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The most important thing you may not know about hypothyroidism

June 28, 2010 in Myths & Truths, Thyroid Disorders, Uncategorized | 55 comments

hypothyroid patientAn 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. 13 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. One recent analysis suggested up to 10% of women over 60 have clinical or subclinical hypothyroidism. 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, and a wide range of other not-so-fun symptoms.

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. For starters.

You can think of the thyroid as the central gear in a sophisticated engine. If that gear breaks, the entire engine goes down with it.

That’s why people with hypothyroidism experience everything from weight gain and depression to infertility, bone fractures and hair loss.

One of the biggest challenges facing those with hypothyroidism is that the standard of care for thyroid disorders in both conventional and alternative medicine is hopelessly inadequate.

The dream of patients with thyroid disorders and the practitioners who treat them is to find that single substance that will magically reverse the course of the disease. For doctors, this is either synthetic or bio-identical thyroid hormone. For the alternative types, this is iodine.

Unfortunately, in the vast majority of cases neither approach is effective. Patients may get relief for a short period of time, but inevitably symptoms return or the disease progresses.

So what’s the problem? Why have replacement hormones and supplemental iodine been such dismal failures?

Because hypothyroidism is an autoimmune disease.

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. While not all people with Hashimoto’s have hypothyroid symptoms, thyroid antibodies have been found to be a marker for future thyroid disease.

Most doctors know hypothyroidism is an autoimmune disease. But most patients don’t. The reason doctors don’t tell their patients is simple: it doesn’t affect their treatment plan.

Conventional medicine doesn’t have effective treatments for autoimmune disease. They use steroids and other medications to suppress the immune system in certain conditions with more potentially damaging effects, such as multiple sclerosis, rheumatoid arthritis and Crohn’s disease.

But in the case of Hashimoto’s, the consequences – i.e. side effects and complications – of using immunosuppressive drugs are believed to outweigh the potential benefits. (Thanks to conventional medicine for a relative moment of sanity here.)

So the standard of care for a Hashimoto’s patient is to simply wait until the immune system has destroyed enough thyroid tissue to classify them as hypothyroid, and then give them thyroid hormone replacement. If they start to exhibit other symptoms commonly associated with their condition, like depression or insulin resistance, they’ll get additional drugs for those problems.

The obvious shortcoming of this approach is that it doesn’t address the underlying cause of the problem, which is the immune system attacking the thyroid gland. And if the underlying cause isn’t addressed, the treatment isn’t going to work very well – or for very long.

If you’re in a leaky rowboat, bailing water will only get you so far. If you want to stop the boat from sinking, you’ve got to plug the leaks.

Extending this metaphor to Hashimoto’s disease, thyroid hormones are like bailing water. They may be a necessary part of the treatment. But unless the immune dysregulation is addressed (plugging the leaks), whoever is in that boat will be fighting a losing battle to keep it from sinking.

What the vast majority of hypothyroidism patients need to understand is that they don’t have a problem with their thyroid, they have a problem with their immune system attacking the thyroid. This is crucial to understand, because when the immune system is out of control, it’s not only the thyroid that will be affected.

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. The most common are transglutaminase (Celiac disease), the cerebellum (neurological disorders), intrinsic factor (pernicious anemia), glutamic acid decarboxylase (anxiety/panic attacks and late onset type 1 diabetes).

In the next post we’ll look more closely at why Hashimoto’s can’t be treated successfully without addressing the autoimmune component, and why both the conventional and alternative approaches to treating hypothyroidism are destined to fail from the start.

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Healthcare vs. disease management

June 24, 2010 in Medical Industrial Complex | 26 comments

disease management In a recent post, The Myth of Evidence Based Medicine, I explained that conventional medicine is based not on evidence, but on profit.

So how’s this working out for us?

The U.S. spends far more than any other country in the world on healthcare – a whopping $2 trillion per year. 1

Considering this enormous expenditure, we should have the best medicine in the world. We should be reversing disease, preventing disease, and doing minimal harm.

