Monday, December 24, 2012

Hidden Hypothyroidism

Hypothyroidism is a deficiency in the ability of the body to maintain an optimal basal metabolic rate. It can be due to malfunctioning of the brain, pituitary gland, thyroid gland, enzyme systems that make thyroid hormone, thyroid receptors in cells, or the powerhouses where you make energy – mitochondria. However, a large number of people who exhibit symptoms of hypothyroidism have clinically acceptable TSH (thyroid-stimulating hormone) and T4 (levothyroxine) levels. Because of this, neither they nor their doctors pursue further diagnosis or treatment. Unfortunately, this means many people go years, or even a lifetime, without addressing an easily treatable condition. And, there are many ways to be hypothyroid with completely normal TSH and T4 levels.

Hypothyroidism on the Rise
A family of Belgian endocrinologists, the Hertoghes, and the late Broda Barnes MD in Austria and this country, have tracked the progression of hypothyroidism over the years, providing valuable data to physicians all over the world. Because of their work we now know that only 10-20 percent of the population was hypothyroid a century ago. Today, that figure is between 50 and 80%.

You might be wondering why there has been such a dramatic increase in this condition in such a relatively short amount of time. There are several reasons. Antibiotics, toxins, and lack of iodine and other nutritional deficiencies top the list.

An important reason is that modern medicine has allowed more hypothyroid people to survive. Because hypothyroidism weakens a person's immune system, many of the people who had it in the past died of infections early in life. Once antibiotics were introduced, people with thyroid conditions were better able to survive serious infections like pneumonia, despite their compromised immune systems.

Another problem that's contributed to an increase in hypothyroidism is exposure to toxins. The proliferation of toxic substances in our current environment has led to a predictable rise in thyroid dysfunction.

Toxins can disrupt thyroid functioning in a number of different ways. Toxins damage the thyroid gland, alter the metabolism of the thyroid hormones: triiodothyronine (T3) and thyroxine (T4), interrupt the binding of the thyroid hormones to cell receptors and damage the mitochondria in the cell.

Mitochondria are the powerhouses that allow cells to make energy and perform their specific vital functions. These powerhouses are also where you burn your last meal or burn fat when you fast or exercise. This is where your calories are converted into energy. So if you just ate a meal and your mitochondria aren't functioning optimally, you're not going to make energy and the calories are going to be put into storage. This condition will make you sluggish and cause you to gain weight, the two most common symptoms of hypothyroidism.

The toxins most likely to create thyroid problems include bromine, mercury, and numerous pesticides and industrial toxins. Bromine, for example, interferes with the use of iodine in the production of thyroid hormones. Unfortunately, bromine is widespread as an additive in bread (brominated wheat), medications containing bromine and soft drinks. Iodine, on the other hand, is not as extensively present in our diets and environment. Small amounts of iodine can be ingested through iodized salt, but the best way to get it is through supplements or kelp. However, if your exposure to bromine isn't reduced, it cancels out the positive effects of the iodine.

Pesticides including chlorinated pesticides like DDT, organophosphates, pyrethroids and many others have compromised thyroid activity in a variety of animals and some human studies.

Mercury displaces zinc and selenium which are needed to produce the most active form of thyroid hormones, T3, tri-iodothyronine. It also triggers an autoimmune reaction against the thyroid gland, slowly destroying it.  This is called Hashimoto’s thyroiditis. Other heavy metals including aluminum, lead and arsenic compromise thyroid function. As do industrial toxins like dioxins and PCB’s.

Iodine is the most important nutrient for thyroid function.  Iodine is necessary for the production of thyroid hormone.  Is also critically important for the immune system to function normally.  Lymph will not flow without adequate iodine.  Iodine is also important for breast health.  Women need more iodine than men because women have larger breasts than men.  This is partly why there are more women affected by hypothyroidism.

