Iodine Deficiency on the Rise

June 25, 2018

Iodine is an essential mineral.  Your thyroid gland uses it to make thyroid hormones, which help control growth, repair damaged cells and support a healthy metabolism.  Unfortunately, up to a third of people worldwide are at risk of an iodine deficiency. Those at the highest risk include:

 

  • Pregnant women.
  • People who live in countries where there is very little iodine in the soil: South Asia, Southeast Asia, New Zealand and European countries.
  • People who don’t use iodized salt.
  • People who follow a vegetarian or vegan diet.

 

Iodine deficiencies had been rare in the United States, where there are sufficient levels of iodine in the food supply.  However, changes in lifestyle have increased the prevalence across the United States in recent years.  Symptoms can include swelling in the neck, pregnancy-related issues, weight gain and learning difficulties.  Its symptoms are very similar to those of suboptimal thyroid function. Since iodine is used to make thyroid hormones, an iodine deficiency means your body cannot make enough of them, leading to hypothyroidism.

 

Signs that you may have an iodine deficiency:

 

Swelling in the Neck

Swelling in the neck is the most common symptom of an iodine deficiency. This is called a goiter and occurs when the thyroid gland grows too big. The thyroid gland is a small, butterfly-shaped gland in the front of your neck. The thyroid gland uses iodine to make thyroid hormones. However, when your body is low in iodine, it cannot make enough of them. To compensate, the thyroid gland works harder to try to make more. This causes the cells to grow and multiply, leading to a goiter. Most cases can be treated by increasing iodine intake. However, if a goiter has not been treated for many years, it might cause permanent thyroid damage.

 

Unexpected Weight Gain

Unexpected weight gain may occur if the body does not have enough iodine to make thyroid hormones. This is because thyroid hormones help control the speed of your metabolism, which is the process by which your body converts food into energy and heat. When your thyroid hormone levels are low, your body burns fewer calories at rest. Unfortunately, this means more calories from the foods you eat are stored as fat. Adding more iodine to your diet may help reverse the effects of a slow metabolism, as it can help your body make more thyroid hormones.

 

Fatigue and Weakness

Fatigue and weakness are also common symptoms of an iodine deficiency. Studies have found that nearly 80% of people with low thyroid hormone levels, which occur in cases of iodine deficiency, feel tired, sluggish and weak. These symptoms occur because thyroid hormones help the body make energy. When thyroid hormone levels are low, the body cannot make as much energy as it usually does. This may cause your energy levels to plummet and leave you feeling weak.

 

Hair loss

Thyroid hormones help control the growth of hair follicles. When thyroid hormone levels are low, your hair follicles may stop regenerating. Over time, this may result in hair loss. For this reason, people with an iodine deficiency may also suffer from hair loss.  Approximately 30% of those with low thyroid hormone levels experienced hair loss. If you experience hair loss because of an iodine deficiency, getting enough of this mineral may help correct your thyroid hormone levels and stop hair loss.

 

Dry, Flaky Skin

Dry, flaky skin may affect many people with an iodine deficiency. Studies show that up to 77% of people with low thyroid hormone levels may experience dry, flaky skin. Thyroid hormones, which contain iodine, help your skin cells regenerate. When thyroid hormone levels are low, this regeneration does not occur as often, possibly leading to dry, flaky skin. Additionally, thyroid hormones help the body regulate sweat. People with lower thyroid hormone levels, such as those with an iodine deficiency, tend to sweat less than people with normal thyroid hormone levels. Given that sweat helps keep your skin moist and hydrated, a lack of sweat may be another reason why dry, flaky skin is a common symptom of iodine deficiency.

 

Feeling Colder Than Usual

Feeling cold is a common symptom of an iodine deficiency. Over 80% of people with low thyroid hormone levels may feel more sensitive to cold temperatures than usual. Since iodine is used to make thyroid hormones, an iodine deficiency can cause your thyroid hormone levels to plummet. Because thyroid hormones help control the speed of your metabolism, low thyroid hormone levels may cause it to slow down. A slower metabolism generates less heat, which may cause you to feel colder than usual. Also, thyroid hormones help boost the activity of brown fat, a type of fat that specializes in generating heat. This means that low thyroid hormone levels, which may be caused by an iodine deficiency, could prevent brown fat from doing its job.

 

Changes in Heart Rate

Your heart rate is a measure of how many times your heart beats per minute. It may be affected by your iodine levels. Too little of this mineral could cause your heart to beat slower than usual, while too much of it could cause your heart to beat faster than usual. A severe iodine deficiency may cause an abnormally slow heart rate making you feel weak, fatigued, dizzy and possibly cause you to faint.

 

Trouble Learning and Remembering

An iodine deficiency may affect your ability to learn and remember. Thyroid hormones help your brain grow and develop. An iodine deficiency, which is required to make thyroid hormones, can reduce brain development. Studies have found that the hippocampus, the part of the brain that controls long-term memory, appears to be smaller in people with low thyroid hormone levels.

 

Problems During Pregnancy

Pregnant women are at a high risk of iodine deficiency – they need to consume enough to meet their own daily needs, as well as the needs of their growing baby. The increased demand for iodine continues throughout lactation, as babies receive iodine through breast milk. Not consuming enough iodine throughout pregnancy and lactation may cause side effects for both the mother and baby. Mothers may experience symptoms of an under-active thyroid, such as a goiter, weakness, fatigue and feeling cold. Meanwhile, an iodine deficiency in infants may stunt physical growth and brain development. Furthermore, a severe iodine deficiency may increase the risk of stillbirth.

 

Heavy or Irregular Periods

Heavy and irregular menstrual bleeding may occur as a result of an iodine deficiency. Like most symptoms of iodine deficiency, this is also related to low levels of thyroid hormones. In one study, 68% of women with low thyroid hormone levels experienced irregular menstrual cycles, compared to only 12% of healthy women. Research also shows that women with low thyroid hormone levels experience more frequent menstrual cycles with heavy bleeding. This is because low thyroid hormone levels disrupt the signals of hormones that are involved in the menstrual cycle.

 

Role of Iodine in Breast Health

Iodine deficiency is rapidly emerging as a major risk factor for breast cancer. Human breast tissue and breast milk contain higher concentrations of iodine than the thyroid gland itself, which contains just 30% of the body’s iodine stores. Breast tissue is rich in the same iodine-transporting proteins used by the thyroid gland to take up iodine from the blood. Iodine plays an important role in the health of women’s breast tissue. Iodine has been shown to exert a powerful antioxidant effect equivalent to vitamin C. Iodine-deficient breast tissue exhibits chemical markers of elevated lipid peroxidation, one of the earliest factors in cancer development. Iodine-deficient breast tissue also shows alterations in DNA and increases in estrogen receptor proteins. Coupled with iodine deficiency-induced increases in circulating estrogen levels, these changes can substantially increase the risk of breast cancer in women with low iodine levels.

 

Iodine also helps regulate levels of the stress hormone cortisol and contributes to normal immune function. Abnormal cortisol levels and deficient immune function are significant contributors to the risks of breast cancer; women with fibrocystic breast disease may also suffer from elevated cortisol levels. Taken together, these biological factors explain the well-known link between iodine deficiency and thyroid disease, thyroid cancer, and breast cancer, all of which predominate in postmenopausal women. The link between iodine consumption and breast cancer is most evident when you compare the Japanese and Western diets against cancer incidence. Japanese women consume a diet high in iodine-rich seaweed, which provides them with an iodine intake 25 times higher than the average American woman’s. Japanese women also have breast cancer rates roughly one-third of those found in American women, a difference that disappears in Japanese women who immigrate to the US, where they consume considerably less seaweed.

 

Studies of iodine therapy for breast cancer prevention are encouraging. Breast cancer cells avidly absorb iodine, which in turn suppresses tumor growth and causes cancer cell death. Added dietary iodine reduces the size of both benign and malignant breast tumors. Further benefits may be obtained by supplementing with selenium in addition to iodine; selenium is an essential cofactor in the enzymes used in thyroid and breast tissue to make optimal use of dietary iodine. In addition to its obvious role in preventing breast cancer, increased iodine intake may be important in mitigating another common, if less lethal, breast disorder—fibrocystic breast disease. Fibrocystic breast disease is extremely common – found in at least 9% of all women who undergo biopsies, though the actual rate is probably much higher. Fibrocystic breast changes can be reversed and women with fibrocystic breast disease can obtain substantial relief.

