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Today’s Hashimoment: Forgiveness
I spent the weekend at a spiritual retreat and was reminded of the importance of forgiveness. We must forgive our immune systems for attacking our body, forgive those who don’t understand what we are going through, forgive ourselves for not being perfect. It is in forgiveness that we find healing.
Understanding Hashimoto’s Antibodies
Some of the most common questions that I get from people who reach out to me are about antibodies.
There seems to be a good deal of confusion about them and also a good deal of emotion and expectation attached to these numbers going up or down.
In this post, we examine thyroid antibodies and, hopefully, dispel some of the myths around them.
What Are Antibodies?
First of all, what are antibodies, exactly? I like to use military analogies when describing the immune system. And antibodies are like military intelligence (hold the oxymoron jokes).
They are the part of the immune system that gathers information on the bad guys (bacteria, viruses, fungus, parasites, etc.) and then they label those bad guys. Kind of like putting a red flag on them.
The invader is called an antigen. Antibodies bind to these antigens like a lock and a key. Every cell has antigens and these are what the immune system recognizes. And every cell in our body has a self-antigen which are supposed to let the immune system know that our own tissue isn’t a bad guy.
Once the bad guys have been labeled, other parts of the immune system are signaled and they attack and, in most cases, kill the bad guys. In some cases these antibodies can neutralize the bad guys all by themselves and not have to wait for reinforcements.
With autoimmune disease these antigen signals get confused and the immune system ends up attacking our own tissue.
Over the last 50 years there has been a lot of research in this area.
HLA is the Place Where Bad Things Happen
There is a region on cells located on some of our genes called the HLA (or Human Leucocyte Antigen) System. Many of these are located on chromosome 6 (for those of you keeping count).
Mutations or defects of HLA has been linked to many different autoimmune diseases. Exactly what happens is not known, there are numerous theories, but the end result is that our own tissue gets attacked and destroyed by the immune system.
There is a specific class of HLA (class II) that has been linked to autoimmune thyroid diseases like Hashimoto’s and there are also specific antibodies that are important in the disease.
What Antibodies Are Linked to Hashimoto’s?
There are 2 autoantibodies that are important:
Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.
Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production.
TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.
In Hashimoto’s, TPOAbs are present in nearly all (>90 %) patients, while TgAbs can be seen in approximately 80%.
What Antigens Do These Antibodies Like?
Antibodies against TPO (TPOAbs) and Tg (TgAbs) are of immunoglobulin G class, (IgG) and both are really good buddies with their antigens.
For TPO, it is for the enzyme thyroid peroxidase, which frees iodine and helps in the production of T4 and T3.
And for TgAb it is for Thyroglobulin, which is also used by the thyroid to produce T3 and T4.
When these 2 things get destroyed, over time, the body can’t make enough thyroid hormone.
This results in hypothyroidism and all the familiar problems of Hashimoto’s: fatigue, constipation, depression, hair loss, cold hands and feet, brain fog, memory issues and lots more.
Unlike TgAbs, TPOAbs can activate certain parts of the immune system (complement) and are able to cause damage to thyroid cells.
However, there isn’t much evidence that both antibodies have a major role in the formation of Hashimoto’s or in the destruction of thyroid cells.
It seems a lot more likely that other parts of the immune system are signaled and that they bring in the Navy Seals of the immune system which attack and kill thyroid cells.
Antibodies Are The Definitive Test for Hashimoto’s
TPO and TgAb antibodies, however, are considered the definitive test for whether or not you have Hashimoto’s. Basically, if either one or both of these are found to be above the lab range values, then you are positive for the disease.
Most labs have the high end at about 25 to 35. Numbers vary considerably, but it is not unusual for people who have been diagnosed to have antibodies above 1,000.
Antibodies Do Not Attack Thyroid Tissue
As I stated above, in most cases these antibodies, themselves, do not attack and kill thyroid cells.
What’s also important to understand is that there are various stages of autoimmune disease and depending on where you are in the progression, you will have different degrees of thyroid tissue destruction and, therefore, different symptoms.
According to Dr. Datis Kharrazian, there are 3 stages of autoimmune disease. While these stages are not recognized by conventional doctors, they are very useful in determining exactly where you are in the progression of the disease.
And realizing that there are stages and that the stages get worse and worse, is also helpful for motivating you to do as much as you can to stop the progression. (Hopefully!)
You can read more about these stages here.
Antibodies Unleash the Attack, But They Aren’t The Destroyers
The antibodies are really involved in signaling the immune system and in setting off a series of events that results in the attack and destruction of the thyroid.
I have written extensively about what happens in this previous post.
The important thing to understand here is that the amount of antibodies don’t necessarily directly correspond to how severe the Hashimoto’s is.
There are many reasons for this, but one simple way to look at it is this: The amount of destruction that is done by the army (the immune system) depends on the strength and number of the soldiers.
As I said earlier, the antibodies are really like the CIA or some intelligence gathering part of the army. The front line soldiers are the killers. If you have lots of soldiers and they are all revved up and ready to dance, then you get more destruction.
If your army is weak and there aren’t that many soldiers, then the CIA tells them to kill, kill, kill, but they can only do so much damage.
On the other hand, even if there are only a few CIA agents and there is a large, aggressive army, you will still have massive destruction (and loss of thyroid function).
Where am I going with all this? The amount of destruction, which really is the cause of how crappy you feel, depends on the strength and number of soldiers, not on the number of CIA agents in the field.
This is why antibodies are not a good measure of progress and often don’t correspond with how well people feel.
Antibody Levels Are Not A Good Measure of Progress (or Lack Thereof)
Antibody numbers don’t correspond, directly, with tissue destruction. As I mentioned above, in some cases TPO antibodies have been linked to tissue destruction, but more often, this is not the case.
Many patients and doctors or practitioners track these numbers and use them as a measure of whether or not what they are doing is working. And many times, they will find that there is no correspondence.
Obviously, getting antibody numbers to drop is not a bad thing. But it is also not necessarily such a good thing, because it may not be an indication that the destruction or the progression of the disease has slowed.
How Do You Measure The Severity of the Attack?
In conventional lab testing there really aren’t tests that are done to look at this. One theory with Hashimoto’s is that the ratio between the CIA and the soldiers is important.
The soldiers are also known as the TH-1 system, the cytokines or immune proteins associated with this part of the immune system are the killers.
The CIA is known as the TH-2 part of the immune system and you can test for ratios between TH-1 and TH-2 cytokines.
If there is a lot more of the soldiers than CIA agents, then the prognosis is not good and the disease tends to be more severe.
With Hashimoto’s there is a tendency towards more TH-1 than Th-2, but this is not always the case.
On the other hand if the CIA is more numerous or more balanced and the control and command part of the immune system (TH-3 or the regulatory part of the immune system- what we can call the General) is also strong, then, usually the prognosis is better and you can calm the attack and slow or stop the progression of the disease.
In reality, the immune system isn’t linear and this is an oversimplification. Testing is available to look at the cytokines that represent these different parts of the immune system, but there are many other factors that make current tests for this unreliable and not that helpful.
However, you can use these ideas to help figure out what you need to do in order to calm the attack, slow the progression of the disease and, most importantly, feel better.
What To Do About It
The major cause of thyroid tissue destruction is something called apoptosis. This is programmed cell death.
Lots of crazy things happen on a molecular level (like cytoskeletal disruption, cell shrinkage, chromatin condensation, nuclear fragmentation, membrane blebbing, and DNA fragmentation – membrane blebbing, people!) to make this happen, but the easiest way to grok the root of it is to understand that it is initiated by inflammation.
Inflammation Is the Root of All Evil
The best way to slow the progression and minimize destruction is to do everything you can to stop inflammation and to strengthen the regulatory part of the immune system.
2 important anti-inflammatory agents are: Vitamin D and glutathione. These supplements strengthen the regulatory part of the immune system (TH-3 or the General).
(One important thing to note is that some people with Hashimoto’s have a defect with vitamin D receptors and may need to take more than is usually required by normal individuals.)
These are important anti-inflammatories.
Another player in the complicated drama of Hashimoto’s is TH-17. This is like a rouge agent that when numerous and aggressive can do major damage. TH-17 is highly inflammatory.
Natural supplements that reduce TH-17 include Turmeric and Resveratrol. Some Chinese herbs that have been shown to reduce TH-17 are Chang Shan or dichroa root and Huang Lian and Huang Qin whose active compound is berberine.
Also, it is very important to reduce the causes of inflammation in your diet. The three most inflammatory foods in our diet are gluten, dairy and soy.
Gluten has been extensively hybridized and deamidated and has been linked to the initiation and progression of thyroid autoimmunity.
Dairy products when commercially produced are full of antibiotics, hormones and god knows what else. They have also been linked to the initiation of various autoimmune diseases.
Soy is one of the most heavily genetically modified foods in our diet and is also quite difficult to digest.
Things That Reduce Antibodies
Some research has indicated that thyroid replacement hormone can reduce TPO antibodies, though there is also some indication that natural desiccated hormone can raise antibodies in some individuals (it seems to be those who have a particularly severe immune reactivity – i.e., they have lots of inflammation).
Selenium has been found to reduce TPO antibodies in a number of studies.
Bottom Line
Thyroid antibodies are important for determining whether or not you have Hashimoto’s but are not always a good indicator of how well what you are doing is working.
Do not get too excited if antibody numbers go up or down. It’s not the antibodies that are the problem as much as the other parts of the immune system that are attacking and destroying the thyroid.
Get excited about reducing inflammation. That should be your daily obsession. Really, its that important.
Thyroid replacement hormone and selenium have been shown to reduce TPO antibodies, but this may not work for everyone.
Hashimoto’s is complicated. It is a multi-system disorder that requires a multi-system approach. That’s why created my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. Click here to learn more.
References:
http://en.wikipedia.org/wiki/Apoptosis
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC555850/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/
http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/– Technichal, but great info on what happens in Hashimoto’s
http://www.ncbi.nlm.nih.gov/pubmed/15307940
http://www.ncbi.nlm.nih.gov/pubmed/7878464
http://www.ncbi.nlm.nih.gov/pubmed/20477110
http://www.medicalnewstoday.com/releases/241571.php
http://www.jimmunol.org/content/185/3/1855.full
http://www.cambridgemedicine.org/news/1299069648
http://jcem.endojournals.org/content/87/4/1687.long
Hashimoto’s: Blood Sugar Blues
The human body is a wonderfully complex playground where hormones, immune cells, neurotransmitters, red and white blood cells, bacteria, and more all frolic.
With Hashimoto’s that playground gets invaded by a hurricane of inflammation and this disrupts many of the systems that produce these things.
In today’s post, we focus on how blood sugar problems can impact the thyroid and how Hashimoto’s and hypothyroidism can also make blood sugar problems worse.
It’s a two way street, people.
The Poor, Dear Pancreas
The endocrine gland that is responsible for helping maintain blood sugar balance is the pancreas. The poor, dear, much beleaguered pancreas.
What does the pancreas do? Quite a lot actually, we really should be nicer to it. It does endocrine stuff and non-endocrine or exocrine stuff.
Blood Sugar Balance and Absorption
On the endocrine side it produces insulin, glucagon and somatostatin. Insulin and glucagon are involved in blood sugar metabolism and somatostatin is involved in intestinal absorption.
The exocrine functions include secreting digestive enzymes into the small intestines. These breakdown proteins, fats and carbs in the diet.
Studies have found pancreatic function was significantly reduced in patients with hypothyroidism.
And, in many people today, the pancreas is under siege.
