Archives for January 2016

Jan
31
2016

The Gut and Brain Connection

By | Alzheimer’s disease, blood brain barrier, Cardiovascular disease, Diabetes, Fitness, Gastrointestinal Disease, heart attack, Heart Disease, Inflammation, Nutrition, toxins

There is a lot of talk about the gut and brain connection. At the 23rd Annual World Congress on Anti-Aging Medicine (Dec. 11-13, 2015) in Las Vegas there were several lectures pointing out the importance of the gut flora for proper brain function. As a matter of fact, if you have the wrong gut flora, you can get a number of diseases like diabetes, fibromyalgia, rheumatoid arthritis, multiple sclerosis, muscular dystrophy, some cancers and even obesity. Martin P. Gallagher, MD, DC talked about this in his talk entitled “Gut on Fire, Brain on Fire!”

Function of the microbiome

The microbiome is the sum of all microbial organisms inhabiting the human body, which colonize mainly the colon, but also to a lesser degree the small intestine. Dr. Gallagher stated that the microbiome weighs only 7.1 oz., although in the past some have estimated its weight to be as high as 3 pounds. The purpose of the microbiome is to help form a gut/blood barrier. It forms a 30-micron thick layer in the GI tract, protects the intestinal lining and metabolizes food remnants, especially from carbohydrates. In addition, it also communicates with the immune system. There is a cross talk between the lining of the gut and the and the body’s immune system. The gut bacteria help the body to create stability; as a result the good bacteria also decrease intestinal permeability.

Leaky gut syndrome develops

When inflammation occurs in the gut, the thickness of the biofilm is less than 30 microns. Intestinal permeability increases and becomes “leaky gut syndrome”. This can be the cause of autoimmune diseases and possibly other diseases.

The enteric nervous system

The gut can produce as many neurotransmitters as the brain and spinal cord can synthesize. The enteric nervous system communicates with the brain through the vagal nerve. Serotonin is an important neurotransmitter that regulates motility of the gut. The control system of the gut can work on its own and override the concerns of the central nervous system.

Parkinson’s disease is a disorder of the enteric nervous system as well as the brain. With Alzheimer’s disease the characteristic brain lesions are also present in the enteric nervous system!

A mouse experiment showed the following. The Lactobacillus strain is  normally part of the microbiome of the gut.  Re-introduction of Lactobacillus into the gut flora resulted in healing certain parts of the brains of these animals, which researchers associate with anxiety and depression. But when the researchers severed the vagal nerve of these animals, none of these healing changes occurred.

The gut-brain-axis

For this reason the researchers suggested that the gut bacteria are able to communicate with the brain via the vagal nerve. Researchers have coined this connection the “gut-brain axis”. These protective gut bacteria have the ability to protect humans from gastric acidity, from bile acid toxicity, they adhere to the lining of the gut and they persist to reside within the gastrointestinal tract. Probiotics help the immune system to maintain the immunologic memory and to secrete antibodies, called immunoglobulins.

Two strains with benefit to humans are Lactobacillus rhamnosus GG and Saccharomyces boulardii. Probiotics often help against diarrhea. The natural food for gut bacteria in the colon comes from starches of chicory, asparagus, inulin and onions that are indigestible in the stomach and small intestine, but are fermented in the colon to provide food for the bacteria residing there.

Small Intestinal Bacterial Overgrowth (SIBO)

Overgrowth of the small intestine with bacteria that produce endotoxins appears to have significance in both animal models and human disease. Chlamydia species as well as Borrelia burgdorferi (Lyme) can produce toxins that cause hypersensitivity to pain in soft tissues in fibromyalgia and animal models of fibromyalgia. Moreover, SIBO – small intestinal bacterial overgrowth – in experimental animals caused the same hypersensitivity of the soft tissues and also leaky gut syndrome.

Risk factors for SIBO

What causes SIBO is too little stomach acid production, treatment with proton pump inhibitors (powerful anti acid medications) and antibiotics. To summarize, Dr.Gallagher said that SIBO also occurs in post-surgical patients, in patients with diabetes, is brought on by alcohol, nicotine, drugs and GMO foods.