 

It is becoming increasingly clear that iodine deficiency interferes with optimum breast health, and intake of levels far higher than the recommended dietary allowance of 150-290 mcg is required to achieve benefits. Daily amounts of 3,000-6,000 mcg may help relieve the symptoms of fibrocystic breast disease.

 

The Role of Iodine in Cardiovascular Health

Iodine and iodine-rich foods enjoy a long history as natural therapies for hypertension and cardiovascular disease. Even when no overt symptoms are evident, hypothyroidism can contribute to heart disease and stroke, and it increases the risk of death from these conditions. Thyroid dysfunction creates unfavorable disturbances in lipid profiles, elevating low-density lipoprotein (LDL) and total cholesterol levels and raising the risk of atherosclerosis. Hypothyroidism also weakens the heart muscle, causing it to ‘squeeze’ less firmly with each contraction; it can cause cardiac arrhythmias as well. These effects may not be evident at rest, but become important during moderate exercise. Low thyroid function is also associated with higher waist-to-hip ratios, an obesity-related risk factor for cardiovascular disease. Restoring normal thyroid function helps reverse multiple cardiovascular risk factors, most notably adverse lipid profiles. Iodine therapy shows promise in safely and effectively modulating these health concerns.

 

Sources of Iodine

As with many diseases, it is better to prevent the problem rather than have to treat it. Over the last 80 years, worldwide efforts have been made to eliminate iodine deficiency. Elimination of iodine deficiency has been a major goal of the World Health Organization. Iodized salt has been the mainstay of treatment for iodine deficiency worldwide, including in the United States. Injections of iodized oil are occasionally used in regions of the world where widespread iodized salt use is not possible. Iodination of water supplies also has been effective in some places.

 

There are very few good sources of iodine in the diet. This is one reason why iodine deficiency is common worldwide. The recommended daily intake (RDI) is 150 mcg per day. This amount should meet the needs of 97–98% of all healthy adults. One teaspoon of iodized salt contains approximately 400 μg iodine. Most iodine-containing multivitamins have at least 150 μg iodine, but only about half of the types of multivitamins in the United States contain iodine.  Pregnant or breastfeeding women need more iron. Pregnant women need 220 mcg daily, while lactating women need 290 mcg daily. Because the effects of iodine deficiency are most severe in pregnant women and their babies, the American Thyroid Association has recommended that all pregnant and breastfeeding women in the United States and Canada take a prenatal multivitamin containing 150 μg iodine per day. 

 

The foods below are excellent sources of iodine:

  • Seaweed, one whole sheet dried: 11–1,989% of the RDI
  • Cod, 3 ounces (85 grams): 66% of the RDI
  • Yogurt, plain, 1 cup: 50% of the RDI
  • Iodized salt, 1/4 teaspoon (1.5 grams): 47% of the RDI
  • Shrimp, 3 ounces (85 grams): 23% of the RDI
  • Egg, 1 large: 16% of the RDI
  • Tuna, canned, 3 ounces (85 grams): 11% of the RDI
  • Dried prunes, 5 prunes: 9% of the RDI

 

 

Seaweed is usually a great source of iodine, but this depends on where it came from. Seaweed from some countries, such as Japan, are rich in iodine. Smaller amounts of iodine are also found in a variety of foods like fish, shellfish, beef, chicken, lima and pinto beans, milk and other dairy products. The best way to get enough iodine is to add iodized salt to your meals. Half a teaspoon (3 grams) over the course of the day is enough to avoid a deficiency.

 

If you think you have an iodine deficiency, it’s best to consult your doctor. They will check for signs of swelling (a goiter) or take a urine sample to check your iodine levels.

 

Too Much Iodine

Taking too much iodine can also cause problems. This is especially true in individuals that already have thyroid problems, such as nodules, hyperthyroidism and autoimmune thyroid disease. Administration of large amounts of iodine through medications (i.e.: Amiodarone), radiology procedures (iodinated intravenous dye) and dietary excess (Dulce, kelp) can cause or worsen hyperthyroidism and hypothyroidism. In addition, individuals who move from an iodine-deficient region (for example, parts of Europe) to a region with adequate iodine intake (for example, the United States) may also develop thyroid problems since their thyroids have become very good at taking up and using small amounts of iodine. In particular, these patients may develop iodine-induced hyperthyroidism.

 

Talk to your heal care provider before starting an iodine regimen.

Growth Hormone – Are You Deficient?

June 1, 2018

The older you are, the harder it is to lose weight. You can eat right, exercise, and cut out sweets, but the scale doesn’t budge. Why? It has a lot to do with your hormones.

 

Hormones play an integral role in health and wellness. They promote growth within the body and influence metabolism, organ function, energy, and weight management. There are many factors that can interfere with hormone production, including aging. As people age, their body may not produce adequate levels of hormones. This creates havoc with your ability to maintain a healthy weight, slowing metabolism and energy levels. And hormone balance can begin to change as early as your 20s.

 

The good news is that you can rebalance your hormone levels with targeted therapies and can effectively manage hormone imbalance.

 

Growth hormone-releasing hormone is a hormone produced in an area of the brain called the hypothalamus. The main role of this hormone is to stimulate the pituitary gland to produce and release growth hormone. Growth hormone acts on virtually every tissue of the body. Growth hormone stimulates production of insulin-like growth factor from the liver and other organs, and this acts in the body to control metabolism and growth. In addition to its effect on growth hormone secretion, growth hormone-releasing hormone also affects sleep, food intake and memory.  

 

If your body produces too little growth hormone-releasing hormone, the production and release of growth hormone from the pituitary gland is impaired.  Adults with growth hormone deficiency may have a wide range of symptoms. The most important consequences of reduced growth hormone levels are changes in body structure (decreased muscle and bone mass and increased body fat), tiredness, being less lively and a poor health-related quality of life.  When these symptoms are severe, they can reduce people’s ability to function – both socially and professionally – and this can dramatically lower the quality of their lives. 

 

Other signs and symptoms include:

  • decrease in the amount of muscle bulk and strength
  • increase in the amount of fat in the body (especially around the waist)
  • abnormalities in the amount of ‘good’ and ‘bad’ cholesterol – this can lead to an increase in the risk of heart disease
  • abnormalities in the blood and in the circulation
  • osteoporosis
  • low energy levels and decreased stamina
  • impaired concentration and memory
  • sleep disturbances 

 

Sermorelin

Sermorelin is a bio-identical synthetic hormone peptide that may be used in conjunction with bio-identical hormone replacement therapy, various weight loss programs and erectile dysfunction treatment.  Sermorelin, a growth hormone-releasing hormone (GHRH), can enhance overall health and well-being by stimulating the production and release of hormones by the pituitary gland. This kick starts your metabolism so that your weight loss efforts are more effective!  It holds the potential to slow the effects of aging in humans by spurring growth of new tissue, muscles and synapses in the brain. It even has the potential to help patients think more clearly.  As you age, your body produces fewer hormones, a phenomenon that is considered one of the principal medical signs of aging. Sermorelin therapy encourages the body to naturally produce hormones. Sermorelin is different from many similar treatments, as it stimulates a natural process rather than requiring patients to directly add hormones to the system – this distinction makes our Sermorelin therapy much less likely to lead to complications.

 

While results may vary from patient to patient, studies have shown that Sermorelin anti-aging treatment can lead to a range of physical and mental benefits, such as:

  • Increased lean body mass
  • Fat reduction – improves the ability to burn fat
  • Improved energy
  • Increased vitality
  • Increased strength
  • Increased endurance
  • Accelerated wound healing – improved recovery and repair from injuries and inflammation
  • Better sleep quality
  • Improved bone density
  • Improved skin quality and higher collagen density
  • Regenerate nerve tissues
  • Strengthen the cardiovascular system
  • Strengthen the immune system
  • Improve cognition and memory
  • Increased sex drive

 

Patient Benefits Over Time

Benefits for patients on Sermorelin shown over the first eight weeks of protocol may include improvements in:

  • Week 1 Quality of sleep
  • Week 2 Recovery from workouts
  • Week 4 Mental clarity
  • Week 6 Skin elasticity
  • Week 8 Body composition

 

Tree of Life Medical is proud to announce Sermorelin for help with reduction of belly fat via lipolysis, boosting energy levels, increasing the skin’s elasticity, elevating endurance levels, promoting speed healing of wounds, ameliorating vision, and promoting deeper sleep. This formula can also strengthen libido in both men and women. Those who have experienced loss of libido are good candidates for therapy. In addition, people who are struggling to control their weight may find it easier to slim down with the help of this formulation.