Sugar Junkies
Americans are addicted to sugar. In some measure, it’s their own doing. In other ways, it is the food industry and public health officials who decided that fat was evil when it was discovered that cholesterol was linked to heart disease in the 1980s. The National Academy of Science made sweeping recommendations at that time to get rid of dietary fat.
Bye, Bye Fat – Hello Sugar
So fat was taken out of many processed, fast foods and in an effort to make it taste less like an old ping pong table, it was replaced with sugar.
Carb Roller Coaster
What has since developed is a nation of carb and sugar addicts riding the roller coaster of sugar highs and crashes.
On average, Americans hammer about 200 pounds of sugar a year, and diabetes is a serious threat to bankrupt our healthcare system in the next 20 years.
It is estimated that almost half the population born after 2000 will become diabetic.
This is almost entirely due to diet. As Thomas Edison said, “We’re digging our graves with our teeth.”
2 Different Types of Sugar Problems
Health is really all about balance. And nowhere is this idea more evident than when you look at blood sugar balance.
There are really 2 different kinds of blood sugar problems and many people have a mixture of both. These are hypoglycemia (or too little sugar in the blood) and insulin resistance (or too much sugar in the blood).
With Hashimoto’s either one or both of these blood sugar problems can make things worse. And just to remind you that this goes in both directions; its important to understand that hypothyroidism can also cause blood sugar problems all by itself.
(We have the makings of a vicious cycle.)
Hypoglycemia
Your body is programmed to recognize low blood sugar as a threat because severe or long term hypoglycemia can cause seizures, coma, and death.
When your blood sugar levels drop below normal, your adrenal glands respond by secreting cortisol. Cortisol then tells the liver to make more glucose, bringing blood sugar levels back to normal.
Hypoglycemia is a condition in which there is not enough cortisol to raise blood sugar into the normal range.
The problem is that cortisol (along with epinephrine) is also a sympathetic nervous system stimulant involved in the “flight or fight” response. This can end up wearing out the adrenals.
In fact, we often see adrenal fatigue and hypoglycemia together.
Low Blood Sugar and Cortisol
Cortisol’s job is to increase the amount of glucose available to the brain, enhance tissue repair, and slow other functions – like digestion, growth and reproduction – that aren’t so important when you are running from hungry lions on the African Savannah (flight).
Unfortunately for these people, repeated cortisol release caused by low blood sugar can also suppress pituitary function.
And the pituitary is the master gland that instructs the thyroid. If this function isn’t working properly, then “Houston, we have a problem.”
And where do we have a problem? In the thyroid.
Low Blood Sugar Causes Thyroid Problems
Cortisol directly inhibits the enzyme (5’-deiodinase) which converts inactive T4 into active T3. This can lead to low T3 levels.
In addition, elevated cortisol will cause thyroid hormone receptor insensitivity meaning that even if T3 levels are high enough, they may not be able to bind normally to receptor sites. And when this happens it doesn’t get into the cells.
Cortisol will also increase the production of reverse T3 (rT3) which is inactive. (It’s kind of like the anti-hormone.)
rT3 can cause an increase in the production of substances known as thyronamines that can cause hypothyroid symptoms (like, low basal body temperature,fatigue, depression, etc.) along with insulin resistance symptoms of increased blood sugar.
Cortisol can also lower the levels of protein that binds to thyroid hormone so it can circulate in a stable structure.
And finally, elevated cortisol will slow TSH production by messing with hypothalamic-pituitary feedback leading to lower TSH production.
In my previous post on the adrenal glands we learned about the HPA (hypothalmus-pituitary-adrenal) axis.
Well, there is also an HPT (hypothalmus-pituitary-thyroid) axis.
And much like wires going through a transformer on an electric grid, the HPT and HPA axis are very closely related and problems in one area can affect the other.
“When things go wrong, wrong with you, it hurts me too.” sings the HPA to the HPT axis.
Common Symptoms of Hypoglycemia
Common symptoms of hypoglycemia include (These come from a form called a Metabolic Assessment Form that I use in my practice that I got from studying with Dr. Datis Kharrazian):
(Many of these symptoms improve when you eat )
*Craving sweets
*Irritable if meals are missed
*Depend on coffee or other kinds of caffeine for energy
*Eating relives fatigue
*Feel shaky, or jittery
*Feel agitated or nervous
*Get upset easily
*Poor memory, forgetful
*Blurred vision
It’s important for hypoglycemics to eat often throughout the day and not skip meals. Each meal should be a combination of protein, carbohydrates and fats. And, for these people, too many carbs will often cause serious problems with their blood sugar levels.
Insulin Resistance
When you eat too many carbs and too much sugar, the pancreas secretes insulin to move extra glucose from the blood into the cells where glucose is used to produce energy.
But over time, the cells lose the ability to respond to insulin. It’s like insulin is a little dog barking outside the cell, but the cell won’t let it in.
“I hear you barking, but you can’t come in.”
The pancreas responds by pumping out even more insulin (barking louder) in an effort to get glucose into the cells, and this eventually causes insulin resistance.
Studies have shown that the repeated insulin surges that come with insulin resistance increase the destruction of the thyroid gland in people with autoimmune thyroid disease.
Let me repeat that, insulin resistance increases the destruction of the thyroid gland in autoimmune thyroid disease (Hashimoto’s).
As the thyroid gland is destroyed, what happens? Thyroid hormone production falls. And this causes hypothyroidism. Not good.
Insulin Resistance Can Lead to Thyroid Problems
Insulin resistance can also cause a reduced conversion of T4 to T3 hormones.
When this is addressed, the cells can once again start using glucose for energy and T3 production picks up.
So for a person who is insulin resistant, a lower carbohydrate diet may help restore better T4 to T3 conversion and often these people lose weight in the process ( a nice side effect).
For other people, other things like long-term chronic stress may be affecting their response to low carb diets. As we have seen in my previous post, chronic stress can interfere with thyroid hormones in several ways.
Common Symptoms of Insulin Resistance:
(These are also from that form mentioned above):
(Eating generally doesn’t improve these symptoms )
* Fatigue after meals (this is the hallmark symptom)
* General fatigue
* Constant hunger
* Craving for sweets that isn’t relieved when you eat sweets
* Must have sweets after meals
* Waist girth equal to or larger than hip girth
* Frequent urination
* Increased appetite and thirst
* Difficulty losing weight
* Migrating aches and pains
Many People Have Symptoms of Both
Life is not a textbook. Many people are somewhere in the middle of this blood sugar odyssey and they have some symptoms of hypoglycemia and some symptoms of insulin resistance.
I put this question to my Facebook Support Group and of the 66 respondents with Hashimoto’s, 24 reported symptoms of hypoglycemia and 14 reported symptoms of insulin resistance.
16 reported some symptoms of both.
While this is hardly a scientific study, it does demonstrate how common this problem is in this population.
Virtually Everyone Has Some Insulin Resistance
On thing that’s important to understand is that whether you have high or low blood sugar, you probably have some amount of insulin resistance.
I explained how high blood sugar causes insulin resistance above, but insulin resistance can also cause low blood sugar.
This condition, called reactive hypoglycemia, happens when the body secretes excess insulin in response to a high sugar and carbohydrate meal.
For example: A burger on a sesame seed bun, french fries and a soda – causing blood sugar levels to spike and then drop below normal. (I’m not lovin’ it!)
Hypothyroidism Can Cause Blood Sugar Problems Too
If you eat like this and you have Hashimoto’s (and hypothyroidism), you are setting yourself up for a world of hurt.
Hypo-function of the thyroid can cause everything we just talked about because:
- it slows the rate of glucose uptake by cells;
- it decreases rate of glucose absorption in the gut;
- it slows response of insulin to elevated blood sugar; and,
- it slows the clearance of insulin from the blood.
These mechanisms present clinically as hypoglycemia. When you’re hypothyroid, your cells aren’t very sensitive to glucose (they are resistant).
So although you may have normal levels of glucose in your blood, you’ll have the symptoms of hypoglycemia (fatigue, headache, hunger, irritability, etc.).
And since your cells aren’t getting the glucose they need, your adrenals will release cortisol to increase the amount of glucose available to them.
This causes a chronic stress response, as I described in a previous post, that suppresses thyroid function.
Does this sound familiar?
In another post on Synthroid, TSH and T4, I wrote about how some people are functionally hypothyroid. In other words, they have enough thyroid hormone, but it’s not getting into the cells.
Many of these people also have enough sugar in their blood but its not getting into the cells. Its another vicious cycle.
And let me tell you this from clinical experience. It is really, really, really, really, really, really, really, hard to manage a Hashimoto’s patient or someone with functional hypothyroidism if he or she doesn’t stop this sugar happy carb fest.
In fact, I’m going to say it. It’s a deal breaker.
If this high sugar diet isn’t stopped, you might as well throw in the towel, pack it in, wave the white flag, say “Uncle”, hear the fat lady sing, and give up, because you’re done.
All the money you’re spending on supplements and therapies won’t work. Instead, the first thing you need to do is to balance your blood sugar.
How to Keep Blood Sugar in A Healthy Range
When balancing blood sugar, there are two things to consider. The first is fasting blood glucose, which can be measured first thing in the morning before eating or drinking anything.
In functional medicine we define normal range for fasting blood glucose as 75 – 95 mg/dL. Although 100 is often considered the top of the range for normal, studies have shown that fasting blood sugar levels in the mid-90s may set the table for future diabetes a decade later.
And although 80 mg/dL is often defined as low end of the range, plenty of healthy people have fasting blood sugar in the mid-to-high 70s (especially if they follow a low-carb diet – all you Paleo fans- time to do the wave).
The second, and more important thing to measure is post-prandial blood glucose. This is measured 1-2 hours after a meal.
Several studies have shown that post-prandial blood glucose is the most accurate predictor of future diabetes and is the first marker (before fasting blood glucose and Hb1Ac) to indicate blood sugar imbalances.
Normal post-prandial blood sugar one to two hours after a meal is 120 mg/dL, but most normal people are under 100 mg/dL two hours after a meal.
How This Applies to You
How does this apply to you? If you’re hypoglycemic, your challenge is to keep your blood sugar above 75 throughout the day.
The best way to do this is to eat a low-to-moderate carbohydrate diet (to prevent the blood sugar fluctuations I described above), and to eat frequent, small meals every 2-3 hours (to ensure a continuous supply of energy to the body.
If you’re insulin resistant, your challenge is to keep your blood sugar below 120 two hours after a meal.
The only way you’re going to be able to do this is to restrict carbohydrates.
Buy A Blood Glucose Meter
Everyone should buy a blood glucose meter. The technology has gotten to the point where they are very precise and quite inexpensive.
How low-carb do you need to go?
Its different for everyone. (But, for most people with Hashimoto’s it is recommended to reduce carbs significantly.)
First, figure out your carbohydrate tolerance by buying a blood glucose meter and testing your blood sugar after various meals.
If you’ve eaten too many carbs, your blood sugar will remain above 120 mg/dL two hours after your meal.
Finally, if you have Hashimoto’s, it’s also important that you take steps to make sure your thyroid is properly balanced as well.
As you have seen, this thing works in both directions.
Sugar problems can mess with thyroid function, and thyroid disorders like Hashimoto’s can cause sugar problems and put you at greater risk for hypoglycemia, insulin resistance and if nothing is corrected, diabetes.
It’s Really Complicated – But There Is A Solution
As you can also see, there are layers and layers here that may need to be addressed and worked on.
Hashimoto’s is so much more than a thyroid problem. Its a multi-system problem and it requires a multi-system approach.
That’s why I created my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health.
In it you will discover how all these systems interact and cause vicious cycles and you will also learn how to correct these imbalances and heal.
