All posts by Marc Ryan

Hashimoto’s Health Tip: Artificial Sweeteners

chemical formula of aspartame on a blackboard

Converted to formaldehyde

Diet soda and other products that contain sugar substitutes can have a harmful effect on the thyroid.

The issue here, in my opinion, is the conversion of artificial sweeteners, like aspartame, into formaldehyde. Like many environmental toxins, this causes inflammation and an immune response.

A case report presented at the American Association of Clinical Endocrinologists (AACE) 22nd Annual Scientific and Clinical Congress. Issac Sachmechi, M.D., F.A.C.E., F.A.C.P., of New Hyde Park, New York, treated a patient diagnosed with Hashimoto’s thyroiditis that resolved completely with the elimination of artificial sweeteners including Sweet’N Low, Equal, SPLENDA®, and diet sodas.

“An overabundance of sugar-substituted beverages could pose a serious health risk if you are a thyroid patient,” says Dr. Sachmechi. “While the issue is being studied more in-depth, thyroid patients should manage their intake of sugar substitutes while consulting their endocrinologist,” he adds.

Formaldehyde, widely known as an embalming fluid, is a by product of the breakdown of aspartame in the liver and may be associated with immune system disorders.

Your Body Can’t Clear These Toxins Normally

It is important to understand how the body clears environmental toxins, pollutants, and chemicals. In our bodies this happens primarily in the liver.

However, although the liver has hundreds of enzymes to clear many compounds, it still does not have enough to clear everything out of your body. And, unfortunately, many of the most common and most toxic environmental compounds can not be cleared by the liver.

What Happens When the Liver Doesn’t Clear These Toxins, Pollutants and Chemicals?

They become lodged in the body and activate inflammation and disrupt the immune system. This can lead to chronic pain and inflammation, cancer growth and autoimmunity.

Recent research has led us to discover several important ways that your body deals with exposure to these toxins.

Toxic Chemicals Affect the Body in the Following Ways

1. They deplete glutathione.

2. They initiate inflammation, cancer and auto-immune disease through a signaling system in your DNA called NF-Kappa B.

3. They clog your liver and make the liver work harder at clearing toxins and they make liver detoxification not work as well.

4. They cause leaky gut syndrome.

5. They lead to loss of chemical tolerance and multiple food allergies and sensitivities to chemicals, smells and things that never used to bother you (which some researchers think may be the beginning of auto-immune disease).

The unintended consequences of better living through chemistry, people.

Hashimoto’s Health Tip: Low Thyroid Function

frappuccino

Frappuccino with low thyroid function

Did you know that low thyroid function is often caused by some other condition first, and often adrenal gland stress and blood sugar problems are the culprits?

Translation? High sugar, high caffeine beverages (coffee drinks, energy drinks, etc.). These stimulate the adrenal stress response and cause serious blood sugar imbalances.

Chronic Adrenal Stress Can:

* Affect communication between the brain and glands that produce hormones. The hypothalamus and pituitary gland are the directors of hormone production and chronic adrenal stress can mess up communication with the thyroid.

* Increase thyroid binding activity, keeping thyroid hormones from getting absorbed by the cells of the body.

* Interfere with the conversion of T4 to active forms of T3 that the body can use.

* Affect detoxification pathways that clear out unnecessary thyroid hormone, when these get stuck in the body you can develop thyroid hormone resistance making cells lose their sensitivity to thyroid hormones.

* Weaken the immune barriers of the gut, lungs, and brain and weaken the immune system, in general. When this happens, you can have more immune flare ups and this can trigger your Hashimoto’s and make it worse.

Blood Sugar Imbalances Can:

Cause cortisol to be released to try to restore blood sugar balance (see the connection between the adrenals and blood sugar?)

* Cortisol directly inhibits the enzyme (5’-deiodinase) which converts inactive T4 into active T3.  This can lead to low T3 levels.

* In addition, elevated cortisol will cause thyroid hormone receptor insensitivity meaning that even if T3 levels are high enough, they may not be able to bind normally to receptor sites. And when this happens it doesn’t get into the cells.

* Cortisol will also increase the production of reverse T3 (rT3) which is inactive.  (It’s kind of like the anti-hormone.)

* rT3 can cause an increase in the production of substances known as thyronamines that can cause hypothyroid symptoms (like, low basal body temperature,fatigue, depression, etc.) along with insulin resistance symptoms of increased blood sugar.

* Cortisol can also lower the levels of protein that binds to thyroid hormone so it can circulate in a stable structure.

* And finally, elevated cortisol will slow TSH production by messing with hypothalamic-pituitary feedback leading to lower TSH production.

So put down that frozen frappuccino hypothyroid drink and your thyroid will thank you!

Thyroid Replacement Hormone: The Wrong Obsession?

pills in blisterpack

This pill may not be the answer.

Some of the most common questions I receive via phone, email, Facebook, and yelled across the street concern thyroid replacement hormone.

The question usually goes something like, “Hey, what’s the best thyroid hormone?”

And like most things with Hashimoto’s, this is a super difficult, complicated question disguised as a simple one.

All I can do is mumble, “It depends”

Thyroid Replacement Hormone Often Doesn’t Help You Feel Better

In addition, the problem is that, in reality, many, many people don’t feel better after taking thyroid replacement hormone.

Or they feel better for a while, then they feel worse again.

And a lot of Hashimoto’s patients get fixated on this drug.

Some have to change to natural desiccated. Some are told they have to get on a synthetic. Others have to add T3 or only be on T3. Or they have to raise the dosage, then lower it, then change to something else.

And doctors also share this fixation because thyroid hormone is really important physiologically and for most, thyroid replacement hormone is the only tool in their tool box. And many refuse to budge from the myth that synthetic T4 is the only safe option.

So we wind up with dueling and intractable obsessions resulting in people being pissed off at their doctors, doctors refusing to prescribe anything except Synthroid or the generic equivalent and, unfortunately for the patient, little or no improvement in their hypothyroid symptoms.

There has got to be a better way.

In this post, we will look past this obsession and help break down and demystify thyroid replacement hormone.

Do You Really Need It At All?

The first question, and one that is controversial, is do you really need to be on thyroid replacement hormone?

This is an important question and, of course, the answer is….(wait for it)…it depends.