 

An initial appointment will include a consultation to discuss your health history, your health goals, and review pertinent medical information. Blood tests may be required to determine levels of hormone imbalance and if Sermorelin is right for you.

MTHFR Mutations

April 17, 2018

What Is MTHFR?

MTHFR is a gene that provides the body with instructions for making a certain enzyme called methylenetetrahydrofolate reductase. There are two main MTHFR mutations: C677T and A1298C. Mutations can occur on different locations of these genes and be inherited from one or both parents. Having one mutated allele is associated with increased risk of certain health problems, but having two increases the risk much more. An MTHFR mutation can change the way a person metabolizes and converts important nutrients from their diets into active vitamins, minerals and proteins. In some cases, although not all, changes in how this enzyme works can affect cholesterol levels, brain function, digestion, endocrine functions and more.

 

MTHFR mutations affect people differently. It is believed that 30-50% of all people may carry a mutation in the MTHFR gene. Around 14-20% of that population have severe effects that impact overall health more drastically. People with this mutation tend to develop certain diseases, including ADHD, Alzheimer’s, atherosclerosis autoimmune disorders, autism, more often than those without the mutation. There is still a lot to learn about what this type of mutation means for people who carry it. To date, there have been dozens of different health conditions tied to MTHFR mutations, although just because someone inherits this mutation does not mean that person will wind up experiencing any problems.

 

Treating MTHFR Symptoms

 

Consume More Natural Folate, Vitamin B6 and Vitamin B12

People with MTHFR mutations have a harder time converting folic acid into its useable form and actually experience worsened symptoms from taking supplements containing folic acid. Look for the bioavailable form of folate in supplements (called L-methylfolate) and consume plenty of foods with folate. Some high-folate foods include:

  • Beans and lentils
  • Leafy green vegetables like raw spinach
  • Asparagus
  • Romaine
  • Broccoli
  • Avocado
  • Bright-colored fruits, such as oranges and mangoes

 

People with a MTHFR mutation are also more likely to be low in vitamins B6 and B12.  You can get these vitamins from supplements or food sources. To get more B vitamins, focus on eating quality protein foods, organ meats, nuts, beans, nutritional yeast and raw/fermented dairy products.

 

Treat Digestive Problems, Like Leaky Gut and IBS

Digestive complaints are common among people with MTHFR mutations. Many things affect digestive health, including nutrient intake, inflammation, allergies, neurotransmitter levels and hormone levels. For people who are already prone to nutrient deficiencies, leaky gut can make problems worse by interfering with normal absorption and raising inflammation.

 

To improve digestive/gut health, the following dietary changes can be beneficial:

  • Reduce intake of inflammatory foods, such as gluten, added sugar, preservatives, synthetic chemicals, processed meats, conventional dairy, refined vegetable oils, trans fats and processed/enriched grains (which often include synthetic folic acid).
  • Increase intake of probiotic foods, which supply ‘good bacteria’ that aids in digestion.
  • Consume gut-friendly foods, including bone broth, organic vegetables and fruit, flaxseeds and chia seeds, and fresh vegetable juices.
  • Consume health fats only, like coconut oil or milk, olive oil, grass-fed meat, wild-caught fish, nuts, seeds, and avocado.

 

Reduce Anxiety and Depression

MTHFR mutations are tied to higher incidences of mental disorders, including anxiety, depression, bipolar disorder, schizophrenia and chronic fatigue. High levels of stress can make MTHFR mutation symptoms even worse. Tips for dealing with these conditions include:

  • Supplement with omega-3 fatty acids: reduces inflammation and beneficial for cognitive health
  • Practice natural stress relievers: meditation, journaling, spending time outside, giving back or volunteering, praying, etc.
  • Regular exercise
  • Use soothing essential oils, including lavender, chamomile, geranium, clary sage and rose
  • Eliminate recreational drugs and reducing alcohol intake

 

Protect Heart Health

Studies show that homocysteine levels tend to rise with age, smoking and use of certain drugs – so the first step is to focus on taking care of yourself as you get older and limiting use of harmful substances. Other tips for keeping your heart healthy include:

  • Eating a healthy diet, especially one with plenty of high fiber foods
  • Getting regular exercise and keeping your weight in a healthy range
  • Managing stress to prevent worsened inflammation
  • Consider the following supplements, which can help improve blood flow, cholesterol and blood pressure: magnesium, omega-3s, CoQ10, caretenoids and other antioxidants, selenium, and vitamins C, D and E. 

Discuss Your Medications With Your Doctor

Some medications can deplete folate levels or interfere with methylation. The following medication classes might make symptoms worse:

  • Antibiotics
  • Birth control pills
  • Hormone replacement therapy drugs
  • Anticonvulsants (like phenytoin and carbamazepine)
  • Antacids
  • NSAIDs
  • Antidepressants
  • Chemotherapy treatments
  • Cholesterol-lowering drugs

Boost Detoxification

Because reduced methylation contributes to poor elimination of heavy metals and toxins, take extra steps to help flush waste and accumulated chemicals from your body. Tips for improving your ability to detox include:

  • Consume fresh vegetable juices to increase antioxidant intake
  • Takie activated charcoal
  • Drink plenty of water and avoiding alcohol or tobacco
  • Dry brushing
  • Take detox baths
  • Exercise regularly
  • Use of saunas
  • Occasionally fast in a healthy way or use natural enemas
  • Only use natural beauty and household products that are free from chemicals

Get Enough Quality Sleep

Sleep disturbances are common among people with anxiety, hormonal disorders, autoimmune disorders, chronic pain and fatigue. Make it a priority to get 7-9 hours of sleep every night, sticking to a regular schedule as much as possible. To help you get better sleep, try natural sleep aids like:

  • Create a relaxing bedtime routine
  • Use essential oils
  • Stay off of electronic devices
  • Read something soothing
  • Cool your bedroom a bit

 

MTHFR Mutation Symptoms and Signs

Evidence exists that the following health problems are tied to one of two primary forms of genetic MTHFR mutation:

  • ADHD
  • Autism and other childhood learning developmental problems
  • Down syndrome
  • Depression and anxiety
  • Spina bifida
  • Schizophrenia
  • Bipolar disorder
  • Autoimmune disorders and thyroid disorders
  • Addictions (alcohol and drug dependence for example)
  • Chronic pain disorders
  • Migraines
  • Heart problems, including low HDL “good” cholesterol levels and high homocysteine levels
  • Hormonal problems and fertility problems, including miscarriages and PCOS
  • Pulmonary embolisms
  • Fibromyalgia
  • Diabetes
  • Chronic Fatigue Syndrome
  • Parkinson’s disease, other tremor disorders and Alzheimer’s Disease
  • Stroke
  • Digestive problems, including irritable bowel syndrome
  • Problems during pregnancy, including pre-eclampsia and postpartum depression. The severity and type of symptoms depends on the variant of the mutation, along with much how the ability to carry out methylation and make MTHFR enzymes is impacted. 

Causes and Risk Factors of MTHFR Mutation

The main reason that MTHFR mutations cause health problems is due to disruptions in the normal process of methylation. Under normal circumstances, MTHFR:

  • Facilitates methylation, which is a metabolic process that switches genes on and off and repairs DNA. Methylation also affects nutrient conversions through enzyme interactions.
  • Forms proteins by converting amino acids.
  • Converts the amino acid homocysteine into methionine. This helps keep cholesterol levels balanced and is important for cardiovascular health. Elevated homocysteine levels put someone at a greater risk for heart attacks, strokes and other problems.
  • Carries out chemical reactions that help the body process folate (also called vitamin B9). This is done by converting one form of the methylenetetrahydrofolate molecule into another active form called 5-methyltetrahydrofolate. Folate/vitamin B9 is required for numerous critical bodily functions, so the inability for the body to make and use enough can affect everything from cognitive health to digestion.
  • Methylation is also tied to detoxification because it helps eliminate heavy metals and toxins through the GI tract.
  • Methylation also helps with the production of neurotransmitters and hormones. Deficiencies in these neurotransmitters can affects things like mood, motivation, sleep, sex drive, appetite and digestive functions. Abnormal levels of neurotransmitters are tied to ADHD, depression, anxiety, IBS and insomnia.
  • In order for methylation to take place, the body requires an amino acid called SAMe. SAMe helps regulate more than 200 different enzyme interactions, and without it methylation stops.

