What?
This week we are looking into the earth element which involves the spleen and pancreas and how this relates to thyroid and autoimmune disease.
A new study in the news this week has found that drinking soda and other sweet beverages (2 or more per day) doubles the risk for getting diabetes regardless of whether or not it is an artificial sweetener or not.
This was a case-control study within a population-based Swedish cohort study that aimed to see whether consumption of sweetened drinks was associated with risk of a lesser known form of diabetes called latent autoimmune diabetes in adults (LADA).
LADA is sometimes called Type 1.5 diabetes because has features of both type 1 diabetes, where the body’s own immune cells destroy the insulin-producing cells in the pancreas and type 2 diabetes, which usually develops later in life and is most commonly caused by eating too much sugar.
But unlike type 1 diabetes, which normally develops in childhood, in LADA the cell destruction is much slower.
Also, the condition often develops later in life and shares many features with type 2 diabetes. For example, the person doesn’t always need treatment with insulin straight away. This study reports that in the Swedish diabetes registry, LADA accounts for 5% of all cases.
Data was available for 1,136 people with type 2 diabetes, 357 people with LADA, and 1,371 diabetes-free controls.
Average age was 59 for people with LADA and controls, and 68 for those with type 2 diabetes.
Just under two-thirds of all people reported consuming sweetened (including artificially sweetened) drinks.
In general they found that consumption of sweetened drinks was linked with higher body mass index (BMI) and other poor lifestyle factors like smoking, low physical activity and consumption of processed meat and sugary foods. (Birds of a feather flock together, as do unhealthy habits.)
One problem with the study is that, as you can see, there are many other potential factors that could also lead to poor health and the development of diabetes, so it’s hard to say it’s just soda and other sweet beverages, though these are certainly very high in sugar.
How does this relate to Hashimoto’s?
There are few interesting links between these two diseases.
Firstly, as we noted in a previous post, when you have one autoimmune disease there is a higher risk of developing others.
What’s interesting is that insulin resistance has been found to increase destruction of the thyroid in thyroid autoimmunity, and it can also clearly be a trigger for Hashimoto’s.
These don’t usually develop at the same time and often take years to progress, just like other autoimmune diseases.
In one study of autoimmune polyendocrine diseases it was found that type I diabetes manifested first in half the cases and autoimmune thyroid disease manifested first in 17% of the cases.
And the most common combination was type I diabetes and autoimmune thyroid disease at 33%.
So, it’s another reminder of how important sugar balance and sugar control is for people with Hashimoto’s.
We explore this idea in depth in this post.
Something else that is really fascinating is that candida is also a common denominator in many autoimmune polyendocrine disorders.
What does candida thrive on?
Sugar.
Adding another layer of reasons why sugar should be taken seriously. It can not only lead to more autoimmunity, it can also lead to secondary conditions that are both causes of the disease and hindrnaces to getting better.
Finally, I think what’s also an interesting revelation from this is that there is a kind of myth that diet soda is a safer alternative.
Well, various research reviews and a case study have found this not to be true.
In fact, here’s one case study that showed dramatic improvement in Hashimoto’s symptoms when the patient stopped drinking diet soda.
BOTTOM LINE IS THIS
Excessive sugar consumption (and this includes artificial sugar substitutes) is a potential threat not just for Type II Diabetes or LADA, but also for autoimmune thyroid and polyendocrine thyroid diseases.
It can also foster secondary infections like candida and SIBO (Small Intestine Bascterial Overgrowth).
Treat sugar like the potentially dangerous substance that it is.
References:
https://www.ncbi.nlm.nih.gov/pubmed/15182509 LADA and Thyroid autoimmunity
http://www.eje-online.org/content/175/6/605.abstract?sid=93eb363b-97d3-4f35-92cd-11e7c2ed5ee4 sweet
beverage consumption and LADA
http://www.medicalnewstoday.com/articles/313612.php Diabetes risk doubled with soda consumption-diet doesn’t change anything
https://www.ncbi.nlm.nih.gov/pubmed/18800291 Sucralose alters microbiome
https://www.ncbi.nlm.nih.gov/pubmed/20693348 Previous research on soda and type 2 diabetes
http://media.aace.com/press-release/cause-and-effect-case-report-shows-association-between-sugar-substitutes-and-common-th Case study on artificial sweeteners and Hashimoto’s
https://www.sav.sk/journals/endo/full/er0301e.pdf LADA and Autoimmune Thyroiditis
http://www.diabetesforecast.org/2010/may/the-other-diabetes-lada-or-type-1-5.html?referrer=https://www.google.com/ LADA or Type 1.5 diabetes
http://www.diabetesselfmanagement.com/diabetes-resources/definitions/type-1-5-diabetes/ More on LADA
A new study published in the Journal of Thyroid Research explores the difference between the theory of T4 (thyroxine) and TSH (thyroid stimulating hormone) interactions and the actual data found in populations.
The conclusion of researchers is that “The population curve is consistent with the physiological studies of the TSH response to T4 and implies a greater interindividual variation in the positive thyroid T4 response to TSH than in the central inhibitory TSH response to T4.”
In other words, TSH responds to T4 therapy, but there is greater variation between individuals’ response to how TSH affects T4 levels than to how TSH is affected by T4 (More T4 is supposed to make TSH levels go down).
This is a really important finding and something I have written about on several occasions.
This matters because so many doctors determine everything they do on lab results and the most common lab tests, by far, that are ordered are TSH and T4.
And what this study tells us is that this is not always the best way to practice because everyone is not the same and everyone does not respond the same way to T4 only treatment.
Let me explain how this all works in your body.
TSH is thyroid stimulating hormone. This is released by the pituitary gland to stimulate the thyroid so that more thyroid peroxidase (an enzyme) is made.
This enzyme combines with iodine to make thyroid hormone, T4 and T3. About 97% is T4 and 3% is T3.
The body can’t really use T4, so it has to convert this into T3 which is the form that the cells of the body can use to do stuff. 60% of T4 is converted by cells in the liver, another 20% by cells in the gut and the remaining 20 or so % is converted by cells in the peripheral tissues of the body (muscles, fat, etc.)
And this is the basic premise of thyroid replacement hormones like Synthroid. It’s synthetic T4. The theory is that you just give it to the patient and tell them to call you in 6 months. An everything should be hunky dory.
(Only in real life, it sometimes isn’t. Here’s a detailed post I wrote on this.)
And the reason it doesn’t work is that thyroid hormone must be converted from T4 into T3 in order for the body to utilize it. This conversion happens differently in different parts of the body.
The problem with TSH only testing to determine thyroid hormone levels in the entire body is that the pituitary, which releases TSH, converts thyroid hormone differently than the rest of the body.
This is why you often see normal TSH with lots of hypothyroid symptoms.
Many doctors, somehow, are ignorant of this fact and instead of truly understanding what is happening physiologically, blame the patient for having symptoms when their lab tests say that they should be fine.
Another thing that this study points out is “The pituitary, though ultimately responsive to T3, is more responsive to T3 generated in the pituitary from circulating T4 by type 2 deiodinase than to circulating T3, and TSH levels are more consistently related to levels of T4 than T3. There are physiological advantages of this preference.”
Another very important observation. Here’s how this happens.
How Does T4 get Converted to T3?
There is an enzyme that is largely responsible for thyroid hormone conversion. It is called 5′ deodinase. And it actually comes in 3 forms: deodinase type I (D1), deodinase type II (D2)and deodinase type III (D3).
D1 and D2 Don’t Behave the Same Way
D1 converts inactive T4 to active T3 throughout the body. In the pituitary, D2 controls this conversion. These two forms behave very differently and are affected by different things.
D1 is suppressed and down-regulated (which means it decreases T4 to T3 conversion and increases reverse T3 levels) in response to stress (both physiologic and emotional), depression, dieting, weight gain and leptin resistance, insulin resistance, obesity and diabetes, inflammation from autoimmune disease or systemic illness, chronic fatigue syndrome and fibromyalgia, chronic pain, and exposure to toxins and plastics.
What did we just describe? Your average Hashimoto’s patient living in the modern world!
Most people with Hashimoto’s have the majority of conditions mentioned above.
In addition, D1 activity is also lower in females, making women more prone to tissue or functional hypothyroidism.
Sound familiar? Normal lab results but hypothyroidism at the cellular level.
And when you have these conditions, there are reduced tissue levels of active thyroid hormone in all tissues except the pituitary because D2 does not behave like this, at all.
D2 is 1,000 times more efficient at converting T4 to T3 than D1 in the rest of the body. And it isn’t suppressed and down regulated by any of the things we mentioned.
So TSH is within normal range because the pituitary is getting plenty of thyroid hormone, but the rest of the body is hurtin’ for certain.
T4 has a long half life, so pituitary responses to it must be slow or you’d have very little TSH signaling.
A large portion of thyroxine (T4) binds reversibly to plasma proteins. Only a small free fraction (0.02% to 0.03%) is available for conversion to T3 and transport to cytoplasm.
T3 is formed from T4 by 5′ deiodination at the outer ring by type 1 deiodinase predominantly in liver, kidney, and thyroid.
Type 2 deiodinase mediates intracellular deiodination in glial cells, pituitary, brown adipose tissue, skeletal muscle, and placenta.
These higher levels of Type 2 deiodinase in the pituitary help keep the body balance and help keep feedback loops working.
In theory.
But real life is not theory and it is very common to have normal test results and still not feel normal, or even feel really lousy. The reason for this is that there is so much variability in how T4 behaves in the body.
There a few simple things that you can do.
#1. Understand that how you feel is diagnostically important and clinically relevant. If you have normal test results, but you feel like crap, something is not working.
Don’t just accept that this is how things are going to be. They don’t have to be, but you will have to look elsewhere for solutions.
#2. Get your doctor to order other tests: free T3, free T4 and reverse T3 all provide meaningful information on how well thyroid hormone is being utilized in your body.
#3. Do everything you can to improve thyroid hormone conversion. There’s a lot you can do. Begin by reading this post where I explain how to improve conversion in depth.
#4. Make reducing inflammation your top priority. Inflammation is the root of all evil. It is a primary reason why thyroid hormone doesn’t work in your body.
Take natural anti-inflammatories and understand that stress is very inflammatory. You need to take it very seriously.
#5. Keep circadian rhythms. TSH is released in a pulse with your body’s natural circadian rhythm. (I’ll be exploring how to do this in an upcoming post.)
#6 Consider treatments that involve adding T3. Natural desiccated hormone therapy like Naturethroid or Armour contains more T3 and there are synthetic T3 treatments like Cytomel. Check out this post for a detailed discussion on thyroid replacement hormone.
http://press.endocrine.org/doi/10.1210/er.2008-0019
https://www.hindawi.com/journals/jtr/2016/6351473/
https://www.hashimotoshealing.com/5-keys-improving-thyroid-hormone-conversion/
https://www.hindawi.com/journals/jtr/2012/351864/
https://www.hashimotoshealing.com/hashimotos-why-do-i-feel-like-crap-on-synthroid/
We’ve had a few posts covering the adrenals this week. In this one, I talk about how they can affect your kidneys and what you can do about it.
Well something that is often overlooked with hypothyroidism and Hashimoto’s is it’s impact on the kidneys (the Water Element in Chinese Medicine)
I’ve had a lot of questions this week about why blood pressure goes up in people who have low blood pressure for years.