Iodine used to be used in the production of wheat flour.  This was abandoned in favor of bromine years ago.  We do not consume adequate amounts of iodine to support normal bodily functions in our diet.  Iodinated salt doesn't come close.  Kelp when used on a very consistent basis may be sufficient.  However with all of the bromine and other halides like fluoride and chlorine that interfere with thyroid function in the environment, its best to take a supplement of at least 12.5 mg of iodine/iodide daily. Other potential causes of hypothyroidism are infections, other nutrient deficiencies, imbalances of other hormones and foods:

  • Infections: The most common infection that can impact the thyroid is parvovirus. We generally only think of this infection as a canine virus, but humans can get it, too. In humans, parvovirus can damage the thyroid gland. There are other infections that injure cell thyroid receptors.
  • Other Nutrient Deficiencies: It can't be overstated how important nutrients are to thyroid functioning. For example, vitamin D is the Velcro that holds thyroid hormones to receptors, and vitamin A helps to relay information from thyroid hormone to the mitochondria. Both should be between 50 and 100 in blood. Other necessary nutrients for a healthy thyroid are selenium and zinc. Just think of it this way: Thyroid hormones are your cheerleaders. Nutrients are the body's football players. If you don't have enough of those players in the right places, you can't win the game.
  • Hormone Imbalances: Too much estrogen interferes with thyroid function. Estrogen must be balanced by progesterone even in women who have had hysterectomies to avoid hypothyroidism. Too much or too little cortisol, the stress hormone, also interferes with thyroid function.
  • Foods: Soy and cruciferous vegetables can both interfere with the incorporation of iodine into thyroid hormones. They can cause a functional deficiency of iodine. Supplementing with iodine reduces the impact of this. Gluten, dairy and other foods can trigger an autoimmune reaction against the thyroid. Just like mercury.

Under the Radar
Despite the growing number of people who suffer from hypothyroidism, very few are diagnosed with the disorder. This is because hypothyroidism, as we understand it today, isn't always clearly identified by standard blood tests. While conventional doctors rely on blood tests and consider the above causes “atypical” and uncommon cases, integrative physicians routinely diagnose these same patients with hypothyroidism. These increasingly common instances of hypothyroidism are now frequently referred to as Hypothyroidism Type 2, the name of a book published in 2005 by Dr. Mark Starr. Dr. Starr explains that the majority of hypothyroid disorders are due to thyroid resistance. The hormones are present but the cells don’t “see” the hormones. Just like diabetes type 2 or insulin resistance when there is an elevated amount of insulin and the cells are resistant to it. They can’t “see” it or be affected by it.

But just because this kind of thyroid dysfunction isn't necessarily identified by traditional tests doesn't mean it's undetectable. On the contrary, there are a number of ways to determine if hypothyroidism is present.

In addition to the customary TSH and total T4 tests, a full thyroid panel should be given to patients in whom hypothyroidism is suspected. The additional tests include free T3, free T4 and reverse T3 tests, as well as a thyroid peroxidase antibody test.

Of course, you can have perfectly normal thyroid hormones and still be hypothyroid. It's not just the hormones. If you don't have the right nutrients, your thyroid hormones may be perfectly normal, but they can't get the job done. So you can't just rely on thyroid hormones testing, you also have to evaluate vitamin A, vitamin D, selenium and zinc levels.

Paying Attention to the Signs
Of course, thyroid testing is typically initiated because hypothyroidism is already suspected. A doctor, or even a layperson, can usually deduce with some degree of accuracy whether someone is hypothyroid. That's because the disorder comes with a number of telltale symptoms and signs:
  • Weight gain or inability to lose weight
  •  Cold intolerance, especially in the hands and feet
  •  Constipation
  • Brittle, ridged nails
  • Very dry skin, especially rough elbows
  • Coarsening of hair or loss of hair
  •  Low heart rate
  • Elevated blood pressure
  • Elevated blood cholesterol
  • Heavy periods
  • Infertility
  • Weakened immune system
  • Chronic pain
  • Chronic fatigue

There is a characteristic fatigue pattern seen with hypothyroidism. The person has a very difficult time getting out of bed in the mornings, then has to keep moving throughout the day to keep his or her energy level up. This is why people who are hypothyroid don't take naps; once they wake up, they feel awful.  If a hypothyroid person rests, reads, watches TV or a movie they are more likely to fall asleep.  They have to get everything done before they stop.  Once they stop, they cannot get going again especially in the evening.