Neurogenic inflammation

Normally the blood brain barrier keeps immune cells from the body out of the brain. Only glucose, proteins and lipids are allowed into the brain, but not lipophilic neurotoxins. In contrast, neurogenic triggers, when admitted to the brain, will compromise the function of the immune cells of the CNS, called microglia. In essence, this can result in memory loss, Alzheimer’s, dementia, seizures, migraines, Parkinson’s Disease, multiple sclerosis, cancer, weakness, numbness, etc.

What triggers inflammation?

Here is a long list of different items that cause inflammation: aging, hormone deficiencies, obesity, diabetes mellitus, cardiovascular disease, fungal infection, the Standard American diet (SAD), pain, trauma and mechanical stress, heavy metals, food allergies, toxins, gut dysbiosis, small intestinal bacterial overgrowth, mal-digestion/absorption, prescription drugs, over-the-counter drugs, recreational drugs and alcohol, lack of exercise and lack of sleep.

Neurotoxic insults start the chain of reactions  like heavy metals, nutritional deficiencies, viruses/fungus/bacteria, inflammatory diet, MSG, solvents, pesticides, herbicides, etc.. One or more of these factors destabilize the tight junctions of the blood brain barrier, which leads to neurogenic inflammation.

Result of neurogenic inflammation

The result is Parkinson’s disease, MS, dementia, chronic pain, behavioral and personality changes, Alzheimer’s disease, ALS and Lyme disease. What seems to be happening a lot is that there is overgrowth of abnormal bacteria in the small bowel, which produce toxins. These in turn lead to leaky gut syndrome, which allows neurogenic triggers to attack the blood brain barrier. It seems like from here it is a short step to neurotoxic insults of the brain overstimulating the microglia, which will produce the diseases listed above.

Healing of brain inflammation

First of all, treatment starts with the Mediterranean diet, which has been shown to have anti-inflammatory properties. Second, people who are gluten sensitive need to eliminate gluten entirely from their food. Third, casein sensitive people need to eliminate dairy products. Furthermore, a triple strength, molecularly distilled fish oil product is taken as a supplement every day with 4 grams or more of DHA/EPA. This helps the anti-inflammatory response.

Glutathione

One of the most powerful antioxidants and anti-inflammatories is intravenous glutathione. This is given as intravenous chelation therapy, which removes heavy metals. Other chelation agents such as EDTA intravenously may be given alternatively. Dr.Gallagher said that glutathione serves as primary cellular defense against free radicals, is a powerful antioxidant and serves as detoxifying agent against xenobiotics. Xenobiotics are remnants of artificial fertilizers, pesticides and pollutants that are contained in crops we eat.

Dr. Gallagher gives 600mg of glutathione twice per day intravenously for 30 days. Uniquely, in Parkinson’s disease patients whose mid brain is often poisoned by mercury this leads to 42% decline of disabilities and the effect lasts for 2 to 4 months after this treatment has been stopped. Coupled with this the treatment also protects telomeres, the caps on the ends of cellular DNA as well as mitochondrial DNA. In addition, glutathione is protective of neurons and nerves.

Curcumin

This common Indian spice, found in turmeric is a potent anti-inflammatory. It is a safe natural agent and has also anti-viral and anti-tumor activities. It binds to the vitamin D receptor and works synergistically together with vitamin D3. Solid lipid curcumin particle technology makes curcumin 65-fold more bioavailable; free curcumin is allowed to pass the blood brain barrier. Lower doses achieve the same effect than regular curcumin.

According to a publication using lipidated curcumin the following observations were made: improved vascular function; equally important, inflammatory markers reduced by 14%; in like manner, triglycerides lowered by 14%; by the same token, oxidative stress reduced; not to mention, catalase increased and finally total antioxidant status improved. Here is another paper about lipidated curcumin.

Omega-3 fatty acids

Omega-3 fatty acids are anti-inflammatory by countering the arachidonic acid pathway that leads to inflammation. Physicians recommend it as triple strength, molecularly distilled fish oil. DHA/EPA are the active ingredients. Chronic inflammation requires 2 to 12 grams daily; irritable bowel syndrome 6 to 12 grams daily; depression, anxiety and insomnia require 2 to 4 grams per day; autoimmune disease, back pain and degenerative joint disease 4 to 12 grams per day.