Read this post and you’ll learn why.While this is one area that is not often discussed, Hashimoto’s and hypothyroidism can have a big impact on kidney function.Hypothyroidism can cause:
(This can cause creatinine to build up and not be excreted. Creatinine is a chemical waste molecule that is generated from muscle metabolism. )
The kidneys fail to filter waste products from your body properly when your pressure is low, and “angiotensin” is produced, which raises your blood pressure.
Also, a rise in cortisol from your adrenals can raise your blood pressure.
Hypothyroidism can also cause edema.
You can see this swelling under the eyes, or as mild swelling of the hands and feet.
This is caused by several things: decreased kidney function, capillaries becoming more permeable-, poor lymphatic drainage and salt and water retention by the kidneys.
Another area that’s important to think about is the amount of protein in your diet.
As many of you know, we advocate the Autoimmune Paleo approach because this diet can be so effective in healing the gut and calming an overactive immune system.
One problem with this diet with regard to the kidneys is that some people have a tendency to focus too much on the meat. It becomes the all-meat-all-day diet.
This is really hard on the kidneys because they are responsible for filtering out the metabolic wastes that are created when protein is broken down.
So, it’s really important to make sure that you have plenty of vegetables and fruit (preferably organic and if you’re ambitious – grown in your garden).
You don’t need to eat meat with every meal. It’s perfectly fine to have some meals that are vegetable and/or vegetable and a good starch only.
Your kidneys will thank you for it!
A new study from the Journal Chemical Research in Toxicology has released some interesting research on how household dust may contain chemicals that bind to thyroid hormone receptors.
When this happens, of course, it may block your thyroid’s own thyroid hormone or thyroid hormone medication from binding and working properly in your body.
What these researcher did was use compounds already known to bind to human thyroid receptors to help predict which other chemicals might also bind to receptors.
They found five chemicals and one of them, an herbicide, bonded most strongly to thyroid receptors.
According to toxipedia.org, this chemical called 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) in no longer registered for use in the US and was discontinued as an herbicide in 1985. However, like many chemicals it can persist in the environment long after it has been discontinued (http://bit.ly/2cIQAJ2)
It also gained infamy by being one of the compounds in Agent Orange, used in the Vietnam War to destroy the forests of Vietnam where guerrillas were thought to be hiding.
It was used for selective control of weeds in cereal crops and lawns, nettles in pasture and woody weeds in forestry, particularly with conifers since 1945.
Some products that contained it are: Dacamine, Ded-Weed, Farmco Fence Rider, Forron, Inverton 245, Line Rider, T-Nox, Transamine, Brushwood Killer, Brush-Rhap, Brushtox, Esterone, Fruitone A, Reddon, Spontox, Tormona, Tributon, Veon 245, Verton 2T, Visko Rhap Low Volatile Ester, Amine 2,4,5-T for Rice, Super D Weedone, Trinoxol, Weedar, Weedone
And this is just one chemical found in household dust. The research showed that common dust particulars could have an impact on the brain, cardiovascular system, metabolism and other systems regulated by thyroid hormones.
A study released last summer found that certain dust chemicals could be a major factor in obesity.
So what do we do about it?
Obviously, vacuuming your house and dusting with something that catches dust and doesn’t just make it airborne, like a wet rag is a good idea.
Using an air filter might also be an excellent idea. This with HEPA filters are effective in removing airborne particles. I have one in my office (that I just paused to turn on :)) made by IQ Air, that is very effective.
Lastly, glutathione is an antioxidant found in virtually every cell of your body and it is used by the body to help rid itself of many environmental toxins.
It is most effective in IV or lioposomal cream form and can also be taken orally in the form of S-acetyl-L Glutathione, which is mostly absorbed by the liver.
Cordyceps is a Chinese herb that helps the body make and reuse glutathione and pharmacologically it is antibiotic, anticancer, it relieves asthma, stimulates immune function, it stimulates the adrenals, and has been found to increase platelets.
In short, it’s the perfect answer to the scourge of household dust.
That’s all for today, be good, be kind and remember to have compassion for everyone (including yourself!)
Comments, questions, observations, shares, and likes are all encouraged!
References:
Chinese Medical Herbology and Pharmacology by John and Tina Chen, 2004 Art of Medicine Press
http://pubs.acs.org/doi/abs/10.1021/acs.chemrestox.6b00171?source=cen&
https://en.wikipedia.org/wiki/Persistent_organic_pollutant
https://chemicalwatch.com/30214/house-dust-chemicals-activate-receptor-linked-to-obesity?
The Heart and Thyroid Connection
Hey people!
In the last few days there’s been lots of news coverage of the influence of thyroid hormone and thyroid hormone levels on the heart. All of these news outlets had stories:
This is all because of a new study out of the Netherlands in a medical journal called Circulation. The study found that elevated levels of free T4 may result in an increased risk (1%-4%) of sudden cardiac death, even in normal patients.
When asked why, the theory was that “Our hypothesis was that thyroid hormone levels could increase the risk of sudden cardiac death by affecting cardiovascular risk factors such as blood pressure levels,” said Dr. Layal Chaker, research fellow in endocrinology and epidemiology at Erasmus University Medical Center Rotterdam in the Netherlands, lead author of the study.
I’ve done a bunch of research on this area and I covered it in my book, Roadmap to Remission. One thing I discovered was that the heart is very sensitive to thyroid hormone, especially T3.
This is an excerpt 9IN ITALICS) from the section on the Fire Element, which includes the cardiovascular system. It includes a good, easy to understand explanation for exactly what might cause all of this to happen.
The heart circulates nutrients by pumping blood throughout the body.
When blood is pumped through your body, it puts pressure against the walls of your blood vessels.
Right? This is your blood pressure.
When doctors describe blood pressure, they use two numbers like “120 over 70”. These numbers describe the pressure when your heart pumps blood into your blood vessels (the high number) and the pressure when your heart relaxes (the low number).
Imagine squeezing a ketchup bottle. When you squeeze it to ‘pump’ ketchup onto your plate, the pressure is high. When you stop squeezing, the pressure is low.
Blood pressure can change a lot during the day. It is usually lower while you are relaxing and higher when you are active. Other things like pregnancy, smoking, medication, being stressed and thyroid hormone levels can change your blood pressure.
Usually, with hypothyroid conditions, you’re blood pressure is low and with hyperthyroid conditions it tends to be high. But there are many reasons why this is not always the case, in fact, many Hashimoto’s people actually have high blood pressure.
This is because even though many thyroid patients, or those being treated with T4 meds like Synthroid, can start out with low blood pressure, factors related to having functional hypothyroidism can actually create hypertension and high blood pressure over time.
For example, as we saw when we looked at the Water Element hypothyroidism leads to a host of problems physiologically that cause kidney and cardiovascular problems.
For example, there’s less blood flow to the kidneys, this causes the kidneys to not filter waste products like creatinine from your body properly.
In addition, when your blood pressure is low, and “angiotensin” is produced, this raises your blood pressure.
Also when you are hypothyroid, blood is taken from the extremities into the body, which tends to raise pressure by forcing the same volume of blood into a smaller network of vessels.
This process is brought about by a constriction of peripheral vessels.
Hypothyroid patients produce an excess of noradrenalin from the adrenal gland, which constricts blood vessels all over the body, another effort of the body to deal with the low blood pressure.
This in turn is partly related to the effort by the body to raise blood sugar levels when low. We’ve already discussed this, as well.
These problems may or may not be caused by being overmedicated.
Anxiety, tachycardia (fast heart rate), and high blood pressure that people with Hashimoto’s experience is not always from being hyperthyroid or overmedicated, it may also be from noradrenaline that the body is secreting for energy to compensate for the lack of thyroid hormone.
Unfortunately, what often happens is that they’re prescribed blood pressure medications (such as beta blockers) and/or anti-anxiety medications (such as benzodiazepines).
Neither of these drugs corrects the underlying functional hypothyroidism (low thyroid condition) that caused the symptoms in the first place, and both have side effects. In one study, noradrenaline was three times higher in hypothyroid subjects than normal controls when lying down.
So what was once low blood pressure, now takes a nasty turn towards hypertension, or high blood pressure.
Another….you guessed it, vicious cycle.
Obviously, too high blood pressure can be dangerous. It means that there is too much stress on your blood vessels. This makes the vessels weak and can damage them. Imagine squeezing a ketchup bottle really hard and fast until it breaks.
High blood pressure is a major cause of heart disease.
Ok, so let’s take a look at how else the thyroid impacts cardiovascular function. Firstly, thyroid hormone has a direct impact on cholesterol; with hypothyroidism serum cholesterol increases.
Thyroid hormone stimulates an enzyme called HMG-CoA reductase, the same enzyme that statin drugs inhibit. This speeds up the synthesis and utilization of cholesterol by the body.
Thyroid hormone stimulates the removal of cholesterol by the liver using LDL receptors. In a hypothyroid state, this whole process is slowed and the result is that cholesterol builds up and isn’t cleared as quickly.
Hypothryoidism can also cause homocysteine levels to rise. High homocysteine can lead to inflammation of the arteries and can make you more prone to blood clots, heart attacks and strokes.
We talked about that in the last chapter too, because nourishing certain pathways in the liver can really help bring down high homocysteine.
CRP, another risk factor and inflammatory marker for inflammation in the arteries is also often high with hypothyroidism.
Another odd thing that too little thyroid hormone can cause is lower plasma volume. This is caused by capillaries becoming more permeable and when this happens albumin and water leak into the interstitial spaces.
So here again, we have the makings of a particular dangerous vicious cycle.
In the chapter on the Earth Element, we spoke about how blood sugar problems like metabolic syndrome can create a lot of conditions that make you more likely to develop heart disease.
Well, when you combine that with hypothyroidism, you have a very potent combination that can put you at risk for heart attack and stroke.
Another area that does not get the attention it deserves is the impact of thyroid hormone on the heart and cardiac tissue. One of the things that research is starting to reveal is that thyroid hormone is absorbed differently by different tissues of the body.
In other words not every part of you body is affected the same way by T4 and T3. For example, the pituitary is different than every cell in the body with different deiodinase enzymes and it has more sensitive to thyroid hormone receptors.
Many physicans assume, incorrectly, that thyroid hormone is simply absorbed via diffusion (which is basically like the cell sucking hormone in through a biochemical straw).
However the reality is that the process is energy dependent and called active transport which means it requires the body to use energy to push it into the cells.
In addition, different parts of the body respond differently to T3 and T4. 90% of T3 is absorbed by the stomach while T4 is much less efficient (50 – 90%) and T4 requires much more energy to get absorbed.
T3 affects cardiac muscle cell (myocyte), it affects contraction, T3 also affects the performance of sodium, potassium and calcium channels in the heart.
And what this new study concluded was that “Higher FT4 levels are associated with an increased risk of SCD (sudden cardiac death), even in euthyroid (normal thyroid) participants.” This was an increased risk of 1% – 4%, so don’t panic, that’s not a huge increase.
What this means is that just throwing more thyroid hormone at the problem may not be the answer and can have unintended consequences.
And something else the research has identified is that thyroid autoimmunity can affect the valves of the heart. So, if you have Hashimoto’s and have been diagnosed with heart murmur, an echocardiogram might be a really good idea.
What this also tells us that this is way more than a thyroid problem and issues in other systems of the body must be treated, as well.
And where your heart is concerned it’s super important to take steps to reduce all the risk factors that contribute to cardiovascular disease. And sugar, inflammation and lack of exercise are the big three that put you at risk.
It’s all connected people!