 

Whether you carry the MTHFR C677T or MTHFR A1298C mutation determines if you’re more likely to suffer from certain diseases than others.

  • MTHFR C677T mutations are tied to cardiovascular problems, elevated homocysteine, stroke, migraines, miscarriages and neural tube defects. Some studies suggest that people with two C677T gene mutations have about a 16 percent higher chance of developing coronary heart disease compared to people without these mutations.
  • MTHFR A1298C are tied to higher levels of fibromyalgia, IBS, fatigue, chronic pain, schizophrenia and mood-related problems. This is especially true if you’ve inherited the mutation from both parents or have both forms of MTHFR mutations.

 

Testing and Diagnosing MTHFR Mutations

Many people have no idea that they carry an MTHFR mutation gene that contributes to their symptoms. If you suspect you might be affected by an MTHFR mutation, consider having a genetic test performed. Other tests that can help confirm a mutation include heavy metal tests, urine tests, homocysteine level tests, folic acid tests, leaky gut testing and hormone level testing.

 

Because it is a problem related to an inherited gene, there is no way to ‘cure’ an MTHFR mutation — however lifestyle changes and natural treatments can help manage symptoms.

Polycystic Ovarian Syndrome

March 30, 2018

Polycystic ovarian syndrome (PCOS) is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make egg that are released each month. With PCOS, eggs may not develop or may not be released during ovulation. Five to ten percent of reproductive aged women have PCOS.  Most often, women find out they have PCOS in their 20’s and 30’s when they have problems getting pregnant – but PCOS can happen at any age after puberty.  Women of all races and ethnicities are at risk for PCOS.  Your risk for PCOS may be higher if you are obese or if you have a mother, sister, or aunt with PCOS.

Conditions Associated With PCOS

  • Diabetes. More than half of women with PCOS will have diabetes or pre-diabetes  before age 40.
  • High blood pressure. Women with PCOS are at greater risk of having high blood pressure compared to women without PCOS. High blood pressure is a leading cause of heart disease and stroke.
  • Unhealthy cholesterol. Women with PCOS often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. High cholesterol raises your risk for heart disease and stroke.
  • Sleep apnea – momentary and repeated interuptions in breathing that disrupt sleep. Many women with PCOS are overweight or obese, which can cause sleep apnea. Sleep apnea raises your risk for heart disease and diabetes.
  • Depression and anxiety. Depression and anxiety are common among women with PCOS.
  • Endometrial cancer. Problems with ovulation, obesity, insulin resistance, and diabetes (all common in women with PCOS) increase the risk of developing cancer of the endometrium (lining of the uterus).

Symptoms of PCOS?

PCOS has many signs and symptoms, some of which may not seem to be related:

  • Menstrual irregularities:
    • No menstrual periods—called amenorrhea
    • Frequently missed periods—called oligomenorrhea
    • Heavy periods
    • Bleeding but no ovulation—called anovulatory periods
  • Infertility
  • Pelvic pain
  • Excess hair growth on the face, chest, stomach, or thighs—called hirsutism
  • Severe, late-onset, or persistent acne that does not respond well to usual treatments
  • Obesity, weight gain, or trouble losing weight, especially around the waist
  • Oily skin
  • Patches of thickened, dark, velvety skin—a condition called acanthosis nigricans

Because many women don’t consider problems such as oily skin, extra hair growth, or acne to be symptoms of a serious health condition, they may not mention these things to their doctor. As a result, many women aren’t diagnosed with PCOS until they have trouble getting pregnant or if they have abnormal periods or missed periods.

Although PCOS is a leading cause of infertility, many women with PCOS can and do get pregnant. Pregnant women who have PCOS, however, are at higher risk for certain problems, such as miscarriage.

Causes of PCOS?

The exact cause of PCOS is unknown. Most experts think that several factors, including genetics, play a role:

  • High levels of androgens. Androgens are sometimes called ‘male hormones’, although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than normal. Estrogens are also called ‘female hormones’. Higher than normal androgen levels in women can prevent the ovaries from releasing eggs (ovulation) and can cause extra hair growth and acne, two signs of PCOS.
  • High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight or obese, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.

Polycystic ovarian syndrome (PCOS) is the leading cause of infertility in reproductive age women. Lack of ovulation is generally assumed to be the cause after other anatomic, hormonal, and male factor causes are ruled out.

Diagnosing PCOS

Because there is currently no universal definition of PCOS, different expert groups use different criteria to diagnose the condition. All the groups look for the following three features:

  1. Menstrual irregularities, such as light periods or skipped periods, that result from long-term absence of ovulation (the process that releases a mature egg from the ovary).
  2. High levels of androgens that do not result from other causes or conditions, or signs of high androgens, such as excess body or facial hair.
  3. Multiple cysts of a specific size on one or both of the ovaries as detected by ultrasound.

Having one or more of these features could lead to a diagnosis of PCOS. If your medical history suggests that you might have PCOS, we will rule out other conditions that may cause similar symptoms.

Some of these conditions include:
  • Excess hormone production by the adrenal glands, called adrenal hyperplasia
  • Problems with the function of the thyroid gland
  • Excess production of the hormone prolactin by the pituitary gland, called hyperprolactinemia

After ruling out other conditions and before making a diagnosis of PCOS, we will also:

  • Take a full personal and family history because PCOS tends to run in families.
  • Conduct a complete physical exam. We will look for extra hair growth, acne, and other signs of high levels of the hormone androgen. We will take your blood pressure, measure your waist, and calculate your body mass index, a measure of your body fat based on your height and weight.
  • Take blood samples. Blood tests will include levels of androgens, cholesterol, and sugar in your blood.
  • Do a pelvic exam or ultrasound to check your ovaries.

Treatment For PCOS

  • Losing weight. Changing your lifestyle like having fewer sugary drinks and hog-calorie desserts to help control your weight, exercising each day and avoiding smoking.  These healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10% loss in body weight (for example, a 150-pound woman losing 15 pounds) can help make your menstrual cycle more regular and improve your chances of getting pregnant.  Consider counseling with a registered dietitian to help you choose healthy foods and lose weight if you are overweight or obese.
  • Removing unwanted facial/body hair. You can try facial hair removal creams, laser hair removal, waxing, or electrolysis to remove excess hair. You can find hair removal creams and products at drugstores. Procedures like laser hair removal or electrolysis must be done by a doctor and may not be covered by health insurance.
  • Slowing hair growth. A prescription skin treatment (eflornithine HCl cream) can help slow down the growth rate of new hair in unwanted places.
  • Medications.  Medicines that contain estrogen and progesterone such as birth control pills, a vaginal ring, or a skin patch; medicines to help your body use insulin better, such as Metformin (for pre-diabetes or diabetes); and/or acne medicine.

Coping With PCOS

Seeing a doctor who knows about PCOS is the first step. Choose a doctor who specializes in hormone problems or a doctor who specializes in women’s health. Remember that the sooner you get help for your PCOS, the sooner you could lower your risk for related health problems such as diabetes. Your doctor can help you find ways to feel better about your appearance. For example, you can ask your doctor about the best way to remove unwanted facial hair. If you feel worried or depressed, ask your parents or your doctor where to go for counseling. You can also go to a support group to talk with others who have PCOS.

Food Intolerance & Food Sensitivity Testing

February 28, 2018

The terms ‘food intolerance’ and ‘food allergy’ are often confused – although the two are completely different.

 

A true food allergy is rare: only about 2% of adults are affected by a food allergy.  With a food allergy the body’s immune system mistakes a food for a ‘foreign invader’ which results in a rapid allergic reaction often within minutes (and generally within a maximum of two hours).

 

Food intolerances are much more common than food allergies. Researchers estimate that at least 60% of the U.S. population suffers from unsuspected food reactions that can cause or complicate health problems. When foods and drinks are digested the proteins within them are broken down into smaller fragments for easy absorption.  Sometimes the body reacts to the fragments by attacking them using antibodies called immunoglobulins. The symptoms can greatly impact a person’s quality of life, but symptoms are not life threatening.  Symptoms of food intolerance can take up to 72 hours to appear after eating the trigger food.  On average people who suffer from food intolerances usually have between 4 and 8 trigger foods. Many people suffer for years, having formed a coping mechanism to deal with the symptoms but being unable to enjoy a normal work and home life.  Many people don’t realize that there are easy steps to take that could resolve their condition. Studies show that those who eliminate trigger foods based on food-specific immunoglobulin tests have: reductions in weight, body mass index, waist and hip circumference and improvements in all indicators of quality of life that were measured. The quality of life indicators included physical and emotional wellbeing, mental health, social life, pain levels and vitality.