Gut/brain dysbiosis

For gut/brain dysbiosis Dr. Gallagher recommended to start with a 10-day fruit/vegetable detox program. Milk thistle, glutathione and pancreatic enzymes in combination lead to improvement. Lipidated curcumin is also useful. The physician also gives glutamine, prebiotics and probiotics for gut support. He also tells the patient to take molecularly distilled fish oil (DHA/EPA) and vitamin D3 as anti-inflammatories. Doctors also administer oral and intravenous glutathione to detoxify. Many doctors use natural as a combination of glutathione, oregano, olive leaf and silver salts.

The Gut and Brain Connection

The Gut and Brain Connection

Conclusion

Inflammation can start in the gut, lead to leaky gut syndrome and break down the blood/brain barrier. The end result is that inflammation develops in the brain and Alzheimer’s disease and dementia can occur. The sooner the physician starts with treatment, the faster the recovery is. When the patient has reached the end stage, it is difficult to turn the inflammatory process around. Fortunately there are effective ways to get the inflammation under control with intravenous glutathione in the beginning and subsequent treatment with lipidated curcumin, omega-3 fatty acid and vitamin D3. A permanent switch to a Mediterranean diet is important as well to keep inflammation under control.

Lifestyle and nutrition choices are important for prevention

A few years back this mainstream medicine considered this type of approach as “quackery”; now it is the latest information from research into the brain/gut connection. The right lifestyle and nutrition choices can do a lot on a preventative basis. Once disease has taken root, treatment may still be possible, but once it is at a later stage a full cure is unlikely.

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Jan
23
2016

Life Extended By Several Decades

By | alcohol, Anti-aging medicine, Cancer, Cardiovascular disease, Diabetes, Fitness, Health, heart attack, High Blood Pressure, Hormones, Inflammation, Nutrition, Pain, Prevention, regenerative medicine, Smoking, stem cells, Stress management, Stroke, Vitamins and supplements

Have you ever thought about the possibility to prolong your “Freshness Date”? At the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas the endocrinologist, Dr. Thierry Hertoghe from Belgium gave a talk about “How to extend the human lifespan by 40 years”. Dr. Hertoghe explained that it is possible to extend life by paying attention to the factors that prolong life and combining them as an anti-aging type lifestyle. He made a distinction between

  1. normal aging: up to age 82
  2. healthy aging: up to age 100
  3. anti-aging medicine: up to age 122
  4. reversing aging medicine: much more than 122, perhaps to age 150 or more.

Normal aging (up to age 82)

Life expectancy is on average about 82 years. From the age of 50 to 60 onwards you may encounter problems with increased cholesterol, high blood pressure leading to heart attacks and strokes. Coronary artery by-pass surgery may extend an individual’s life by 10 to 15 years. But hardening of the arteries in the general circulation will eventually cut down the blood supply to vital organs leading to premature death that could have been avoided.

Around the mid 60’s to mid 70’s 12.4% of African Americans or 2.9% Caucasians get Alzheimer’s disease. These figures worsen rapidly with further aging: in their mid 70’s to mid 80’s 32.5 % of African Americans and 9.8% of Caucasians suffer from Alzheimer’s disease. At the age of 85+ years 54% of African Americans and 27% of Caucasians have Alzheimer’s disease. With normal aging Alzheimer’s has already increased, and this trend likely is continuing.

Loss of memory, depression and musculoskeletal pain

Memory loss also leads to a shortened survival curve; people with memory loss live two years less on average than compared to a group with no memory loss.

Add to this loss of life because of depression, common in older age. Compared to a non-depressed group over 2 years of older people the depressed group lived 30% shorter.

Musculoskeletal pain in younger age (18-44) was 38%; the next demographic group aged 45-64 reported 61% of musculoskeletal pains; seniors between 65 and 74 had 68% of musculoskeletal pain, and in the demographic group of 75 and up 71% of persons suffered of musculoskeletal pain. As we will learn later there may be hormone deficiencies behind these neck and back pains. If the patient does not seek treatment, this can lead to falls, fractured hips and premature loss of life. Those who survive accidents often become wheel chair bound and end up in nursing homes.