Everything we do or don’t do has consequences. Properly managing and treating your thyroid may also heal your heart and properly managing and treating heart disease may also heal your thyroid.
Not sure what to do? Set up a consult and we’ll discuss how to create a heart healthy program for you.
The impact of stress on the body has been well documented. Research has shown that stress has direct impacts on the immune system, the endocrine system and the nervous system.
Since Hashimoto’s is an autoimmune disease of the thyroid, stress has a profound effect on people who are afflicted with the disease because all these systems are involved.
It can be a cause of flare ups of symptoms, and can be a factor in the progression and worsening of the condition.
In addition, because having autoimmune disease is so stressful on the body’s physiology, people with Hashimoto’s can be very sensitive to stress.
And sometimes, they are unaware of the extent of stress’ destructive impact on their health.
Most people are conscious of it’s obvious forms: impossibly full schedules, driving in traffic, financial problems, divorce, losing a job, moving, losing a loved one and the many other emotional and psychological challenges of modern life.
But other things you don’t normally think of, can also tax the body.
These include blood sugar swings, gut dysfunction, leaky gut, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems and inflammation.
Not to mention the psychological toll that Hashimoto’s can cause by creating feelings of isolation, lonliness, depression and anxiety.
(To learn more, read my previous post on the physiology of stress in Hashimoto’s).
What this all boils down to is that external stress and stressful events can sometimes be very difficult to handle and it can be easy to feel overwhelmed emotionally and psychologically.
In fact, other research has also shown that for many (up to 80%) some major stressful life event often precedes a diagnosis of Hashimoto’s (this was true of my own experience, as well).
The reality is this, for some people, stress is the elephant in the room and the real problem, yet too little is being done to address it.
And this means that they may not be seeing the improvements that they expect in the way they feel and they may be disappointed by the results that they are getting.
In this post, I explore the impact of stress on the thyroid and the rest of the body.
In addition, I focus on how effective a solution meditation can be for relieving the destructive effects of stress.
One thing that’s important to understand is that stress can have a major impact on thyroid hormone conversion and absorption.
This is such a common thing that it’s basically a cliche for those who suffer from Hashimoto’s and hypothyroidism.
Let’s Review the Physiology
First of all, let’s look at basic physiology.
In the body, normally, the thyroid is signaled by the pituitary with TSH (Thyroid Stimulating Hormone). The purpose of this is to goose the thyroid into producing more thyroid hormone.
This occurs because of signals from the body that it needs more. If it’s cold or you need your heart rate to increase, or your metabolism to rev up or you needs to get things moving for sex, etc.
When this happens the thyroid releases T4 (about 97%) and a little bit of T3 (do the math – yup, 3%).
And this is the basic premise of thyroid replacement hormones like Synthroid.
It’s synthetic T4. The theory is that you just give it to the patient and tell them to call you in 6 months.
An everything should be hunky dory.
And the reason it doesn’t work is that thyroid hormone must be converted from T4 into T3 in order for the body to utilize it. This conversion happens differently in different parts of the body.
The problem with TSH only testing to determine thyroid hormone levels in the entire body is that the pituitary, which releases TSH, converts thyroid hormone differently than the rest of the body.
This is why you often see normal TSH with lots of hypothyroid symptoms (like fatigue, weight gain, hair loss, cold hands and feet, brain fog and other cognitive problems, depression and anxiety, etc.)
For a more in depth look at thyroid hormone conversion and how to improve it, check out this post.
Many doctors, somehow, are ignorant of this fact and instead of truly understanding what is happening physiologically, blame the patient for having symptoms when their lab tests say that they should be fine.
They tell their patients to eat better, get more exercise and relax and to come back in 6 months for more tests.
Only, they don’t order the right tests to determine whether or not thyroid hormone is getting converted properly and absorbed (for this you need to order the free fractions free T3 and free T4 and reverse T3.)
An important indicator of whether or not thyroid hormone is being utilized by the body is reverse T3 (rT3).
Basically, T3 is so biologically active (about 10 times stronger than T4) that the body has to have a way of disabling it.
If it isn’t disabled, it can cause hyperthyroid symptoms which can lead to heart attack, stroke, and dangerously low levels of cholesterol, and other symptoms like insomnia, palpitations, nervousness and anxiety.
(This is also why so many doctors are so hesitant to prescribe T3, because if the dosage given is too high, it can cause all the symptoms mentioned above and can even put patients at risk for cardiovascular events.)
So, in order to prevent this, the body makes rT3. It is mostly inactive, having about 1% of the power of T3. It is also what is known as a “T3 antagonist” which means it can bind to T3 receptor sites and block the action of T3.
As you can see from this illustration, rT3 is a kind of mirror image of T3 in it’s molecular structure, so it fits nicely into T3 receptors.
Think of it as a kind a break pedal for your body’s metabolism.
Normally, T4 is produced by your thyroid (or is delivered in the form of T4 medications, like Synthroid) and the body takes that and creates what is basically a balance of T3 to rT3.
When more T4 is converted to reverse T3 than into T3 and free T3, then the body may exhibit common symptoms of hypothyroidism, described earlier.
There is a medical condition called Wilson’s Syndrome (also known as Wilson’s Temperature Syndrome or Wilson’s Thyroid Syndrome, WTS) which is popular in some alternative medicine camps.
The American Thyroid Association does not recognize Wilson’s Syndrome.
The term was coined by an MD named E. Denis Wilson from Longwood, Florida (I’ve actually been there, oddly enough. :)).
He listed about 60 different symptoms associated with it (many of which are common to hypothyroid and Hashimoto’s patients).
Wilson believed this condition was brought on by stress and that it may persist even after the acute stress had passed.
The main diagnostic sign was a chronically depressed body temperature of 98.6 or lower. Wilson then recommended treatment of time released T3 and some herbs which are intended to increase T3 levels, and reduce reverse T3 levels over time.
While Wilson’s Syndrome and his treatment protocol for it are popular in some circles and are endorsed by some thyroid support groups, it has not been accepted by the wider medical community.
And unfortunately for Dr. Wilson (and the poor patient), a patient under his care in 1988 apparently died from taking excessive amounts of T3 (Though, there is some controversy about whether or not she took the medication as directed).
He was discredited by the Florida Board of Medicine and fined $10,000, given a 6 month suspension and required to take 100 hours of continuing education (in more orthodox care, no doubt).
Dr. Wilson was also subjected to psychological testing, accused of being a fraud and was not permitted to use his protocol unless “Wilson’s Syndrome” was proven to be a valid medical condition by his peers.
It has not, to date, been recognized as a valid medical condition. However, there are some practitioners who believe in Dr. Wilson’s theories and who continue to practice using his protocol.
As I mentioned, many doctors are fearful of prescribing T3 because it is so biologically active and in researching my book, How to Heal Hashimoto’s: An Integrative Roadmap to Remission I discovered that there really are causes for concern.
T3 affects cardiac muscle, contraction of the heart, and that it impacts the performance of sodium, potassium, and calcium channels in the heart.
This is why you must be very careful when taking T3, of which 90% is absorbed in the stomach.
Our thyroids naturally produce 97% T4 and 3% T3, for a reason. T4 must be converted in the liver, then in the gut by good bacteria and finally in the peripheral tissue.
So throwing caution to the wind and taking lots of T3, driving your TSH into the ground and not listening to the warnings of trained professionals may not be the best course of action.
There may be consequences to overdoing T3, especially over time, and these include bone loss, risk of heart attack and stroke, dangerously low levels of cholesterol (which is needed to make lots of hormones and is important for your brain) and more.
As always, my quest is to ask, is there a better way to approach this problem?
Well, it turns out there is. We’ll get to that in a moment. First, let’s see if Dr. Wilson may have been right about some things and let’s look at the many factors that can cause reverse T3 to become high.
In my opinion, there are parts of this that Dr. Wilson may have been right about.
Firstly, high rT3 is an indication of a metabolic problem and not just thyroid deficiency.
There is also no doubt that stress has profound effects on thyroid hormone metabolism.
With stress, cortisol levels often go up. The increased cortisol levels contribute to this disconnect in the body between the TSH and peripheral tissue T3 levels.
Stress reduces T3 levels in the tissues and increases reverse T3 and this results in hypothyroidism in the tissues of the body and potential weight gain, fatigue, and depression.
This vicious cycle of weight gain, fatigue, and depression that is associated with stress may be helped with supplementation with timed-released T3, but the risks that I mentioned do remain.
The reduced immunity from chronic stress has also been thought to be due to excess cortisol production; but the associated reduction in tissue thyroid levels are shown to play a larger role in the decreased immunity seen with stress.
As with stress, treatment with prednisone or other glucocorticoid has been shown to suppress the enzyme 5 alpha dieodinase, reducing T4 to T3 conversion and increasing T4 to reverse T3, causing a relative tissue hypothyroidism that is not detected by TSH testing.
There are also many other potential causes of high reverse T3 including: insulin resistance, leptin resistance, inflammation, yo-yo dieting, iron deficiency, chronic pain, chronic stress, serious diseases like liver, kidney, and heart disease, traumatic events and shock, serious burns, surgery, toxic chemical and heavy metal exposure, and deficiencies in other vitamins and minerals that are vital for healthy thyroid hormone production like: zinc, selenium, chromium, vitamins B6 and B12, and vitamin D.
Again, the thing that many of these conditions have in common is that they are very stressful for the body.
Now that we have established how destructive stress can be and how important it is for proper thyroid function to do something about it, let’s have a look at treatment options.
Treatment involving additional T3 can, without question, help some patients. Taking natural desiccated hormone (which uniformly has four parts T4 and one part T3) can be helpful.
Adding synthetic T3 to treatment using only T4 may also be helpful for those who don’t do well with natural desiccated. (to learn more about thyroid hormone and how to assess which one is right for you, check out my previous post.
However, treating high rT3 only by adding more T3 is not always the answer and it sometimes doesn’t address the underlying problem: STRESS
The reality is that T3 speeds up your body’s metabolism. This can add more stress because it can disrupt sleep, make you feel more nervous or anxious, give you palpitations and generally amp everything up.
So, regardless of whether or not you decide to add T3 to your treatment plan, you still need to do something to counteract the affects of stress on your body.
Meditation, as just about everyone knows, is an ancient technique for improving well being, mindfulness and a sense of balance and modern research has revealed that it has real physiological benefits.
Meditation can be done lying down, seated or standing. It involves breathing and visualizations or focused attention or deliberate lack of visualizations, the simple practice of letting go.
Let’s take a look at some of these benefits now and, in particular, look at how these practices may be used to reduce rT3, decrease the destructive impact of stress and help us solve the problems at hand without adding more medication or spending more money on supplements.
Meditation has been shown to cause improvement in various cardiovascular, neurological, autoimmune, and kidney diseases.
It has also been widely used in medical and psychological treatment therapies for stress-related physical and mental disorders.
I looked at a number of papers which analyzed the results of modern diagnostic techniques (like functional MRIs, positron emission tomography, single-photon emission computed tomography, functional electro-encephalogram, and diffusion tensor imaging).
These all assess the function and integrity of connections of the brain and show us how meditation benefits the body, mind and spirit.
The following are the results of various studies on the effects of meditation on the brain and the body. Many of these studies were done on people who had practiced meditation regularly for a prolonged period of time.
The benefits of meditation, like the benefits of exercise, are better and more prolonged if you continue to practice and do it. If you treat it like a fad and stop doing it, chances are the benefits will stop too.
Long term benefit is the result of long term commitment (just like marriage 🙂 ).