On what?

Really, it depends on how much thyroid function you have left.

Hashimoto’s is an autoimmune disease in which your immune system slowly destroys your thyroid.

If enough of your thyroid gets destroyed and it stops producing sufficient amounts of thyroid hormone, you can not be without replacement hormone. End of conversation.

On the other hand, if you do have enough thyroid function (and a lot of people do), then the problem may lie elsewhere.

You May Not Need It

Often the problem is an out of control immune system impacting thyroid function or problems with breakdowns in thyroid pathways that are causing the hypothyroidism.

It’s not the lack of thyroid replacement hormone.

If you focus on properly managing the autoimmune disease part of the equation and on properly evaluating and improving the pathways that make thyroid hormone work, then you may not need extra thyroid hormone at all.

(To complicate matters, once you start taking replacement hormone it impacts the amount of thyroid hormone your body is producing.

So if you have been on it for many years, chances are you may have compromised the thyroid’s ability to produce it alone.)

You Always Must Address the Autoimmunity

Even when thyroid hormone replacement is used, it is still very important to manage the autoimmune condition.

This will make the medication work better, slow the destruction of the thyroid gland, and prevent the progression of the autoimmune condition into attacks on other parts of the body like the brain, which comes in really handy, at times.

This is where we should really be fixated. Slowing or stopping the progression of the autoimmune part of this disease should be our obsession. (Ok, I admit it, it’s mine.)

Let’s Look At The Options

That being said, let’s take a look at what the options are and how you can make the best decision for you and your unique set of circumstances.

First there are 2 important factors to consider:

* Bio-identical versus Synthetic

* T3

Bio-identical Versus Synthetic

Bio-identical, as the name suggests, is more like what your body actually produces. The most popular of these are Armour or Nature-throid. The advantage to these is that we can actually test their levels in your system using laboratory testing other than TSH.

The disadvantage is that some people with Hashimoto’s will feel worse on these because their immune system can attack T3 and T4 because they actually have antibodies against them.

Unfortunately, we do not yet have laboratory tests available to test these antibodies.

The advantage of synthetic drugs like Synthroid and levothyroxine is that they are synthetic and the immune system will not attack them.

The disadvantage is that TSH is the only test to measure levels of these drugs and there are many reasons why TSH is an unreliable marker of thyroid hormone levels.

The criticism by doctors leveled against bio-identical hormones is that the dosage varies from batch to batch. A frequently perpetuated myth (from the marketers of Synthroid) is that the dosages and ratio of T4:T3 in Armour aren’t consistent.

That’s just not true, studies have shown otherwise. Armour contains a consistent dose of 38 mcg T4 and 9 mcg T3 in a ratio of 4.22:1. As does Nature-throid.

T3 to the Rescue

Many patient advocates and thyroid support groups sing the praises of T3. And for some, there is no question, T3 is the answer. For others, it’s a nightmare.

T3 is the active form of thyroid hormone, this is what has the greatest impact on our bodies. This is what gives you energy, gets the bowels moving, makes you feel happier and helps you think more clearly. For some this is what helps their hair grow better and their skin get that blood flow back into it.

These people may have trouble converting T4 to T3 because their cells develop thyroid hormone resistance.

On the other side of this are the people who get hyperthyroid with the addition of T3. Think anxiety, insomnia, palpitations, weirdness, a strong desire to vacation at the funny farm.

This is also the case with people who are not managing the autoimmune part of this disease. The attacks against the thyroid causes more thyroid hormone to be released into the bloodstream.

For these people, synthetic T4 might be the better choice along with a concerted focus on managing the causes of these inflammatory incidents (like eliminating gluten, dairy, soy, stress and environmental toxins).

2 Common Things Make You Feel Worse

There are also 2 important factors that can make you feel much worse on thyroid replacement hormone:

Fillers and Adrenal Issues.

Fillers: These are extra things added to the drugs by the manufacturers. Many popular thyroid medications contain common allergens such as cornstarch, lactose and, in some cases, even gluten.

Most Hashimoto’s patients have issues with gluten, and many of them also react to corn and dairy (which contains lactose).

Synthroid has both cornstarch and lactose as a filler. Cytomel, which is a popular synthetic T3 hormone, has modified food starch – which contains gluten – as a filler.

Even the natural porcine products like Armour use fillers. In 2008, the manufacturers of Armour reformulated the product, reducing the amount of dextrose & increasing the amount of methylcellulose in the filler.

This was great for some patients who were sensitive to dextrose and a disaster for others who were sensitive to the methylcellulose.

Nature-throid is considered the most hypo-allergenic of the bio-identicals.

The best choice may be to ask your doctor to have a compounding pharmacy fill the prescription using fillers you aren’t sensitive to. This can be more expensive and unfortunately, some insurance companies refuse to cover it.

Adrenal Issues: If you take Synthroid or even a bio-identical and feel so horrible on the drug that you just can’t continue taking it, one thing to check right away is your adrenals.

The warning label of Synthroid states explicity “Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.”

This can cause an acute adrenal crisis in the most extreme cases.

But even in less extreme cases, like those people who have adrenal fatigue and/or exhaustion, taking this drug can result in the patient feeling really lousy.

The adrenals should always be evaluated whenever a patient is prescribed thyroid replacement hormone. (Ideally, this should happen before it is prescribed. Good luck with that.)

Other Common Scenarios

Let’s take a look at some other common clinical situations and look at why these things happen.

Normal TSH, But Still Feel Like Crap

This is by far the most common scenario for people with Hashimoto’s. Chronic inflammation can prevent thyroid hormone from getting absorbed in to the cells of the body. This the root of autoimmune disease, but can also come from other things (like infections, surgery, obesity, overtraining, poor diet, etc.).

This can:

*Inhibit thyroid receptors on cells from responding to thyroid hormone.

*Prevent T4 from converting to T3.

*Interfere with the communication between the pituitary and the thyroid (and the adrenals).

Felt Better With Bio-Identical

Some people truly do feel better with bio-identicals. It’s not true of everyone but the addition of T3 can sometimes be the answer because these people:

*May need T3 due to problems with the thyroid hormone receptors on cells

* Were unable to convert T4 to T3 when using T4-only medication

*Had sensitivities to dyes or fillers in synthetic compounds that are not in bio-identical compounds

*Have receptor sites on cells that simply respond better to bio-identical than synthetic hormones

Did Better With T3 Only

As we have seen, some people improve with the addition of T3, while others do their best with T3 only. And these can be synthetic or bio-identical.