Patients with rheumatoid arthritis and patients with other disabilities have a lower life expectancy

One specific subgroup of patients with musculoskeletal pain are rheumatoid arthritis sufferers. After 10 years of having rheumatoid arthritis patients will have a survival of only about 50%. With involvement of more than 30 joints  (more severe form of the disease) only about 40% will survive. In other words, rheumatoid arthritis is an important factor for lowering people’s life expectancy.

At an age of 65 to 74 men have 23% of disabilities, while woman have 27.5% disabilities. This increases between the ages of 75 or older to 40% for men and 44.5% for women. At the age of 65 disabled men have a 3.5% higher death rate than the average population; disabled women’s death rate is 2.5% higher than the normal population. In other words, disability kills.

Obesity, and heart disease

Urinary urgency and incontinence leads to a 3.13-fold higher mortality rate than a control group of men who do not have these symptoms.

65% of men and 85% of women above the age of 50 have abdominal obesity. This is not just a harmless condition. There is an association between increased triglyceride levels and increased mortality due to cardiovascular disease and diabetes.

By the age of 65-74 heart disease has a frequency of 32% in men and 23% in women. At the age of 75 years and older this jumps to 44% in men and 32% in women. Once the doctor diagnoses heart disease, it causes a lot of premature deaths: an average person with heart disease lives 10 years shorter than those who do not have heart disease!

Healthy aging (up to age 100)

Improving lifestyle factors increases life expectancy

If we look at normal aging, we realize that all these diseases and disabilities we discussed are eventually killing us. In order to live longer we have to take steps that are known to interfere with some of these factors. For instance, quitting smoking will prevent heart disease, several cancers and chronic obstructive lung disease (emphysema). Positive thinking, social support and transcendental meditation will increase survival by preventing mental illness and depression, which in turn will prevent suicides. A healthy diet such as the Mediterranean diet or the Pegan diet will avoid cardiovascular disease and cut down cancer rates.

Live longer with better diet

One dietary change is called the “polymeal”. It consists of fish, fruit, vegetables, garlic, almonds, a moderate amount of wine and dark chocolate. Compared to the Standard American diet this type of diet would add 9 years for men and 8.1 years for women regarding their life expectancy. For instance, prostate cancer showed a 7-fold increase in a group of men who ate a lot of pickled vegetables, fermented soy products, salted fish and preserved meats, when compared to a control group who did not include these foods. In a group of women who had their meat well done and ate three servings of beef per week, breast cancer risk was 4.62-fold higher compared to women who ate meat done rare or medium rare. Overall cancer and cardiovascular mortality dropped by 35% in a study where 5 or more servings of fruit and vegetables were eaten per day.

Regular exercise and supplements of vitamin C and omega-3

A regular exercise program will strengthen the heart and lungs, keep your weight stable, reduce heart attacks and strokes and reduce the probability to develop cancer. A group of men between 61 and 81 were observed over 12 years and divided into those who did not exercise versus those who walked more than 2 miles per day. The exercising men had 19% less mortality compared to the sessile men. Vitamin C from fruit and vegetables or from taking supplements reduces global mortality from all causes by 46% compared to controls that did not. Similarly taking omega-3 fatty acid supplements (fish oil) daily reduced all cause mortality by 20%.

Dr. Hertoghe calls this “healthy aging” and this would allow you to be able to reach an age of about 100 years.

Anti-aging medicine (up to age 122)

Low thyroid hormones

Dr. Hertoghe told the audience that further attention to anti-aging factors could reduce mortality even further. He found over the years that paying attention to correcting hormonal weaknesses would have profound effects on how old a person becomes. Thyroid hormone replacement has been one of the steps that has helped people to feel more energetic, have less muscle pain, less falls, less fractures and complications. It also translates into longer lives.

One slide showed that a low free T3 level (low thyroid) was associated with a 3.6-fold higher death rate. A low free T3 level is an accurate predictor of cumulative death rate in cardiac patients.

T3 is also important for the maintenance of the immune system, which shows in patients with tuberculosis: the one-year mortality rate from TB in thyroid deficient patients was 75%, while patients with a normal thyroid had a mortality from TB of only 7%.

Replacement of missing sex hormones

Secondly, replacing missing sex hormones can add more life because cardiovascular disease is postponed (less heart attacks, less strokes), there is less cancer and better cancer survival, if a person comes down with cancer. Many statistics were quoted.