Recognizing the unique characteristics of hypothyroidism is important because, otherwise, a person can be treated for the wrong condition. For example, many women have undergone unnecessary hysterectomies to treat painful, heavy periods when, if their hypothyroidism had been detected, they could have treated the root cause of their problems and avoided invasive surgery.

Likewise, the money spent on fertility treatments is often wasted because of undetected hypothyroidism. If hypothyroidism is present in an infertile woman and she's treated properly for it, she can get pregnant within three to six months.

Another condition that often has an unexplored connection to hypothyroidism is fibromyalgia. Other types of chronic pain, such as headaches, joint pain and back pain can also indicate the disorder.  Chronic pain is a very common symptom of hypothyroidism.

Sometimes, however, hypothyroidism masks itself in universal symptoms like high blood pressure and high cholesterol. This can be problematic since standard therapies, such as beta-blockers and statins, can actually make a thyroid disorder worse.

Do-it-Yourself Thyroid Testing
If you're experiencing symptoms that make you suspect you have hypothyroidism, there are tests you can perform at home to confirm or dismiss your likelihood of having the disorder.

The best self-exam is the basal body temperature test discovered by Dr. Broda Barnes. You can perform this by taking your oral (mouth) or axillary (arm pit) temperatures first thing in the morning before getting out of bed. It must be taken at that time because the minute you get up and start moving your temperature will rise.

Although some physicians recommend the axillary method, it's perfectly fine to take your temperature orally as it is quicker. Once your temperature is taken, you should note what the reading is. If your thyroid functioning is normal, your basal body temperature will be 98 degrees, plus or minus 0.2 degrees. So, anywhere from 97.8 to 98.2 is considered normal. If you're hypothyroid, your temperature will read below 97.8.

To ensure your readings are accurate, take your temperature every morning for approximately five days in a row. Men, children and post-menopausal women can do this any time of the month. Ideally, women of childbearing age should conduct the test during the week of menstruation.

Basal body temperature testing can confirm hypothyroidism, but because it can also indicate low cortisol or sex hormone levels, you should have a doctor evaluate your findings.

Taking your temperature isn't the only way to determine whether or not you're hypothyroid. It's wise to do it in conjunction with a mirror test. The mirror test is very simple. It involves standing in front of a mirror and evaluating how your arms hang. As you stare into the mirror, just relax and look at your hands. Your palms should face your outer thighs. If they do, your thyroid function is probably normally. However, if your hands are naturally turned so that your thumb is aimed toward your thigh and your palm is facing backward, you may be hypothyroid.

Also, look at your face. Coarse features, loss of the lateral aspect of your eyebrows, bags beneath your eyes, a big tongue with scalloping, doughy pale dry skin, and overall puffiness are very suggestive of hypothyroidism.

Lastly, you can test for iodine sufficiency by applying tincture of iodine to the skin of your abdomen or forearm. It should still be present in 24 hours. If it has disappeared, you are deficient in iodine.  A second test can be done by measuring the amount of iodine in the urine. This is called an iodine loading test.

Treating the Thyroid
Because hypothyroidism is so under-identified, getting to a diagnosis is often the hard part. Treating the disorder, however, is fairly uncomplicated. The first step is to make sure the person is getting the nutrients (iodine, vitamin A, vitamin D, selenium and zinc) they need. And fish oil for healthier thyroid receptors.
This involves blood tests the fat soluble vitamins or blood or taste tests for the minerals. Iodine sufficiency can be easily tested by applying

The next step is to eliminate any problematic toxins. Don’t consume bromine-Mountain Dew and lemon lime Gatorade contain bromine. Check for brominated vegetable oil on the list of ingredients. This is used to keep citrus oils in suspension in these and similar drinks. Check your medications for bromine.

A provoked urine test for heavy metals followed by chelation therapy to remove them may be necessary. Dietary changes starting with the elimination of wheat and dairy may be critical if your TPO antibodies are elevated. A cleanse or detoxification program may be helpful.