The prefrontal cortex is the part of your brain right behind your forehead. It controls cognitive behavior, personality expression, decision making, and moderating social behavior.
Studies have found lower levels of T3 (but not T4) in the pre-frontal cortex of brains of deceased Alzheimer’s patients. (Hypothyroidism can impact glucose metabolism in the brain which can have profound effects on brain function.)
Meditation has been found to improve a number of activities associated with the prefrontal cortex such as differentiating among conflicting thoughts, determining good and bad, future consequences of current activities, working toward a defined goal, predicting outcomes, and expectation based on actions.
This is the mid-part of the brain associated with emotion, learning and memory.
Problems with focus, attention and various symptoms that resemble ADD are associated with thyroid hormone resistance.
Meditation has been shown to bring more blood flow to this area of the brain (oxygen, sugar and thyroid hormone are all carried by the blood).
And this part of the brain was shown to be more developed and thicker in subjects who had practiced meditation regularly.
Meditation activates areas in the brain, which are responsible for motivation, memory, emotion, i.e., hippocampus, amygdala, and anterior cingulate.
This activity exerts protective effects on the brain generally by increasing blood flow and helping to reduce inflammation by clearing out harmful byproducts that come from the body’s metabolic processes, i.e., oxidative stress.
Meditation also improves concentration and cognitive function( like memory) this may be due to activation of reward or motivation circuit in the hippocampus/limbic system.
Stress reduces the growth of neurons in the brain and promotes the destruction of brain cells in adult hippocampus, therefore causing memory impairment, and meditation relieves stress, and increases neuronal growth, making it really helpful in dementia syndromes.
(And just so you know, dementia and Alzheimer’s is the second leading cause of death in the US. Chances are, you or someone you love is going to be impacted by this.)
Meditation also increases levels of inhibitory (GABA- a calming neurotransmitter) neurons, therefore reducing anxiety and depression.
It’s also interesting to note that increased bridging of hemispheres of the brain (corpus callosum, which acts as a bridge between two hemispheres) is increased in thickness and enhanced in meditator.
This may indicate greater connectivity, possibly reflecting increased integration of the two hemispheres during brain activity involving pre-frontal regions.
What that means is meditation actually gives you a bigger brain. 🙂
Several studies have shown how the parasympathetic system is more predominate during meditation. This causes a decrease in heart rate, blood pressure, and oxygen metabolism.
However, a recent study suggested that both the parasympathetic and sympathetic systems were stimulated as there is variability in heart rate during meditation.
This may suggest that both parts of the nervous system are actually activated. This could also explain why meditation produces that feeling of calm and awareness at the same time.
These are the molecules of emotion.
Often with Hashimoto’s and hypothyroidism we find deficiencies in one or more of the neurotransmitters, such as: serotonin, dopamine, acetylcholine and GABA.
This is one of the reasons why anxiety and depression are such common symptoms for Hashimoto’s patients.
Meditation has been shown to increase blood plasma levels of melatonin, resulting in the feelings of calmness, decreased feelings of pain and better sleep.
Levels of serotonin metabolites in the urine of meditators are elevated suggesting increased serotonin in the brain.
Increasing serotonin can also increase dopamine levels and concentration and sustained focus of meditation can also increase acetylcholine levels.
Another possible reason for the impact of meditation on neurotransmitters is how it affects the hypothalamus and the thyroid axis.
With aging and hypothyroidism, TSH levels rise and activities in the body slow. This can cause resistance to TSH and problems with the thyroid-hypothalmus-pituitary axis.
But the opposite effect to that is seen in long-term practitioners of meditation, which may be due to more efficient functioning of the pituitary-thyroid axis.
Nitric oxide levels also increase during meditation, increasing blood flow. (This can be very beneficial for those who suffer with cold hands and feet and poor circulation.)
Regarding stress, in a study that had people do meditation for 4 months, cortisol decreased significantly in long-term practitioners during meditation and remained somewhat low afterward.
Which means that rT3 levels may also be reduced. (I have seen this in some of my patients who practice meditation.)
Beta endorphins are your body’s natural opiates. This is what low dose naltrexone helps to increase. Well, it turns out you may not need that medication if you meditate regularly.
Levels of beta endorphins are also increased during meditation producing a state of deep calmness with increased tolerance for stress and challenges. (That’s the buzz you get from meditating, running or exercising – feels good!)
Finally, Hashimoto’s and many other forms of chronic disease are caused by destructive inflammation.
And the reality is that stress is very inflammatory.
Especially long term chronic stress that goes untreated for years. Prolonged stress alters the effectiveness of cortisol to calm inflammation because it decreases tissue sensitivity to the hormone.
Immune cells can become insensitive to cortisol’s regulatory effect. As a result, non-stop inflammation is thought to promote the development and progression of these chronic diseases.
Cytokines are the immune modulators and controllers of the defense system of our body. Their levels are definitely influenced by meditation.
IL-6 and TNF-alpha are increased, IL-4 and IL-12 levels remain stable, interferon-gamma-secreting cells increased and IL-10- secreting cells decreases these results are according to a pilot study (see below).
More studies need to be done on this and I think there is a possibility that meditation and qi gong (which is what that pilot study looked at) may also have a modulating effect on the immune system.
The immune system doesn’t exist in a vacuum, it is in constant communication with the endocrine system, the nervous system, the digestive system and the brain.
Given all the positive impacts of meditation on all these other systems, it is not hard to imagine that meditation may also have a calming effect on the immune system.
This is particularly important in autoimmune diseases like Hashimoto’s where an overzealous immune system is attacking and destroying thyroid tissue.
Calming that activity is very, very important. And as we have seen there is ample evidence that meditation does this.
Meditation has many positive effects for Hashimoto’s patients. But like a proper diet, it is not a fad.
In order for it to be most effective you must do it and it must become a daily part of your maintenance of health and well being.
I am currently involved in a long term experiment of my own. I meditate a minimum of 15 minutes daily and I am combining this with qi gong and HIIT training.
My goal is to see to what extent diet and exercise can have a positive impact on my Hashimoto’s. I am roughly 9 months into this and I feel amazing.
I’m in the best shape of my entire life and more importantly I have lots of energy and feel a generally high level of contentment.
And when I’m faced with challenges, disappointments and set backs, they seem smaller and less significant and I am much more skilled at letting them go and not dwelling on them.
You know, all of this science and research is great for skeptics and for understanding how these things benefit us, but the proof is in the pudding.
How do you feel every day?
That’s what really matters.
If your current treatment strategy isn’t making you feel better (and I mean significantly better), then it may be time to look at other things like meditation.
It costs you nothing but a few minutes a day.
It doesn’t require a prescription.
You don’t need a doctor or a guru.
All you need to do is sit and breath.
Stress can kill you, literally. Medication can sometimes help and can also be a unending sinkhole of frustration. especially when your doctor doesn’t really have a good sense of what to do next.
Meditation is the gift that keeps on giving. Take a look at these studies and, more importantly, start doing it and start feeling the rewards.
They are definitely cumulative. Like a good wine they just keep getting better and better with time. 🙂
No more excuses, do it and see how amazing you feel!
Want a free guided meditation audio that you can listen to today? Click here and it’s yours.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/ 30 Years of studies on stress’ impact on the body.
http://www.ncbi.nlm.nih.gov/pubmed/18190880 Up to 80% of people reported a major stress event prior to autoimmune disease onset
State of Florida, Department of Health. February 12, 1992. Final Order Number: DPR9200039ME Dr. Wilson’s final sentencing decree
http://www.ncbi.nlm.nih.gov/pubmed/10956378 Review of Thyroid hormone metabolism
http://www.iaea.org/inis/collection/NCLCollectionStore/_Public/11/544/11544357.pdf Peripheral conversion of T4 into T3 and rT3
http://www.umasatyayogaanatomy.com/uploads/6/2/1/2/62123413/molecular_mechanisms_of_meditation.pdf Self explanatory
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953721/ Thyroid hormone levels in the prefrontal cortex in Alzheimer patients
http://www.endocrine-abstracts.org/ea/0011/ea0011s16.htm Affects of hypothyroidism on brain function
Brefczynski L JA, Lutz A, Schaefer HS, Levinson DB, Davidson RJ (2007) Neural correlates of attentional expertise in long-term meditation practitioners. Proc Natl Acad Sci U S A 104:11483-11488 3. Pollmann S (2004) Anterior prefrontal cortex contributions
http://www.sciencedirect.com/science/article/pii/0006899396001771 Attention problems and thyroid hormone resistance
Esch T, Fricchione GL, Stefano GB (2003) The therapeutic use of the relaxation response in stress-related diseases. Med Sci Monit 9:23-34
Travis F, Tecce J, Guttman J (2000) Cortical plasticity, contingent negative variation, and transcendent experiences during practice of the transcendental meditation technique. Biol Psychol 55:41- 55
Stefano GB, Fricchione GL, Slingsby BT, Benson H (2001) The placebo effect and relaxation response: neural processes and theircoupling to constitutive nitric oxide. Brain Res Brain Res Rev 35:1-19
Esch T, Stefano GB, Fricchione GL, Benson H (2002) The role of stress in neurodegenerative diseases and mental disorders. Neuroendocrinol Lett 23:199- 208
Elias AN, Wilson AF (1995) Serum hormonal concentrations following transcendental meditation- potential role of gamma aminobutyric acid. Med Hypotheses 44:287- 291
Luders E, Phillips O, Clark K, Kurth F, Toga A, Narr K (2012) Bridging the hemispheres in meditation: thicker callosal regions and enhanced fractional anisotropy (FA) in long-term practitioners.
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Jevning R, Wallace K, Beidebach M (1992) The physiology of meditation: a review. A wakeful hypometabolic integrated response. Neurosci Biobehav Rev 16:415-424
Sudsuang R, Chentanez V, Veluvan K (1991) Effects of Buddhist meditation on serum cortisol and total protein levels, blood pressure, pulse rate, lung volume an reaction time. Physiol Behav 50:543- 548
Travis F (2001) Autonomic and EEG patterns distinguish transcending from other experiences during transcendental meditation practice. Int J Psychophysiol 42:1-9
Tooley GA, Armstrong SM, Norman TR, Sali A (2000) Acute increases in night-time plasma melatonin levels following a period of meditation. Biol Psychol 53:69-78
Yoshida M, Sasa M, Takaori S (1984) Serotonin-mediated inhibition from dorsal raphe neurons nucleus of neurons in dorsal lateral geniculate and thalamic reticular nuclei. Brain Res 290:95-105
Zhelyazkova-Savova MG, Giovannini G (1997) Increase of cortical acetylcholine release after systemic administration of chlorophenylpiperazine in the rat: an in vivo microdialysis study. Neurosci Lett 236:151-154
Werrner O, Wallace R, Charles B, Gregorius Janssen G, Stryker T, Chalmers R (1986) Long-term endocrinologic changes in subjects practicing the transcendental meditation and TM-Sidhi program. Psychosom Med 48:59-65
https://www.sciencedaily.com/releases/2012/04/120402162546.htm How stress affects inflammation
Jones BM (2001) Changes in cytokine production in healthy subjects practicing Guolin Qigong:a pilot study. BMC Complement Alternat Med 1:8
http://www.ncbi.nlm.nih.gov/pubmed/350747?dopt=Abstract Meditation lowers cortisol
http://www.sciencedirect.com/science/article/pii/S0031938498000717 Beta endorphin levels lower in meditators
http://www.ncbi.nlm.nih.gov/pubmed/16142396?dopt=Abstract Nitric oxide levels in meditators
http://www.ncbi.nlm.nih.gov/pubmed/12883106 Mindfulness and brain and immune system
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695992/ mindfulness and neuroendocrine and innate immune system responses
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1332237/pdf/brjsmed00012-0042.pdf Meditation modifies immune impact of excessive exercise
http://files.sld.cu/mednat/files/2011/07/yoga-clinical-research-review.pdf Yoga research review
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1456909/ Mind body research mainstream
http://www.holistic-hypothyroidism-solutions.com/reverse-t3.html Reverse T3 and meditation
In this first post of this series we will examine different Hashimoto’s types and explore the possibility of different types or subtypes of the disease in women.