One interesting slide showed the longitudinal survival follow-up of congenital dwarfs in comparison with their normal brothers or sisters. Untreated male dwarfs turned only 56 years on average, while their unaffected normal brothers turned 75 years on average (19 years longer). With female dwarfs the difference is even more striking: untreated females dwarfs turned 46 years on average, while their normal sisters turned 80 years on average (a difference of 34 years).

Bioidentical hormone treatment prolongs life, lowers heart attack rates and lowers cancer rates

Another publication showed that the heart attack risk was 3.8-fold higher in a group of patients with hypopituitarism (under function of the pituitary gland), but the treatment group (treated with GH) had a normal rate of heart attacks.

11606 men aged 40 to 79 years were followed for between 6 and 10 years. The group who had the top 25% range of testosterone had a 19% lower mortality rates from heart attacks or cancer.

Older women, particularly aged 100 in Okinawa had 2.3-fold higher testosterone levels than women in the US at age 70. On the other hand 70-year old Okinawan women had 2.7-fold higher estrogen levels than US women.

Bioidentical hormone replacement therapy (BHRT) prior to developing breast cancer showed a 27% longer survival among 984 breast cancer patients in Sweden compared to those without prior hormone treatment.

Lower mortality rates for bioidentical hormone replacement therapy of breast cancer patients

In another group of breast cancer patients (2755 patients) aged 35 to 74 who were treated with bioidentical hormone replacement therapy (BHRT) after their breast cancer diagnosis, 50% had a lower recurrence rate (compared to no-BHRT treatment) and there was a reduction of 66% of mortality from breast cancer compared to controls without BHRT treatment. Another study showed that breast cancer patients would have a mortality rate of 33.3% without hormone treatment. After non-estrogen hormone treatment the mortality rate dropped to 12.5% and to 6% after estrogen/progesterone use. This shows the healing results of the various natural hormones.

Treating the cause rather than the symptoms

A group of 280 men and women around the age of 50 were treated with anti-aging hormone replacement for 2 or more years. In the beginning there were 34% of women and 15% of men with coronary artery disease. There were also 36.4% of women and 34.1% of men with high blood pressure. After replacing all of the missing hormones with bioidentical hormones for more than 2 years, coronary artery disease had dropped to 1.6% of the women and 1.08% of the men; high blood pressure had dropped to 2% of the women and 3% of the men. No drugs, just hormones! Of course, initially the doctors prescribed drugs to stabilize their condition, but they could gradually drop them safely. The reason was that the doctors treated the underlying hormone deficiency. The doctors were treating the cause of the cardiovascular disease rather than only the symptoms.

Low mortality of women on bioidentical hormone replacement

Dr. Hertoghe presented data of 6.38-year follow-up of 286 consecutive patients using anti-aging medicine (replacement of missing hormones with bioidentical hormones). These patients had an overall cancer rate of 2.1%, which compared very favorably to the 3.2% cancer rate among US women. The overall cancer rate was  3.1% in French women and 3.1% in Belgium women on no hormones. This is the type of information that is needed following the Women’s Health Initiative (WHI) that scared women into the false belief that hormones would be “poisonous”.

Synthetic hormone do not fit the hormone receptor

In the WHI synthetic hormones caused cancer and heart attacks; the reason for this was that synthetic hormones are not the identical shape as the natural hormones. But hormones and hormone receptors have to fit like a key into a lock; otherwise they are not effective or even block the natural life prolonging action of the natural hormone. This is why in the WHI study the outcomes were poor. Using bioidentical hormones the doctor can prevent heart attacks and strokes and they are also cancer-protective.

Reversing aging medicine (much more than 122, perhaps to age 150 or more)

General medicine has the goal to make patients as healthy as possible. With reversing aging medicine the goal is to make patients as young as possible. They are at their healthiest and feel younger again.

With anti-aging medicine using a healthy diet, exercise and bioidentical hormone replacement therapy the patients can add 15 years of good life. Add to these organ transplants, if necessary, telomerase activators and stem cell therapy. This can add another 25 years of life expectancy to a total of 40 years.