This can happen for a couple of reasons:

* Their receptor sites are resistant to thyroid hormone because of high cortisol, high homocysteine, inflammation, low progesterone, vitamin A deficiency and more.

* Difficulty in converting T4 to T3

Didn’t Feel Better With T3 or Bio-identical Hormones

In both cases, more T3 is introduced. These people often don’t have too little T3, they have an active and uncontrolled autoimmune process causing the release of thyroid hormone.

These are also the people who often vacillate from hyper to hypo. They have an immune flare up, more hormone is released and then they crash, it calms done and they are hypo again.

In some cases, these people can have excess adrenal hormones caused by too much nicotine, caffeine, stress or exercising too much.

Feel Better on Synthetic Hormones

Some people actually feel better on synthetic hormones. These can be people who are converting well, have an overactive metabolism and just don’t need more T3.

These are people who also really benefit from an approach that will calm the autoimmune attacks that cause their thyroid to be revved up in the first place.

Bottom Line:

In every single case described above addressing the underlying autoimmune process first will result in a better clinical outcome (you will feel better) because by reducing the inflammation which is the root of this problem you can:

Improve thyroid receptor site sensitivity

Prevent further destruction of the thyroid

Slow the progression of the autoimmune disease so it doesn’t spread to other parts of the body.

Once again, there are so many variables with Hashimoto’s. The best approach involves a full thyroid work-up and exam, followed by trial and error of different types of replacement medications.

Such a work-up includes more than just TSH, it also has a more complete thyroid panel (including antibodies), other important blood markers (glucose, lipids, CBC with diff, electrolytes, iron, etc.) and additional inflammatory markers like homocysteine, vitamin D, CRP, ferritin, etc.

A history must be taken with attention paid to the patient’s past responses to replacement hormones. With Hashimoto’s patients what a patient feels is clinically relevant and diagnostically important.

Unfortunately, this rarely happens in the conventional model, where the standard of care is to test only for TSH and, if you’re lucky T4.

If TSH is elevated, the patient will get whatever hormone that particular doctor or practitioner is fond of prescribing and that’s the end of it.

Then they are told, “Come back in 6 months to a year and get your TSH tested again. Buh bye.”

And all too often, as many of you know, this approach is doomed to failure. But there is a better way and we are practicing it here at Hashimoto’s Healing.

We offer a complete work up and we focus…, ok, I’ll say it…rather obsessively on reducing the inflammation at the root of this disease and at doing other things to calm, slow and prevent the advancement of autoimmunity to other parts of your body.

This is not just a thyroid problem and there is a lot at stake here. If we’re going to be obsessive, let’s obsess about the things that are at the root of the problem.

Want Someone To talk To About This?

I set aside time every week to talk to people with Hashimoto’s about what’s going on with them. In the last year, I have had over 500 of these conversations.

I offer a free 30 minute Hashimoto’s Healing Discovery Session.

In it you can share where you are and where you want to be, I can give you some advice that will help right away and we can discuss how else I may be able to get you feeling better.

If you want to talk with someone who gets it, someone who has been there and who has devoted his life to help people with Hashimoto’s, then I suggest you schedule a time to chat with me.

You might just learn something. Here’s the link to schedule.

References:

http://www.ncbi.nlm.nih.gov/pubmed/23072197 T3 to T4 ratios

http://www.womensinternational.com/pdf/thyroid_hormone_therapy_options.pdf T3 to T4 ratios

http://www.medscape.com/viewarticle/722086_1 Full on medical discussion

http://www.ncbi.nlm.nih.gov/pubmed/15767619 Interesting study on the difference additional T3 therapy makes

http://chriskresser.com/3-steps-to-choosing-the-right-thyroid-hormone

http://thyroidbook.com/blog/which-thyroid-hormone-is-right-for-you/

http://www.rxlist.com/synthroid-drug.htm

http://www.rxlist.com/armour-thyroid-drug.htm

http://www.rxlist.com/cytomel-drug.htm

http://www.nature-throid.com/what_is_nature_throid.php

http://tpauk.com/main/?page_id=1054 Argument against marketing propaganda

The Thyroid, A Fundamental and Clinical Text, Braverman and Utiger, 9th Edition, 2005

Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? Dr. Datis Kharrzian, Elephant Printing 2010

My Top 5 Clinical Pearls From This Last Year

smiledoc

Clinical Pearls From Working In The Trenches

Hey People!

Wow, it’s been a year since I launched my website and Facebook support group. SO MUCH HAS HAPPENED!

I am a big proponent of looking back at the data and the experiences and analyzing what we learned. And, hopefully, we can build from that and improve what we are trying to do.

And that is to help and educate people to heal their Hashimoto’s.

Over 500 Consultations with Hashimoto’s Patients

Over the course of this year, I have had over 500 consultations with people with this disease.

I’ve listened as people described their symptoms and their health histories and I’ve also taken a number of surveys and polls at our Facebook support group which has now reached 10,000 Likes.

I want to thank everyone who has joined us for their continued love and support! This is something we could not have achieved without you.

A PRACTICE NOT ANALYZED IS NOT WORTH LIVING

In this blog post I’m going to summarize the top 5 things that I think are really important (from a clinical and practical point of view) and I’ll share a few odds and ends that are just really interesting to me.

Top 5 Clinical Pearls

Here are my top 5 clinical pearls and a little discussion on each and why I believe it matters to you.

Pearl #1. The Majority Are Functionally Hypothyroid.

By far, the most common thing I have seen is that many, many people taking thyroid replacement hormone are functionally hypothyroid.

What does that mean?

Well, they are taking thyroid replacement hormone (and it doesn’t seem to matter whether it’s Synthroid, Armour, or Synthroid and Cytomel, or Naturethroid, etc.), their lab test results (usually this means TSH and if we’re lucky TSH and T4) are normal.

However, they have all the common hypothyroid symptoms: they are tired all the time, they are frequently depressed and/or they have anxiety, they have trouble losing weight, their hair is falling out, they have brain fog and memory issues, etc.