Autoimmune thyroid disease is the most common autoimmune disease in the US and it affects an estimated 2% of the female population and an estimated 0.2% of the male population.
That’s roughly 3.08 million women in the US. Yet, for some reason all of these cases are treated the same way in the conventional medical model.
If it is determined that they are hypothyroid (their TSH is high and their total T4 is low), then they are prescribed synthetic T4 (Synthroid or a generic equivalent). From there, their TSH and total T4 is monitored and managed and kept within a certain range (which many doctors don’t agree on). That’s the full extent of care.
Actually there are many problems with this approach, but the biggest one is that it ignores two fundamental truths.
Firstly, not all of these people are at the the same stage of progression of the disease. Hashimoto’s is a progressive disease, if untreated or poorly managed it can progress and advance and cause widespread damage in the body. (More on this in a moment.)
Secondly, not everyone who has Hashimoto’s is at the same place in their lives. Women, in particular go through major changes in their lives in adolescence, pregnancy, peri-menopause and in their later years of menopause.
It is common knowledge that the endocrine system, the immune system and the central nervous are all impacted by these changes of life.
Why, then, wouldn’t Hashimoto’s be effected, also?
Well, the truth is, that Hashimoto’s is impacted by different stages in life and these changes can provide important clues on how to better manage the disease and how to prioritize and focus care.
Let’s examine this theory and review the different stages of autoimmune disease and Hashimoto’s.
3 Stages of Hashimoto’s:
In the medical literature several different researchers have identified 3 stages of Hashimoto’s disease.
Dr. Datis Kharrazian has proposed 3 stages of autoimmunity and researchers Arvin Parvathaneni, Daniel Fischman and Pramil Cheriyath has identified 3 stages of Hashimoto’s, as well.
Both theories overlap and this matters because the further the disease progresses the more it impacts other systems of the body.
Here’s an excerpt from my book, Roadmap to Remission which details this progression:
Stage 1: Silent Autoimmunity
In this stage, the body has lost tolerance to its own tissue, but there are no symptoms yet and it doesn’t really affect the way that the system functions. This stage can, however, be identified by lab tests that show elevated antibodies. People can stay in this stage for years.
This is the best place to begin some sort of treatment aimed at prevention, because your odds of getting good results are highest.
Physiologically, in this stage thyroid specific antigens are presented to antigen presenting cells (APCs) by thyroid cells, often after some kind of insult or environmental stressor(s). (For example, infection(s), excessive iodine, pregnancy, toxins in cigarette smoke, etc.)
Stage 2: Autoimmune Reactivity
In this stage, the destruction of the target tissue has begun. Elevated antibodies and some symptoms appear. However, the destruction is not significant enough to actually be labeled autoimmune disease because 70–90 percent of the target tissue has not yet been destroyed. This stage is where a lot of Hashimoto’s patients are.
They may or may not have been placed on thyroid replacement hormone, and that may or may not have normalized their thyroid lab results. However, the destructive autoimmune process is active and is progressing.
This is a very important stage for treating the immune dysfunction, because you have a greater chance to slow or stop the destruction of that tissue and slow the progression to other autoimmune diseases.
Physiologically, this is the stage where APCs (Antigen Presenting Cells) differentiate into T cells and B cells and begin the process of destruction.
Stage 3: Autoimmune Disease
This stage is where Western medicine finally acknowledges the autoimmune disease. And it takes this long, because you need significant destruction of tissue in order to see the destruction with an MRI or ultrasound.
Other findings include elevated antibodies, serious and significant symptoms, lab results, and special studies that all confirm a loss of function. Unfortunately, this is really late in the game. With Hashimoto’s, this stage is where the thyroid is almost completely destroyed.
Luckily, most people don’t reach this stage before they have been given thyroid replacement hormone, because the symptoms have already become so serious that they will have sought out a doctor to help them before they got here.
Finally, this is the stage, physiologically, where positive feedback has led to massive destruction of the thyroid gland and major loss of function in other systems of the body. T cells have induced cytotoxicity, and B cells have produced antibodies that have led to apoptosis or programmed cell death of thyroid cells, and macrophages have infiltrated the thyroid and started producing the interleukin proteins we spoke about earlier.
The reality is that Hashimoto’s can begin at any time in a woman’s life and during the different changes that her body goes through there are different challenges and stressors that can exacerbate or complicate the disease.
In studying the medical literature and in examining my patient population (at the time of writing this blog post I have spoken with over 2,000 people with Hashimoto’s, 99% them have been women, and I have treated over 500 women).
I have identified five different times of life for the onset and/or exacerbation of Hashimoto’s that could represent “types” or “subtypes” of Hashimoto’s patients.
The onset for this age group is most commonly mid-puberty. (Although we are seeing an increase in the prevalence of children diagnosed with the disease.)
Of course, puberty is a time of many hormonal changes, which can also impact the immune system and the nervous system and brain.
These young women have many of the common symptoms of Hashimoto’s and hypothyroidism and may also have developmental disorders if the disease has gone undiagnosed or it began earlier in childhood.
Common symptoms include:
According to an Italian study, the evaluation of these patients, according to their final outcome, revealed that subjects with deteriorating thyroid function had significantly higher anti-TG antibodies, TSH concentrations, and greater thyroid volume at presentation. And after 5 years, more than 50% of the patients remained or became euthyroid (meaning they had a normally functioning thyroid gland).
So this can resolve, and never be a problem again or it can resurface later in life. One of the life events that leads to it resurfacing and/or is a cause for onset all by itself is pregnancy.
In pregnancy, a woman’s body goes through many hormonal changes and the immune system makes large adjustments in order to preserve the fetus and not reject it as a foreign invader.
During the third trimester a pregnant woman becomes TH-2 dominant, then TH-1 dominant after giving birth. This is thought to be due more to the body naturally suppressing TH-1, rather than boosting TH-2.
The Th-1 suppression ends after birth and this causes the immune system to surge. If it is already unstable, this can result in the onset of Hashimoto’s.
Postpartum Thyroiditis
This is inflammation in the thyroid that comes on after pregnancy in about 5 to 7 % of women, usually within two to four months after giving birth.
Interestingly, this is also a form of autoimmune disease. (In fact, these two disorders are very hard to distinguished from one another.)
This usually presents as a painless, small, firm enlargement of the thyroid or goiter. And it can cause either hyper or hypothyroid symptoms.
As noted, this can also lead to postpartum depression because of it’s impact on thyroid function.
Common Symptoms:
During postpartum thyroiditis, there are, potentially two phases. The inflammation and release of thyroid hormone may first cause signs and symptoms similar to those of a hyperthyroid condition, including:
Hyperthyroid symptoms usually happen two to ten months after delivery—most commonly at three months—with recovery taking place over the next two to three months after it begins. It is important to figure out if it’s postpartum thyroiditis or Graves’ disease with proper lab testing.
Later, as thyroid cells are attacked, signs and symptoms of a hypothyroid condition may develop, including:
Hypothyroid symptoms usually happen two to twelve months after delivery—most commonly at six months. About eighty percent of women with postpartum thyroiditis return to normal thyroid function around the one-year mark, however, 30 to 50 percent develop permanent hypothyroidism within nine years.
So again, it can resolve and then resurface later after another pregnancy or another stressful time of life or other life change (see below).
Pregnancy and the Pituitary
Another thing that can cause hypothyroidism with pregnancy is the pituitary becoming depressed. Chronic stressors like food intolerances, blood sugar imbalances, gut infections and out of whack hormones can all depress the function of the pituitary.
And the pituitary is responsible for signaling the thyroid, so when it’s depressed it can fail to send enough TSH to the thyroid. Which means this isn’t a thyroid problem at all. It’s really a pituitary issue. For many women this can result in low thyroid function and depression.
And, of course, proper thyroid hormone levels are also essential for the healthy development of the fetus and infants. Some researchers believe that one factor in the development of autism is severe hypothyroidism in their mothers.
In addition, TPO andtibodies have been found to be a risk factor for complications during pregnancy and beyond.
Another possible type are women who have difficulty conceiving and suffer one or more miscarraiges due to Hashimoto’s and hypothyroidism.
When women have hypothyroidism, a common problem is an increase of another hormone called prolactin. This causes less of a release of LH, and a loss of progesterone receptor site sensitivity, and a loss in sensitivity to FSH in the follicle. All of these losses lead to problems with ovulation, and they also may hamper communication to the pituitary gland.
Using birth control pills on top of this can further harm the communication and feedback loops in this system. Using herbs to stimulate the ovaries or the reproductive system will also not work unless the hypothyroid issues are corrected.
Studies have found that even mild hypothyroidism may cause ovarian problems. Testing thyroid function is very important with women who suffer from infertility, especially if they have elevated prolactin or they can’t ovulate.
Hypothyroidism may lead to low FSH levels, which may lead to immature follicles and infertility. Suppressed LH levels will often lead to problems with ovulation in timing or abnormal luteal phase progesterone levels. These changes may cause miscarriage, depression in the second half of your cycle, or migraines in the second half of your cycle.
To summarize, hypothyroidism can cause:
There are a number of important issues to address when trying to conceive, here’s a post I wrote on this that goes into more depth on this.
The changes of life leading up to and during the transition to menopause are another time of life when Hashimoto’s can come on, resurface or progress.
As the ovaries retire and reproductive hormones decline, the adrenal glands step in and take over.
Essentially, what happens is this: FSH (Follicle Stimulating Hormone) receptors in the ovaries begin to lose sensitivity during perimenopause. This leads to changes in levels of FSH and estradiol.
The adrenals, in turn, step in and create more adrostenedione, a steroid hormone and this is converted to estrogen by adipose (fat) tissue. It’s the body’s way of compensating for declines in estrogen.
Obviously, there is a potential problem here if the adrenals are already taxed or exhausted. A lot more demands are made on them in perimenopause.
So adrenal health is very important prior and during this transitional time.
Here are some of the common symptoms of peri-menopause and how they are connected to Hashimoto’s:
Common Symptoms and their Causes During Perimenopause
1. Systemic inflammation and pain: This is caused by surges in certain immune cells and proteins called cytokines. Cytokines like IL-6, IL-1 and TNF-alpha are all implicated in Hashimoto’s, as well.
2. Multiple food sensitivities, gastrointestinal symptoms: These are often caused by Intestinal permeability or “leaky gut”: This maybe caused by declines in estrogen, increases in cortisol production, hypothyroidism and dysfunction in the gut. Intestinal permeability is ground zero for autoimmunity, as well.
3. More stress, poor sleep, fatigue during the day: The adrenals have to do additional work when other female hormones, like estrogens decline. Adrenals issues are also very common with Hashimoto’s.