In the meantime, put down the happy meal and step from away from the counter! 🙂
REferences:
http://www.ncbi.nlm.nih.gov/pubmed/16530289: Study on insulin resistance and inflammation
http://www.eje-online.org/content/134/1/21.extract : Cytokines and autoimmune disease
http://www.ncbi.nlm.nih.gov/pubmed/3500324: Impact of immune cells on TSH
http://care.diabetesjournals.org/content/24/8/1448.full: Study on Glucose Tolerance and Neuropathy
http://nahypothyroidism.org/insulin-resistance-can-trigger-hashimotos-disease/
http://chriskresser.com/thyroid-blood-sugar-metabolic-syndrome
http://diabetes.niddk.nih.gov/dm/pubs/statistics/
http://www.ncbi.nlm.nih.gov/pubmed/939192 : Study on impact of thyroid hormone on insulin secretion.
http://www.ncbi.nlm.nih.gov/pubmed/2013384 : Influence of the thyroid on pancreatic function
http://diabetes.diabetesjournals.org/content/16/9/643.full.pdf+html: Effects of thyroid function on insulin secretion
http://www.ncbi.nlm.nih.gov/pubmed/19364696 : Excess thyroid hormone and carbohydrate metabolism
http://www.huffingtonpost.com/t-colin-campbell/low-fat-diets-are-grossly_b_740543.html
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Why Do I Still Have Thyroid Symptoms? (When My Lab Tests Are Normal), Dr. Datis Kharrazian, Elephant Printing 2010
Is Fibromyalgia Undiagnosed Hashimoto’s?
Hashimoto’s is the most common cause of hypothyroidism in the United States. An estimated 20 million people suffer from some form of thyroid disease.
Up to 60 per cent have no idea that they have a thyroid problem.Women are five to eight times more likely than men to have thyroid issues.
Fibromyalgia is a multi-symptom disorder that affects an estimated 5 million Americans 18 or older. Between 80 and 90 percent of people diagnosed with fibromyalgia are also women.
This week, I was thinking about the number of patients that I have seen that have been diagnosed with both conditions.
Many People Have Been Diagnosed with Both
I put the question to my Facebook support group and 74 people with Hashimoto’s responded.
Almost all of them confirmed that they had been diagnosed with both or had all of the symptoms of fibromyalgia.
This is hardly a scientific study, but it does give us some evidence that there is a lot of overlap between the 2 conditions.
As I said, several patients have come to me with a pre-existing diagnosis of fibromyalgia, or FMS, for which they have received little effective treatment or relief.
Many doctors treat these symptoms using drugs rather than uncovering the root cause of the patient’s issues.
Diagnosing Fibromyalgia
Diagnosing fibromyalgia is admittedly difficult. For years it has involved assessing the presence in the patient of multiple symptoms that indicate the syndrome.
Currently, there are three main symptoms which must be present for a fibromyalgia diagnosis. They are:
1. Widespread pain
2. Sleep problems
3. Fatigue
The only existing blood test available is the FM/a, which tests for a lowered cytokine level suggestive of fibromyalgia, but the test is controversial and not yet considered definitive.
I do not mean to diminish or discount a diagnosis of fibromyalgia. What I am curious about is the link between FMS and Hashimoto’s.
Studies Show A Clear Link
Studies have come to indicate there is a component of thyroid dysfunction associated with FMS. A 2007 study by the Division of Rheumatology at the Department of Internal Medicine at the University of Pisa looked into a possible link between fibromyalgia and Hashimoto’s Hypothyroidism. It concluded that the presence of thyroid autoimmunity may predispose one to fibromyalgia.
This opens up the possibility that the opposite may be true: what if in some cases the various symptoms that point to a diagnosis of fibromyalgia are, in fact, just Hashimoto’s (which is often undiagnosed)?
In my own experience, I can tell you that a lot of fibromyalgia symptoms are present in my Hashimoto’s patients.
Is there a connection between the two?
In a review published in Thyroid Science by John C. Lowe and Jackie Yellin at the Fibromylgia Research Foundation, the authors wrote that, based on the available research, “inadequate thyroid hormone regulation is the most likely underlying mechanism of the symptoms and objective abnormalities of patients who meet the criteria for FMS.”
In the authors’ view, only hormone therapy has been seen to result in the mitigation of fibromyalgia symptoms. This, obviously, points to a connection between fibromyalgia and thyroid autoimmunity.
In fact, 2 neuroscientists at Stanford (Dr. Ian Carroll, MD and Dr. Jarred Younger PhD) are currently doing a clinical trial investigating T3 treatment for fibromyalgia.
Fibromyalgia and Hashimoto’s Share A Lot of Symptoms
So, at the very least, FMS and Hashimoto’s share a great number of symptoms. If you are diagnosed with FMS, it is highly advisable that you be tested for Hashimoto’s.
If you aren’t familiar with which tests to order for Hashimoto’s, check out my previous blog post for an in depth discussion on this.
Let’s Break it Down
Since there is so much overlap, I have decided to illustrate how virtually all the common symptoms of fibromyalgia can be caused by hypothyroidism (and, often, Hashimoto’s).
According to WebMD the most common symptoms of fibromyalgia are those in italics below. We will examine how hypothyroidism leads to each group of symptoms and why.
Chronic Pain
• Chronic muscle pain, muscle spasms, or tightness: Muscle-related symptoms are common with patients with hypothyroidism. The symptoms vary, but in a recent series of studies 79% of patients reported some kind of myopathy (muscle pain).
The exact reasons why are not known, theories include impaired glycogenolysis (the breakdown of glycogen to glucose – a reminder of why blood sugar balance is so important), reduced mitochondrial activity (mitochondria are the cell’s energy producers) and a decrease in production of ATP (Adeosine triphosphate), the actual fuel in the cell.
A recent study also showed increased lactate production during exercise with hypothyroid patients – this is also consistent with mitochondria problems.
• Tension or migraine headaches: Any of the causes above or below can lead to tension and headaches.
• Jaw and facial tenderness: Jaw and facial tenderness can also be caused by the same factors that lead to other muscle pain.
Fatigue
• Moderate or severe fatigue and decreased energy: Fatigue and decreased energy are some of the most common symptoms of hypothyroidism and Hashimoto’s.
There are many factors that lead to this including too little thyroid hormone production, the affect of too little thyroid hormone on the adrenals and blood sugar metabolism and the problems with ATP and mitochondria mentioned above.
Insomnia
• Insomnia or waking up feeling just as tired as when you went to sleep: Sleep issues are also incredibly common with hypothyroidism. Instability of thyroid hormone levels due to poorly managed autoimmunity, T3 building up and being released into the bloodstream, and the thyroid’s affect on the adrenals can all lead to insomnia.
With hypothyroidism, too little T4 can lead to a slower breakdown of cortisol. It then builds up in the body and this impacts the HPA axis (hypothalmus-pituitary-adrenal axis). See my past blog post for an in depth look at this.
Stiffness
• Stiffness upon waking or after staying in one position for too long: Hypothyroidism tends to cause a slower relaxation of tendons and some studies have shown high serum creatinine kinase levels. The levels are almost invariably in the MM isoenzyme that is the type of creatinine kinase found in skeletal muscles.
High levels of this enzyme are normally found in people who have been under extreme stress or who have just completed heavy exercise.
• Reduced tolerance for exercise and muscle pain after exercise: This certainly could be caused by what we just discussed. In addition, there are a host of issues that hypothyroidism can cause that relate to reduced tolerance for exercise. Check out my previous post on this.
Brain Function
• Difficulty remembering, concentrating, and performing simple mental tasks (“fibro fog”): According to Dr. Datis Kharrazian, the role of the thyroid on the brain is profound. Thyroid function impacts brain inflammation, plasticity, neurotransmitter activity and general brain function.
Thyroid hormone impacts all neurotransmitter receptors in men and women.
All of them.
So hypothyroidism can impact serotonin, dopamine, acetylcholine and gaba levels.
These neurotransmitters have a huge influence on memory, concentration and mood. Especially acetylcholine. Hypothyroidism can lead to acetylcholine deficiency and inefficient nerve firing.
This can cause memory loss and poor concentration.
Brain fog is brain inflammation, plain and simple. It is really important not to ignore it, like many doctors do. The consequences can be really bad.
• Feeling anxious or depressed: As we just discussed, thyroid hormone impacts all neurotransmitter receptors. Gaba is an inhibitory neurotransmitter, it keeps you calm.
Hypothyroidism can impact gaba synthesis, release and reuptake. All of this can lead to increased anxiety.
Dopamine and serotonin are responsible for enabling us to experience joy and enjoy activities in our life and to get pleasure out of what we do. Hypothyroidism can also impact these neurotransmitters and can lead to deficiencies in both serotonin and dopamine.
• Increase in urinary urgency or frequency (irritable bladder): Acetylcholine deficiency can impact urinary urgency and frequency.
Abdominal Issues:
• Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome): Studies in human and dogs of hypothyroid patients have demonstrated a decrease in the electric and motor activity of the esophagus, stomach, small intestine and colon.
Digestive dysfunction is also incredibly common with hypothyroid patients. Leaky gut has been implicated in the formation and progression of various autoimmune diseases including Hashimoto’s.
Neurological Issues:
Neuropathic symptoms including parasthesias (tingling or prickling sensation caused by issues with peripheral nerves) and painful dysthesias (an abnormal, uncomfortable sense of touch) are also common with hypothyroidism.
The most common type of neurological symptom in hypothyroid patients is carpal tunnel syndrome.
• Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold: Neuropathies involving the cranial nerves (those that control smell, hearing, vision) have all been reported. Hearing loss due to hypothyroidism is the most common and has been reported in 31%-85% of patients.
There are many theories on how hypothyroidism impacts nerves, but some studies have shown demyelination (the loss of the coating around nerve fibers), and axonal degeneration (degeneration of the nerve branches).
• Numbness or tingling in the face, arms, hands, legs, or feet: Certainly, this can be caused by what we just discussed.
• A feeling of swelling (without actual swelling) in the hands and feet: This could be neurological or it could simply be caused by the destructive inflammatory process that is at the root of Hashimoto’s.
Bottom Line
As you can see, there is a plausible argument to be made that almost all of the symptoms of fibromyalgia could be rooted in hypothyroidism and Hashimoto’s.
Of course, this begs the question of what to do.
As with all things related to this disease, we are once again reminded that this is a multi-system disorder.
It’s much more than just a thyroid problem and it requires a multi-system approach if you want to manage it successfully.
This is exactly why I created my program: Healing Hashimoto’s: The 5 Elelments of Thyroid Health.
In it, I teach a step by step strategy for finding and healing your issues in all of these systems.
For more information, check out my program here.
References:
http://www.thyroid.org/media-main/about-hypothyroidism/ : Statistics on thyroid disease
https://med.stanford.edu/clinicaltrials/trials/NCT00903877 : Clinical study using T3 to treat fibromyalgia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856434/?tool=pubmed : Paper on leaky gut
http://69.89.19.190/thyroidscience/reviews/lowe.yellin.6.17.08/ithr.review.6.17.08.pdf
: A review of the evidence on the link between fibromyalgia and hypothyroidism
http://www.ncbi.nlm.nih.gov/pubmed/21085966 : Study linking fibromyalgia and autoimmune thyroid disease
Rodcolico C, Toscano A, Benvenga S, et al. Myopathy as the persistently isolated symptomaology of primary autoimmune thyroidism. Thyroid 1998;8:1033
Monzani F, Caraccio N, Siciliano G, et al. Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism. J. Clinical Endocrinol Metab 1997;82:3315
Goti I. Serum creatinine phosphokinase isoenzymes in hypothyroidism, comvulsions, myocardial infarction and other diseases. Clin Chim Acta 1974;52:325
Kowalewski K, Kolodej A. Myoelectrical and mechanical activity of the stomach and intestine in hypothyroid dogs. Am J Dig Dis 1977;22;235
Bhatia PL, Gupta DP, Agrawal MK, et al. Audiological and vestibular function tests in hypothyroidism. Laryngoscope 1977;87:2082
Dyck PJ, Lambert ED. Polyneuropathy associated with hypothyroidism. J Neuropathl Exp Neurol 1970;29:631
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Why Isn’t My Brain Working? Dr. Datis Kharrazian, Elephant Press, 2013
Hashimoto’s: How the Adrenals Cause All Kinds of Problems
The human body, like the planet earth, is made of many ecosystems all interacting and influencing each other. With Hashimoto’s many of these ecosystems are altered and dysfunctional.