The final critical treatment is thyroid hormone therapy. When done in combination, these treatments should return the entire thyroid system to normal functioning. 

Monday, December 10, 2012

Beat the Winter Blues

The days are shorter. The landscape is dull and barren. The weather is, at times, harsh and unwelcoming. It's no wonder many people feel glum during winter. Add to that the stress of the holidays, and you have a recipe for full-blown depression. But whether you develop a mood disorder out of the blue, or you experience depressive symptoms every winter (a condition known as seasonal affective disorder, or "SAD"), there are treatments and preventive measures that will help you get back to your normal self.

"D" is for Daylight
Most people do not get enough exposure to sunlight during winter. They go to work when it's dark, and by the time they get home, the sun has already gone down. This reduced exposure to sunlight means most people aren't making enough vitamin D.

Vitamin D is important for a number of functions in the human body in addition to building bone. It boosts the immune system and helps to fight cancer. Without it, we slow down, get sluggish and gain weight. This is due to the connection between Vitamin D and thyroid. Sufficient levels of Vitamin D are necessary for optimal thyroid function. If we were bears and hibernated throughout the winter, less would be fine. (We would get hypothyroid) But because we are humans on the go, we need the extra support that vitamin D can give.

Another important benefit of this vitamin is that it can positively affect the brain. In recent years, doctors have noticed that patients who experience depression or SAD tend to be low on vitamin D. Research confirms this connection as well. A study of people in nursing homes found that taking vitamin D improved their depression and cognitive abilities.

Actually, older adults should consider taking vitamin D year-round, with an increased dose in winter. Older adults do not make as much Vitamin D in the summer as their children and grand children.

A Secret Weapon for Serotonin Production
Here's a challenge: Look up the amino acid 5-hydroxy tryptophan (5-HTP) on the internet. You're likely to find lots of warnings against using it in conjunction with SSRIs, (selective serotonin reuptake inhibitors), the most commonly prescribed class of antidepressants. The truth is, 5-HTP can be a great addition to depression treatment, especially considering the tendency for SSRIs to become less effective over time.

5-HTP crosses the blood brain barrier and is converted to serotonin, 5-hydroxytryptomine (5-HT), which is a calming neurotransmitter that promotes self esteem, reduces the tendency to feel overwhelmed, reduces fear, reduces the tendency to be overly critical of others and of oneself and decreases the tendency to worry. People with adequate serotonin are happier with themselves and their surroundings.

Deficiencies or disruptions in serotonin can lead to depression or obsessive compulsive tendencies. SSRIs play only one role in correcting this problem, however. They allow serotonin to remain in brain synapses longer so that downstream nerves get a higher concentration of the neurotransmitter. While this is helpful, it does not address the problem of deficiencies in serotonin.

SSRIs only rearrange where serotonin is; they don't stimulate production of more of it. And, in fact, these antidepressants can lead to a reduction in serotonin levels over months to years. In the late 1980s when Prozac, the first SSRI, became popular, doctors began noticing a phenomenon known as "Prozac poop-out." Patients would respond successfully to the drug at first, but then their symptoms would start returning.

It's now believed that SSRIs' continual blocking or inhibition of the serotonin reuptake devices in the brain may actually reduce the amount of serotonin being produced. This finding surprised a lot of doctors. To get around the problem, they began changing dosages and prescribing additional anti-depressants, beta-blockers or naltrexone. But none of these changes really helped patients achieve the results they had when first taking SSRIs.

Integrative physicians, however, quickly realized that 5-HTP would assist SSRIs by helping increase the amount of serotonin in the brain. Traditional doctors still stay away from this practice because they fear it will create a condition known as serotonin syndrome. This syndrome, which is marked by hypertension, profuse sweating, diarrhea and possible psychosis, can occur if too much 5-HTP is taken. However, in small doses, it can safely produce positive results for depressed patients.

Many integrative physicians prescribe 5-HTP to patients regularly, and in the 20-some years since SSRIs have been out, most have never had a patient experience a life-threatening reaction to the combination of an SSRI and low doses of 5-HTP.