4. Poor circulation, cold hands and feet, poor nails beds, fungal overgrowth in nail beds: This is caused by problems with peripheral circulations, especially in the small vessels. And may be due to altered nitric oxide function. These symptoms are also very common with Hashimoto’s.
5. Brain fog, depression, memory loss and poor cognitive function: This is due to inflammation in the brain and deficiencies or declines in neurotransmitters. These are some of the most common symptoms of Hashimoto’s.
6. Hot flashes, night sweats: A hallmark of perimenopause caused by altered FSH (follicle stimulating hormone) and feedback from the ovaries. This is a less common symptom of Hashimoto’s but something many women experience.
7. Poor bone density: This is caused by problems in osteoclast or bone cell formation and other issues. It is also a very real concern for Hashimoto’s patients, as well because osteoporosis can be a side effect of thyroid medication . (One of the major causes of this breakdown in bone health is the cytokines that we spoke about above.)
Here’s a previous post I wrote on this subject that looks into all of these factors in more depth.
The important take away here is to see that all of these issues must be addressed. As I am fond of repeating, this is way more than a thyroid problem.
If these other areas are not addressed, the result is the perfect recipe for compounded problems and more aggressive symptoms and progression of the disease.
As women enter their later years the symptoms of long standing hypothyroidism and Hashimoto’s become harder to separate from other aging symptoms.
Analysis of patients with long term hypothyroidism due to Hashimoto’s thyroiditis suggested that metabolism of thyroxine (T4), including conversion (via deiodination) to triiodothyronine (T3), was reduced in the elderly. Consequently, low-T3 syndrome is also common in this population.
Another serious concern is that there are real risks of long term treatment with levothyroixine. Adults aged ≥70 years treated with it have a significantly increased risk of fractures, with a strong dose-response relationship, a Canadian research group has found.
Although autoimmune thyroiditis is the most common cause of hypothyroidism in elderly subjects, other things, such as medications can also cause complications. Unfortunately, many elderly women have been prescribed a number of medications and often doctors to not communicate with one another to determine if there are problems that may result from these different prescriptions.
Medications Can Complicate Hypothyroid Symptoms
A small subset of medications including dopamine agonists, glucocorticoids and somatostatin analogs affect thyroid function through suppression of TSH.
Other medications that may affect TSH levels are metformin, antiepileptic medications, lithium carbonate and iodine-containing medications.
In addition, other drugs can alter T4 absorption, T4 and T3 transport in serum and metabolism of T4 and T3, such as proton-pump inhibitors and antacids, estrogens, mitotane and fluorouracil, phenobarbital and rifampin. Amiodarone administration is also associated with hypothyroidism.
The Immune System Also Ages
As the body ages, many systems of the body also age. The immune system is no exception. Aging of the immune system, or immunosenescence, is characterized by a decline of both T and B cell function, and paradoxically the presence of low-grade chronic inflammation.
Chronic inflammation is at the root of Hashimoto’s and autoimmunity and many other disease such as cardiovascular disease and Alzheimer’s. So, this can have serious health impacts over time and be a factor in the progression of these other diseases.
Other Systems Also Decline
Other systems of the body also decline as the body ages, stomach acid levels tend may lessen, the intestinal lining can break down and commensal bacteria may decline and all of this this can impact thyroid hormone absorption and conversion.
In addition, there are numerous cardiovascular symptoms. These include:
There are also a host of psychological issues that are related to the impact of hypothyroidism and autoimmunity on the brain. These include:
Finally there are also pulmonary issues. These include:
Here’s the important take away from this post. Women with Hashimoto’s at different stages of life are not all the same. And treating them all the same way does not make sense.
When you are diagnosed, the stage you have progressed to and where you are in your life are all important factors in determining the best course of treatment. It’s time we start acknowledging this and looking more deeply into the nuances of patient care.
In the next few posts of this series I will examine how the most common challenges for Hashimoto’s patients (weight gain, fatigue/exhaustion, brain fog and memory/cognitive issues and diet) may be different for these different “types” and how the treatment strategies and priorities might also be different.
We will begin by looking at how the brain is impacted in each of these Hashimoto’s “types”.
http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/ Stages of disease
http://cdn.intechopen.com/pdfs-wm/28726.pdf 3 Stages of Disease referenced
20 and Under:
http://adc.bmj.com/content/83/3/207.short Prevalence and etiology of hypothyroidism in the young
http://www.hindawi.com/journals/jtr/2011/675703/#B2 Autoimmune Thyroid disease in children
P. Saravanan and C. M. Dayan, “Thyroid autoantibodies,” Endocrinology and Metabolism Clinics of North America, vol. 30, no. 2, pp. 315–337, 2001.
http://www.ncbi.nlm.nih.gov/pubmed/24756046 Natural course of Hashimoto’s in children
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338651/ Thyroid function in pregnancy
http://www.ncbi.nlm.nih.gov/pubmed/17137901 Natural history of euthyroid in Hashimoto’s patients
http://www.ncbi.nlm.nih.gov/pubmed/11305796 Clinical course of Hashimoto’s in children and adolescents a 6 year follow up.
http://www.ncbi.nlm.nih.gov/pubmed/2189331 51 cases of children and adolescents with Hashimoto’s
Postpartum Thyroiditis:
http://www.thyroid.org/thyroid-disease-pregnancy/
http://www.mayoclinic.org/diseases-conditions/postpartum-thyroiditis/basics/symptoms/con-20035474
http://annals.org/article.aspx?articleid=691332 14 Cases of Transient Postpartum thyroiditis
https://drknews.com/why-pregnancy-can-trigger-hypothyroidism/
http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/thyroid/thyroid_preg.html Changes in thyroid function during pregnancy
http://www.thyroidmanager.org/chapter/thyroid-regulation-and-dysfunction-in-the-pregnant-patient/
http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2003;volume=57;issue=6;spage=252;epage=258;aulast=Kumar Thyroid function tests in pregnancy
http://www.ncbi.nlm.nih.gov/pubmed/9588218 Shifts in TH-1 and Th-2 during pregnancy
http://www.hindawi.com/journals/mi/2012/416739/ TH-1 suppression rather than TH-2 dominance
Stagnaro-Green A. Clinical review 152: postpartum thyroiditis. J Clin Endocrinol Metab. 2002;87:4024-7.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518419/ TPO antibodies and risk for pregnancy complications
Infertility:
http://www.ncbi.nlm.nih.gov/pubmed/1427622 The role of thyroid hormone in ovulation
http://ttvps.com/saegre/revista/numeros/2010/n2/act_efectos_de_hormonas_tiorideas_n2.pdf Effects of thyroid hormone on ovarian function
Perimenopause and Hashimoto’s:
http://www.ncbi.nlm.nih.gov/pubmed/9356978 Perimenopause and thyroid issues (lipid and weight)
http://www.endocrine-abstracts.org/ea/0029/ea0029p1688.htm
https://www.hashimotoshealing.com/hashimotos-and-perimenopause/
Hashimoto’s in the Elderly:
http://www.ncbi.nlm.nih.gov/pubmed/9893482 Hashimoto’s and the elderly
http://www.ncbi.nlm.nih.gov/pubmed/1987440 Thyroid disease in the elderly
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889224/ Aging and the immune system
Nature Reviews Endocrinology 7, 435 (August 2011) | doi:10.1038/nrendo.2011.99 Pharmacotherapy: Levothyroxine in the elderly—finding the breaking point by Linda Koch
Marc Ryan, L.Ac.
Founder of Hashimoto’s Healing
Every year, as we celebrate our anniversary I like to reflect back on what we’ve learned from working together over this last year. (Here’s a link to last year’s if you’re feeling nostalgic.)
Going through this process a great opportunity to review, reflect and build on these lessons this coming year.
What an amazing year it has been! I wrote and published my book, Roadmap to Remission, a mere 436 pages of practical information. My daughter and I personally shipped over a 1,000 copies until we couldn’t stand it any more and had to hire a fulfillment house. Thanks to so many of you who showed remarkable patience through that process. That was a major learning experience!
(I’m currently working on the second edition which has some new material and a foreword by Dr. Datis Kharrazian).
A lot of people have shared with me via our Facebook group and via email how much the book has helped them. And I’ve had my share of haters tell me just how awful they think the book is and how terrible I am for writing and selling it (at cost for no profit on my website). That was something I wasn’t entirely prepared for. It stings when you’re really trying your best just to help people. But it was also a really valuable learning experience.
And I’ve done quite a bit of thinking about what else I learned and I’d like to share them with you, dear readers. Here are my top 5 Clinical Pearls for this year:
1. This is an inside job
2. It’s all about the proteins
3. Oral Tolerance
4. Diet matters times infinity
5. Hashimoto’s isn’t the end of your life, it’s the beginning of your journey
The more I work with people, the more I have come to believe that the vast majority of healing happens between our ears (in both a literal and metaphorical sense). The brain is profoundly impacted by Hashimoto’s and our thoughts and beliefs are so often the the difference between success and failure.
There’s a quote attributed to Henry Ford:
“Whether you think you can or think you can’t, you’re right.”
And nowhere is that more true than the process of healing. You have to first, fundamentally, believe that it is possible.
I know for myself and for many of the people I’ve worked with that this belief is constantly being tested and some days you really need a powerful inner confidence and faith to keep going.
And there is also no question in my mind that this inner faith is something that for most of us needs to be cultivated and nurtured.
Resilience and the ability to bounce back and overcome difficulties are not always innate skills.
However, like any skills, these improve if you practice them.
For myself, it wasn’t until I started instituting a daily practice of writing my personal vision, writing the things I am grateful for and the also writing the “wins” that I had accumulated that I started to make significant strides in this direction.
Now I recommend this to everyone.
I can’t overemphasize the importance of this practice. It can yield remarkable results because it can shape your entire outlook on everything.
Last year one of the books I read was The Obstacle is the Way by Ryan Holiday. (You have to read this book!) It’s all about using obstacles, disappointments and adversity to transform the world. And not just in a “glass half empty or half full” accentuate-the-positive sort of way.
This book takes it to a whole new level and it points out the incredible blessing of failure, illness, and disappointment. And, essentially, some of the greatest inventors, thinkers and doers of history weren’t defeated by hard times, pain and struggle they were made possible by it.
Instead of fighting it, they embraced it and used it to their advantage to do great things.
And transforming obstacles and adversity into positive action is a conscious choice. With our health it involves letting go of the victim mentality and becoming accountable.
I discussed this process of accountability in a recent video I made. At any time, you have a choice to be the victim or to make the obstacle your way.
So I encourage you to really spend some time cultivating this way of thinking and behaving and if you are feeling defeated and discouraged know that you are not alone is this and that the opportunity is there for you to accept it, embrace it and use it to create great things of your own.
The other part of what you really need to explore, in my opinion, is the physiological “why” of your signs and symptoms. Hashimoto’s and autoimmunity can be so complicated complicated and there are sometimes many different layers to our health challenges.
If we can find at least some of the “why”, then we can find important clues to getting you better, faster and more deeply. This brings me to my next clinical pearl:
This last year I was invited to attend a powerful gathering of healers called the Thyroid Mastermind, hosted by Michael and Dr. Izabella Wentz. The keynote speaker of the event was Dr. Datis Kharrazian, who has been a longtime teacher and mentor of mine (and many others who attended).
Dr. K shared some of this research he has been doing over the last year or so with Dr. Vajdani, founder of Cyrex Labs. This was funded entirely on his dime (and we’re talking a serious chunk of change) because, while these issues that are very important to those of us with autoimmune diseases, they are not really seen as that important by the powers that be.