Since there is such a consistency of symptoms despite the thyroid replacement hormone, then you have to look at the possibility that the solution can be found in something other than thyroid replacement hormone.

Many people really focus on switching hormones or switching back or switching dosage up and down and for a few, the change works, for others it works for a little while and stops working and for the majority it doesn’t matter because it doesn’t work at all.

For some the addition of T3 can help tremendously, for others it helps for a little while and then stops working. And for others it doesn’t seem to help very much either.

So, if it’s not the thyroid replacement hormone, then what’s the problem?

The problem that I have seen repeatedly is that they are not converting and/or absorbing the replacement hormone.

One reason for this is that TSH is produced by the pituitary which absorbs thyroid hormone differently than the rest of cells in the body.

The pituitary can register thyroid hormone levels when the rest of the body is resistant or just not absorbing it.

There are lots of other reasons why this can happen, but the most important thing to understand is that it’s not always the choice of thyroid hormone, it’s a problem somewhere along the process of getting that hormone into the cells of your body.

What this means is that this becomes a systemic problem and trying to solve that kind of problem by just adding more thyroid hormone is like trying to fix global warming by driving a hybrid.

It might help a little, but there’s a whole lot more that needs to be done.

For example, I worked with one woman who as taking both Levothyroxine and Cytomel. She had the exact symptoms described above. Normal TSH and T4 and all the hypothyroid symptoms I described.

After doing a compete panel we discovered that she had high cholesterol, LDL and triglycerides (because she was functionally hypothyroid) and she wasn’t converting or absorbing well.

We focused on cleaning up her diet, giving her targeted nutrition to help her liver and we worked on improving conversion. She contacted me a month later in total disbelief because her cholesterol had dropped by a little more than 50 points and she noticed that she had a lot more energy.

No cholesterol medication, no changes in thyroid replacement hormone. We just made everything work better and this caused her liver to convert more efficiently. In addition, the changes to her diet help reduce the systemic inflammation and this allowed her cells to better absorb thyroid hormone.

Check out this post on T4 that goes into detail about what is happening here.

Pearl #2. Diet Is The Foundation and Key to Success

This is really a “no brainer”, but I am continually surprised at how many people refuse to accept this or want to negotiate a kinder, gentler half way approach that doesn’t involve them changing their diet and, of course, their lives.

Hashimoto’s is an autoimmune disease and that means that your immune system is attacking your your own tissue. Tissue attack and destruction is induced by immune system stimulation.

Where is your immune system? An estimated 70% lives in your digestive tract. So everything that passes through there interacts with your immune system.

Also, there is a lot of research evidence that shows a clear link between “leaky gut” or intestinal permeability and autoimmune disease.

The breakdown of your intestines is a breakdown in the barrier to your immune system and this clearly is a factor in the initiation of autoimmune disease, but it is also an important factor in people’s symptoms because if this is not addressed you have constant immune stimulation and constant tissue attack.

My advice is always get off of gluten, dairy and soy 100% and for many, because of the state of their intestines, this is not enough. They need to do more. For them we recommend a version of the Paleo diet designed for autoimmune disease and Hashimoto’s, in particular.

I have gotten messages on Facebook and emails from at least a dozen different women who have credited this change alone with completely transforming their lives.

If you’re on the fence about your diet, you’re just prolonging your misery needlessly. It’s such a simple part of the solution.

Pearl #3. Blood Sugar Imbalances Can Stop the Whole Train

This is another common area of dysfunction that is often overlooked. However, in my experience and in the experience of many of my colleagues (including my teacher and mentor, Dr. Datis Kharrazian,) this is one of the first steps that needs to be taken.

There are a couple of different types of blood sugar dysfunction. Hypoglycemia, which means your fasting glucose is generally too low and Insulin Resistance, which can be a whole combination of symptoms but is generally brought on by too much sugar in the diet.

And, in reality, lots of people have a mix of both.

The reason this can wreck the whole show is because of the impact of sugar fluctuations on the entire endocrine system.

Blood sugar and insulin spikes impacts cortisol and thyroid hormone levels. This creates a vicious cycle that impacts the pancreas and the pituitary and winds up driving you down.

And to add insult to injury, many people use sugar to get energy to overcome their fatigue.

This is like smoking cigarettes to help your asthma, it does way more harm than good.

For example, I worked with a woman who really had supplement fatigue. She had been put on so many different things that she had spent what amounted to a small fortune on supplements.

She sent me two full pages of things she had been prescribed. This was giving her very expensive urine, but wasn’t helping her feel a whole lot better.

The one thing that no one had told her was that she needed to balance her blood sugar. She had what amounted to a pretty serious case of insulin resistance. She had really bad fatigue, brain fog and memory issues and depression. She just felt like she had lost her life.

One of the main reasons that she had developed this was that her fatigue was so oppressive that sugar was the thing she relied on to get her through the day. Well, what she didn’t realize was that this was intensifying the fatigue and actually making her feel worse and worse.

So we focused on normalizing her blood sugar by getting her to stop the sugar habit and start using protein and good fats and by giving her targeted nutrition that helped to improve insulin receptor sensitivity.

And lo and behold, she felt like a new person. That was the one missing link for her. It restored her energy, it improved her brain fog and memory issues, it helped her to start feeling like her old self again.

Check out this post to get an in depth look at what happens with blood sugar issues.

Pearl #4. Adrenal Problems Can Trump Thyroid Issues

The next area that is really crucial to evaluate and treat, if necessary, is the adrenals.

There are various stages of adrenal issues from adrenal fatigue to exhaustion and if your adrenals are compromised it can dramatically impact the way you feel when you take thyroid replacement hormone.

In fact, the warning label for Synthroid reads:

“Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.

Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone.”

What this means, in plain English, is that in cases of hypothyroidism, the adrenals need to be evaluated before putting patients on thyroid replacement hormone.

How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency?

I put this question to my Facebook support group and 100% of the 85 respondents with Hashimoto’s said they had most of the symptoms of adrenal insufficiency such as:

* Fatigue, also a thyroid symptom

* Headaches, splitting headaches especially

* Decreased immunity

* Sleep issues. Difficulty falling asleep, staying asleep and waking up feeling exhausted even after you had enough sleep.