Incorporating 5-HTP into Depression Treatment
There are a number of ways to find out whether or not your serotonin is low. One way is if you notice your SSRI isn't working as well as it used to. Another is to take inventory of your mood and actions. If you're low on serotonin, you'll notice some of the following things:

  • A hypercritical attitude—particularly as it relates to your feelings about yourself
  • Feeling overwhelmed
  • A need for control
  • Indecisiveness
  • Obsessive compulsive feelings (this occurs with very low serotonin)
  • Craving carbohydrates like bread, rice and sugar

 The way to determine whether or not a patient might benefit from 5-HTP in conjunction with his or her antidepressant is by taking a thorough history. Questionnaires are also helpful. Usually this is enough data to determine the need for 5-HTP. Then one can take a small dose of 5-HTP and increase it slowly.

Sometimes, a urine test is useful. Serotonin is made in the brain, but it is excreted in the urine. So by monitoring a patient's urine levels, a doctor can determine a patient's serotonin level.

If a depressed patient's urine has low levels of serotonin, that's an indication that his or her brain doesn't have the serotonin levels necessary for an SSRI to properly rearrange the concentrations of the neurotransmitter. Then one can use 5-HTP to increase the patient's serotonin levels. This will help the SSRI work better, and it may reduce the patient's dose of the SSRI. This, in turn, tends to reduce any side effects the patient experiences from taking the antidepressant.

Always start patients out on the lowest dose of 5-HTP possible— 50-100mg a day. Over time, increase the dosage. Most people require between 200mg and 500mg a day. The maximum dosage recommended  is 800mg daily, divided up into 200mg four times a day. If a patient is on an SSRI, they will usually use 100-400mg daily. If a person seems particularly sensitive to 5-HTP and is experiencing an increase in side effects similar to those felt with the SSRI, reduce the dosage..

The nice thing about 5-HTP is that it's easy to monitor. People respond to it within 30 minutes. A single dose lasts 4-6 hours. This not only means they start feeling better sooner; it means one can make dosage adjustments quickly.

Another advantage of 5-HTP is that it only needs to be taken as necessary—and can even be taken alone (without an SSRI). Some people may only need it in wintertime; others may just require it to get them through a rough period.
The brain needs magnesium and activated vitamin B6, Pyridoxyl-5-phosphate, P-5-P to make serotonin from 5-HTP. So take these or take a good multiple vitamin that contains them.

Tryptophan also works. It is converted in the brain into 5-HTP. It is in turkey and other foods or can be bought as a supplement. Doses are 5-10 times higher than 5-HTP since only 10-20% of it is converted to 5-HTP. Cofactors for this conversion are oxygen, iron and the cofactor, tetrahydrobiopterin (BH4).

No one has ever developed Eosinophilic Myalgia Syndrome when taking real tryptophan. Those that had a severe reaction in 1987 to a batch of imported tryptophan from Japan were actually consuming a genetically modified tryptophan.  It wasn’t “contaminated”. It was a genetically engineered tryptophan.

Consult with your physician or psychiatrist before using 5-HTP or tryptophan.

A Helpful Herb
Another commonly prescribed treatment for SAD and depression is St. John's Wort, which is often known as the antidepressant of the herb world. St. John's Wort raises the number of many neurotransmitters in the brain, not just serotonin. While the herb works well in the treatment of depression, it does take a little longer to produce results than 5-HTP. So, if you're using it to treat SAD, you may want to start taking it in late summer every year before your depression symptoms kick in. If your mood is easy to track by seasons, this can be a great preventive treatment for you.

If you choose to take St. John's Wort, just be cautioned that it can interact negatively with some prescription medications, like HIV drugs. And unlike 5-HTP, St. John's Wort shouldn't be taken with SSRIs. To be on the safe side, consult with your physician before taking this, or any, herb.

Nothing Happens without Fish Oil
You can take all the above drugs, vitamins and supplements and still be “blue” if you have sick, starved cells. If one does not have enough fish oil (DHA in the brain and EPA in the body), the cells are malnourished, toxic, energy poor, and isolated. All cells, including nerve cells, have receptors on their cell membranes. These receptors are the communication sensors for the cell.