There are many layers to this research and it’s going to be released soon, and he’d have to kill me if I revealed the details because it could compromise the study, but here’s the big takeaway: It’s all about the proteins.
Autoimmune reactions are reactions by your immune system to various proteins. Or, really, protein fragments – the sequences of amino acids that make up those proteins.
They are what cause the immune reaction that destroys our tissue.
Proteins are the building block of life. So these proteins and the amino acid patterns that make them up are everywhere. In lots of different foods (and many you don’t think of as proteins like grains and vegetables) and in meat and in the tissues of our body.
And these proteins are the “on switch” for autoimmune destruction. They turn on the antibodies (which don’t destroy tissue) that signal other parts of the immune system to attack, kill and destroy.
And because these amino acid sequences repeat all over the place, all kinds of different tissue can get destroyed. Really important stuff. One example of this is the affinity of thyroid antibodies (like antibodies to TPO and T3) to tissues in our brain.
Proteins don’t just signal destruction of the thyroid, they can also signal other parts of our immune system to destroy our cerebellum and myelin, the sheath that protects our nerves. (Destruction of myelin is what causes Multiple Sclerosis (MS).
This is one of the reasons “why” some people with Hashimoto’s will develop encephalopathy. Their brain is being attacked and, in some cases, it’s being signaled by TPO. The most common symptoms of this process? Memory loss, fatigue and depression!
These proteins are a really big deal!!! Which leads me to my next clinical pearl:
Another important discovery for me was the importance of something called oral tolerance in autoimmunity and in sensitivity to dietary proteins.
Oral tolerance is defined as your immune system NOT REACTING locally and systemically to antigens such as food proteins.
In other words, oral tolerance is when you eat a certain protein and you become tolerant to that protein.
We can think about this in terms of our own evolution. If you are eating something (a protein) all the time, it would be a really good thing for you to develop a tolerance to it and not attack it.
If we’re only eating certain kinds of foods, we‘d be more likely to survive if we could build tolerance to them.
Proteins are the things we are most often exposed to. (They’re the building blocks of life, after all.)
And it turns out that tolerance to ingested proteins is also really important for the barrier function of the intestines i.e. to prevent leaky gut.
When this tolerance breaks down, chronic diseases follow; like celiac, Crohn’s, ulcerative colitis (these all occur locally in the intestines) and other systemic autoimmune disease like Multiple Sclerosis and even Hashimoto’s.
In other words, oral tolerance is a kind of dimmer switch, it turns down the attack. Both in the intestines and in the rest of the body.
When you have oral tolerance, your immune system doesn’t attack as aggressively.
Clinical Pearl: One thing I’ve observed is that some people actually lose some of this oral tolerance after being on an elimination diet for a prolonged period of time.
It has made re-think the reintroduction of foods after the elimination phase of Autoimmune Paleo diet and also to realize that this is an often missed opportunity to both reduce sensitivities and to restore immune system equilibrium.
To learn more about this and why it matters, check out my detailed post on this here.
Diet Matters Times Infinity
The single largest source of these proteins is the food we eat. This is why it makes me insane when doctors say things like “Diet doesn’t matter”.
That is a very dangerous and ignorant lie.
Not only does diet matter, ignoring the role of diet can literally ruin your health. Some of these proteins can lead to inflammation and destruction of parts of your brain. No bueno.
Much of the research that Dr. Kharrazian and Dr. Vajdani have done involves testing the effects of these various proteins on the thyroid axis and the brain. And the results are going to be available to us soon and it’s going to radically transform how we can help you, but for right now here’s what we can tell you.
Dr. Izabella Wentz did a very interesting study of 2, 322 Hashimoto’s patients and she collected some really important data on just how important and effective dietary changes are.
Here are some of the results:
This illustration reveals just how effective diet is in improving symptoms and lowering antibody levels.
And here’s some more important information on some common foods that may cause problems:
Highly reactive foods per IgG test sampling:
100% – Cottage cheese, brewer’s yeast
90%- cola, safflower, whey, baker’s yeast
80%- casein, blue cheese, chicken, cow milk, goat milk, rosemary, yogurt
70%- corn, cheddar, Swiss, licorice, mushroom, sugar cane
60%-pineapple, pinto bean, ginger, oregano, oyster, white potato, sesame, walnut
For myself and my patient population I know that tomatoes can also be a problem. And as we know gluten, dairy and soy proteins can also wreak havoc.
Spinach can also be a problem. One thing I’ve observed with spinach is that it can actually reduce iron levels. I had a patient who was eating spinach salad 3 times a day and she was severely iron deficient.
I tried everything and nothing worked and finally I said stop eating spinach and that turned out to be the problem. Once she stopped, we were able to successfully restore her iron levels to the normal range.
One important thing to understand about these foods is that you may or may not react to them. As I said this is highly individualized. You can use the percentages to make an educated guess about what you might react to, but you are unique and you may not have these same reactions.
Here’s another pearl that’s really helpful: One important thing you can do to strengthen the T regulatory or the “good guy” part of your immune system is to feed them fiber: Here’s what Dr. Vajdani drinks every morning (Pay attention to this, this is a guy who has devoted the better part of his life to researching autoimmunity):
Psyllium powder
Hemp or chia seed powder
Flax seed powder
Almond milk (You can substitute coconut milk if you are sensitive to almonds.)
One important thing to understand about all of this is that there is tremendous variability and millions of possible permutations of this. So everyone doesn’t have sensitivities to all these foods. But, you really need to figure out which foods you have a problem with.
And here’s another clinical pearl: Since the problem is these amino acid sequences, the affinity that is formed is based on longer sequences. If you can break down those sequences into smaller pieces, then you can minimize their destructive potential.
Digestive enzymes that break down protein have the ability to do this in some measure. They break apart the amino acid connections and can render the protein harmless or at least less harmful.
Finally, remember this:
The last point I want to emphasize is that Hashimoto’s is not the end of your health (or life as you know it), it’s the beginning of your journey.
The good news is that we are all traveling this journey together and there are some really amazing people working on this.
But the reality is we are only in the infancy of understanding what is going on and what we need to do about it.
But there is reason for optimism because there are some great minds and some incredibly devoted people who are working day and night to help you.
So let me end on a positive note and say how grateful I am am to all the people who are working on solving these problems and to all of you that are committed to finding solutions outside the box.
The obstacle is our way and the journey is our path and together we will find hope, help and healing.
I can’t wait to see where this journey takes us and where this year will bring us.
Need help in getting there? Schedule an appointment with me and let’s talk!
This month we are celebrating our 3rd Anniversary of launching Hashimoto’s Healing. I can’t believe it’s been 3 years! I’ve had the privilege to work with speak with over 2,000 people with Hashimoto’s during that time and to work one on one with over 750. And as part of the celebration, I’ll be releasing a new updated version of my book, Roadmap to Remission. And I’m truly honored that Dr Datis Kharrazian (without whom this book and many of my clinical skills would not be) has written the foreword.
I’d like to share it here because it’s a wonderful summary of what I have tried to achieve with this book, the website and our Facebook community.
With Dr. Kharrazian in Boulder Co., 2015 at the Thyroid Mastermind
Few Chinese medicine practitioners are willing or able to explain Chinese medicine concepts in Western terms. But Marc Ryan, LAc, who calls Traditional Chinese Medicine the “original functional medicine,” gamely builds us a bridge between the Eastern and Western arts of healing.
If you’ve read my books you’ll see familiar functional medicine concepts of Hashimoto’s hypothyroidism management. Not simply a problem of the thyroid, Hashimoto’s is an autoimmune disease in which the immune system attacks and destroys the thyroid gland.
Thus, Hashimoto’s is a problem of the immune system that involves a complex web of dysfunction and requires careful attention to the root causes of its debilitating symptoms.
What sets Marc’s book apart is how he takes us on functional medicine journey of Hashimoto’s hypothyroidism through the lens of Traditional Chinese medicine.
Where Western medicine concerns itself with science and studies, Chinese medicine tells us a story about the human body, weaving in natural phenomenon and earthly elements.
The Hashimoto’s patient will find herself surprised by the uncanny knowing of this ancient healing art. For instance, in Chinese medicine the thyroid is seen as the place where communications and dreams are generated. When this area becomes clogged due to an inflamed and under functioning thyroid, the patient may feel stuck in her situation and unable to express her needs.
Marc weaves many such examples in, along with Chinese concepts of yin and yang, the five elements, Chinese herbs, and Chinese healing exercises. For the Hashimoto’s patient, this book is a fascinating integration of sound functional medicine with an introduction to Chinese medicine’s view of thyroid and immune function.
What’s more, Marc presents the material in a conversational style that is fun to read. Hashimoto’s is a complex topic that can seem overwhelming at first. Many people with Hashimoto’s have difficulty with concentration, which makes it hard to read a complicated book about the topic.
In response, Marc has gone the extra mile to make his information easy to absorb with short paragraphs, clear descriptions, real-life examples, and helpful summaries. Throughout the book, his warm sense of humor, upbeat attitude, and genuine concern for helping people really shine through.
At the same time, staying true to Chinese medicine’s broad-sweep approach to healing, he continually reminds us of the bigger picture — the spiritual nature of our journey, the connection of our health to that of the planet, and how facilitating the flow of energy through the organs is reflected in our flow through life’s journey.
I have taught thousands of practitioners over the years and I know Marc to be a passionate and dedicated practitioner with clear integrity and humility, one of the few who leaves a seminar and reads and rereads the manuals in order to master the material.
This, combined with his innate ability to incorporate larger life meanings of the Hashimoto’s journey, has moved him beyond the role of practitioner into that of healer.
This passion was born out of Marc’s personal experience as someone with Hashimoto’s and the parent to a child with the disease. Knowing he was sick long before he knew why, his experiences were like that of many Hashimoto’s patients:
Being told he’d have to wait until he was much worse before getting any treatment; being offered immunosuppressant therapy that would disable his body further; being dismissed by doctors; and most importantly, his doctors not getting to the root of the problem.
It was when he decided to step outside of outdated, traditional modes of treatment that he made progress.
He went on to become an experienced acupuncturist and herbalist whose entire medical practice is now devoted to Hashimoto’s.
He truly cares that patients have the opportunity to understand how their bodies work, what is out of balance, and what steps they must take to live in a state of vitality and wellness again.
With the disconnect between conventional hypothyroidism care and the realities of Hashimoto’s, the medical world clearly needs a renewed approach.
In Roadmap to Remission, Marc takes the best parts of both Western and Eastern functional medicine to create a methodical approach that touches all aspects of the Hashimoto’s journey with grace, humor, and firm encouragement.
In doing so, he has empowered patients to better understand their bodies so they can engage as active participants in their own healing.
Datis Kharrazian, DHSc, DC, MS
Author,
Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?
Why Isn’t My Brain Working?
Adapted from Chapter Seventeen of How to Heal Hashimoto’s: An Integrative Road Map to Remission, published by Hay House. 
In this post, I will show you how to use the A.P.A.R.T. System to heal the adrenals.
Not sure what that means? Click here to learn about the A.P.A.R.T. System.
Open your journal (keeping a food/behavior/reaction journal is an absolute necessity, in my opinion, if you are serious about healing your Hashimoto’s) and try to figure out which symptoms of problems with the adrenals you have (see below for a list).
Note what they are, then create a plan for addressing them.
After that take inventory of what you did. Look at what worked and what didn’t. Both will provide valuable information.
Double down on what worked, change what didn’t. Keep at it.