And one example of this is the interaction between the adrenal glands and the thyroid.
The Adrenals: Little Gland, Big Trouble
The adrenals are two little glands, about almond size that sit on top of the kidneys.
The one on the right kidney has a triangular shape and the one on the left kidney has a sort of half moon shape.
Each of the adrenals has different inner and outer parts or zones. The inner zone or the medulla is what secretes adrenalin and norepinephrine and just the right amount of dopamine.
These are the stress hormones.
The outer zone……(cue Rod Serling)
You’re traveling through another dimension — a dimension not only of sight and sound but of mind. A journey into a wondrous land whose boundaries are that of the imagination. That’s a signpost up ahead: your next stop……
The outer zone of the adrenal cortex,
this is where 3 different types of hormones are secreted: glucocorticoids, mineralcorticoids and androgens.
These hormones are all made from cholesterol (See? It does do good things.) and are critical to every day function.
Cortisol, the Star of the Show
Of the glucocorticoids, cortisol is the star.
It is stimulated by ACTH from the pituitary. This is very much like the relationship between TSH (also secreted by the pituitary) and T4.
ACTH and cortisol are the analogous hormones of the adrenals.
What does cortisol do?
It regulates blood sugar levels, increases body fat, defends the body against infections and helps the body adapt to stress. It also helps to convert food into energy and is anti-inflammatory.
What doesn’t it do might be a better question.
There are other hormones produced by the adrenals, but let’s not go there right now. Keep your focus here on the cortisol’s reason for being (or raison d’être, as the French would say).
Stress, the Femme Fatale of the Body
Ok, so let’s take a look at few different ways that stress, the femme fatale of the body, causes hypothyroid symptoms.
Most people are aware of the obvious forms of stress that affect the adrenal glands: 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, also place just as much of a burden on the adrenal glands.
These include blood sugar swings, gut dysfunction, leaky gut, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems and inflammation.
All of these conditions sound the alarm and cause the adrenals to pump out more stress hormones.
So really, stress can be thought of as anything that disturbs the body’s natural balance (or if you like, homeostasis).
Adrenal stress is one of the most common problems encountered in modern clinical practice, because nearly everyone is dealing with at least one of the things I just discussed.
Signs and Symptoms of Adrenal Stress
Symptoms of adrenal stress are many, because the adrenals (like its buddy, the thyroid) can affect every system in the body.
Symptoms of Adrenal Stress
Some of the more common symptoms are:
* Fatigue, also a thyroid symptom
* Headaches, splitting headaches especially
* Decreased immunity
* Sleep issues. Difficulty falling asleep, staying asleep and waking up feeling exhausted even after you had enough sleep.
* Mood swings
* Sugar and caffeine cravings, (have a hankering for a Red Bull? It could be your adrenals)
* Irritability or lightheadedness between meals, a blood sugar and adrenal problem
* Eating to relieve fatigue, another blood sugar problem
* Dizziness when moving from sitting or lying to standing, it affects your blood pressure
* Gastric ulcers, ulcers in the stomach can be caused by the adrenals
Treat the Adrenals to Heal the Thyroid
Weak adrenals can cause hypothyroid symptoms alone without any problem in the thyroid gland itself.
In such cases, working on the adrenals themselves may be the key to improving thyroid function.
The most significant indirect effect the adrenals have on thyroid function is through their affect on blood sugar.
Low or high cortisol – caused by any of the chronic stressors listed above – can cause hypoglycemica, insulin resistance or both.
Blood sugar imbalances cause hypothyroid symptoms in a variety of ways. (More on this in an upcoming post).
But adrenal stress also has more direct impacts on thyroid function. And, (darn the luck!) hypothyroidism has a direct impact on adrenal function. (I feel a vicious cycle coming on!)
Everything Causes Everything
Let’s reflect on non-linearity for a moment, none of this happens in one direction. Hypothyroidism impacts adrenal function and adrenal function, in turn, impacts the thyroid.
First, what happens with the adrenals when the body is in a hypothyroid or functionally hypothyroid state?
There is a very clear link between hypothyroidism and hypoadrenalism. When there is trouble from this, it is often linked to problems in a part of the brain called the hypothalmus.
The Hypothalmus, Boss of the Boss
The hypothalamus is really like the boss of the boss. (The pituitary is the master or boss endocrine gland and the hypothalamus is the pituitary’s boss.)
You know, like when the boss is real arrogant and always doing bossy things and then, all of a sudden, the boss’s boss shows up and he gets put in his place?
Well, the pituitary and the hypothalamus’ relationship is nothing like that. (Just wanted to see if you were paying attention.) 😉
Their relationship is more like, “Hey, we have this amazingly complex, super complicated body to run, do you want to help each other? Cool. Oh and by the way, this is not linear.”
HPA Axis, The Axis of Goodness
With the adrenals, this little benevolent, enlightened dictatorship is called the hypothalmic-pituitary-adrenal axis or the HPA axis. These 3 run the whole show.
The HPA axis plays a major role in regulating immune function, digestion, energy use, mood and thrill of thrills, sexuality.
This HPA axis is controlled by hormones (in a non-linear fashion) and it is totally manipulated by stress.
Stress is like the femme fatale of the HPA axis. It’s the mean wife of the boss’ boss.
Where am I going with all of this?
Well, a dysfunctional HPA axis, like the troubled empire ruled by the mean boss’ wife, can cause all kinds of problems.
With Hashimoto’s, one of the reasons why people continue to feel exhausted even though they are taking thyroid hormones is because of a messed up HPA axis.
And adrenal stress can lead directly to a messed up HPA axis.
Hypothryoidism also impacts the HPA axis. When you are hypothyroid it leads to elevated cortisol due to decreased clearance and a negative feedback loop (The HPA axis doesn’t work properly.)
This, in turn, inhibits thyroid function because cortisol inhibits the enzyme (5’ deodinase) that is responsible for converting T4 to the form the body uses, T3.
It can also inhibit TSH. Hmmmm…..
Thyroxine Treatment Can Cause Adrenal Problems
Something else no one ever tells you is that treatment with T4, like Synthroid or Levothyroxine, can cause adrenal problems.
If someone has adrenal insufficiency, then they are at risk for thyroxine making the problem worse!
Even if the adrenal insufficiency is not that bad, it may have an effect on thyroid conversion, tissue uptake, and thyroid response. And not in a good way.
If the T4 to T3 conversion doesn’t happen as it should, the body can become overloaded with unused T4.
If it is converted, but the T3 cannot enter the cell walls due to adrenal insufficiency or iron deficiency, the T3 cannot be used, and may pool or build up in the blood.
Studies have shown that very high levels of T3 can be toxic to the liver.
Sometimes this T3 pools and then releases or dumps into the blood stream. When this happens, you may suddenly feel all the hyper symptoms like heart palpitations, insomnia, nervousness, etc. This is one of the reasons why some Hashimoto’s people experience hyper to hypo cycles.
In many cases, T4 and TSH blood tests will appear normal, but the patient will feel really lousy.
If a doctor raises the thyroxine dose in this situation, things may become worse. How bad depends on the degree of adrenal insufficiency.
Symptoms may include all the symptoms mentioned above.
And check this out! (This comes from the warning label for Synthroid, but is true of all synthetic T4 drugs.)
“Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.
Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone.”
What this means, in plain English, is that in cases of hypothyroidism, the adrenals need to be evaluated before putting patients on thyroid replacement hormone.
How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency?
I put this question to my Facebook support group and 100% of the 85 respondents with Hashimoto’s said they had most of the symptoms of adrenal insufficiency mentioned in the list I posted above. Granted, that’s not a scientific study, but it certainly is emblematic of this problem.
Have you ever heard of a doctor checking for this prior to beginning treatment?
It’s not very common, believe you me. Many doctors dismiss adrenal insufficiency as one of those make believe disorders.
The Flip Side
The other side of this is the many ways that adrenal stress can cause hypothyroidism.
As we discussed above, it messes with the HPA axis and this, in turn, messes with the HPT (hypothamus-pituitary-thyroid) axis. Communication gets all garbled all around.
And we all know how important good communication is. Especially when you have a super complicated body to run.
Adrenal Stress Can Lead to Autoimmunity
The GI tract, lungs and the blood-brain barrier are the main immune barriers in the body.
They prevent the bad guys from entering the bloodstream and the brain.
Adrenal stress weakens these barriers, weakens the immune system in general, and promotes poor immune system regulation.
Cortisol can impact this in both directions. Too little cortisol causes the immune system to rev up and can lead to an over aggressive immune response.
Too much cortisol can weaken the immune system and make you more vulnerable to attacks or unable to defend yourself.
When these immune barriers are breached large proteins and other antigens are able to pass into the bloodstream or brain where they don’t belong.
If this happens over and over again, the immune system gets thrown out of whack and we become more prone to autoimmune diseases – such as Hashimoto’s.
Adrenal Stress Leads to Thyroid Hormone Resistance
In order for thyroid hormone circulating in blood to work, it must first activate receptors on cells.
Inflammatory immune cells called cytokines have been shown to make thyroid receptor sites less sensitive.
With insulin resistance, where the cells gradually lose their sensitivity to insulin, we see a similar pattern. There it is insulin, here it is thyroid hormone.
It’s like thyroid hormone is knocking on the cell’s door, but the cells don’t answer.
“I hear you knockin’ but you cain’t come in.”
A perfect example of this in practice is the Hashimoto’s patient who is taking replacement hormones but still suffers from hypothyroid symptoms – often in spite of repeated changes in the dose and type of medication.
In these patients, inflammation is depressing thyroid receptor site sensitivity and producing hypothyroid symptoms, even though lab markers like TSH, T4 and T3 may be normal.
Adrenal stress reduces conversion of T4 to T3
93% of the hormone produced by the thyroid gland is T4, it is inactive in that form and must be converted into T3 before it can be used by the cells.
The inflammatory cytokines I just mentioned not only disrupt the HPA axis, they also interfere with the conversion of T4 to T3.
The enzyme 5″-deiodinase is responsible for the conversion of T4 into T3 in peripheral tissues such as the liver and the gut.
Both Th1 and Th2 inflammatory cytokines – IL-6, TNF-alpha, IFN-gamma and IL-1 beta – have been shown to suppress the conversion of T4 to T3.
In patients without thyroid illness, as levels of IL-6 (a marker for inflammation) rise, levels of serum T3 fall.
These inflammatory immune cells make T3 and TSH levels go down and reverse T3 levels go up.
So, adrenal insufficiency leads to poor conversion and adrenal stress due to inflammation can lead to this, as well. Giving us a lovely double whammy.
Adrenal stress causes hormonal imbalances
Cortisol also acts on the liver. When it is high, caused by chronic stress, this decreases the liver’s ability to clear certain hormones, like excess estrogens from the blood.