Serotonin may be knocking at the door of the down stream nerve across the synapse, trying to tell it “Don’t worry, be happy”, but it will fall on deaf ears if the nerve doesn’t have healthy receptors. Low levels of DHA and high levels of saturated and trans fats make the nerve cell membrane stiff. When serotonin floats into a receptor on the down stream nerve, the receptor changes shape to signal to the cell that serotonin has arrived. It can’t move in a stiff membrane so the message never arrives. The receptors need to be able to wiggle. They can only wiggle in a flexible membrane.

Secondly, depression is an inflammatory disease. DHA and EPA are fundamentally anti-inflammatory molecules. If you are depressed take at least 2400mg of EPA+DHA. You may need even higher doses.

A Menu of Treatments for SAD and Depression
Vitamin D, SSRIs, 5-HTP, tryptophan, St. John's Wort and fish oil are not the only treatments for depression. There are a number of treatments, both medical and behavioral, that can help:
  • Neurofeedback. This treatment can provide electromagnetic feedback to the brain, which helps the practitioner re-train the brain. In my 30 years of medical practice, I've seen many people helped by this therapy.
  • Energy Therapy. Acupuncture, Reiki, Healing Touch, Emotional Freedom Technique and other forms of energy therapy have been demonstrated to help improve symptoms of depression.
  •  Counseling. This method doesn't cure depression by itself, but it can help you cope with and adjust areas of your life that are in need of repair.
  •   Faith. A belief that in some spiritual or cosmic sense that one's life matters is hugely important in helping a depressed person think past the low points.
  • Laughter. Humor heals. A sense of humor and laughter are some of your strongest weapons against depression.
  •  Exercise. There have been countless studies showing the connection between physical activity and mood improvement. In fact, exercise is now a universally recommended treatment for depression. This is because it optimizes the amount and balance of every neurotransmitter in our bodies.
  •  Dietary Changes. Avoid foods that drain your body of energy; eat foods that nourish it. Indulge now and then, but remember: your brain needs real food to thrive. The more processed the food, the less it will nourish your body and brain.
  •  Detoxification. Eliminating toxins from your body helps "free up" neurochemicals. Some people's brains hold on to heavy metals like mercury, which can interfere with neurotransmitters.

Get a Checkup
First see your doctor or other health care provider. Depression isn't always due strictly to neurochemical factors. Many people suffer from the mood disorder because they don't have enough of certain vitamins and minerals. B vitamins—especially thiamin, folic acid and B6—are essential to good mental health. You also need proper levels of magnesium and iron to support the production of neurotransmitters like serotonin.

Normal thyroid function, Vitamin D and A, and minerals are all important.

For a person suffering from depression, get full blood work, including a complete iron panel, Vitamin D and A levels, B-12 and folic acid levels, and thyroid levels.  This is in addition to a urine test that determines serotonin levels in the body.

Take care of yourself this winter. And thrive in 2013!

Tuesday, December 4, 2012

FREE Talk - How to Get Your Brain Back

Thursday, December 13, at 6 p.m.

Vaughan Integrative Medicine and The Natural Vitality Center will host a free one-hour talk with Dr. Gail Sanders Durgin of Neurofeedback Associates, Inc. Dr. Durgin will discuss research about the brain and what you can do to heal and protect your brain.

As we age, we get more concerned about the health of our brains. Is my forgetfulness an early indicator of dementia? What foods should I eat or not eat? Are there supplements that would help me? Why am I out of sync since I got rear-ended in my car last month? Am I really more stressed or is it my imagination? How does the brain work anyway?

Join Dr. Durgin on Thursday, December 13, at 6 p.m. when she will address these concerns and more. The talk takes place in the lobby of Vaughan Integrative Medicine, located at 1301-A West Wendover Ave., at the intersection of Wendover and Grecade in Greensboro. Call 336.808.3627 x. 10 or email for reservations; seating is limited.