* Mood swings

* Sugar and caffeine cravings, (have a hankering for a Red Bull? It could be your adrenals)

* Irritability or lightheadedness between meals, a blood sugar and adrenal problem

* Eating to relieve fatigue, another blood sugar problem

* Dizziness when moving from sitting or lying to standing, it affects your blood pressure

* Gastric ulcers, ulcers in the stomach can be caused by the adrenals

Granted, that’s not a scientific study, but it certainly is emblematic of this problem.

Unfortunately, many doctors dismiss adrenal insufficiency as one of those make believe disorders. It’s not make believe at all, it’s very real.

For example, I had a patient who had developed Hashimoto’s after having a baby. She was diagnosed after lab tests revealed antibodies above the normal range and elevated TSH.  Her doctor immediately put her on Synthroid.

She had a terrible reaction and felt so sick that she literally could not continue with the drug. The doctor dismissed this reaction and insisted that she get back on the drug.

She dismissed her doctor and eventually found me. We did a number of different things including getting her on the autoimmune diet, cleaning up her liver and we worked on restoring her adrenals and helping her body adapt to stress.

After three moths of following this protocol she went back to her doctor and asked him to reorder the tests. He grudgingly did saying there wouldn’t be any change he was sure of it.

The lab test all came back normal, TSH was within normal range and the antibodies were undetectable. Naturally, she felt vindicated and was overjoyed.

This doesn’t happen with everyone, but this was a perfect example of a case that illustrates this point.

Here’s a post I wrote that goes into the adrenal thyroid connection in much greater detail.

Pearl #5. Remission is Our Mission,

But It’s Impossible If You Don’t Go All In

I think my last important observation is one that I had to learn myself the hard way. I struggled for years before I was diagnosed with Hashimoto’s.

Largely because I didn’t really know what was happening, I kept making excuses for not fully committing to what I have now come to call the Hashimoto’s lifestyle.

Once I got diagnosed and got obsessed with learning about this disease and seeing the damage it can cause in people’s bodies, I started to realize what was at stake and went all in.

After that, things really started to turn around for me in a big way. And I have seen the exact same thing in many, many people I have worked with.

Those that aren’t successful in getting this under control are usually the ones who are unwilling to give up certain things in their lives in order to save their health.

These include stressful jobs and relationships that are repeatedly causing flare ups of their condition. Foods like gluten, dairy and soy that are in virtually every processed and fast food. (You can’t eat like the average American if you have Hashimoto’s, you just can’t).

In addition, you really need to understand that this becomes a systemic problem over time. It progresses into other systems of the body and these can include the liver, the stomach, the gall bladder, the intestines, the cardiovascular system, the brain and nervous system, the muscles and joints and more.

And sometimes you need to go through every system and evaluate it and fix what’s not working.

So you have to go all in. You have adopt a lifestyle that includes diet, includes eliminating triggers like stress and toxic (chemical and emotional) situations.

You know, I was the co-owner of large and lucrative medical practice which it took me 2 years to close. I was so stressed out running that place that it totally fired up my autoimmunity.

I am now a couple of years into an entirely new life and this life is richer, happier and it has far less stress in it.

Plus, I really love what I do. Honestly, I believe that my higher power has a plan for me and that is to help people with Hashimoto’s.

That’s why I’ve gone all in and have devoted both my personal and professional life to bringing hope, help and healing to people who suffer from Hashimoto’s.

Odds And Ends

These were some interesting observations I have made:

1. More than 80% of the people I worked with had Mono and were exposed to the Epstein Barr Virus.

Clearly this virus is somehow involved in Hashimoto’s. How? The research is far from definitive. Theories include activation of NF Kappa Beta, activation of rouge B cells and proteins like IL-8.

This is an area I intend to explore in much greater depth this year.

2. The most common symptom is fatigue.

Of all the many potential symptoms of Hashimoto’s fatigue is by far Public Enemy #1. And fatigue is often brain based which means it is the result of neurodegeneration caused by hypothyroidism and autoimmunity in the brain. Read more about this here.

3. The disease is progressive. My teacher and mentor, Dr. Datis Kharrazian and others have identified 3 stages. Read this post to learn more about this.

4. Many people have more than one autoimmune disease or at the very least antibodies to other tissues.

One of the most common places for these additional antibodies is to brain tissue, especially cerebellar tissue.

A lot of people don’t understand this and they just dismiss cognitive issues as “aging”. Well, with Hashimoto’s your brain is at serious risk of degenerating rapidly. This is something that really needs to be taken seriously.

Read this post to learn more.

Well, that’s all for now. I can’t wait to see what this next year will bring!

And if you’re not aware of it, I offer a free 30 minute Hashimoto’s Healing Discovery Session. In it you can share your story with me. Tell me where you are and where you want to be.

I’ll make some recommendations that I think will help right away and we can discuss how else I might be able to help.

I set aside time every week to talk with people who have Hashimoto’s and I’d love to talk to you.

You can schedule a free session by clicking here.

Hashimoto’s Health Tip: The Best Kind of Exercise

Exercise

With Hashimoto’s: How Much Is Too Much?

People often ask me about exercise. What’s the best kind of exercise for Hashimoto’s?

2 Kinds of Exercise

There are 2 types and both can be beneficial. But the real key is not to overdo it. If you do too much you defeat the purpose of exercise and you wind up doing more harm than good.

The first type is simple and slow.

Walking, slow jogging, slow cycling or other exercises like yoga, tai chi or qigong that involve endurance can support your adrenals. This type of exercise can decrease cortisol, help with blood flow and circulation and normalize blood pressure.

Something like this should be part of your routine a few times a week.

The second type involves high intensity for short duration. This should also be part of the mix.

According to research, the optimal exercise level to achieve all the health benefits described above is high intensity: when doing this you will:

* Break a sweat after 3-5 minutes

* Breathe deeply and rapidly

* Only talk in short phrases while you are doing this.

You want to go hard enough to achieve 70% or greater of your maximum heart rate. This can be calculated by this simple equation: 220 – your age in years = your maximum heart rate.

Fine Line Between Just Right and Too Much

There is a fine line between the right amount of exercise which can really improve health and too much which can actually cause more health problems.

