she was consistently consuming a protein-rich whole food diet, avoiding offending foods, and consuming the nutritive tea I formulated for her"
This case has taught me the importance of taking a supportive approach toward a client's health concerns by addressing underlying imbalances and assisting the body's natural healing processes through Vitalist interventions. As an extension of Nature, the body is designed to heal itself, but it requires certain conditions under which life can thrive. When those conditions aren’t being created, or are being suppressed, symptoms of disease arise as they are the body’s best attempt to restore balance.
The most critical factor in the outcome of this case seems to be the client's commitment to creating optimal conditions through which her vitality could express and begin to do some “clean up work.” Her willingness to make lifestyle changes, modify her diet, and take supplements and herbs contributed to the improvement of her health. When her vitality began to increase, she was more receptive to her intuition which was warning her that if she maintained her course with her job, she wasn’t going to get better. It was when she reached a state of crisis that she made the decision to prioritize her health by quitting her job. This was a profound moment for her, and I feel honored to have witnessed the evolutionary stages of healing that took place. I observed first-hand that when an individual is given the proper tools and the opportunity to take charge of their health, they have a chance to experience a level of self-mastery that can usher in a new era of well-being.
The client and I plan to continue working together with follow-up appointments to monitor progress and make further adjustments to the treatment plan as needed.
"I observed first-hand that when an individual is given the proper tools and the opportunity to take charge of their health, they have a chance to experience a level of self-mastery that can usher in a new era of well-being"
Bergner, Paul. Vitalism and Herbal Medicine, https://www.naimh.com/vitalism