June 6, 2018
Under Diagnosed and Under Treated
Thyroid hormone is responsible for many bodily functions so it is imperative to have optimal circulating levels. Yet, an estimated 20 million Americans have some form of thyroid disease. Up to 60 percent of these people are unaware of their condition. One in eight women will develop a thyroid disorder during her lifetime. Levothyroxine, a synthetic form of thyroid hormone, is the 4th highest selling drug in the U.S. Thirteen of the top 50 selling drugs are either directly or indirectly related to hypothyroidism.
The number of people suffering from thyroid disorders continues to rise each year. Hypothyroidism is one of the most common thyroid disorders. It is characterized by mental slowing, depression, dementia, weight gain, constipation, dry skin, hair loss, cold intolerance, hoarse voice, irregular menstruation, infertility, muscle stiffness and pain.
According to the American Association of Clinical Endocrinologists, 27 million Americans suffer from thyroid dysfunction – half go undiagnosed. Subclinical hypothyroidism may affect an additional 24 million Americans. Taken together, more than 50 million Americans are affected by some form of thyroid disorder.
As you will see, diagnosing hypothyroidism is not as straight forward as ordering a simple blood test. New research demonstrates that thyroid hormone enters receptors differently depending on what tissue is being stimulated. In other words, the way the circulating thyroid hormone enters your pituitary gland and the way the same hormone enters heart or brain tissue is different. It is possible to have normal circulating levels and have underperformance of the thyroid hormone depending on how the thyroid hormone is being transported to the tissue.
This concept has profound clinical significance. Unfortunately, many physicians are not aware of these new developments in thyroid hormone transport. This results in an over-reliance on the sole use of standard thyroid blood tests (e.g., thyroid-stimulating hormone (TSH) and T4 levels) to determine the presence or absence of hypothyroidism. This leads to the misdiagnosis of many hypothyroid patients. These patients are misdiagnosed with depression or some other disease associated with hypothyroidism. This over-reliance on standard thyroid blood tests and the overconfidence of the diagnostic accuracy of standard thyroid blood tests may be particularly troublesome in the presence of a wide range of common conditions present in a large percentage of the population.
Every cell in the body has receptors for thyroid hormone. These hormones are responsible for the most basic aspects of body function, impacting all major systems of the body. Thyroid hormone directly acts on the brain, the G.I. tract, the cardiovascular system, bone metabolism, red blood cell metabolism, gall bladder and liver function, steroid hormone production, glucose metabolism, lipid and cholesterol metabolism, protein metabolism and body temperature regulation.
Studies show that 90% of people with hypothyroidism are producing antibodies to thyroid tissue. This causes the immune system to attack and destroy the thyroid, which over time causes a decline in thyroid hormone levels. This autoimmune form of hypothyroidism is called Hashimoto’s disease. Hashimoto’s is the most common autoimmune disorder in the U.S., affecting between 7-8% of the population. Hashimoto’s often manifests as a “polyendocrine autoimmune pattern”. This means that in addition to having antibodies to thyroid tissue, it’s not uncommon for Hashimoto’s patients to have antibodies to other tissues or enzymes as well.
Hypothyroidism patients need to understand that they don’t have a problem with their thyroid, they have a problem with their immune system attacking the thyroid. Unfortunately, misdiagnosis is common in the management of hypothyroidism. So many times, if you have hypothyroid symptoms but your lab tests are normal, you’ll be told you’re “fine”. If you insist you’re not, you might be sent home with an antidepressant, but no further clue about the cause of your symptoms. The following are the five major thyroid patterns that don’t show up on standard tests.
1. HYPOTHYROIDISM CAUSED BY PITUITARY DYSFUNCTION. This pattern is caused by elevated cortisol, which is in turn caused by active infection, blood sugar imbalances, chronic stress, pregnancy, hypoglycemia or insulin resistance. These stressors fatigue the pituitary gland at the base of the brain so that it can no longer signal the thyroid to release enough thyroid hormone. There may be nothing wrong with the thyroid gland itself. The pituitary isn’t sending it the right messages.
With this pattern, you’ll have hypothyroid symptoms and a TSH below the functional range (1.8 – 3.0) but within the standard range (0.5 – 5.0). You will also have higher than optimal fasting insulin levels.
2. UNDER-CONVERSION OF T4 TO T3. T4 is the inactive form of thyroid hormone. It must be converted to T3 before the body can use it. More than 90% of thyroid hormone produced is T4.
This common pattern is caused by inflammation and elevated cortisol levels. T4 to T3 conversion happens in cell membranes. High cortisol also suppresses the conversion of T4 to T3. Elevated cortisol levels also cause increase production of Reverse T3 (RT3) which is a metabolite of T4. Reverse T3 competes with T3 at the cell receptor.