Growth hormone deficiency

Growth hormone deficiency is the one factor that has been underestimated. The discussion of dwarfs in comparison to their healthy brothers and sisters showed us the following. Growth hormone production can add between 19 and 34 years (average 26.5 years) of life. Dr. Hertoghe has done blood tests (IGF-1) and lately also 24-hour urine metabolite tests of growth hormone on aging patients and found that many are deficient with regard to GH production. These were patients where Dr. Hertoghe already replaced their thyroid hormones, if abnormal and replaced their sex hormones when they were low. But they lost hair, developed old looking faces with wrinkles. In addition, a loss of subcutaneous fatty tissue is giving the face a hollow appearance. They also had muscle and joint pains and thin skin, particularly over the back of their hands.

Replacement of growth hormone

He replaced their missing GH using daily GH self-injection with a tiny needle (similar to diabetes injections). Within 1.5 to 3 years the wrinkles disappeared, the faces started to look younger and patients did feel younger. Their muscle and joint pains had disappeared and their hair grew back. The dosage range is between 0.1mg and 0.3mg, a tiny amount of GH daily. This is not inexpensive, but some health care plans pay for this, as a lack of GH is a true hormone deficiency.

About organ transplants

Often it is a single limiting organ that determines when we die, typically the heart, lungs, brain, liver, kidneys, small bowel, pancreas or bone marrow. Organ transplants can add years of life, but it can be cumbersome to find a suitable donor. One study showed that only 40% to 60% of organ transplants are surviving 8 years after the surgery.

Stem cell therapies are other ways to prolong life. More research will perfect this, but essentially stem cells can provide 220 different cell types for in-vitro organ culture. This can probably be of use in the future to replace malfunctioning organs.

Life Extended By Several Decades

Life Extended By Several Decades

Conclusion

The dream of staying younger for longer can be a reality today. You just need to be willing to discipline yourself and watch what you are eating (Mediterranean type diet). Also, exercise regularly and have a positive psychological attitude. If the outdoor air is poor where you live, you may want to consider moving. Move to a place with good air quality. Sleep well for 7 ½ hours every night and retire not later than 10 to 11PM. You need to be asleep between midnight and 3AM as the growth hormone peak occurs at that time.

Take supplements

Take supplements that contain longevity micronutrients (magnesium, vitamins A, C, D, E, B6, B12, Co-Q-10, selenium, zinc, iron in premenopausal women etc.). Replace all missing hormones with bioidentical ones, like thyroid hormones (T3 and T4), sex hormones, DHEA and GH. Stem cell therapy and telomerase activators for cell rejuvenation will also have more of a place in the future.

Even, if you do only part of this reversing aging program you will slow down aging.

Jan
16
2016

Low Thyroid (Hypothyroidism)

By | Hormones, Insomnia, Obesity, Pain

Dr. Pamela Smith gave a detailed talk regarding low thyroid (hypothyroidism) at the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas. As a lack of thyroid hormones is one of the causes of premature aging, it is important to pay attention to your thyroid hormones. Here I am summarizing the highlights of this talk.

Thyroid disease, particularly low thyroid hormone levels (hypothyroidism) is very common in the population. Part of the problem is that in 72% of the world population dietary iodine is insufficient to provide adequate amounts of iodine to the body that is required for thyroid hormone production in the thyroid gland. The US Institute of Medicine has recommended 150 micrograms of iodine intake every day. Japan with its emphasis on seaweed intake, which provides iodine supplementation is one of the few countries where thyroid deficiency is extremely low (Ref.1).

But apart from dietary factors there are many other factors that can lead to insufficient amounts of circulating thyroid hormones (see below).

The production of thyroid hormones

The thyroid gland produces the thyroid hormones by adding iodine atoms into the amino acid L-tyrosine to make thyroxin (T4) and triiodothyronine (T3). T3 is the main active hormone, which is about 5-times more powerful than T4. There is a feedback cycle between thyroid hormones, the hypothalamus and the pituitary gland. Both the hypothalamus and the pituitary gland have thyroid hormone receptors that sense the level of T3 and T4 and can modify the production of these hormones. The majority of T3, which is the main active thyroid hormone, comes from conversion of T4 into T3 by a selenium-dependent enzyme.

Most of the thyroid hormones are bound in the blood by thyroid binding globulin. Only the free T3 and free T4 are metabolically active and will affect the metabolism of our body cells. The delicate balance can be easily disrupted. Oral contraceptives and sex hormone replacement therapy can increase the amount of circulating thyroid binding globulin, thus creating a thyroid hormone deficiency state, as the free T3 and free T4 are diminished.