But that’s not what’s happening at all. The U.S. ranks just 34th in the world in life expectancy and 29th for infant mortality. Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from bottom) for 16 available health indicators. 2

Even worse, a study published a few years back in JAMA suggested that medical care may be the leading cause of death in the US. (For more on this, read my article The Failure of U.S. Healthcare).

Yes, you read that right. Medical care kills more people than heart disease, strokes or cancer.

How can it be that we spend nearly 16% of our GDP on healthcare, but have one of the worst health care systems in the industrial world?

The answer, in short, is that we don’t have healthcare in the U.S.. We have disease management. And there’s a world of difference between the two:

wellnesscare

Wellness care is what we need. Disease management is what we have.

Wellness care would save insurance companies billions of dollars each year. But it would devastate the bottom lines of the pharmaceutical industry.

Wellness care is what I will offer my patients. And it’s the vision I have for what medicine could be here in the U.S. and elsewhere.

I’m just not holding my breath. Until we can lessen the influence of Big Pharma, disease management will rule.

  1. Park, A. America’s Health Check Up. 11/20/2008. Time Magazine Online. ↩
  2. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press; 1998. ↩

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How to Save Your Family’s Life: 30 Ways to Prevent Modern Disease

March 22, 2010 in Babies & Kids, Food & Nutrition | 27 comments

magnifying glassI just came across a website called Modern Paleo, put together by Diana Hsieh. It has a section called “modern paleo principles” with a list of 30 nutritional and lifestyle recommendations for staying healthy and avoiding disease.

If you’re looking for a good “blueprint” for health to follow, this is it. It’s one of the bests lists of this kind that I’ve seen. I agree with Diana on every point, with the exception of #30 (which is more about politics than nutrition). I also have some minor quibbles on #2/#6 (I think grains and legumes are okay in moderation when properly prepared/soaked, and I definitely think refined grains are worse than whole grains), #15 (although some nuts are high in omega-6, they are nutrient-dense whole foods with antioxidants to minimize oxidative damage), and #19 (I don’t recommend most commercial fish and cod liver oils, which are rancid, contain synthetic nutrients, or are not high enough in DHA/EPA to have a therapeutic effect).

I’m re-posting the first ten principles here with Diana’s permission. Visit this page on the Modern Paleo website to read the remaining 20 principles. Even better, Diana has included links to additional information for each principle that you can access by clicking on the “+/-” sign.

One last thing. As the saying goes, “don’t let the perfect be the enemy of the good.” Embrace the 80/20 rule with these principles. If you follow them 80% of the time, you’ll be on the fast track to vibrant health. An occasional ice cream or piece of bread isn’t going to kill you or reverse the positive effects of this approach. (Of course this isn’t true for those with true intolerances to dairy and gluten. In that case, 100% avoidance is the rule.)

Modern Paleo Principles: A Work-In-Progress

These principles are in a rough order of importance. If you’re overwhelmed by them, try working your way down the list slowly.