The key point is this: The more intense the exercise, the greater the potential for health benefits that include everything mentioned above, but also the greater risk of doing too much and this results in the loss of all those benefits.

This is especially true if you suffer from an autoimmune disease like Hashimoto’s because you may not be able to exercise like a normal person and you may reach the threshold of maximum benefit sooner than people who do not have this condition.

Start Slow and Build

So the best thing to do is to start slow and gradually build. And the objective is not to “feel the burn” or “pain is gain”. You are in enough pain. The object is to feel better, feel energized and feel the beneficial effects of exercise. If you are wiped out after your workout, you’ve gone too far.

Start small and only increase when you feel like what you are doing is physically not demanding enough. A high intensity workout can be beneficial if you doing as little as 5 minutes per day. Err on the side of too little, if you’re not sure.

Here’s a longer blog post that really goes into detail and provides a great 7 minute high intensity work out. Check it out and try it!

 

Today’s Hashimoment: Don’t Lose Sight of the Forest

cut tree

Don’t loose sight of the forest because of the big trees.

With Hashimoto’s, its easy to lose sight of the forest for the trees. And some of the trees can feel like redwoods that take a lot of time and effort to deal with.

You work on your thyroid, then you have to deal with digestive problems. You clean up the diet, then you have to fix the adrenals. You work on the adrenals and then you have work on your liver and gall bladder, then you have to deal with stress and all the emotional issues.

Jeez Louise! When will it ever be over?

I think we all know the answer. If you focus on this process as being a destination, you will be continually frustrated because you will never arrive. There is no destination.

A better way to look at this is that this is a journey. And that journey involves a committed approach to developing a lifestyle that leads you towards healing. We are in this for the long haul.

It gets better, at first it’s all bad days. Then, when we accept that this is more than a thyroid issue and we start seeing and working on healing the whole forest, we start to have some good days.

Once we deal with a few problem trees, we start to realize they aren’t as huge as we had feared and then we start having more good days than bad ones. But the reality is, we’re going of have to revisit some of those things again as things progress.

So don’t be discouraged that you haven’t arrived at the destination yet. Enjoy the journey! There’s a lot to appreciate about simplifying your life and discarding old things that weren’t good for you in the first place.

It’s a beautiful forest, full of beautiful trees. I know some days it doesn’t seem that way, but it really is.

Thoughts, comments?

 

Hashimoto’s Health Tip: Immune Cells & TSH

Antibodies

Immune Cells Directly Impact the Thyroid

Hey people! Today’s post in about how the immune system and the thyroid interact.

In researching this week’s content I stumbled on something fascinating that I just have to share with you.

Did you know that the immune system actively modulates thyroid hormone levels and TSH?And I do not mean indirectly, I mean directly.

Immune Cells Produce TSH

Check this out! TSH is not only produced in the pituitary. 20 years ago, it was discovered by researchers that immune cells actually produce TSH.

Where? In the bone marrow where immune cells are born, by white blood cells and also in the intestines, when exposed to a virus, or when exposed to bacterial toxins like lipopolysaccharide (LPS), which can end up in the blood stream when you have leaky gut or intestinal permeability issues.

Bacteria Increases Conversion of T4 to T3

LPS exposure also increases conversion of T4 to T3 causing a local surge of T3. This in can result in a lower output of thyroid hormone.

And 2 immune proteins, IL-18 and IL-12, both of which have been implicated as proteins that may make flare ups and inflammation worse with Hashimoto’s also produce TSH.

Case In Point

I was working with someone the other day, who is a perfect example of this.

Her lab tests say her TSH is too high, yet she is having all these hyper symptoms (she should be hypo). Anxiety, palpitations, mood swings, she’s going nuts.

One possible explanation? She isn’t gluten or dairy free. She has some gluten and dairy, it causes a massive immune response in her intestines, maybe she’s exposed to a bovine virus or viral fragments, these immune cells produce TSH. It looks high because of this, but she’s functionally hyperthyroid because the immune system has overcompensated.

It Works Both Ways

And this works both ways, a hypothyroid state creates impaired immune function. There is still a lot that is not known about this, but one of the theories is that immune cells produce this local surge of T3 and this causes a systemic decline in TRH and TSH production.

One theory on this is that in times of infection and immune induced inflammation (which autoimmune disease is a chronic state of) the immune system shuts down thyroid function and then at some point kicks it back in again.

Communication Is Out of Whack

Well, with Hashimoto’s, this endocrine-immune communication is out of whack. The immune system may not be able to kick things in again. Or may not know when the “infection” is over due to chronic inflammation and tissue attack. The antigen is the tissue of the body. The fight never stops, you understand what I’m saying?

So the immune system is actively throwing the body’s thyroid hormone levels out of whack trying to keep the body in a lower metabolic state so that it can recover from this infection. But there may be a chronic state of infection, or ongoing chronic infections in the body.

Food for thought. Heal your gut. Address chronic infections. This is not just a thyroid problem!

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768616/

Today’s Hashimoment: Have Faith!

There will be times,

When even though you are doing all the right things: eating right, exercising, meditating, dealing with stress, etc.

That you will still have set backs.

And some of these set backs may seem like they bring you right back to zero.

But, I can tell you from experience with working with many people that often:

The biggest implosions happen before the biggest insights.

The biggest defeats come before the biggest victories.

As one of my teachers, Jesse Koren, says, the biggest breakdowns happen before the biggest breakthroughs.

The worst doubts come before the miracle.

So, it comes down to believing.

Have faith, it will be rewarded.

Man holding faith word

Have faith.

The Truth About Acid (Stomach Acid, People!)

stomach acid

The truth hurts

In this post we’re going to break down the stomach, stomach acid, and, of course, it’s relationship to the thyroid and Hashimoto’s.

The Stomach Breaks It Down

What does the stomach do?

It’s role is really to take food that has been chewed (hopefully well) and mixed with saliva and to break it down.

Break it down! Like James Brown!

Actually, Stomach Acid Breaks It Down

Break it down, stomach! Do the mashed potato. Ok, what breaks all this food down?

Hydrochloric acid. This is vitally important for breaking down vitamins, minerals (like iron) and vital nutrients so that they can be absorbed by your small intestine.