Excess estrogen increases levels of thyroid binding globulin (TBG), the proteins that thyroid hormone is attached to as it’s transported through the body.
When thyroid hormone is bound to TBG, it is inactive. Meaning it doesn’t work.
It must be taken from TBG to become “free” before it can activate the receptors on cells. (These are the free-fraction thyroid hormones that you see on lab tests as “free T4 [FT4]” and “free T3 [FT3]“.)
When TBG levels are high, the percentage of free thyroid hormones drops. This shows up on labs as low T3 uptake and low free T4/T3.
When stress is not the cause, the most common reason for elevated TBG are birth control pills and estrogen replacement (i.e. Premarin).
What To Do?
Here’s the tricky thing about adrenal stress: it’s almost always caused – at least in part – by something else.
These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies, environmental toxins, and of course, chronic emotional and psychological stress.
Sound familiar?
These are also all the things that make Hashimoto’s worse.
You can’t ignore them or pretend like they aren’t there like so many doctors do. We have to deal with all of them.
All of them. Half measures don’t lead to half results, they often lead to no results.
When they exist, these conditions must be addressed or any attempt to support the adrenals directly will either fail or be only partially successful.
So much more than a thyroid problem. Hashimoto’s is a multi-system problem.
Need help? I offer a free 30 minute Hashimoto’s Healing Strategy Session. In it you can share where you are, where you want to be and I can give you some recommendations that will help right away.
Book your session now: https://hashimotoshealing.as.me/strategy
How Do We Support the Adrenals?
This has been a long, exhausting blog post. It’s time to rest (for the sake of our adrenals). In an upcoming post I’ll look at all the things we can do to love our adrenals back to health. 🙂 Stay tuned!
References:
http://www.rxlist.com/synthroid-drug/warnings-precautions.htm
https://cfids-cab.org/cfs-inform/Neuroendocrin/tsigos.chrousos02.pdf – Adrenal stress leads to Hashimoto’s
http://www.karger.com/Article/Abstract/87001 -HPT and HPA responses during repeated stress
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Hashimoto’s Thryoiditis, Izabella Wentz, Wentz LLC publishing, 2013
http://www.holtorfmed.com/blog/adrenal-health-understanding-the-adrenal-and-thyroid-connection/
http://articles.mercola.com/sites/articles/archive/2000/08/27/adrenals.aspx
http://www.ncbi.nlm.nih.gov/pubmed/3527687
http://www.ncbi.nlm.nih.gov/pubmed/3500324
Hashimoto’s: The Liver and The Thyroid
Hashimoto’s: The Liver and the Thyroid
Hashimoto’s can cause a host of problems all over the body, but one place in particular where we can see it’s influence is on the liver and gall bladder.
In this post we explore these relationships and explain why a healthy liver is so important for healing your Hashimoto’s.
With Hashimoto’s The Liver and Thyroid Affect Each Other In Many Areas
The body is not a machine, like our earth it is a group of interacting ecosystems that all talk to one another and influence each other in both good and bad ways.
The liver and the thyroid are a perfect example of this. Here is a brief breakdown of how they interact:
* 60% of thyroid hormone is converted from T4 to T3 in the liver. Both T3 and T4 are glucoronidated and sulfated there. (More on that in a minute).
* Thyroid hormone influences the way that cholesterol and other lipids are synthesized and broken down (and where does this happen? – yes, the liver). With Hashimoto’s and hypothyroidism, this is often slowed down resulting in high cholesterol and other lipids like LDL and triglycerides.
* Thyroid hormone affects detoxification pathways in the liver and affects insulin growth factor and cytochrome P450 enzymes which metabolize lots of drugs and environmental toxins. When this slows you can have toxins build up.
* On the autoimmune side, research has shown a link between autoimmune thyroid and autoimmune liver diseases.
*Very high levels of thyroid hormone (T3) can raise bilirubin levels and can actually be toxic to the liver because it damages mitochondria.
How Does the GallBladder Fit In to This?
The liver has several pathways through which it metabolizes hormones, filters toxins, and cleans the blood. Byproducts from these processes are dumped into the gall bladder to help get them out of the body.
Low thyroid function slows down this whole process, making the liver and gall bladder sluggish and congested and helping to make gallstones.
Gallbladder x-rays in hypothyroid patients can show a bloated gall bladder that contracts sluggishly. This slows down the flow of bile which can lead to slower breakdown of fats and cholesterol and other toxins that are broken down in the liver.
This whole process can also lead to the formation of gall stones. Many people with Hashimoto’s have gall bladder issues.
How Is Thyroid Hormone Converted in the Liver?
Thyroid hormones are converted into their usable form in the liver (60% happens there), you can see how low thyroid function can create a vicious cycle.
Hypothyroidism messes with liver function and fewer thyroid hormones become active. So it goes until you have all of the common symptoms of too little thyroid hormone: fatigue, brain fog, joint pain, hair loss, weight gain, depression, etc.
Thyroid hormone is converted primarily through 2 processes:
Glucornidation and sulfation, let’s break these down:
According to Dr. Datis Kharrazian, DC, these processes are supported in the following ways:
Glucoronidation
Glucoronidation is an important process for converting thyroid hormone.
This pathway is supported by B vitamins, magnesium, and glysine, click here to learn about food sources of B vitamins and magnesium.
Sulfation
Sulfation involves binding things partially broken down in the liver with sulfur containing compounds. It is one of the major detoxification pathways for neurotransmitters, toxins, and hormones (like thyroid hormones). Vitamin B6 and magnesium are important for sulfur amino acid metabolism, as are foods containing sulfur such as: eggs, cheese, meat, poultry, nuts and legumes. Click here to learn more about food sources of vitamins and minerals.
Its important to choose animals products wisely, buy organic whenever possible because organic foods have far fewer toxins like antibiotics, hormones, and pesticides which can all cause problems of their own.
Another important point about sulfating is that it requires sulfate which is often poorly absorbed by the digestive system, especially by people with Hashimoto’s who often suffer from intestinal permeability or leaky gut syndrome. Sulfate is the oxidized, inorganic form of sulfur produced by an oxidation step called (you guessed it) sulfoxidation.
This step is made possible by an enzyme that is called sulfite oxidase which uses the essential mineral molybdenum, click here to see food sources of molybdenum. Problems with sulfoxidation can be seen in people who are sensitive to foods that contain sulfites (garlic) or dugs and food additives (in dried fruit and herbs, preservatives, in salad bars used to keep vegetables looking fresh).
(These people may also have an abnormally strong odor in their urine after eating asparagus. For these people one should consider molybdenum supplementation or organic sulfates like sodium sulfate or magnesium sulfate.)
The Emotions of the Liver & Gall Bladder
In Chinese medicine, we view interactions in the body in the context of body, mind and spirit. This can be really helpful to see how these physical problems can affect you emotionally and psychologically.
In the book, Between Heaven and Earth by Harriet Beinfeld, L.Ac. and Efrem Korngold, L.Ac., the liver is described as something like a military commander in the body. It formulates tactics and strategies, moving blood and energy (qi) throughout the body.
The thyroid is part of the endocrine system which is viewed as qi and is derived from the yang energy of the kidneys. So the ancient Chinese recognized this relationship and how important one is for the other. The liver needs that qi to have the energy to do its job, and if it is clogged or blocked it can’t facilitate the movement of that energy throughout the body.
Anger, Irritability and a Short Fuse Are Symptoms of Liver Issues
When the liver gets stuck or clogged, the most common emotion that people experience is anger. This can be directed outwardly at people you know (usually people closest to you: family, co-workers, or friends), or this anger can be directed inwardly and result in depression and feeling of self-hatred and low self-worth. Or sometimes you have a combination of these two.
It is also interesting to note that in Chinese medicine the nervous system, tendons and ligaments and the eyes are thought to be part of the sphere of influence of the liver. So many people with Hashimoto’s also have issues in all of these areas: eye problems, tendon issues, and cognitive issues affecting the brain.
Gall Bladder Issues Make You Unable to Make Decisions
The Gall Bladder stores and secretes bile, this stimulates flow through the stomach and intestines and is very important in helping us to absorb and eliminate different foods as well as different ideas and concepts.
So proper bile flow and production also help us with proper judgment, clear thinking and decision making. If there are Liver/Gall Bladder issues we can end up taking actions without thinking them through, or making decisions and not following through on them or simply getting stuck, unable to decide what to do.
How Can You Help the Liver, Gall Bladder and (Indirectly) The Thyroid?
Here are some important herbs for helping the liver and gall bladder.
Ginger: this common food contains chemicals that have been shown to increase bile secretion and to reduce cholesterol levels by up regulating an enzyme responsible for bile acid production (cholesterol-7-alpha-hydorxylase).
Dandelion: The root of this common weed promotes the production of bile and its delivery to the gall bladder. It causes the gall bladder to contract and release bile.
Milk Thistle: This herb increases the solubility of bile and has been shown to significantly lower cholesterol concentrations in the gall bladder. It has potent anti-oxidant activity which supports detoxification and it prevents depletion of glutathione in the liver, which is often depleted in people with Hashimoto’s. It also has anti-inflammatory properties and it promotes protein synthesis to replace damaged liver cells.
Panax ginseng:This herb has been shown in several studies to have numerous positive impacts on liver function. It has been shown to reverse fatty liver in animals and can be really helpful in cleaning toxins out of the liver. It also has really important benefits for the immune system like promoting Kupffer cells (specialized immune cells located in the liver) and can be beneficial in balancing the immune system by increasing key proteins like IL-8.
Herba sargassi, Laminaria Kun Bu: These seaweeds have important detoxification properties and can be used to treat metabolic toxicosis with arthritis, rheumatism, dermatitis and psoriasis. They are quite mild and have very few if any side effects. In addition, they are rich in trace minerals and are helpful in reducing swelling, particularly in the lymphatic glands.
A word of caution with seaweeds: They contain iodine which can be problematic with some Hashimoto’s folks.
Fructus Gardeniae: This herb is the seed pod of the gardenia plant. It has potent anti-bacterial and anti-viral properties and can be used to reduce liver and gallblader congestion and infections.
Caution: Liver infections can be quite serious, consult a trained physician if you suspect that you have any form of hepatitis or liver disease.
Rhubarb Root: This herb is a potent laxative that can be used to treat acute gall bladder and pancreatic infections. It has potent anti-bacterial, anti-fungal and anti-viral properties.
Dosage is critical with this herb and too much can cause gastric pain and diarrhea. Never use during pregnancy or lactation or with gout, hemorrhoids or oxalic acid stones. Consult a trained professional before using this herb.
Herbs That Help With Anger and Irritability
There is a very effective herbal formula in Chinese Medicine whose name is translated as Rambling Powder. The name comes from the title the first chapter of a book by Zhuang Zi, “Rambling Without A Destination” that includes stories about wandering freely with an open mind. It is a reference to how this combination of herbs can help one feel less constrained emotionally, feel happy and less stressed.
It has several variations and contains a number of herbs that are very helpful for the liver including buplerum, mint, atractylodes and more. With modifications, it has also been used successfully to treat eye issues, hypertension, hepatitis, anemia, depression, irritability and anger.
Hashimoto’s Requires A Multi-Prong Approach
Hashimoto’s has so many moving parts and affects so many systems of the body that you really need to have a treatment strategy that looks at all these different areas and gives you solutions for all of them.
That’s why I developed my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. In in we explore the 5 major systems of the body and learn how they impact us physically, emotionally and spiritually.
Because true healing requires more than simply taking a few pills or herbs. It requires a complete overhaul of your body, mind and spirit. And it is a tremendous opportunity for growth and for healing all aspects of your life. Click here to learn more.