 

Food Intolerance verses Food Allergy

 

Food Intolerance Food Allergy
Reactions up to 72 hours after eating Immediate reactions (2 hours or less)
Multiple foods can be involved Rarely more than 1-2 foods
Any organ system can be affected Primary skin, airways and digestive system
Very common Trace amounts of foods can cause reactions
Difficult to self-diagnose Caused by raised IgE antibody
Symptoms can clear after avoidance (3-6 months) Lifelong

 

Symptoms of food intolerance:

 

  • Abdominal Cramps/Pain
  • Muscle and Joint Aches
  • Acne
  • Bloating
  • Constipation and/or diarrhea
  • Fatigue
  • Dizziness
  • Eczema/Rashes
  • Itching
  • Fluid Retention
  • Headaches
  • Hyperactivity
  • Migraine
  • Nausea
  • Rhinitis/Sinusitis
  • Anxiety/Tension
  • Weight loss/Weight Gain
  • Wheezing

 

In considering food sensitivities, the role of ‘leaky gut’ must be discussed. Leaky gut, or ‘intestinal permeability’, is a condition in which the lining of the small intestine becomes damaged, causing undigested food particles, toxic waste products and bacteria to ‘leak’ through the intestines and flood the bloodstream. The foreign substances entering the bloodstream cause inflammation throughout the body, stirring up trouble everywhere. A vicious cycle of worsening inflammation and worsening leaky gut occurs, which leads to a variety of health issues. This cycle of inflammation triggers an antibody immune response and a whole cascade of inflammatory signals travel to anywhere and everywhere in the body.

 

Inflammation and leaky gut are tied to a variety of conditions, from autoimmunity – like Hashimoto’s, lupus, rheumatoid arthritis, and psoriasis – to depression, anxiety, migraines, irritable bowel, eczema, chronic fatigue, fibromyalgia, PMS, PCOS, infertility, cervical dysplasia and more.  In many cases, leaky gut is caused by your diet. Leaky gut can also be caused by medications including antibiotics, steroids or over-the-counter pain relievers like aspirin and acetaminophen, which can irritate the intestinal lining and damage protective mucus layers.

 

The best way to resolve health issues is to heal leaky gut – the best way to heal leaky gut is to avoid foods that cause it.
To do that, we need to start by doing a food sensitivity panel, so we can determine where we are starting and which foods to avoid.

Transgender Health Issues

February 11, 2018

“Transgender” is an umbrella term used to capture the spectrum of gender identity and gender-expression diversity. Gender identity is the internal sense of being male, female, neither or both. Gender expression — often an extension of gender identity — involves the expression of a person’s gender identity through social roles, appearance and behaviors.

 

Transgender persons are at increased risk for certain types of chronic diseases, cancers, and mental health problems.

If you’re a transgender person, don’t avoid seeing a doctor out of fear of a negative encounter. Instead, look for a doctor who is empathetic and respectful of your specific needs. By doing so, your doctor can help identify ways to reduce your risk of health concerns, as well as identify medical conditions and refer you to specialists when necessary.

 

Health Issues to Consider:

#1: Access to Health Care

Transgender persons may avoid medical care for fear of being rejected. Many have been turned away by healthcare providers or had other negative experiences. Not all providers know how to deal with specialized transgender issues. Often, transgender health services are not covered by insurance. For these reasons, transgender persons may not be able to access the care they need.

Transgender persons should find a personal doctor who understands transgender health issues.

#2: Hormones

Hormone therapy is often used to make a transgender person more masculine or feminine. But the use of hormones has risks. Testosterone can damage the liver, especially if taken in high doses or by mouth. Estrogen can increase blood pressure, blood glucose (sugar), and blood clotting. Anti-androgens, such as spironolactone, can lower blood pressure, disturb electrolytes, and dehydrate the body. Hormone use should always be supervised by a doctor.

Transgender persons wishing to use hormones should only do so under the supervision of a doctor who can prescribe an appropriate dose and monitor its effects.

#3: Cancer

Trans men who still have a uterus, ovaries, or breasts are at risk for cancer in these organs. Trans women are at risk for prostate cancer, though this risk is low. Cancers related to use of hormones are rare, but counseling is still needed.

Transgender persons should be screened for cancers of the reproductive organs.

#4: Injectable Silicone

Many transgender persons use silicone injections to enhance their appearance. The injection of silicon by non-medical persons is a dangerous practice that can lead to serious health problems. Silicone, when administered by someone who is not a doctor, can move through the body and disfigure it. Also, silicone injected outside of a healthcare setting is typically not medical grade, may be contaminated, and is often injected using shared needles, which can transmit hepatitis.

Transgender persons need to be counseled about the risks of injecting silicone.

#5: Substance Use

Transgender persons use substances at higher rates compared to others. Substances used include amphetamines including crystal meth, marijuana, ecstasy, and cocaine. Use of these drugs has been linked to higher rates of HIV transmission through impaired decision making during sex. Although the long-term effects of these substances are unknown, evidence suggests that their prolonged use is likely to have serious negative health consequences.

Transgender persons should be screened for substance use and get appropriate education and risk-based counseling.

#6: Depression and Anxiety

Transgender persons have higher rates of depression and anxiety compared to others. These problems are often worse for those who do not have adequate social support or who are unable to express their gender identity. As a result, teenagers and young adults have an increased risk of suicide. However, culturally sensitive mental health services can help prevent and treat these problems.

Transgender persons should be screened for signs and symptoms of depression and anxiety and should seek appropriate mental health services provided as needed.

#7: Sexually Transmitted Diseases (STDs)

Transgender persons are at risk for sexually transmitted diseases. These include infections for which there are effective cures (gonorrhea, chlamydia, syphilis, pubic lice or crabs), as well as those for which treatments are more limited (HIV, hepatitis A, B, or C, human papilloma virus). Safe sex, including the use of barriers, is key to preventing STDs.

Transgender persons who are sexually active should be routinely screened for sexually transmitted diseases.

#8: Alcohol

Studies have shown that transgender persons have higher rates of alcohol abuse and dependence. Although limited alcohol use, such as one drink a day, may not be unhealthy, any use can be a problem for a transgender person with an alcohol related disorder. Alcohol abuse is a common problem among transgender persons and can increase the risk for being injured or becoming the victim of a crime.

All transgender persons should be screened for alcohol dependence and abuse, and alcohol use should be limited.

#9: Tobacco

Transgender persons smoke and use tobacco products at much higher rates than others. This can lead to a number of serious health problems, including heart disease, high blood pressure, lung disease, and lung cancer.

Transgender persons should be screened for tobacco use and offered tobacco cessation programs.

#10: Heart Disease

Transgender persons are often at higher risk for heart disease because of hormone use, smoking, and obesity. All transgender persons should have their blood pressure and cholesterol checked as generally recommended. Also, transgender persons should learn about the signs and symptoms of heart disease and stroke.

Transgender persons should have their blood pressure checked at least once a year and their cholesterol screened at least every five years.

 

Experts recommend that you take steps to protect your health based on your anatomy, regardless of your gender identity or expression. This might include:

 

  • Age-appropriate screening for cervical and breast cancers
  • Age-appropriate screening for prostate cancer
  • Age-appropriate screening for colon cancer
  • Age-appropriate vaccinations
  • Screening for mental health conditions
  • Screening for substance abuse
  • Screening for HIV
  • Screening for hepatitis

 

Additional issues might need to be considered if you have had feminizing or masculinizing hormone therapy or surgery.

Your health is important — regardless of your gender identity or gender expression. If you’re due for a screening or you have health concerns, don’t put off seeing a doctor. Early diagnosis and treatment help promote long-term health.

 

More About Transgender Hormone Health:

Hormone replacement is also often part of the transition process . Many transgender persons experience dysphoria, or psychological distress experienced in relation to the discrepancy between the sex they were assigned at birth and their gender identity. There is a high prevalence of depression, anxiety and suicidal thoughts.