But don’t wait to deal with stress and heal the adrenals. They are just too important to wait.
Symptoms of Low Cortisol (Adrenal Exhaustion Phase)
Cannot stay asleep
Crave salt
Slow starter in the morning
Afternoon fatigue
Dizziness when standing up quickly
Afternoon headaches
Headaches with exertion or stress
Weak nails
Symptoms of High Cortisol (Adrenal Resistance /Alarm Stages)
Cannot fall asleep
Perspire easily
Under high amount of stress
Weight gain when under stress
Wake up tired even after 6 or more hours of sleep
Excessive perspiration or perspiration with little or no activity
In this section let’s take a look at some testing we can do for the adrenals and also to talk about the 3 stages of adrenal burnout.
Ok, so like virtually everything in our body, things don’t usually happen overnight. They develop over time and progress from ok, to sort of bad to really bad if you do’t do anything to stop that progression.
We saw this with the progression to type 2 diabetes. It goes from dysglycemia to insulin resistance to metabolic syndrome to full blown diabetes.
The same is true with autoimmune disease. It goes from silent autoimmunity to reactive autoimmunity to full blown autoimmune disease.
The adrenals are no exception. Adrenal problems also go through a progression as well.
It looks like this:
1. Alarm reaction: This happens in normal life. The adrenal glands become hyperactive to increase cortisol levels to adapt to the demands of stress.
2. The second stage is the Resistance stage: This occurs in response to prolonged stress as the body steals pregnenolone from cholesterol to make cortisol- also known as the pregnenolone steal.
When this happens, hormonal imbalances arise because there isn’t enough cholesterol to make them. It can cause PMS, infertility, male menopause, and polycystic ovarian syndrome (PCOS).
3. The third stage is the Exhaustion stage: At the point the adrenals are saying “Uncle” and they can no longer adapt to stress.
The cofactors needed to make cortisol become depleted and cortisol levels drop too low. Because the adrenals no longer produce sufficient cortisol, the pregnenolone steal cycle also stops.
Basically, let me give you a quick run down of what they are.
The first is to test your blood pressure in 2 different positions: sitting or lying down and standing.
Firstly, Take and compare two blood pressure readings—one while lying down or sitting and one while standing. Rest for five minutes in a relaxed position before taking the reading.
Stand up and immediately check your blood pressure again. If the blood pressure is lower after standing, then you may have reduced adrenal gland function, and more specifically, an aldosterone issue–(Aldosterone is an adrenal hormone and hypothyroidism can lead to low levels of aldosterone in the blood.)
(Normal adrenal function will elevate your BP on the standing reading in order to push blood to the brain.)
It’s also a good idea to do this test both in the morning and in the evening, because you can appear normal one time, and not another.
The second test you can do is to check your pupils. This is called the Pupil Test and it also tests levels of aldosterone.
You need to be in a dark room with a mirror. From the side (not the front), shine a bright light like a flashlight or penlight towards your pupils and hold it for about a minute. Carefully observe what happens to your pupil.
With healthy adrenals (and specifically, healthy levels of aldosterone),your pupils will constrict, and will stay small the entire time you shine the light from the side.
The light causes them to constrict, it’s a natural response to having light shone in your eye.
In adrenal fatigue, the pupil will get small, but within 30 seconds, it will soon get larger again again or obviously start to flutter as it tries to stay small.
Why does this happen?
Because when you have adrenal insufficiency you can also have low aldosterone, which can cause an imbalance in sodium and potassium (too little sodium and too much potassium).
This imbalance is what causes the sphincter muscles of your eye to be weak and to dilate in response to light.
So the fluttering struggle to keep the pupil small may mean you have adrenal challenges.
In terms of laboratory tests, there are a couple ASI or Adrenal Salivary Index and the DUTCH or Dried Urine Test for Comprohensive Hormones. These provide the most accurate, useful and comprehensive test for the adrenals.
One important thing to understand about this test; (and this is true of a number of different tests) The most important test is the second or even third test.
One test is useless, because we are establishing a baseline and then we are going to take action. And we need to know if what we are doing is helping.
The second and third tests give us that information. We must always reassess and readjust.
And the adrenals generally respond to treatment pretty well. If they don’t you need to look for something deeper. A parasite or heavy metal toxicity, a chronic viral infection or some food intolerance.
Some times you have to be a detective and examine, step by step, all of these things.
The ASI tells us how a person’s adrenals are working throughout the day. Its a 24 hour test. Cortisol is secreted in a specific pattern over a 24 hour day and by measuring saliva at different intervals throughout the day, we can chart the cortisol levels.
Being in a chronic state of alarm or prolonged stress will mess with this rhythm. One example of this is people who are night owls, or have trouble falling, staying asleep or they wake up really tired after getting enough sleep.
Their rhythm has been disrupted.
The ASI shows abnormalities in this circadian rhythm, charts key hormone levels and pinpoints where problems arise along the way. It can be a really valuable test.
The DUTCH test, which uses dried urine, is innovative in a number of respects, and offers several benefits over older hormone tests.
For example, a conventional (liquid sample) urine test gives you metabolites you simply can’t get in a blood or saliva test, but the collection method can be quite messy and inconvenient.
One of the biggest problems with hormone testing is that some hormones fluctuate throughout the day. Cortisol, for example, rises as soon as you get out of bed and then declines as the day wears on.
If your diurnal pattern is dysfunctional, meaning you’re low in the morning and high at night, you have a serious problem. But a 24-hour urine test cannot show you this.
That’s really the advantage of a saliva test, which is done several times over the course of a day. By taking multiple samples throughout the day, you can get a more accurate measure of your cortisol pattern. The drawback is the collection method, which can be time consuming and tedious.
The DUTCH test, on the other hand, captures all of that information and more in one simple test. Simply urinate on the filter paper on the collection device and let it dry.
Those test strips are then used to give you a complete hormone panel, including metabolites, (which can’t be measured in blood or saliva), effectively replacing multiple testing methods.
Both of these tests can be useful tools for determining your next steps and identifying the type of adrenal problem that you have.
If we want to heal out Hashimoto’s, we absolutely have to heal our adrenals.
And the reality is that this whole process of healing these multiple systems is, without question going to take longer than it takes you to read this book.
I am teaching you about what is going on. Correcting it takes time, patience, vigilance and devotion.
But it is so worth it, people.
Some of the tests that you can do for the adrenals are:
1. The blood pressure test. Take 2 measurements, one seated or lying downand one standing. Compare them. If there is a big difference, this may point to adrenal problems.
2. The pupil test. Point a light at your pupils. Watch it constrict, then watch it return to normal. If it gets small and quickly goes back to normal or flutters, then, “Houston, we’ve got a problem”.
3. Lastly, the best laboratory test is the ASI or Adrenal Salivary Index. This takes multiple saliva tests throughout the day and tracks your circadian rhythm. It can be very helpful, not only for identifying the problem but also for tracking your progress in fixing it.
Not everything has the same level importance. This is what 80/20 teaches us. Some things are having more of an impact than others. Figure out which they are (the positive feedback loops) and then make a plan to fix them.
What does that mean when it comes to the adrenals? Check kidney and adrenal function. Adrenal health is very important if you are taking? thyroid replacement hormone.
The warning label for Synthroid states:
“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. And if they aren’t and you give them thyroid hormone anyway, this may cause an acute adrenal crisis. Not good.
How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency? A lot.
And how many were tested for adrenal insufficiency before they were put on thyroid hormone? Very few.
Clearly, evaluating and treating the adrenals, if necessary, is a major priority.
Once you have evaluated your adrenals, and you’ve established a plan, the you need to act on that plan. Here’s a some of the actions you can take.
Adaptogenic Herbs:
There are quite a few herbs that have adaptogenic properties, meaning that they help your body adapt to stress.
But as with everything, there is a risk/benefit analysis that must be done with them, especially when autoimmunity is involved. You must be cautious about stimulating the immune system when taking adaptogenic herbs.
Here’s a list of herbs that can be helpful, it may be best to introduce them one at a time rather than in a mixed formula. That way, if you have a reaction, you’ll know which herb was responsible:
Acanthopanax
American gensing
Ashwaghanda (this plant is a nightshade and may cause a reaction)
Cordyceps
Codonopsis
Eleuthrococcus
He shou wu (also excellent for helping promote hair growth)
Holy Basil
Jiaogulan (also excellent for reducing cholesterol)
Licorice
Maca
Panax gensing
Rhodiola
Schizandra
ACTH is to the adrenals what TSH is to the thyroid. It regulates cortisol production. High ACTH may mean the adrenals aren’t producing enough cortisol. Low ACTH may mean the pituitary isn’t producing enough adrenal hormones.
ACTH Increasing:
Ginko
Panax ginseng
Tripterygium
ACTH Reducing:
Acanthopanax
Hypercium
Licorice
Earlier, we looked at symptoms for the different stages of adrenal issues. Figure out which stage you are in and try the supplements below.
1. Alarm Stage:
Balance blood sugar and support healthy response to insulin resistance: alpha lipoic acid, biotin, chromium, gynemma sylvestre, inositol, magnesium, zinc
Adaptogens: See above
Essential fatty acids: fish oil, evening primrose oil
2. Resistance Stage:
Balance blood sugar and support healthy response to insulin resistance: alpha lipoic acid, biotin, chromium, gynemma sylvestre, inositol, magnesium, zinc
Adaptogens: See above
Essential fatty acids: fish oil, evening primrose oil
Add licorice, and B vitamins (see food sources below)
3. Adrenal Exhaustion:
1. Chromium, adrenal, pancreas glands, choline bitartrate, co-enzyme Q 10, inositol, rubidium chelate, vanadium.
Adaptogens: See above
Essential fatty acids: fish oil, evening primrose oil
Add licorice, and B vitamins (see food sources below)
In cases of extreme exhaustion, consider consulting a physician or practitioner. You may benefit by adding pregnenolone and/or DHEA.
VITAMIN B1: rice bran, pinto bean, peas, millet, lentils, almonds, turnip greens, collard greens, kale, asparagus
VITAMIN B2: salmon, trout, cod, mackerel, perch, oysters, mushrooms, almonds, hijiki
VITAMIN B3: rice bran, red pepper, wild rice, kelp, sesame seed, peaches, brown rice, mushrooms, barley, almonds, apricot
VITAMIN B5 (PANTOTHENIC ACID): beef, chicken, salmon, mackerel, sardines, barley, rice, avocado, plums, raisins, almonds, dates
VITAMIN B6: banana, barley, brewer’s yeast, molasses, brown rice, liver, beef, cabbage, carrots, potato, yams
VITAMIN B12: beef liver, beef kidney, ham, sole, scallops, eggs, oats, pickles, amasake, algae, spirulina and chlorella, brewer’s yeast
FOLIC ACID: liver, asparagus, lima beans, spinach, swiss chard, kale, cabbage, sweet corn
Retest, Reassess and ask all over again. Figure out what worked and what didn’t. Double down on what worked and either eliminate or recreate a plan for what didn’t.
Try some things and reassess.
Retest your adrenals, Reorder the ASI (Adrenal Salivary Index) and see if what you did helped.
Keep doing it, keep refining, keep building on the positive results and keep looking for the remaining positive feedback loops that are causing vicious cycles.
The adrenals are a critically important part of the puzzle and given their importance for whether or not you can take thyroid hormone, it makes sense to make healing them your top priority.
Looking for help in assessing your adrenals? Do a consultation with Marc. Click here to learn more.