With this pattern you’ll have hypothyroid symptoms, but your TSH and T4 will be normal. If you have your T3 tested, which it rarely is in conventional settings, it will be low.
3. HYPOTHYROIDISM CAUSED BY ELEVATED TBG. Thyroid binding globulin (TBG) is the protein that transports thyroid hormone through the blood. When thyroid hormone is bound to TBG, it is inactive and unavailable to the tissues. When TBG levels are high, levels of unbound (free) thyroid hormone will be low, leading to hypothyroid symptoms. Elevated TBG is caused by high estrogen (high not optimal) levels, which are often associated with birth control pills or estrogen replacement not properly monitored. You can have high estrogen levels from estrogen metabolism problems or obesity.
With this pattern, TSH and T4 will be normal. If tested, T3 will be low, and T3 uptake and TBG will be high.
4. HYPOTHYROIDISM CAUSED BY DECREASED TBG. This is the mirror image of the pattern above. When TBG levels are low, levels of free thyroid hormone will be high. You might think this would cause hyperthyroid symptoms. But too much free thyroid hormone in the bloodstream causes the cells to develop resistance to it. So, even though there’s more than enough thyroid hormone, the cells can’t use it and you’ll have hypothyroid – not hyperthyroid – symptoms. Decreased TBG is caused by high testosterone levels. In women, it is commonly associated with PCOS and insulin resistance. Reversing insulin resistance and restoring blood sugar balance is the key to treating this pattern.
With this pattern, TSH and T4 will be normal. If tested, T3 will be high, and T3 uptake and TBG will be low.
5. THYROID RESISTANCE. In this pattern, both the thyroid and pituitary glands are functioning normally, but the hormones aren’t getting into the cells where they’re needed. This causes hypothyroid symptoms. Thyroid resistance is usually caused by chronic stress and high cortisol levels. It can also be caused by high homocysteine and genetic factors.
In this pattern all lab test markers will be normal because we don’t have a way to test the function of cellular receptors directly.
The five patterns above are only a partial list. There are other reasons to have hypothyroid symptoms that don’t show up on standard lab tests. If you have hypothyroid symptoms, but your lab tests are normal, you may have one of them.
Not only do these patterns fail to show up on standard lab work, they don’t respond well to conventional thyroid hormone replacement. If your body can’t convert T4 to T3, or you have too much thyroid binding protein, or your cells are resistant, it doesn’t matter how much T4 you take; you won’t be able to use it.
I have personally treated multiple people who have complained of symptoms consistent with hypothyroidism but have a normal TSH and no other thyroid labs taken. Several have been treated with a commercial T4 only drug. When checking the other thyroid labs I have seen free T3 in the low 2s and below. You need both T3 and T4. T4 crosses the blood brain barrier while T3 does not. T3 is the thyroid that is used at the cellular level.
There are multiple reasons a person can experience hypothyroid symptoms and have normal thyroid labs. If you are on a commercial thyroid medication and are still having symptoms, I would suggest checking some other thyroid labs. Even if the other labs are normal, that doesn’t mean there is no need for treatment. I don’t always make my decision based on labs alone. Nutrition, labs, symptoms, and the patient’s history must also be considered.
There are functional medicine providers, like me, that successfully treat Hashimoto’s disease with lifestyle changes, nutrition, diet and supplements. If you are having hypothyroid symptoms and not being treated because your labs are normal, it might be a good time to begin a discussion with your health care provider about the best way to obtain optimal circulating thyroid levels.
Remember normal is not optimal,
June 21, 2017
Let's Talk Supplements
In this newsletter I will try to answer three of the most common questions I receive regarding food supplements.
1. Do I need to take supplements?
2. Why should I take supplements?
3. How long will I have to take supplements?
The short answer to the first question is, ABSOLUTELY! Whether or not you should take supplements can be as confusing as which diet should to follow. I often receive medical articles with studies that show no benefits to taking supplements. On the other hand, many people like me recommend taking supplements. A prime example is an article I read recently in a medical journal on Vitamin D3. According to this study subjects using 800 iu of Vitamin D3 and followed for 12 months showed no improvement in bone health. Here is the problem with this study and similar studies on supplements. First, most medical studies look at supplements like a drug study. They test one drug to determine the effect of the drug. You cannot do that with a vitamin. Most vitamins don't act alone. That is why I have added Vitamin K2 in the form of MK7 with Vitamin D3. In order for D3 to benefit your bone health Vitamin K2 has to be present in your body to activate the proteins. These proteins enable Calcium to enter the bones and teeth. Second, studies often use ineffective doses. According to nutrition scientists, the amount of Vitamin D3 needed to impact bone health is ten times the amount prescribed in the above study. Third, outcomes are impacted by inadequate follow-up times. In most cases it takes years of optimal doses to achieve therapeutic effects. Fourth, some studies use the wrong form of a supplement. There are at least 4 forms of B12 and one type is not easily absorbed in the human body rendering it useless. Unfortunately, that is the most common form sold in drug store supplements. There are multiple forms of many supplements. Some beneficial and some not.