References:
Between Heaven and Earth, Harriet Beinfeld, L.Ac. and Efrem Korngold, L.Ac., Ballantine Books, New York, 1991
Chinese Herbal Medicine Formulas and Strategies, Dan Bensky & Randall Barolet, Eastland Press, 1990
Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? Datis Kharrazian, DC, Morgan James Publishing, 2010
The Thyroid, A Fundamental and Clinical Text, Ninth Edition, Lewis E. Braverman and Robert D. Utiger, 2005 Lippincott Williams and Wilkins
Severe hyperthyroidism induces mitochondria-mediated apoptosis in rat liver.
Upadhyay G, Singh R, Kumar A, Kumar S, Kapoor A, Godbole MM.
Source: Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Laukkarinen J, Kiudelis G, Lempinen M, Raty S, Pelli H, Sand J, Kemppainen E, Haglund C, Nordback I. Increased prevalence of subclinical hypothyroidism in common bile duct stone patients. J Clin Endocrinol Metab. 2007 Nov;92(11):4260-4. Epub 2007 Aug 28
Inkinen J, Sand J, Nordback I. Association between common bile duct stones and treated hypothyroidism. Hepatogastroenterology. 2000 Jul-Aug:47(34):919-21
Food Sources of Vitamins & Minerals
Wouldn’t it be great to have a list of food sources of vitamins? Well, look no further! In our continuing effort to provide you with all things healthy and beneficial here’s a pretty comprehensive list.
A word of caution: If you are following an autoimmune protocol there will be some foods here that you can not eat. However, I wanted to provide a pretty comprehensive list so that you can get a sense what’s available outside of a multi-vitamin.
VITAMIN A: red pepper, dandelion greens, carrot, apricot, kale, mustard greens, watercress, sweet potato, parsley, spinach, turnip, swiss chard, cantaloupe, broccoli
VITAMIN B1: rice bran, wheat germ, sunflower seeds, peanut, soybean, 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, peanuts, 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, soybeans, wheat bran, brown rice, liver, beef, cabbage, carrots, potato, yams
VITAMIN B12: beef liver, beef kidney, ham, sole, scallops, eggs, oats, soybean
miso, soy sauce, tempeh, pickles, amasake, nut and seed yogurts, sourdough bread, algae, spirulina and chlorella, brewer’s yeast
BIOTIN: beef liver, peanuts, eggs, peas, cauliflower, mushrooms, filberts
VITAMIN C: red pepper, currants, kale, parsley, turnip greens, mustard, spinach, green bell pepper, broccoli, Brussels sprouts, cauliflower, lemon, orange, red cabbage
VITAMIN E: soybean oil, corn oil, navy bean, oatmeal, green peas, brown rice, turnip greens, sweet potatoes, parsley
VITAMIN K: spinach, cauliflower, cabbage, carrots, soybeans, liver, oats
BIOFLAVONOIDS: lemon, lime, grapefruit, orange, red pepper, prune, parsley, apricot, plum, cherry, walnut, buckwheat
BORON: soybeans, prunes, raisins, almonds, rosehips, peanuts, hazelnuts, dates, honey, wine
CALCIUM: sesame seed, kelp, agar, dulse, collard greens, kale, turnip greens, almond, soybean, mustard greens, filbert, parsley, dandelion greens, brazil nut, spoon cabbage, watercress, chickpea, white bean, pinto bean, horseradish, pistachio, red pepper, figs, sunflower seed
CHROMIUM: beer, brewer’s yeast, brown rice, beans, mushrooms, potatoes
COPPER: oysters, liver, chocolate, cocoa, mushrooms, almonds, pecans, avocado, rye, walnuts
FLOURIDE: seafood, seaweed
FLOURINE: tea, sardines, salmon, mackerel, shrimp, kale, potatoes, spinach, apples
FOLIC ACID: liver, asparagus, lima beans, spinach, swiss chard, kale, cabbage, sweet corn
IODINE: kelp, dulse, agar, swiss chard, turnip greens, summer squash, mustard greens, watermelon, cucumber, spinach, asparagus, kale, turnip
IRON: dulse, kelp, rice bran, pumpkin seeds, beans, lentil, parsley, walnut, apricot, almond, raisins, swiss chard, spinach, dates, fig, kale, cucumber, cauliflower, cabbage
LYSINE: chicken, yoghurt, ricotta, cheese, avocado
MAGNESIUM: kelp, wheat bran, wheat germ, almonds, cashews, soybeans, brazilnut, dulse, peanut, walnut, filbert, sesame seed, lima beans, peas, millet
MANGANESE: oatmeal, whole wheat, peas, beans, egg yolk, spinach, kale, bananas, nuts, pineapple, sunflower seeds
MOLYBDENUM: buckwheat, eggs, oats, soybean, lima beans, barley, lentils, sunflower seeds, liver
PANTHOTHENIC ACID: liver, broccoli, mushrooms, eggs, peanuts, oils, peas, soybeans, sweet potatoe
POTASSIUM: dulse, kelp, soybean, lima bean, rice bran, banana, red pepper, white bean, pinto bean, apricot, peach, prune, sunflower seed, chickpea, lentil, almond, raisin, parsley, sesame seed, avocado
SELENIUM: brazil nuts, brown rice, brewer’s yeast, eggs, garlic, liver
SULFUR: kale, watercress, brussels sprouts, horseradish, cabbage, cranberry, turnip, cauliflower, raspberry, spinach, red cabbage, kelp, parsnip, leek, radish, cucumber, celery
ZINC: oysters, herring, liver, oatmeal, wheat bran, maple syrup, brewer’s yeast, sunflower seeds, soybeans, mushrooms, sardines, pecans, pumpkin seeds
How to Exercise with Hashimoto’s
There is no question that exercise is a very important part of any healthy lifestyle. This is especially true if you have an autoimmune disease. However, when you exercise with Hashimoto’s you must be careful to do it properly or you can wind up doing more harm than good.
In this post we examine new research on exercise and look at the best type of exercise program for people with Hashimoto’s.
Exercise with Hashimoto’s Has Many Health Benefits
Exercise has many health benefits and many of these are hugely important if you suffer from Hashimoto’s. In my last post, I mentioned a lecture I attended that was taught by Dr. Datis Kharrazian, here is some additional information I learned and how I think it applies to Hashimoto’s people. According to Dr. Kharrazian, the benefits of exercise include:
* Growth Hormone Release
* Opioid Response
* Nitric Oxide Synthase (eNOS) Responses
* Brain-Derived Neurotrophic Factor Release
* Insuline Receptor Sensitivity
* Immune Enhancement
Growth Hormone
Growth hormone stimulates cell reproduction and regeneration, and growth in our bodies. It also has a number of positive effects on our nervous, endocrine, and immune systems
A lot of growth hormone’s effects are felt in the liver where it can improve the burning of body fat, improve blood glucose levels and increase protein synthesis.
It also has important effects on the nervous system where it can improve synapses in the brain. It also improves heart function, immune function and decreases recovery time.
In addition, it has been found to increase calcium absorption and improve bone density.
Studies have shown that growth hormone release is increased with increased exercise intensity. (So walking on a treadmill and watching t.v. probably won’t result in much being released.)
Hypothyroidism can cause increases in body fat and alter lipid metabolism, and can lead to poorer absorption of calcium and protein. So these effects can be very beneficial for Hashimoto’s patients.
Opioid Response
Exercise has been found to release the body’s natural opioids called endorphins and enkephalins. This is commonly known as the “runner’s high” or that blissful feeling that you get after certain kinds of exercise and sports.
Endorphins have many positive effects including pain relief, stress reduction, and improving our moods. Exercise can also result in the release of more dopamine and serotonin both of which are responsible for happiness and satisfaction with life and relationships.
Studies have shown that moderately high to high intensity exercise stimulates the release of these natural proteins. It also seems to depend on the individual with some people needing to do more than others.
Hypothyroidism can lead to declines in dopamine and serotonin and to feelings of depression and overwhelm. Some of the most widely prescribed drugs for Hashimoto’s people are anti-depressants, so exercise can have huge benefits for these people, as well.
Nitric Oxide Synthase
Nitric Oxide Synthases (NOS) are enzymes that can do both good and bad things in the body. Increased eNOS (endothethelial NOS) increases blood flow which can get more blood to the brain, can improve heart health and can get more nutrients and oxygen to our bodies’ cells. This results in tissue repair and more energy.
Increased nNOS (neuronal NOS) causes more muscle contraction and brain focus which results in improved performance in various activities.
On the other hand, increased iNOS (inducible NOS) can result in a host of bad things like: surges in destructive immune cells called cytokines, damage to mitochondria and inflammation. Too much of this can lead to injury, muscle wasting and breakdown and pain.
(Arginine is an important nutrient for iNOS and should be avoided before exercise.)
NOS plays a key role in cardiovascular, immune and brain function. All things that can be compromised in Hashimoto’s people.
It seems that the right amount of exercise is key for getting the right amounts of the right kinds of NOS. Too little and you won’t get the benefits, too much and you get the damaging consequences mentioned above. One again, the key is high intensity, but not for too long.
Brain Derived Neurotrophic Factor (BDNF)
BDNF helps with nerve growth and differentiation in the brian. It is very important in building new nerve pathways and preserving and keeping healthy old ones. So it is critically important in maintaining a healthy brain and in slowing the destruction of nerves in the brain that can lead to dementia and Alzheimer’s.
Exercise increases levels of BDNF and also improves brain function. Once again (are you seeing a trend emerging?), the amount released is dependent on the intensity of the exercise.
Brain fog and neuro-degeneration are very common complaints from people with Hashimoto’s. This is caused by numerous things, but the underlying mechanism is inflammation caused by immune cells and the destruction of brain cells.
Insulin Receptor Sensitivity
Problems with insulin resistance are very common in today’s society and are a driving force in the initiation of Hashimoto’s. It can also prevent people from getting any better once they have developed the disease.
Insulin normally helps sugar get into cells, when people become insulin resistant because they are exposed to too much sugar, the cells of the body start blocking insulin because they can’t deal with so much sugar.
This person feels like she needs to nap after every meal, and may actually fall asleep after eating a carbohydrate rich meal. This person will also have belly fat and will complain of insomnia.
Insulin resistance can drag down thyroid function and contributes to diabetes, heart disease, sleep apnea, hormone problems, obesity and certain types of cancer.
Aerobic and strength-training exercises improve insulin sensitivity by increasing the number of protein molecules called glucose transporters (GLUT), which allow your cells to better respond to insulin.
Immune Enhancement
Hashimoto’s is an autoimmune disease. The immune system has short circuited and attacks the thyroid as if it were a foreign invader.
Exercise can be very beneficial for improving immune function. The right kind of exercise can be helpful in healing the gut and in improving gastrointestinal immunity. Since 70% of the immune system lives in the gut, this can be very beneficial.
But, excessive exercise can actually cause major problems with immune function. And if you have Hashimoto’s it is very important not to overtrain or you can wipe out all of the benefits and actually make many things worse.
What Kind of Exercise Is The Right Kind?
It is clear that exercise can be very beneficial for Hashimoto’s patients, but what is the right kind and the right amount?
According to research, the optimal exercise level to achieve all the health benefits described above is high intensity: when doing this you will:
* Break a sweat after 3-5 minutes
* Breathe deeply and rapidly
* Only talk in short phrases while you are doing this.
You want to go hard enough to achieve 70% or greater of your maximum heart rate. This can be calculated by this simple equation: 220 – your age in years = your maximum heart rate.
Fine Line Between Just Right and Too Much
There is a fine line between the right amount of exercise which can really improve health and too much which can actually cause more health problems.