  1. Eat real foods, prepared well. Prepare your own food as much as you can. Beware the junk ubiquitous in convenience and restaurant foods.
  2. Don’t eat wheat, corn, rice, or other grains. If you choose to eat some grains, eat them sparingly and prepare them to minimize toxins, such as by sprouting and soaking. Wheat seems to be the worst of all the grains, while rice seems to be the most benign. Whole grains are not better than refined grains.
  3. Don’t eat sweets: avoid sugar, corn syrup, agave nectar, honey, maple syrup, and artificial sweeteners. If you must have some sweetener for a dish, you might try a bit of stevia. With time, your tastes will adjust: ordinary sweets will taste cloying, but formerly bland vegetables will seem delightfully sweet.
  4. Don’t eat modern oils derived from grains and seeds — such as canola oil, corn oil, or soy oil. Make your own mayonnaise and salad dressing. Don’t eat fried foods in restaurants: rancid vegetable oils are standard for frying. Avoid all hydrogenated fats; they contain damaging artificial transfats. Instead, use liberal amounts of animal fats — like butter, ghee, lard, and tallow — as well as unrefined coconut oil and olive oil. (Reserve your bacon grease: it’s delicious rendered lard!) Do not fear saturated fat: it’s healthy, including for your heart.
  5. Don’t eat soy. Some fermented soy might be okay, if tolerated. However, all soy is goitrogenic and contains estrogen-mimicking hormones.
  6. Don’t eat beans and other legumes. If you choose to eat some legumes, eat them sparingly and prepare them to minimize toxins, such as by soaking them.
  7. Watch your ratio of omega-6 to omega-3 polyunsaturated fats, as well as your total omega-6 intake. Most people eat far too much omega-6, both absolutely and relatively. Today, the average ratio of omega-6 to omega-3 in Western diets is 17:1, but the ideal ratio looks to be between 2:1 and 1:4. To achieve that you’ll need to limit omega-6 intake by eliminating modern vegetable oils and eating high-omega-6 nuts sparingly. You’ll likely need to supplement with high omega-3 fish oil too.
  8. Eat plenty of high-quality meat, preferably from pastured animals. Grass-fed meats have a better ratio of omega-6 to omega-3 polyunsaturated fats than grain-fed meats. Avoid meats treated with antibiotics and hormones, if feasible: the animals are likely treated better, and they taste better. Enjoy plenty of red meat. Try uncured bacon and other breakfast meats. They might not be any healthier, but they taste so much better!
  9. Eat eggs, preferably from pastured chickens. Eggs enriched with omega-3s are a good option too. Prefer nutrient-dense egg yolks to nutrient-poor egg whites.
  10. Eat fish and shellfish periodically, preferably caught wild rather than farm-raised.

Don’t forget to click here to read the remaining 20 principles!

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Inflammation worsens danger of heart disease

January 22, 2009 in Heart Disease | 13 comments

inflammationA recent study published in the American Journal of Pathology adds to the already considerable body of evidence which suggests that inflammation is a primary cause of heart attacks and strokes.

In an article I wrote last year, Preventing Heart Disease Without Drugs, I reviewed the current scientific understanding of what causes heart disease. If you’ve been following this blog, you know that inflammation and oxidative damage – not saturated fat and cholesterol – are the primary causes of heart disease.

I wrote:

Inflammation is the body’s response to noxious substances. Those substances can be foreign, like bacteria, or found within our body, as in autoimmune diseases like rheumatoid arthritis. In the case of heart disease, inflammatory reactions within atherosclerotic plaques can induce clot formation.

When the lining of the artery is damaged, white blood cells flock to the site, resulting in inflammation. Inflammation not only further damages the artery walls, leaving them stiffer and more prone to plaque buildup, but it also makes any plaque that’s already there more fragile and more likely to burst.

Oxidative damage is a natural process of energy production and storage in the body. Oxidation produces free radicals, which are molecules missing an electron in their outer shell. Highly unstable and reactive, these molecules “attack” other molecules attempting to “steal” electrons from their outer shells in order to gain stability. Free radicals damage other cells and DNA, creating more free radicals in the process and a chain reaction of oxidative damage.

Normally oxidation is kept in check, but when oxidative stress is high or the body’s level of antioxidants is low, oxidative damage occurs. Oxidative damage is strongly correlated to heart disease. Studies have shown that oxidated LDL cholesterol is 8x greater stronger a risk factor for heart disease than normal LDL.

The data from this study provide further support for the “oxidative response to inflammation” hypothesis described above. The researchers found that inflammation leads to a reduction of mature collagen in atherosclerotic plaques, leading to thinner caps that are more likely to rupture. This is important because other studies have shown that it is not atherosclerosis alone, but the rupture of the atherosclerotic plaques, that causes heart attacks and strokes.

It follows, then, that if we want to prevent heart disease we need to do everything we can to minimize inflammation and oxidative damage.

Top four causes of oxidative damage & inflammation

  1. Stress
  2. Smoking
  3. Poor nutrition
  4. Physical inactivity

By focusing on reducing or completely eliminating, when possible, the factors in our life that contribute to oxidative stress and inflammation, we can drastically lower our risk for heart disease.