Hormones help align physical characteristics with gender identity. Many individuals find hormone therapy extremely beneficial because it enables them to maintain a physical appearance that more closely matches their gender identity, thus increasing their comfort with their physical appearance and decreasing dysphoria and distress. Research shows that hormone therapy significantly reduces depression, anxiety, and sensitivity, along with feelings of hostility. Additionally, hormone therapy often has the effect of increasing self-esteem and feelings of attractiveness. During gender transition, people who receive hormones typically experience a second puberty, during which secondary sex characteristics change to align with gender identity.  These hormones help to produce characteristics that align with their identity or eliminate characteristics causing distress/dysphoria.

It is essential to remember that it is not possible to choose which characteristics result from hormone therapy, and hormone therapy will affect people in different ways. Because of this, the initiation of hormone therapy can also increase feelings of dysphoria and distress.  Many transgender patients don’t quite know what to expect.  Often the changes experienced as a result of hormones therapy are not the results that patients anticipated or have side effects that were not considered.  For the reason, it is essential to counsel these patients thoroughly before initiating a regimen.

What You Need To Know About Thyroid Disease

January 10, 2018

The thyroid gland is a small, gland located in the base of the neck. It plays a huge role in our body, influencing the function of many of the body’s most important organs, including the heart, brain, liver, kidneys and skin.

I use this example with my patients to explain the role of the thyroid gland:

Think of your thyroid as a car engine that controls how your body functions. An engine produces the necessary energy for a car to operate in a certain manner. In the same way, the thyroid gland produces enough thyroid hormone to prompt your body to perform functions in a certain manner. Just as a car cannot produce energy without gas, your thyroid needs fuel to produce thyroid hormone. Your thyroid’s fuel is iodine. The thyroid extracts iodine from the bloodstream and uses it to make two thyroid hormones: T4 (contains four iodine atoms) and T3 (contains three iodine atoms). T3 is made from T4 when one iodine is removed, a conversion that occurs mostly outside the thyroid in organs and tissues where T3 is the primary thyroid hormone that is used. When T4 is produced, it is stored within the thyroid as a reserve for later use. A small amount of T3 is also produced and stored in the thyroid. When your body needs thyroid hormone, it is secreted into your bloodstream in quantities set to meet the needs of your cells. Your car engine produces energy, but you tell it how fast to go by stepping on the accelerator. The thyroid gets its instruction from the pituitary gland, which is located in your brain. These instructions come in the form of thyroid-stimulating hormone (TSH). TSH levels rise or fall depending on whether enough thyroid hormone is produced to meet your body’s needs. Higher levels of TSH prompt the thyroid to produce more thyroid hormone. Conversely, low TSH levels signal the thyroid to slow down production.

When Things Go Wrong

Normally, the thyroid produces just the right amount of hormone to keep your body running smoothly. TSH levels remain fairly constant. But even the best systems are subject to interference. When outside influences such as disease, damage to the thyroid or certain medicines inhibit proper communication, your thyroid might not produce enough hormone. This slows down all of your body’s functions – known as hypothyroidism or underactive thyroid. I like to use the term ‘suboptimal’ thyroid function.  Your thyroid could also produce too much hormone which would send your systems into overdrive, a condition called hyperthyroidism or overactive thyroid.  I like to use the term overactive thyroid.  When considering thyroid disease, doctors ask two main questions: First, is the thyroid gland inappropriately producing an abnormal amount of thyroid hormone? And second, is there a structural change in the thyroid, such as a lump (a nodule) or an enlargement (a goiter)? Though one of these characteristics does not necessarily imply that the other is present nor do they diagnose hypo- or hyperthyroidism.

 

Out of Gas

Sometimes the thyroid can’t meet your body’s demands for thyroid hormone, even though TSH levels increase. As your body slows down, you may feel cold, tired and even depressed. You may gain weight, even though you’re eating less and exercising. There could be a number of reasons why your thyroid is not performing well. For example, if your body isn’t getting enough iodine, your thyroid can’t make enough thyroid hormone, but it will try to respond to rising TSH levels by working harder and harder anyway.

Causes of Hypothyroidism
  • Autoimmune thyroiditis:  When your thyroid comes under attack by your body’s immune system. Normally, antibodies protect you from infection or inflammation. But in this condition, called Hashimoto’s thyroiditis, your antibodies mistake your thyroid for a foreign invader. Hashimoto’s generally involves the presence of two types of antibodies called antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG) antibodies. These antibodies lead to destruction of the thyroid by the immune system. Hashimoto’s thyroiditis results from an abnormal immune response are called autoimmune diseases. Hashimoto’s thyroiditis is only one form of thyroiditis —an inflammation of the thyroid—that causes hypothyroidism.  Other autoimmune diseases may be associated with this disorder, and additional family members may also be affected.
  • Central or pituitary hypothyroidism:  Any destructive disease of the pituitary gland or hypothalamus, which sits just above the pituitary gland, may cause damage to the cells that secrete TSH, which stimulates the thyroid to produce normal amounts of thyroid hormone. This is a rare cause of hypothyroidism.
  • Congenital hypothyroidism: An infant may be born with an inadequate amount of thyroid tissue or an enzyme defect that does not allow normal thyroid hormone production. If this condition is not treated promptly, physical stunting and/or mental damage may develop.
  • Medications: Lithium, high doses of iodine and Amiodarone, for example.
  • Postpartum thyroiditis: 5-10% of women develop mild to moderate hyperthyroidism within months of giving birth. Hyperthyroidism in this condition usually lasts for approximately 1-2 months. It is often followed by several months of hypothyroidism.  Most women will eventually recover normal thyroid function. In some cases, however, the thyroid gland does not heal, so the hypothyroidism becomes permanent and requires lifelong thyroid hormone replacement. This condition may recur in subsequent pregnancies.
  • Radioactive iodine treatment: Hypothyroidism frequently develops as a desired therapeutic goal after the use of radioactive iodine treatment for hyperthyroidism.
  • Silent Thyroiditis: This condition appears to be the same as postpartum thyroiditis but not related to pregnancy.
  • Subacute thyroiditis: This condition may follow a viral infection and is characterized by painful thyroid gland enlargement and inflammation, which results in the release of large amounts of thyroid hormone into the blood. This condition usually resolves spontaneously. The thyroid usually heals itself over several months.
  • Thyroid surgery: Hypothyroidism may be related to surgery on the thyroid gland, especially if most of the thyroid has been removed.
Signs & Symptoms of Hypothyroidism

In its earliest stage, hypothyroidism may cause few symptoms, since the body has the ability to partially compensate for a failing thyroid gland by increasing the stimulation to it, much like pressing down on the accelerator when climbing a hill to keep the car going the same speed. As thyroid hormone production decreases and the body’s metabolism slows, a variety of features may result.

  • Pervasive fatigue
  • Drowsiness
  • Forgetfulness
  • Difficulty with learning
  • Dry, brittle hair and nails
  • Dry, itchy skin
  • Puffy face
  • Constipation
  • Sore muscles
  • Weight gain and fluid retention
  • Heavy and/or irregular menstrual flow
  • Increased frequency of miscarriages
  • Increased sensitivity to many medications
Diagnosing Hypothyroidism

Characteristic symptoms and physical signs  can signal hypothyroidism. However, the condition may develop so slowly that many patients do not realize that their body has changed, so it is critically important to perform diagnostic laboratory tests to confirm the diagnosis and to determine the cause of hypothyroidism.

Treating Hypothyroidism

Hypothyroidism is generally treated with a daily medication. There are multiple types of thyroid medication.  Not everyone respond the same to each medication, and not every medication is appropriate for a particular type of thyroid disease  An experienced physician can prescribe the correct form and dosage to return the thyroid balance to normal. Thyroid hormone acts very slowly in some parts of the body, so it may take several months after treatment for some features to improve.

It is extremely important that women planning to become pregnant are kept well adjusted, since hypothyroidism can affect the development of the baby. During pregnancy, thyroid hormone replacement requirements often change, so more frequent monitoring is necessary. Various medications and supplements (particularly iron) may affect the absorption of thyroid hormone; therefore, the levels may need more frequent monitoring during illness or change in medication and supplements. Thyroid hormone is critical for normal brain development in babies.

Since most cases of hypothyroidism are permanent and often progressive, it is usually necessary to treat this condition throughout one’s lifetime. Periodic monitoring of laboratory levels and clinical status are necessary to ensure that the proper dose is being given, since medication doses may have to be adjusted from time to time. Optimal adjustment of thyroid hormone dosage is critical, since the body is very sensitive to even small changes in thyroid hormone levels.

