The lack of thyroxine (T4) associated with hypothyroidism can affect the sphincter of Oddi (layers of muscle that regulate the flow of bile into the small intestine/duodenum, which close between meals, preventing bile from continuing to flow into the small intestine when it isn’t needed). The sphincter may experience increased tension, which can prevent normal bile flow. This has been thought to contribute to the formation of common bile duct stones, as well as gallstones. Thus, it’s not surprising that there is an increased prevalence of hypothyroidism found in patients with common bile duct stones. In fact, patients with common bile duct stones and gallstones have, respectively, 7-fold and 3-fold increase in the frequency of hypothyroidism. Experiments with hypothyroid rats have confirmed the thyroxine effect on bile composition, decreased bile flow, and relaxation of the sphincter of Oddi. Research in rats has also shown that the administration of thyroid hormone improves bile flow – suggesting that there is a strong correlation between developing gallbladder issues and hypothyroidism. Fat malabsorption is easily overlooked by patients and practitioners alike. If you have issues with digesting fat — like up to 73 percent percent of people with Hashimoto’s do — you may benefit from an enzyme that aids in fat digestion. Studies have found that people with Hashimoto’s and hypothyroidism have low stomach acid. Low stomach acid makes it more difficult to digest proteins, making us more tired, as digestion is one of the biggest energy-requiring processes of our bodies. Additionally, when proteins are poorly digested, we are more likely to become sensitive to them. Thus, many people with Hashimoto’s will be sensitive to gluten, dairy, and soy (as well as possibly other foods). This is because these proteins are amongst the most difficult to digest and are also the most eaten proteins in the standard western diet. We know that everyone with Hashimoto’s has some degree of intestinal permeability, or leaky gut, which occurs when poorly digested molecules of food or other toxins permeate the intestinal lining and become absorbed into the bloodstream. When this occurs, the body may recognize them as foreign invaders. This causes inflammation in the body as it begins to attack the intruders, and eventually leads to autoimmunity. Using a digestive aid that includes Betaine with Pepsin (Protein Digestive Enzymes) will greatly improve digestion.