For more in-depth information about each of these factors and how to minimize your risk of heart disease without drugs, please refer to Preventing Heart Disease Without Drugs.

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Pleasure is good for you

April 23, 2008 in Mind Over Medicine | No comments

gramophoneThere’s no doubt that optimal nutrition plays a significant role in supporting our health and well-being. But nutrition, as important as it is, obviously isn’t the only factor that influences our physiology.

Over the past several years, an increasing amount of research has focused on the role of emotions, behavior and beliefs in contributing to both health and disease. In fact, an entirely new discipline called “psychoneuroimmunology” (say that three times fast!) has emerged to study the connection between the mind and the body. In short, what has been revealed is that the separation we make between “the mind” and “the body” is largely an illusion. Mind and body exist in a continuous and interrelated web of connections that is only now beginning to be discovered by western science.

But though the idea that our thoughts and emotions can directly influence our physiology is new to modern biomedicine (just ten years ago it was dismissed by most physicians and researchers as so much “New Age” fluff), it has been deeply ingrained in our cultural paradigm for centuries. It is embedded in our language; consider the phrases “worried sick” or “scared to death”, and you’ll know what I mean. I’m sure all of you have had the experience of becoming ill after a particularly stressful period at work, or feeling moody and perhaps depressed while you are physically ill. These are both prime examples of how interconnected our mental and emotional health is.

In their book Feeling Good Is Good For You, researchers Carl J. Charnetski and Francis X Brennan set out to review the emerging evidence that pleasure can boost our immune systems and lengthen our lives. According to the authors,:

“In every way, stress is the antithesis of pleasure. It jangles your nerves, juggles a whole host of your body’s hormones, elevates your blood pressure, and makes your pulse race… It also weakens your immune system’s ability to resist illness and disease.”

If stress is the antithesis of pleasure, then it follows that pleasure is the antithesis of stress. And the best way to fight stress, say Charnetski and Brennan, is with pleasure. Our bodies secrete chemicals called endorphins when we experience pleasure. Animal research has revealed, for example, that endorphin levels are up to 86 times higher after animals experience multiple orgasms! But endorphins are also released, albeit at lower levels, in more mundane daily activities such as playing with a pet, watching a funny movie, listening to our favorite music, visiting a favorite place or connecting with loved ones.

The chemicals released when we experience pleasure do more than counteract stress hormones and improve mood. Consider these additional effects:

  • They improve immune function by producing an antibacterial peptide
  • They enhance the killer instincts and abilities of various immune components, including B cells, T cells, NK cells, and immunoglobulins.
  • They enable certain immune cells to secrete their own endorphins as a way of improving their disease-fighting capacity

Charnetski and Brennan examine several “pleasure inducing” experiences that have been scientifically proven to promote health and well-being.

  • Music
  • Touch
  • Pets
  • Humor
  • Positive attitude and insight

Most of us are already aware of the healing power of those things listed above – at least on some level. But in this culture, there is also an overwhelming reliance on medicine, surgery, diet and other physiological interventions to treat disease. Though we may pay lip service to the idea that stress causes illness and pleasure can prevent it, how many of us actually attribute the same importance to listening to music or watching a funny movie as we do to taking a pill? The lesson in this book is that our thoughts, beliefs, emotions and behavior are all capable of inducing the same physiological changes in our bodies as foods, supplements, pills and even surgery are.

If you doubt that this is true, consider the placebo effect. It has been proven over and over again that pharmacologically inert substances like sugar pills can have identical or even greater therapeutic effects than drugs in certain cases. Even more impressive are the trials that have shown that sham surgery (when small incisions are made to convince the patient they have had the operation, but no surgery is performed) is at times as effective as the actual surgery.

Clearly this points to the power we all have to heal ourselves. If only the suggestion or belief that we will heal is enough to induce the physiological changes that lead to healing, without the presence of any “active” pharmacological substance or surgical intervention, then clearly our thoughts, beliefs and emotions have the potential to be powerful medicine.

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