 

Revved Up – Hyperthyroidism

Hyperthyroidism develops when the body is exposed to excessive amounts of thyroid hormone. This disorder occurs in almost one percent of all Americans and affects women five to 10 times more often than men. In its mildest form, hyperthyroidism may not cause recognizable symptoms. More often, however, the symptoms are discomforting, disabling or even life-threatening.

Causes of Hyperthyroidism
  • Graves’ Disease: Graves’ disease is an autoimmune disorder that frequently results in thyroid enlargement and hyperthyroidism. In some patients, swelling of the muscles and other tissues around the eyes may develop. This is characterized by swollen, bulging, red eyes; widely open eyelids; and double vision. In its most severe form, diminished visual acuity may be present. As with Hashimoto’s thyroiditis, antibodies attack the thyroid, but in this case they stimulate the thyroid to overproduce thyroid hormone. The antibodies present in Graves’ disease are generally thyrotropin receptor antibodies (TRAb), including one kind known as thyroid-stimulating immunoglobulins (TSIs). They work by mimicking TSH, attaching to the TSH receptor on the thyroid gland and confusing the thyroid into producing too much hormone. Like other autoimmune diseases, this condition tends to affect multiple family members. It is much more common in women than in men and tends to occur in younger patients.
  • Postpartum Thyroiditis: 5-10% of women develop mild to moderate hyperthyroidism within months of giving birth. Hyperthyroidism in this condition usually lasts for 1-2 months. It is often followed by several months of hypothyroidism, but most women will eventually recover normal thyroid function. In some cases, however, the thyroid gland does not heal, so the hypothyroidism becomes permanent and requires lifelong thyroid hormone replacement. This condition may occur again with subsequent pregnancies.
  • Silent Thyroiditis: Transient (temporary) hyperthyroidism can be caused by silent thyroiditis, a condition similar to postpartum thyroiditis, but is not related to pregnancy. It is not accompanied by a painful thyroid gland.
  • Subacute Thyroiditis: This condition may follow a viral infection and is characterized by painful thyroid gland enlargement and inflammation, which results in the release of large amounts of thyroid hormones into the blood. This condition usually resolves spontaneously over several months, but often not before a temporary period of low thyroid hormone production occurs.
  • Toxic Multinodular Goiter: Multiple nodules in the thyroid can produce excess thyroid hormone, causing hyperthyroidism. Typically diagnosed in patients over the age of 50, this disorder is more likely to affect heart rhythm. In many cases, the person has had the goiter for many years before it becomes overactive.
  • Toxic Nodule: A single nodule or lump in the thyroid can produce more thyroid hormone than the body requires and lead to hyperthyroidism.
  • Excessive Iodine Ingestion: Various sources of high iodine concentrations, such as kelp tablets, some expectorants, amiodarone and x-ray dyes may occasionally cause hyperthyroidism in patients who are prone to it.
  • Overmedication with thyroid hormone: Patients who receive excessive thyroxine replacement treatment can develop hyperthyroidism. They should have their thyroid hormone dosage evaluated routinely and should NEVER give themselves “extra” doses.

 

Signs & Symptoms of Hyperthyroidism

When hyperthyroidism develops, a goiter (enlargement of the thyroid) is usually (but not always) present and may be associated with some or many of the following features:

  • Fast heart rate, often more than 100 beats per minute
  • Becoming anxious, irritable, argumentative
  • Trembling hand
  •  Weight loss, despite eating the same amount or even more than usua
  •  Intolerance of warm temperatures and increased likelihood to perspire
  • Loss of scalp hair
  • Tendency of fingernails to separate from the nail bed
  • Muscle weakness, especially of the upper arms and thighs
  • Loose and frequent bowel movements
  • Smooth skin
  • Change in menstrual pattern
  • Increased likelihood for miscarriage
  • Prominent “stare” of the eyes
  • Protrusion of the eyes, with or without double vision (in patients with Graves’ disease)
  •  Irregular heart rhythm, especially in patients older than 60 years of age
  • Accelerated loss of calcium from bones, which increases the risk of osteoporosis and fractures

 

Diagnosing Hyperthyroidism

Characteristic symptoms and physical signs of the disease can be detected by a trained physician. In addition, tests can be used to confirm the diagnosis and to determine the cause.

 

Treating Hyperthyroidism

Antithyroid Drugs

Two drugs are available for treating hyperthyroidism: propylthiouracil (PTU) and methimazole. Except for early pregnancy, methimazole is preferred. These medications control hyperthyroidism by slowing thyroid hormone production. They may take several months to normalize thyroid hormone levels.

 

Radioactive Iodine Treatment

Iodine is an essential in the production of thyroid hormone. Each molecule of thyroid hormone contains either four (T4) or three (T3) molecules of iodine. Since most overactive thyroid glands are hungry for iodine, it was discovered that the thyroid could be “tricked” into destroying itself by feeding it radioactive iodine. The radioactive iodine is given by mouth, usually in capsule form. Maximal benefit is usually noted within 3-6 months.  Most physicians strive to completely destroy the thyroid gland with a single dose of radioiodine. This results in the intentional development of an underactive thyroid state (hypothyroidism), which is easily, predictably and inexpensively corrected by lifelong daily use of oral thyroid hormone replacement therapy.
Thousands of patients have received radioiodine treatment. The treatment is a very safe, simple and reliably effective. Because of this, it is considered by most thyroid specialists to be the treatment of choice for hyperthyroidism cases caused by overproduction of thyroid hormone.

 

Surgical Removal of the Thyroid

Although seldom used now as the preferred treatment for hyperthyroidism, surgically removing most(or all) of the thyroid gland may be recommended in certain situations. Surgery usually leads to permanent hypothyroidism and lifelong thyroid hormone replacement therapy.

 

Other Treatments

A drug from the class of beta-adrenergic blocking agents (which decrease the effects of excess thyroid hormone) can temporarily control hyperthyroid symptoms until other therapies take effect. In cases where hyperthyroidism is caused by thyroiditis or excessive ingestion of either iodine or thyroid hormone, this may be the only type of treatment required. Also,  iodine drops are prescribed when hyperthyroidism is severe or prior to undergoing surgery for Graves’ disease.

 

How common is thyroid disease?

Thyroid disease is more common than diabetes or heart disease. As many as 30 million Americans are affected by thyroid disease – and more than half of those people remain undiagnosed. Women are five times more likely than men to suffer from hypothyroidism.

 

How important is my thyroid in my overall well-being?

The thyroid gland produces thyroid hormone, which controls virtually every cell, tissue and organ in the body. Untreated thyroid disease may lead to elevated cholesterol levels and subsequent heart disease, as well as infertility and osteoporosis. Research also shows that there is a strong genetic link between thyroid disease and other autoimmune diseases, including types of diabetes, arthritis and anemia. Simply put, if your thyroid gland isn’t working properly, neither are you.

 

How do you know if you have a thyroid problem?

First, you must recognize the symptoms and risk factors of thyroid disease. Since many symptoms may be hidden or mimic other diseases and conditions, the best way to know for sure is to ask your doctor.

 

What are some of the reasons to consider a thyroid evaluation?

  • Family history:  If you have a first-degree relative (a parent, sibling or child) with thyroid disease, you would benefit from thyroid evaluation. Women are much more likely to be thyroid patients than men; however, the gene pool runs through both.
  • Prescription medications: If you are taking Lithium or Amiodarone, you should consider a thyroid evaluation.
  • Radiation therapy to the head or neck: If you have had any of the following radiation therapies, you should consider a thyroid evaluation: radiation therapy for tonsils, radiation therapy for an enlarged thymus, or radiation therapy for acne.
  • Chernobyl: If you lived near Chernobyl at the time of the 1986 nuclear accident, you should consider a thyroid evaluation.

 

Thyroid Nodules

A thyroid nodule is a lump in or on the thyroid gland. Thyroid nodules are common, but are usually not diagnosed. They are detected in about 6% percent of women and 1-2% of men. They are 10 times as common in older people. Sometimes several nodules will develop in the same person. Any time a lump is discovered in thyroid tissue, the possibility of malignancy (cancer) must be considered. Fortunately, the vast majority of thyroid nodules are benign (not cancerous).

 

Causes

Nodules can be caused by a simple overgrowth of “normal” thyroid tissue, fluid-filled cysts, inflammation (thyroiditis), or a tumor (either benign or cancerous).