Other factors influencing circulating thyroid hormones

Low adrenal gland hormone activity

Low adrenal gland hormone activity can occur simultaneously with hypothyroidism. On the other hand, when thyroid hormones are low by themselves, the adrenal glands often compensate by producing more cortisol to offset some of the symptoms of hypothyroidism.

Conversion of T4 to T3

An enzyme located in the liver, kidneys, pituitary gland, hypothalamus and brown fat is necessary for conversion of T4 to T3, the more active thyroid hormone. Anything that interferes with this conversion leads to hypothyroidism. Over the years medical research has identified many factors that interfere with this process. For instance, there are trace elements necessary for this enzymatic reaction, like selenium and zinc; if they are low in the diet, low T3 will be the result. But other nutrients, if missing, will also interfere with T4 to T3 conversion: iodine, iron as well as vitamins A, B2, B6 and B12.

Medication can interfere with conversion of T4 to T3

Several medications can also interfere with the conversion of T4 to T3: we already mentioned birth control pills; others are estrogen, lithium (patients with bipolar disorder are often on this), phenytoin, theophylline, beta blockers (such as propranolol), chemotherapy and clomipramine.

Too much fiber in diet can interfere with conversion of T4 to T3

But dietary factors can also lower T3 due to a lack of conversion from T4: too many cruciferous vegetables, a low carbohydrate diet, low fat diet, low protein diet, excessive alcohol use, walnuts and soy. In a study that examined the effects of soy involving 37 adults on a high soy diet over three months 50% developed hypothyroidism. When the soy diet was stopped it took one month to normalize the thyroid function (Ref. 2).

Chronic inflammation, diabetes, aging and more can lower T3

There is no end of factors that cause low T3 because of the inability to convert from T4: chronic inflammation due to cytokines, diabetes, aging, poisoning with heavy metals like mercury, lead and cadmium (cigarette smoking), fluoride, pesticides, exposure to radiation and stress. Other toxic substances that enter the body can interfere with the same T4 to T3 conversion process: dioxins, phthalates (chemicals added to plastics) and PCB. But excess calcium and copper (copper salts could come from spraying of organic fruit) can also lead to low T3.

Too much cortisol from stress can lower T3

Other hormones can disbalance the equilibrium and cause low T3 because of a lack of conversion from T4. One reason can be too much stress, which causes cortisol from the adrenal glands to rise. Surgeries cause the same stress response (high cortisol levels) also will lower T3.

Reverse T3, an inactive form of T3

There is another conversion process that has been shown to lead to lowered T3: it is called “reverse T3 (rT3)”. rT3 is an inactive form of T3, which blocks thyroid receptors and renders T3 less active. rT3 is particularly important in stressful situations and in athletes who engage in extreme exercise. In these individuals T3 and T4 blood tests are normal, TSH is suppressed and rT3 is elevated. That’s how the doctor can diagnose this condition. Other conditions that lead to high reverse T3 are: aging, diabetes, exposure to free radicals (chemotherapy or radiation in cancer treatment), fasting, prolonged illness, toxic metal exposure, inflammatory cytokines, depression and anxiety, bipolar disorder, Alzheimer’s and Parkinson’s disease, chronic fatigue syndrome and fibromyalgia.

Certain supplements and dietary habits can help to increase the conversion from T4 to T3

After all this negative news it is almost a wonder that the thyroid is still doing its work! Since we know the risk factors, it is important to be aware that certain supplements and dietary habits can help to increase the conversion from T4 to T3. Here is a list of those that help: iodine, iron, zinc, selenium, potassium, Ashwaganda, and a high protein diet. Other positive factors are vitamins A, B2 and E; growth hormone, testosterone, insulin, glucagon, melatonin and estrogen (high dose).

Symptoms of hypothyroidism

There was an overwhelming amount of information about signs and symptoms of hypothyroidism that was reviewed. I can only highlight some of the more common symptoms here. It is important to know that some of these signs and symptoms occur several years before the lab values become abnormal. This is particularly true of the “eye brow sign” and the thinning of eyebrows is a pointer to hypothyroidism!