Don’t Believe the Hype

A lot of people, misled by advertising, think that stomach acid is bad. 2 of the top 10 most prescribed drugs in the US are Nexium and Prevacid.

These are designed to block the production of stomach acid and are called proton pump inhibitors.

These proton pump inhibitors work by completely blocking the production of stomach acid. They do this by inhibiting (shutting down) a system in the stomach known as the proton pump.

Because we don’t need that.

No, actually, it’s hugely important.

Stomach Acid Is There For A Reason

Having enough stomach acid prevents food poisoning, parasites and other critters from taking over your digestive tract.

Enough hydrochloric acid also stimulates gall bladder and pancreas function to complete digestion and keep everybody in the digestive tract happy, happy, happy.

Proton Pump Inhibitors – Unintended Consequences

Proton pump inhibitors also affect thyroid hormone absorption and a study from Endocrinology Practice, the official journal of the Endocrine Society of America found their impact is so significant that patients taking these drugs and thyroid hormone may need to adjust their dosage.

What I’m saying is you actually do need hydrochloric acid or HCL and it’s production depends on the hormone gastrin.

And guess what else has an impact on gastrin? Thyroid hormone.

So hypothyroidism causes less gastrin to be produced, which leads to lower amounts of hydrochloric acid which, in turn leads to heartburn, bloating, gas and..wait for it…….!

Did You Say Heartburn?

Why, yes I did.

But didn’t you also say too little hydrochloric acid?

Why, yes I did.

Let me explain…mechanisms, people. It’s how things work.

It turns out,  having enough stomach acid actually prevents heartburn by helping to thoroughly digest your food.

acid reflux

The burning is felt in the lower esophagus.

The burning sensation that people feel from heartburn is actually from the poorly digested food rotting in your gut and shooting up into your esophagus, where there is no protection from the acid.

Even a small amount of acid will cause problems there.

In an editorial published in the journal Gastroenterology first published online in 2009, the author remarked:

Treating gastroesophageal reflux disease with profound acid inhibition (which the popular drugs are) will never be ideal because acid secretion is not the primary underlying defect.

You see, there is the truth rearing it’s ugly little head. Another study referenced below suggests the actual cause of GERD is pressure on the abdomen (often made worse by weight gain and obesity) not too much acid.

What’s Going On Here?

For decades the medical establishment has been directing its attention at how to reduce stomach acid secretion in people suffering from heartburn and GERD, even though it’s well-known that these conditions are not caused by excess stomach acid.

Advertising, people. Great for making money, not so good for healing.

Say It Loud! I’m HCL and I’m Proud!

Another thing that HCL is important for is the absorption of vital nutrients like B12, iron, and calcium and for breaking down and absorbing protein.

Too little HCL can also lead to inflammation, lesions and infections in the intestines.

All of that leads to poor absorption of thyroid hormone, leading to…this one is a gimmee….(yup, you guessed it) normal lab tests but hypothyroid symptoms.

2 Things Happen When You Have too Little Stomach Acid

With too little stomach acid, also called hypochlorhydria, 2 important factors lead to GERD and acid reflux.

The first is bacterial overgrowth. Stomach acid acts like the police of the digestive tract. It keeps the riff raff out. When you don’t have enough you can get overgrowth of bacterial species that cause problems like copious amounts of gas. (Whew!)

The second problem that too little stomach acid causes is that it can lead to poor digestion, especially of carbohydrates. And these 2 problems feed each other because these problem bacteria really like to feed on carbohydrates.

So you wind with yet another vicious cycle.

This is also why people with acid reflux often feel better after going off of gluten (and other carbs). You stop feeding the problem.

Let’s Ask Some People With Stomach Problems and Hashimoto’s

I am very fortunate to have a robust community of Hashimoto’s folks at our Facebook support group.

I asked them how many of them experienced symptoms of acid reflux or GERD. And of the 75 respondents, virtually all of them had symptoms related to issues involving stomach acid.

Here’s a chart that illustrates their symptoms.

3 Symptoms of Acid Reflux – SURVEY TABULATION – January 13 2

And a second chart that looks at what helped.

3 Symptoms of Acid Reflux – SURVEY TABULATION – January 13 4

While this is hardly a scientific study, it is emblematic of how common these problems are among this population. Notice how many people improved by going off of gluten and wheat and/or going Paleo. All approaches that limited the number of carbs. Also notice how many are on proton pump inhibitors.

More Problems From Too Little Stomach Acid

Too little stomach acid also leads to anemia because you can’t absorb B12, and you can’t properly absorb iron.

Couple this with heavy bleeding during your cycle which can also be caused by too little thyroid hormone (more on that in an upcoming post) and you have a recipe for iron deficiency anemia.

Let’s Review

The stomach is important for breaking down and digesting foods and for allowing the body to absorb important vitamins, minerals and protein.

Too little stomach acid can lead to a host of problems: like heartburn (counter-intuitive but true), anemia, iron and protein deficiency.

All of this creates a vicious cycle of less conversion and utilization of thyroid hormone and lower stomach acid. Not good.

What Should I Do?

So glad you asked.

Let’s use logic, even though it can be counter intuitive. If you have too little stomach acid and this is the cause of the problem then….yup, that’s right, do something to increase the stomach acid when you eat.

Some simple natural solutions include:

* Going gluten free or Paleo (to cut out the carbs)

* Apple cider vinegar (to increase stomach acid)

*Lemon or Lime juice in some water (to increase stomach acid)

*Fresh Ginger or ginger tea (to increase stomach acid secretion)

*HCL supplements (to boost HCL levels)

How much really depends on how bad you’ve got it and on whether or not there are other things going on. And all the things that increase stomach acid should be done with your meal, not on an empty stomach.

Other Complications

H. Pylori

There are some other things that can make resolving this more difficult. One of the most common is the bacteria Heliobactor Pylori also known as H. Pylori.

This little critter can take over when there is not enough stomach acid in your stomach. So be sure to test for it to rule it out if you have these symptoms.

Alkaline Water

This stuff is often marketed as the answer. “Cancer can’t grow in an alkaline environment.”

Here’s the thing. Different parts of your body have different acid and alkaline requirements. Your stomach needs to be acidic.

When you drink lots of alkaline water, especially if it’s with your meal, you may wind up causing everything I have just described.

Don’t believe the hype, acid ain’t all bad.