Another great example is a study that showed an association between taking vitamin E and an increased risk of cancer. That study lead to many physicians recommending against taking vitamin E. However, if you look closely, the form used in the study was the synthetic DL alpha tocopherol and not the natural alpha tocopherol. These are completely different compounds.
So why take supplements? There are several reasons. Food sources are not always reliable. In the first place, soil is depleted of nutrients. There needs to be sufficient soil concentrations of nutrients for the plants to absorb. It is estimated the soil is depleted of nutrients. Fruits and vegetables have had a 76% decrease in nutrients since the 1940's. Today it takes 53 peaches to get the same nutrients in 2 peaches grown in the early 1950's. In addition, vegetables are most nutritious when picked ripe. Yet most of the fruit and vegetables are harvested when they are unripe and therefore less nutritious. Throw in the effects the pesticides found in most fruits and vegetables which effects absorption, and you can start to see why you need supplements. Still not convinced? Most people on the standard American diet (SAD) eat a lot of processed foods which remove a lot of the natural nutrients and replace them with a cheaper synthetic version. Most people on the SAD have unhealthy gut biome which is known to cause nutritional deficiencies. Ingestion does not guarantee digestion or absorption. Industrial framing and new ways of life has left us lacking for nutrients we used to get from spending more time outside or eating wild game. Let’s look at Vitamin D3 and Vitamin K2 again. We used to get most of our D3 from the sun. Now we hardly ever stay outside long enough to get the benefits from the sun. Vitamin K2 came from the meat and dairy products from wild game or pasture raised grass fed animals. CoQ10 is found in high concentrations in organ meat. Had any of that lately? Grass fed meat is higher in Omega 3 fatty acids. 90 percent of Americans have Omega 3 fatty acid deficiency. The ideal Omega 6 to Omega 3 ratio is 1/1. Most Americans are in the 15/1 ratio. Starting to get the picture? A study of native diets reveals they contain 4 times more water-soluble vitamins and 10 times more fat-soluble vitamins than the standard American diet (SAD). I recommend probiotics because the SAD destroys our gut microbiome in many ways. Another destroyer of nutrients are medications. Are you aware that certain medications will deplete the body of certain nutrients? So, I hope you see, that supplements are necessary. And, not only do we need supplements we need the right supplements. That's where I come in. I make sure you get good quality supplements in the most beneficial forms. We haven't even discussed antioxidants, but the story is the same.
How long do you have to supplements? It depends. I really believe it is best to get all the nutrients from natural means. That means cleaning your diet. What that means is eating fresh harvested organic vegetables and all pasture raised grass fed meat and dairy and no processed or GMO foods. You would also have to drink filtered water. As hard as I try, I can't eat clean enough so I have resolved to take supplements for life. If you take medications that rob your body of nutrients you will need to supplement as long as you are being robbed of the nutrients. The good news is the amount and frequency can lessen. Once you get optimized and remain there for a year or so and are feeling the benefits and are eating "clean" you can cut back on some of your supplements if you wish. For instance, I now take my multivitamin 3 or 4 times a week. I take the weekends off from most my other supplements but not my prescribed medications. I take my probiotic 3 times a week and I take different ones every other time. With that being said, there are times I take more supplements than usual. If my body is under more than normal stress or inflammation, I may increase my dose until things normalize. As time goes on and most of you gain more knowledge in nutritional health and become more in tune with your body, you will be able to make those adjustments based on how you feel.
Vitamins play an essential role in most metabolic processes governing human physiology. It is not as simple as stating that a particular vitamin is needed for a single function. The Recommended Daily Allowance (RDA) is the minimal dose of a vitamin needed to prevent a certain disease. It is not the optimal or most beneficial dose. Don't be fooled. Eat healthy, get plenty of sun and take your supplements.
Commercial farming practices have drained the soil of essential elements resulting in fruit and vegetable crops that are significantly less nutritious than they used to be. All vitamins are not created equal and research on the supplementation can be misleading. In a perfect world, we could obtain all the nutrients we need from nature. As I explained in this article, that is hard to do even if you make a consorted effort and eat organic food and avoid man made processed foods. That is why I recommend good high-quality supplements also referred to as nutraceuticals. It can take years of supplementing to correct decades of a nutritionally depressed diet. After maximal effects are achieved, you can reduce the amount or frequency of some supplements. So, eat healthy, live healthy and take your supplements!
I would like to recommend the book, "THE GUT BALANCE REVOLUTION" by Gerard E. Mullin MD. It is a great book that details the new medical frontier of the connection between the gut and your overall health. The information is this book is revolutionary and interesting and will lead to life changes.