More signs and symptoms of hypothyroidism

Depression, weight gain, constipation and migraine type headaches can be early non-specific signs of hypothyroidism. Women often present with irregular periods. Other symptoms are: decreased memory and inability to concentrate, anxiety/panic attacks, muscle and joint pains, a puffy face, swollen eyelids, decreased sexual interest, and sleep disturbance. Sparse, coarse, dry hair; missing hair confined to the outside 1/3 of both eye brows (eye brow sign) and carpal tunnel syndrome are also associated with a lack of thyroid function. Often there is also a loss of eyelashes or eyelashes that are not as thick. Blood tests can show high cholesterol, iron deficiency anemia or vitamin B12 deficiency. This should prompt the physician to order thyroid tests.

Blood tests for hypothyroidism

The doctor needs to order TSH, free T3, free T4, reverse T3 and thyroid antibodies to have a complete documentation of what is going on. In addition the doctor will order these three thyroid antibodies: antithyroglobulin antibody, antimicrosomal antibody and antithyroperoxidase (anti-TPO) antibody. There are a number of more studies that an endocrinologist would order in difficult to diagnose cases. Thyroid antibodies are an important cause of hypothyroidism in the US. They can also be due to Hashimoto’s thyroiditis, an inflammatory condition of the thyroid gland. Some people have autoimmune antibodies against adrenal gland tissue. There are also patients who have gluten sensitivity. They may produce these autoantibodies to both the adrenal glands as well as the thyroid gland.

Treatment of hypothyroidism

Treatment for hypothyroidism consists of detoxification, proper nutrition and thyroid hormone replacement.

Detoxification can include intravenous chelation therapy, if heavy metals are part of the development of hypothyroidism. In some cases detoxification is all that is necessary.

Proper nutrition with a Mediterranean diet and some iodine supplements or seaweed is important. By the time the physician diagnoses hypothyroidism, there is  damage  in the thyroid gland and the missing thyroid gland hormones have to be replaced.

Replacement of thyroid hormones

Replacement of thyroid hormones is best done by desiccated thyroid or compounded thyroid (both T3 and T4). The physician takes the normalization of the TSH level as the end point. It should be below 2.0 (not the lab normal value of below 5). Free T3 should be optimally between 3.5 and 4.3 and reverse T3 should be 50 to 150 pg/ml to be optimal.

If reverse T3 is high, the patient will have hypothyroid symptoms, even if T3 and T4 blood tests are normal. Because reverse T3 derives from T4, the physician will have to lower T4 or take the patient off T4. Replacement with T3 will lead to lower TSH production by the pituitary gland. At the same time production of T4 and inappropriate conversion to reverse T3 will decrease.

Treating concomitant factors

Depending on what other conditions the patient presents with, it likely will help to eliminate stress, treat selenium and iodine deficiency, treat infections and treat growth hormone deficiency, if present.

There were many more pearls of wisdom in this very comprehensive talk on hypothyroidism, but there is not enough room in this blog to mention all of this. For more info read Dr. Pamela Smith’s book (Ref.3).

Low Thyroid (Hypothyroidism)

Low Thyroid (Hypothyroidism)

Conclusion

The maintenance of our health and well being involves the thyroid as one of the main players. Hypothyroidism can develop for multiple reasons: inadequate iodine intake, toxins including heavy metals, autoantibodies from gluten. In addition there may be another sensitivity and side effects from certain medication usage. It is a fallacy to think that supplements, vitamins and lifestyle choices can “cure” thyroid deficiency. Once the levels are low, thyroid replacement is the only way to reestablish a hormonal balance! The treating physician must consider many factors when replacing thyroid hormones optimally. Desiccated thyroid hormone replacement (containing T3 and T4) is the best type of replacement of missing thyroid hormones. The needs can differ a great deal, as no patient is the same! For best results the treating physician needs to individualize treatment.

References

Ref. 1: Brownstein, D., “Iodine: Why You Need It, Why You Can’t Live Without It”. Medical Alternatives Press, 2004.

Ref. 2: Kelly, G., “Peripheral metabolism of thyroid hormones: A review,” Alt Med Rev 2000; 5(4):306-33.

Ref. 3: Smith, P. “What You Must Know About Thyroid Disorders”. Garden City Park, NY: Square One Publishers, 2016.