Bottom Line:

Once again we see how there is an explanation for what’s gong on and the conventional medical approach or the multi-marketed hype, while profitable, is actually counterproductive to healing.

I envision a day, sometime in the future when medicine actually becomes about healing and resolving people’s issues.

Wait! It’s here… at Hashimoto’s Healing where we provide hope, help and healing for Hashimoto’s and the varied ways that it wreaks havoc on our bodies. For example check out my program The 5 Elements of Thyroid Health.

Please, please, please! Give your body a chance to heal by learning the truth. Question the drug companies and the marketers who are talkin’ loud and sayin’ nothin’.

(I will give a free 30 minute consultation to anyone who can identify the numerous allusions to James Brown songs and/or dances that I have in this post.)

References:

http://www.natap.org/2009/HIV/070409_02.htm :Article on how proton pump inhibitors actually cause the problem they are supposed to fix

http://www.gastrojournal.org/article/S0016-5085(07)01843-4/preview : The real cause of GERD

http://www.ncbi.nlm.nih.gov/pubmed/9079271 : Study showing how antibiotics can improve gastric reflux

http://www.ncbi.nlm.nih.gov/pubmed/16871438 : An interesting study showing that a low carb diet improves acid reflux

http://www.ncbi.nlm.nih.gov/pubmed/17669709 : Study showing how proton pump inhibitors affect thyroid hormone absorption

The Thyroid, A Fundamental and Clinical Text, Ninth Edition. Lewis E. Braverman and Robert D. Utiger 2005

Hashimoto’s Health Tip: Blood Sugar Vicious Cycle

Hey, People!

Big boy with a big drink

Hypothyroidism and Blood Sugar Problems Go Together Like a Big Boy and A Big Gulp

This week’s tip involves blood sugar issues and Hashimoto’s. This is one of those vicious cycles where one thing leads to another and together they make a downward spiral.

Welcome to the Blood Sugar Vicious Cycle

Did you know that both high blood sugar and low blood sugar levels can make your Hashimoto’s worse?

On average, Americans hammer about 200 pounds of sugar a year, and diabetes is a serious threat to bankrupt our healthcare system in the next 20 years.

Well, diabetes doesn’t happen overnight, it’s progressive. And often that progression passes through something called metabolic syndrome and insulin resistance on its way to diabetes.

Metabolic Syndrome

According to Chris Kresser, L.Ac., Metabolic Syndrome is defined as a group of bad things appearing together, including:

▪ abdominal fat; “the muffin top”

▪ high cholesterol and triglycerides (caused by sugar being stored as fat in the liver)

▪ high blood pressure (caused by plaque build up in the arteries that comes from excess sugar and cholesterol)

▪ insulin resistance

▪ tendency to have blood clots (because sugar makes the blood more prone to clotting)

▪ our good friend, inflammation (the root of all evil – well, at least the root of autoimmune diseases like Hashimoto’s)

Metabolic syndrome is caused by a chronic state of too much sugar in the blood.This is caused by eating too many carbohydrates.

Hammering Too Many Carbs Disease

So really, metabolic syndrome could be called “hammering too many carbs disease”.

Because that’s what it is.

When you eat too many carbs, the pancreas secretes insulin to move extra glucose from the blood into the cells where glucose is used to produce energy.

But over time, the cells lose the ability to respond to insulin. It’s like insulin is knocking on the door, but the cells won’t let it in.

“I hear you knocking but you can’t come in.”

The pancreas responds by pumping out even more insulin (knocking louder, “Please, let me in!”) in an effort to get glucose into the cells, and this eventually insulin receptors get tired of it all and this leads to insulin resistance.

Insulin resistance Leads to Destruction of The Thyroid Gland

Studies have shown that the repeated insulin spikes that come with insulin resistance increase the destruction of the thyroid gland in people with autoimmune thyroid disease. Read all about them in this detailed post on blood sugar.

Let me repeat that, insulin resistance increases the destruction of the thyroid gland in autoimmune thyroid disease (Hashimoto’s).

As the thyroid gland is destroyed, what happens? Less thyroid hormones are made by the thyroid and you get all the hypothyroid symptoms like fatigue, weight gain, brain fog, depression, joint pain, hair loss and on and on.

Hypoglycemia Not So Good Either

Low blood sugar or hypoglycemia can also cause problems with the thyroid.

Your body sees low blood sugar as a threat because severe or long term hypoglycemia can cause seizures, coma, and death. Not good things.

When your blood sugar levels drop below normal, your adrenal glands respond by secreting cortisol. Cortisol then tells the liver to make more glucose, bringing blood sugar levels back to normal.

The problem is that cortisol is involved in the “flight or fight” response. This response includes speeding up your heart rate and lung action, increasing blood flow to the muscles to get us ready to fight or to scream and run for the hills.

Cortisol’s job is to increase the amount of glucose available to the brain, help with healing, and to slow down certain things – like digestion, growth and reproduction – that aren’t so important when we were running from hungry lions on the African Savannah (flight).

Unfortunately for hypoglycemics, repeated cortisol release caused by episodes of low blood sugar makes the pituitary gland not work as well.

The pituitary is in charge of the thyroid and when it isn’t working properly, this can cause problems with the thyroid.

So either too much or too little sugar can mess with thyroid function and cause problems.

Hypothyroidism Leads To Hypoglycemia

And, check this out. Hypo-function of the thyroid can cause everything we just talked about because:

▪ it slows the rate of glucose uptake by cells;

▪ it decreases rate of glucose absorption in the gut;

▪ it slows response of insulin to elevated blood sugar; and,

▪ it slows the clearance of insulin from the blood.

These mechanisms present clinically as hypoglycemia. When you’re hypothyroid, your cells aren’t very sensitive to glucose.

So although you may have normal levels of glucose in your blood, you’ll have the symptoms of hypoglycemia (fatigue, headache, hunger, irritability, etc.).

And since your cells aren’t getting the glucose they need, your adrenals will release cortisol to increase the amount of glucose available to them.

This causes a chronic stress response, as described above, that suppresses thyroid function.

Its a Vicious Cycle

A vicious cycle. If you want to heal your Hashimoto’s, you need to deal with blood sugar issues. And that means dealing with your sugar habit.

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