The key point is this: The more intense the exercise, the greater the potential for health benefits that include everything mentioned above, but also the greater risk of doing too much and this results in the loss of all those benefits.
This is especially true if you suffer from an autoimmune disease like Hashimoto’s because you may not be able to exercise like a normal person and you may reach the threshold of maximum benefit sooner than people who do not have this condition.
Certain Factors Can Make You More Vulnerable to Overtraining
Dr. Kharrazian also noted that there are a number of things that can make exercise not work for you. If you have any of these conditions, you must be very careful not to overdo it when working out.
These conditions include:
* Pre-existing high or low cortisol levels
* Pre-existing systemic inflammation
* Pre-existing immune weakness
* Pre-existing intestinal permeability
* Pre-existing hormone imbalance
* Pre-existing nutrient deficiencies
* Pre-existing obesity
People who suffer from Hashimoto’s often have a majority of conditions from that list, which means they are very vulnerable to getting worse as the result of exercise.
How Do You Know If You are Doing Too Much?
There are a number of signs and symptoms that can help you identify if you are working out too much.
Performance Signs and Symptoms
If you have a hard time recovering from workouts, can’t complete your workouts, notice your performance is declining or that you have more injuries then you may be doing too much.
Psychological Signs and Symptoms
If you are exercising frequently and you notice a loss of motivation and enthusiasm, a loss of competitive drive, depression, irritability or aggression for minor reasons then you may be doing too much.
Physical Signs and Symptoms
If you are exercising regularly and you notice that you have a weakened immune system, a loss of libido, loss of menstrual cycle, decreased muscle strength or unexplained increases or decreases in weight then you may be over doing it.
The Best Workout: Maximum Results With Minimal Energy Expenditure
An article in the May-June issue of the American College of Sports Medicine’s Health & Fitness Journal offers an example of an optimal 7 minute workout that can be used as a starting point for Hashimoto’s patients and can be utilized to achieve all the health benefits without causing any of the negative effects of overtraining.
I really like this workout because it can help you achieve all the health benefits we have discussed in a very short time, it works on your entire body and it can be modified so that you can do more or less.
This entire workout can be done at home, in a hotel room or anywhere that has an open room and a chair. You don’t need to purchase any equipment and you can do it by yourself without having to hire a personal trainer or therapist.
The entire workout is 7 minutes and you can repeat the circuit up to 3 times. It consists of 12 different exercises each done at high intensity for 30 seconds.
For people with Hashimoto’s, I recommend starting with one cycle and seeing how you feel. For some, even a 7 minute workout will prove to be too much. If that is the case, cut the 30 second intervals in half.
If you are able to do all 12 exercises as suggested for 30 seconds then do one interval for one to 2 weeks (a minimum of 4 times per week). Repeat the entire sequence after 2 weeks and then add a third repetition after an additional 2 weeks. If pressed for time, you can simply do 1 round of 7 minutes.
When Is The Optimal Time to Exercise?
The optimal time to get most benefit is within 10 minutes after you wake up, before you have had breakfast. This is the perfect time to exercise because you can take advantage of your body’s natural cortisol surge and exercising before breakfast will also help you burn fat more efficiently and help reduce insulin resistance.
Nutritional Support Before and After You Workout
For my patients and myself, I recommend taking a drink that provides electrolytes (not Gatorade – which is loaded with sugar). Here’s a recipe for a simple Electrolyte Lemonade:
Electrolyte Lemonade:
3 organic lemons, peeled, but leave white pith intact
3 tablespoons coconut oil, olive oil or flax oil
1 organic pear, cored
1 tablespoon Celtic sea salt or Himalayan Salt
6 cups filtered water
Blend everything well in a Vitamixer, makes 1 pitcher
Drink 1 glass before your workout.
It is also recommended to support nitric oxide synthase production. The following nutrients and co-factors can do this: ATP, N-Acetyl L-Carnitine, Huperzine A, Alpha-GPC, Vinpocetine and Xanithol Nicotinate. This will help boost eNOS and nNos.
After the workout take something that will reduce inflammation and support the immune system like turmeric and/or resveratrol and another glass of electrolyte lemonade.
The 5 Elements of Thyroid Health System
Hashimoto’s is a complicated condition that can impact all the major systems of the body. In order to treat it effectively, you really need to adopt a lifestyle that supports you with the right kind of diet, exercise and supplement regimen to get you feeling your best and to slow or stop the destructive progress of the autoimmune disease.
Would like help in designing the right kind of diet, exercise and supplement regimen from someone who has worked with over 2,000 people with Hashimoto’s?
I offer a free 30 minute Hashimoto’s Healing Strategy Session. In it you can share where you are, where you want to be and I can give you some recommendations that will help right away.
Book your session now: https://hashimotoshealing.as.me/strategy
Resources:
The Neuroendocrine Immunology of Exercise, Dr. Datis Kharrazian, 2013
Opioids and Exercise. An Update. Sports Med. 1989 Feb;7(2):109-124
Life Food Recipe Book, Annie Padden Jubb and David Jubb, North Atlantic Books, 2003, page 186, Electrolyte Lemonade
4 Secrets to Weight Loss with Hashimoto’s
Hashimoto’s is the most common autoimmune disease in the United States. And one of the most common complaints for people with Hashimoto’s and hypothyroidism is that they have difficulty with weight loss.
This is even true for people who are taking thyroid replacement hormone (especially T4), exercising and eating well. It seems that no matter what they do they just can not get the weight off.
There are many reasons for this and in this post I will explore 4 secrets to weight loss that new research has revealed.
The Old Metabolism Model Is Outdated
The old model of your metabolism and hormone levels, alone, being the reasons for success or failure of your weight problems is proving to be outdated.
In the old model, the primary reasons for difficulty with weight loss are: eating too much, or eating too much food laced with sugar, fat and salt ( this is a still a real problem for many). In addition, a lack of exercise and hormone related problems like not enough thyroid hormone or excess cortisol.
While these are very real issues and should be considered in any weight related treatment, they have been shown to not be the answer for many women (and men ) with Hashimoto’s struggling with their weight.
New Research Shows Immune System Is a Big Factor As Well
I recently attended a seminar taught by Dr. Datis Kharrazian, one of the world’s leading experts on the treatment of thyroid issues with functional medicine, called The Neuroendocrine Immunology of Exercise and he taught us about this new research that has discovered an entirely new model of causes for stubborn weight gain.
This model involves causes of weight problems that are related to the immune system. And this makes sense for people with Hashimoto’s because it is an autoimmune disease and a thyroid disorder.
If blood tests show that your TSH and T4 levels are “normal”, you are eating well and exercising and you still can’t lose weight, then this may be exactly what is going on with you.
4 Reasons for Weight Gain Related to the Immune System
According to Dr. Kharrazian, in the immune system model, there are 4 main reasons for stubborn weight gain.
They are:
* The mix of bacteria in your gut
* Intestinal permeability (also known as leaky gut)
* Low grade inflammation
* Immune reactive dietary proteins
Let’s explore each one of these in more detail.
The Mixture of Bacteria in Your Gut Matters
An important thing to understand is that your body is an ecosystem, or really, a lot of interconnected ecosystems. And the digestive tract is one of the most complex and dynamic of them all.
Each one of us has their own unique mix of bacteria and other organisms that live in our guts. This mix is determined by our genetic profile, our diets, what medications we have taken and our environment.
There are an estimated 100 trillion different cells and over 1,000 different species of bacteria. 90% of these species belong to 2 families: Firmicutes and Bacteriodetes.
The Balance of Bacteria Can Make You Unable To Lose Weight
New research has shown that the balance of these 2 bacterial species matters for whether or not you are able to lose weight.
In obese and overweight people, there is more Firmicutes than Bacteriodetes. The balance between these 2 species of bacteria generates certain signals to specific genes in the intestines that produce more fat cells.
It is also interesting to note that, according to the research, Lactobacillus bacteria (the most common species sold in over the counter probiotics) actually increases body weight. Both dairy and non-dairy sources.
What that means is that while probiotics may be beneficial for the ecosystem of your gut they are not that helpful in helping you shed the pounds.
Increase Bacteriodetes and Lose Weight
Firmicutes really like junk food. To feed them and gain weight, eat like your average American. To starve them and lose weight, read on.
The more important question is: how do you increase the Bacteriodetes? It seems these little critters really like plants. And the best way to increase their number is to increase the amount of plant based foods and fiber in your diet.
Especially oligosaccharides (found in Jerulsalem artichokes, and onions, leeks, garlic asparagus and jicama, etc.) and monosaccharides (found in pears, grapes, peaches, apples, pineapples, apricots, bananas, yams, carrots, onions, and sweet potatoes). And other plant based fibers that come from green leafy vegetables, green tea, etc.
These get fermented in the colon by the good guys and help you to become a mean, lean weight loss machine! But, just so you know, this is not something you can change in 5 minutes or 5 days. It may take a few months to alter this environment.
Leaky Gut Leads to a Bigger Gut
While it is true that people with Hashimoto’s often suffer from intestinal permeability or leaky gut syndrome, new research shows that this can also lead to fat around the organs.
In leaky gut, the intestines lose their ability to keep tiny particles of all sorts of stuff out of the bloodstream. It turns out that there may be a connection between a fatty liver and the breakdown of the gut barrier system.
In addition, zonulin, a protein that is used by the intestines to bind tight junctions, leaks into the blood stream when people have a breakdown of this barrier. It is also increased with obesity associated insulin resistance.
Finally, the toxins that are produced by bacteria known as lipopolysaccharides have also been linked to obesity and the onset of diabetes.
Bottom line: If you want a smaller gut, you need to heal your leaky gut.
Low Grade Inflammation: The Chicken or The Egg?
Autoimmune disease is a disease that is closely linked to inflammation. So is type 2 diabetes, so is eating a lousy diet and eating too much sugar, salt and fat.
What research is now showing us, is that obesity is also an inflammatory condition. It is becoming less clear which came first. One thing we now know is that adipose tissue (fat tissue) produces inflammation in the body all by itself.
So you have the creation of this destructive cycle of abnormal gut bacteria and leaky gut leading to a process (insulin and leptin resistance) which makes glucose not able to enter cells. When glucose can’t enter cells it gets converted into fat in the liver (triglycerides). These fat cells start the whole process all over again.
Leptin and Insulin Resistance Are Similar
Leptin is one of the main hormones involved in hunger, metabolism and the control of how energy from carbs and fats get stored and used. It comes from the Greek word ‘leptos’ meaning thin.
The amount of leptin produced directly correlates with weight loss or weight gain. (Women have significantly higher circulating leptin than men).
Leptin resistance is very similar to insulin resistance. With insulin resistance, long term elevated levels of insulin make your muscle and fat cells more resistance to the action of insulin.
Chronic elevated levels of leptin end up making you eat way too much. And abnormal gut bacteria and leaky gut feed this process as well (pun intended ;)).
Its A Vicious Cycle That Makes It Harder to Lose Weight
This whole process creates more fat tissue which causes more inflammation, and on and on it goes, snow balling and making it harder and harder to lose weight.
So you can see, while this is kind of complicated, it is hugely important to do everything you can to reduce inflammation that is the root cause of everything that we have just examined.
Immune Reactive Dietary Proteins
Certain proteins can also add gasoline to the flames of inflammation.
Everything that is living in our world is made of proteins. With autoimmune disease the immune system confuses our own proteins with that of an invader like a virus or a food we are allergic to.
There are some proteins in our diet that can cause an immune response that can also lead to inflammation and add more insult to injury.
These proteins are found in gluten, dairy and soy and in some other foods called cross reactors. You can learn more about them in this post.