Health and happiness,
April 14, 2017
A NEW WAY TO THINK OF FOOD!
Food is more than calories.
Food is information that influences your genes. Nutrigenomics is the scientific study of the interaction of nutrition and genes, especially with regard to the prevention or treatment of disease. Science is discovering the multidimensional role of food in health. Food is information that instructs body functions that control all aspects of your health and disease risk. We have coevolved with the food in our environment and use it to regulate every single bodily process including our gene expression, inflammation, oxidation, hormonal function, immune function, and gut flora balance.
Epigenetics is the study of biological mechanisms that will switch genes on and off. In simple terms, epigenetics is how your environment affects your gene expression. What you eat, where you live, who you interact with, when you sleep, how you exercise, even aging – all of these can eventually cause chemical modifications around the genes that will turn those genes on or off over time. Additionally, in certain diseases such as cancer or Alzheimer’s, various genes can be switched into the opposite state, away from the normal/healthy state.
People in North America die more from inflammatory disease than they do from infectious disease. Most chronic diseases including obesity, type II diabetes, heart disease, dementia and cancer, all have roots in inflammation. I see inflammatory diseases every day in my practice. These diseases are so prevalent most people consider them normal. It doesn't have to be that way. It never fails to amaze me how most patients accept their disease as inevitable. The attitude is, both my parents had this disease so it is only natural that I now have it. I hope everyone reading this email understands this does not have to be. What is the biggest source of inflammation? Sugar! And where do we get sugar? From our diet. It is everywhere. The average American consumes 150 pounds of sugar a year. That's right, 150 pounds. Two hundred years ago the average yearly consumption was 20 teaspoons. Most of you have heard me say, Cholesterol is not the problem oxidized cholesterol is the problem. What causes oxidation and oxidative stress? Inflammation. Get the picture?
As you can see your environment and the food we eat is important in gene expression. Just because your parents had a particular disease or health problem does not mean you have to have it.
What can you do to reverse the family curse of disease? Most of you are doing it. Hormone optimization, proper nutrition, exercise, and nutraceuticals.
Let's look at diet. It is a confusing topic. This expert says to eat this and another one says to eat that and on and on it goes. Who is right and how do you know who to listen to? I attend lectures. I read multiple diet books and articles from many leading authorities. They all do a great job of making their case backed by good research. The truth is they are all right in some form or another. We are all individuals and no one size fits all. If you look at the research on native diets around the world you will see that some people thrive off acorns and cactus. Other cultures survive on yak meat and horse blood. Some live on high fat diets while others exist on high carbohydrate plant based diets. How is that possible? Genetics and gut microbiome, that's how.
There was a study that compared low-fat, low carb and the Mediterranean diets. What the researchers found was there was an overall decrease in weight of 1 Kg among participants. The same people were subjected to genetic testing and the results were much different. Those with the low-fat gene lost 14 lbs on a low-fat diet, but only 3 lbs on low carb diet. Those with low-carb gene preference lost 12.3 lbs with a low carb diet, but only 2.2 lbs with low-fat diet. That does not mean we should all get genetic testing although it might be indicated for some individuals. My advise is to eat real food (not processed), nature made food and not covered with pesticides. Try to eat organic pasture-raised and grass fed meat. Dairy should also come from grass-fed live stock.
We will discuss supplements in a future newsletter.
Live Healthy MD BHRT would like to wish everyone a Happy and Healthy New Year.
I would like to thank everyone for your business and allowing me to share in your quest for optimal health. Every new client in 2016 came by the way of referrals from friends, clients, or colleagues. Thank you and please continue to share this program with your friends and family members. Referrals are always welcome.
Remember the program consist of four areas. In order to achieve maximal benefits all four areas must be incorporated into your program. The four areas are: Hormone optimization, proper nutrition, nutraceuticals, and exercise.
If you are like most people, you may have made a health related resolution for 2017. Please allow me to make another.
Try to eat more organic this year.
Try to include more organic vegetables and pasture raised meats and dairy products. When possible, eat recently harvested vegetables. Vegetables are more nutritious when picked ripe. Don't assume all organic vegetables are picked ripe.
Organic foods contain less chemicals. The chemicals, hormones and antibiotics found in non organic foods are running havoc on your health. Organic meat and dairy contain Vitamin K2 and more healthy omega 6 to omega 3 ratios. Once upon a time, organic meat and dairy was the number one source of vitamin K2.
One thing I would like to do in this and future news letters is to recommend certain books or articles I think are helpful and beneficial. The first book I would like to recommend is Effortless Healing by David Perlmutter and Joseph Mercola. It maps out multiple ways we can improve our health span and quality of life.
Healthy New Year!