These need to be eliminated from the diet if you want to lose weight because this will begin to unwind the vicious cycle of inflammation at the root of the immune system’s influence on weight gain.
Bottom Line
Bye bye inflammation, bye bye weight.
Have you had trouble losing the pounds even though your lab test numbers look “normal”?
Do you eat well and exercise, but still can’t lose the pounds?
Do you experience the common symptoms of inflammation like brain fog (inflammation of the brain), joint pain (inflammation of the joints), thyroid nodules (inflammation of the thyroid) and weight gain (body wide inflammation).
Need help? Schedule a 30 minute Hashimoto’s Healing Discovery Session: Click here to set up a time to chat.
Resources:
The Neuroendocrine Immunology of Exercise, Dr. Datis Kharrazian, 2013
Diabetes. 2007 Jul; 56(7): 1762-1772. Metabolic endotoxemia initiates obesity and insulin resistaence.
Hashimoto’s: Why Do I Feel Like Crap on Synthroid?
The Tyranny of T4 Supplementation and TSH Only Testing for Hashimoto’s
Hashimoto’s is one of the most common autoimmune diseases in the US. It is routinely undiagnosed or under-diagnosed and when it is treated, the gold standard of treatment is to give patients Synthroid or Levothyroxine (Synthetic T4).
To monitor whether or not this is working most doctors periodically test TSH.
This approach often does not work and, more importantly, millions of women and men with Hashimoto’s who are being treated this way do not feel any better, or feel better for a period of time, then end up feeling really lousy.
They wind up feeling all the symptoms of hypothyroidism like being tired all the time, they can’t lose weight, they have lots of joint and muscle pain, they suffer from brain fog, anxiety and depression, their hair falls out, they feel cold, they have no sex drive and their lives become miserable.
And many of them have blood test results that look normal.
In this post I will examine why TSH is not a good measure of whether or not thyroid hormone is absorbed by the cells of the body and discuss some better alternatives to testing, supplementation and monitoring of whether or not a given approach is working.
How Does Thyroid Hormone Work in The Body?
Before we look at how most people are treated, it’s important to understand how thyroid hormone works in the 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.)
Why Is Synthroid (Levothyroxine) Sold As The Answer?
Because most of the hormone that is made in the thyroid is T4, the logic is that for those with Hashimoto’s (an autoimmune disease that slowly destroys the thyroid) and hypothyroidism (low thyroid activity) giving a synthetic form of T4 such as Synthroid or Levothyroxine will replace what the body is not doing for itself.
Then, theoretically, the rest of the process will happen as it should – the liver will do it’s thing, the gut will do it’s thing, and the rest of the peripheral tissues will do what they are supposed to do.
Oh, if it were only as simple as that!
Many Things Hinder the Conversion of T4 to T3
There are many, many factors that can cause problems all along the way in getting this synthetic hormone into a form that the body can use and, getting the tissues of the body to effectively absorb it.
And for millions of people, this process just does not work. This is because there are so many things that disrupt thyroid hormone’s ability get into cells, these include: dieting, anxiety, stress, insulin resistance, obesity, diabetes, depression and bipolar disorder, high cholesterol and triglycerides, chronic fatigue syndrome, fibromyalgia, neurodegenerative diseases (Alzheimer’s, Parkinson’s and multiple sclerosis), migraines, cardiomyopathy, and aging.
(Here’s a really interesting graph that shows how this works.)
Testing TSH, T3 and T4 Doesn’t Measure Thyroid Hormone In The Cells
What most doctors learn in medical school is that testing TSH and total T3 and total T4 will tell you how the thyroid is functioning or how well thyroid hormone replacement is working.
This is just not true. This false idea is based on assumptions about how thyroid hormone gets into the cells of the body. In the old, out dated theory, it is thought that thyroid hormone simples diffuses or is absorbed like soda from a straw into the hungry mouths of eager cells.
More recent research has shown that its not diffusion at all, but rather active transport that requires energy from the cells to get the hormone in. What this means is that anything that compromises energy production in the cells (mitochondria make energy in the cell – so things that mess with the mitochondria) will cause less thyroid hormones to get into cells.
These include all of the list of conditions mentioned above and stress is one of the most profound blockers of this process.
In addition, the different thyroid hormones require different amounts of energy to get into the cells. For example, T4 takes more energy to get into cells than T3. (This is why many people do better on T3 only supplementation or combinations of hormones that combine T3 and T4.)
So if you have any or some combination of these conditions: dieting, anxiety, stress, insulin resistance, obesity, diabetes, depression and bipolar disorder, high cholesterol and triglycerides, chronic fatigue syndrome, fibromyalgia, neurodegenerative diseases (Alzheimer’s, Parkinson’s and multiple sclerosis), migraines, cardiomyopathy, and/or aging, and you are taking T4 only, you are going to have a very hard time getting that into the cells of your body.
Almost Everybody Has This Problem
That pretty much covers most of the population on thyroid replacement hormones.
This is important because T4 has to get into cells to be converted. What’s also interesting is that measuring serum T4 (T4 in the blood) won’t tell you anything about how much of it is getting into the cells. Instead, you have to measure Reverse T3 and free T3 levels and measure their ratio. (More on this in a moment).
This is also why some people have normal numbers but still have lots of hypothyroid symptoms (fatigue, hair loss, joint pain, brain fog, constipation, depression, low libido, etc.) even though their lab results are normal.
They have low T4 levels in their cells and more in their serum. So everything looks hunky dory, but they feel terrible. TSH testing will not pick up this problem because TSH is produced in the pituitary and this gland absorbs thyroid hormone very differently than the rest of the body.
The Pituitary Not the Thyroid Determines TSH Levels
The pituitary is much more sensitive to thyroid hormones and transports thyroid hormone differently than all other cells in the body.
In the pituitary, thyroid hormone does not depend on energy to get into the cells. The transporters for T4 and T3 in the pituitary are also not inhibited by numerous environmental toxins and substances produced by the body during physiologic stress and dieting, things that inhibit thyroid transport into other cells in the body, including bilirubin and fatty acids.
In other words, all of the stuff that prevents the cells in the rest of the body, do not affect the absorption of T3 and T4 in the pituitary. So TSH does not reflect the hypothyroid state in the rest of the body and is really only a good measure of thyroid hormone IN THE PITUITARY.
Thyroid hormone is absorbed into the cells of the liver differently than it is by the cells of the pituitary. This is really important to understand and most doctors and endocrinologists do not know this. Since 60% of T4 is converted in the liver, this makes a huge difference.
Why Dieting Can Make Thyroid Hormone Less Available
Many overweight people with Hashimoto’s try to lose weight and are just not able to. This has lead to a huge industry of weight loss drugs, products and procedures.
But what many people do not understand is that the reason that weight loss may be so difficult for these people is that the very process of trying to lose weight may be preventing them from being able to absorb thyroid hormone into their cells.
This creates a vicious cycle of dieting, yo-yo weight loss and gain and miserable results. And all those things actually create a state of a slower, more sluggish metabolism that all but dooms them to failure.
If thyroid hormone is not being absorbed by the cells, then you have a state of cellular hypothyroidism and your body slows down and does not lose weight. And this state of poor cellular absorption of thyroid hormone is not seen in laboratory results unless free T3 and Reverse T3 levels are done.
A very interesting study published in the American Journal of Physiology-Endocrinology and Metabolism, Van der Heyden et al studied the effect of dieting on the transport of T4 and T3 into the cell.
It was found that dieting obese individuals had a 50% reduction of T4 into the cell and a 25% reduction of T3 into the cell due to less energy in their cells, showing that in such patients standard thyroid blood tests are not good indicators of thyroid hormone levels inside the cells.
This also demonstrates why it is very difficult for obese patients to lose weight; as calories are decreased, metabolism drops.
This will, however, not be detected by standard TSH, T4 and T3 testing. In addition, there are increased levels of free fatty acids in the blood with chronic dieting, which further suppresses T4 absorption into the cells and this causes more cellular hypothyroidism.
How You Feel Is More Important Than What Your Lab Tests Say
Another interesting study published in the Journal of Clinical Endocrinology and Metabolism, by Zulewski et al clearly shows that TSH is not a useful measure of proper thyroid replacement because there was no connection between TSH and tissue thyroid levels.
Levels of T3 and T4 were better, and T3 was the best indicator. However, a thorough assessment of how patients felt determined by how many signs and symptoms of hypothyroidism they had (i.e. weight gain, fatigue, hair loss, depression, low libido, brain fog, etc.) was shown to be the most accurate method to determine proper thyroid hormone replacement dosage.
How you feel is a lot more important than what your TSH test results say.
This Is Why You Are So Tired All The Time
What all of this means is that people with Hashimoto’s and hypothyroidism who are on T4 only thyroid replacement hormone feel tired all the time, are losing their hair, can’t lose weight, etc. and just generally feel like crap because this hormone is not getting into the cells of their body.
When thyroid hormone doesn’t get into the body’s cells, it can’t do its job.
There Is Another Way
It doesn’t have to be this way. You can change this by, first, testing appropriately to see how well your cells are absorbing thyroid hormone and then by making changes in your diet, lifestyle and medications (if necessary) to make sure that you are converting and absorbing enough thyroid hormone for it to work in your body.
The proper way to test whether of not your cells are absorbing thyroid hormone is to order free T3 (fT3) and/or T3 and reverse T3 (rT3). And then to measure their ratio: the proper ratio of free T3 to reverse T3 is greater than 20. The proper ratio of T3 to reverse T3 is greater than 10.
If your numbers demonstrate that you have high reverse T3 and a low ratio, then you are not absorbing thyroid hormone into the cells of your body.
The next step is to improve the function of the areas that convert thyroid hormone and to clean up your diet and alter your lifestyle to support proper absorption of thyroid hormone.
Since 60% of T4 is converted into T3 in the liver is vitally important to make sure that you improve liver function and make sure that your liver is working properly. A good liver detox and changes in diet can accomplish this.
The next step is to clean up your gut and make sure that you don’t have intestinal problems or inflammation of the intestines that can slow or prevent proper absorption and conversion of thyroid hormone.
Next, you need to supplement and gradually heal the body so that the many conditions that can slow or stop absorption of thyroid hormone are reversed and make sure the cells of your body have enough energy to get thyroid hormone into your cells.
Lastly, you may need to start taking T3 or try a thyroid hormone that contains both T4 and T3. This will insure that enough T3 is getting into the cells of your body.
30 Minute Confidential Telephone Consultation
I am offering a 30 minute telephone consultation if you would like to learn more and discover whether or not you have issues that may be preventing your cells from absorbing thyroid hormone.
Click on this link to schedule the consultation.
Its Not Easy, But The Results Can Be Dramatic
This is not a simple process and you need to work with someone who understands how to guide you through this process.
That’s why I have created a simple 60 day program that can dramatically improve the way the cells of your body absorb thyroid hormone:
This program includes:
* Free T3 (fT3) and reverse T3 (rT3) testing
* A 30 day liver detox program
* A 30 day gut healing program that incorporates the Hashimoto’s Diet Plan
* Supplementation and guidance to improve cellular energy production.
* Follow Up testing
Click on this link to schedule a confidential 30 minute consultation.
References:
http://nahypothyroidism.org/thyroid-hormone-transport/
http://nahypothyroidism.org/files/thyroid_transport_graph_3.pdf
http://www.stopthethyroidmadness.com/rt3-ratio/
Zulewski H, Muller B, Exer P, et al. Estimation of tissue hypothyrodisim by a new clinical score: Evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997;82(3):771-776.
Kharrazian, Datis, DC, Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? 2010, Elephant Printing