 

Signs & Symptoms

Most patients with thyroid nodules have no symptoms. Many are found by chance on a routine physical exam or an imaging study of the neck done for unrelated reasons. A substantial number of nodules are first noticed by patients or those they know who see a lump in the front portion of the neck, which may or may not cause symptoms, such as a vague pressure sensation or discomfort when swallowing. Finding a lump in the neck should be brought to the attention of your physician, even in the absence of symptoms.

 

Diagnosis
  • Thyroid Scan: A  picture of the thyroid gland taken after a small dose of a radioactive isotope has been injected or swallowed. The scan tells whether the nodule is hyperfunctioning (a “hot” nodule), or taking up more radioactivity than normal thyroid tissue does; taking up the same amount as normal tissue (a “warm” nodule); or taking up less (a “cold” nodule). Because cancer is rarely found in hot nodules, a scan showing a hot nodule eliminates the need for fine needle biopsy. If a hot nodule causes hyperthyroidism, it can be treated with radioiodine or surgery.
  • Thyroid needle biopsy: A very thin needle takes a small sample of tissue from the nodule.  This is a simple procedure performed in the physician’s office and patients can usually return to work or home afterward. A thyroid needle biopsy will provide sufficient information on which to base a treatment decision more than 75% of the time, eliminating the need for additional diagnostic studies. Use of fine needle biopsy has reduced the number of patients who have undergone unnecessary operations for benign nodules. However, about 10-20% of biopsy specimens are interpreted as inconclusive or inadequate – uncertain whether the nodule is cancerous or benign. In such cases, a physician who is experienced with thyroid disease can use other criteria to make a decision about whether or not to operate. The fine needle biopsy can be repeated in patients whose initial attempt failed to yield enough material to make a diagnosis. Many physicians use thyroid ultrasonography (ultrasound) to guide the needle’s placement.
  • Thyroid ultrasonography: Obtaining pictures of the thyroid gland by using high-frequency sound waves to create detailed images of the thyroid. It can visualize nodules as small as 2-3 millimeters. Ultrasound distinguishes thyroid cysts (fluid-filled nodules) from solid nodules and help physicians identify nodules that are more likely to be cancerous. Thyroid ultrasonography is also utilized for guidance of a fine needle for aspirating thyroid nodules. Ultrasound guidance allows biopsy samples to be obtained from the solid portion of those nodules that are both solid and cystic, and it avoids getting a specimen from the surrounding normal thyroid tissue if the nodule is small. Even when a thyroid biopsy sample is reported as benign, the size of the nodule should be monitored. A thyroid ultrasound examination provides an objective and precise method for detection of a change in the size of the nodule. A nodule with a benign biopsy that is stable or decreasing in size is unlikely to be malignant or require surgical treatment.
Treatment

Most patients who appear to have benign nodules require no specific treatment and can be followed by their physician. Some physicians prescribe thyroid medications with hopes of preventing nodule growth or reducing the size of cold nodules, while radioiodine may be used to treat hot nodules. If cancer is suspected, surgical treatment is recommended. The primary goal of therapy is to remove all thyroid nodules that are cancerous and, if malignancy is confirmed, remove the rest of the thyroid gland along with any abnormal lymph nodes. If surgery is not recommended, it is important to have regular follow-up of the nodule.

 

Cervical Cancer Awareness

January 1, 2018

January is Cervical Cancer Awareness Month!!

Cervical cancer was once one of the most common causes of cancer death for American women. Over the last 30 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change is the increased use of screening tests. Screening can find changes in the cervix before cancer develops. It can also find cervical cancer early – when it’s small, has not spread, and is easiest to cure. Another way to help prevent cervical cancer in the future is to have children vaccinated against human papilloma virus (HPV), which causes most cases of cervical cancer.

What Is Cervical Cancer?

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. Cervical cancer starts in the cells lining the cervix — the lower part of the uterus (womb). This is sometimes called the uterine cervix. The fetus grows in the body of the uterus (the upper part). The cervix connects the body of the uterus to the vagina (birth canal). The cervix has two different parts and is covered with two different types of cells.

  • The part of the cervix closest to the body of the uterus is called the endocervix and is covered with glandular cells.
  •  The part next to the vagina is the exocervix (or ectocervix) and is covered in squamous cells.

 

These two cell types meet at a place called the transformation zone. The exact location of the transformation zone changes as you get older and if you give birth.  Most cervical cancers begin in the cells in the transformation zone. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent cancer from developing.

 

Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with pre-cancers of the cervix will develop cancer. It usually takes several years for cervical pre-cancer to change to cervical cancer, but it also can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. Treating all cervical pre-cancers can prevent almost all cervical cancers.

 

What Are the Types of Cervical Cancer?

Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. The main types of cervical cancers are squamous cell carcinoma and adenocarcinoma.

  • Most (up to 9 out of 10) cervical cancers are squamous cell carcinomas. These cancers develop from cells in the exocervix and the cancer cells have features of squamous cells under the microscope. Squamous cell carcinomas most often begin in the transformation zone (where the exocervix joins the endocervix).
  • Most of the other cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from gland cells. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Cervical adenocarcinomas seem to have become more common in the past 20 to 30 years.
  • Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

 

Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can develop in the cervix. These other types, such as melanoma, sarcoma and lymphoma occur more commonly in other parts of the body.

 

What Are the Risk Factors for Cervical Cancer?

A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But having a risk factor, or even several, does not mean that you will get the disease.

 

Several risk factors increase your chance of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease. When a woman develops cervical cancer or pre-cancerous changes, it might not be possible to say that a particular risk factor was the cause.

 

In thinking about risk factors, it helps to focus on those you can change or avoid (like smoking or human papillomavirus infection), rather than those you cannot (such as your age and family history). However, it is still important to know about risk factors that cannot be changed, because it’s even more important for women who have these factors to get regular Pap tests to detect cervical cancer early.

 

Cervical Cancer Risk Factors Include:

Human Papillomavirus (HPV) Infection

Infection by the human papillomavirus (HPV) is the most important risk factor for cervical cancer. HPV is a group of more than 150 related viruses. Some of them cause a type of growth called papillomas, which are more commonly known as warts .

  • HPV can infect cells on the surface of the skin, and those lining the genitals, anus, mouth and throat, but not the blood or internal organs such as the heart or lungs.
  • HPV can spread from one person to another during skin-to-skin contact. One way HPV spreads is through sexual activity, including vaginal, anal, and even oral sex.
  • Different types of HPV cause warts on different parts of the body. Some cause common warts on the hands and feet; others tend to cause warts on the lips or tongue.

Certain types of HPV may cause warts on or around the female and male genital organs and in the anal area. These are called low-risk types of HPV because they are seldom linked to cancer.

Other types of HPV are called high-risk types because they are strongly linked to cancers, including cancer of the cervix, vulva and vagina in women, penile cancer in men, and cancers of the anus, mouth and throat in both men and women.

Infection with HPV is common, and in most people the body can clear the infection by itself. Sometimes, however, the infection does not go away and becomes chronic. Chronic infection, especially when it is caused by certain high-risk HPV types, can eventually cause certain cancers, such as cervical cancer.

Although there is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes.

Smoking

When someone smokes, they and those around them are exposed to many cancer-causing chemicals that affect organs other than the lungs. These harmful substances are absorbed through the lungs and carried in the bloodstream throughout the body.

Women who smoke are about twice as likely as non-smokers to get cervical cancer. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer. Smoking also makes the immune system less effective in fighting HPV infections.

Having a Weakened Immune System

Human immunodeficiency virus (HIV), the virus that causes AIDS, damages a woman’s immune system and puts them at higher risk for HPV infections.
The immune system is important in destroying cancer cells and slowing their growth and spread. In women with HIV, a cervical pre-cancer might develop into an invasive cancer faster than it normally would.

Another group of women at risk for cervical cancer are those taking drugs to suppress their immune response, such as those being treated for an autoimmune disease (in which the immune system sees the body’s own tissues as foreign and attacks them, as it would a germ) or those who have had an organ transplant .

Chlamydia Infection

Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Chlamydia infection can cause pelvic inflammation, leading to infertility.

Some studies have seen a higher risk of cervical cancer in women whose blood tests and cervical mucus showed evidence of past or current chlamydia infection.  Women who are infected with chlamydia often have no symptoms. In fact, they may not know that they are infected at all unless they are tested for chlamydia during a pelvic exam.

A Diet Low in Fruits and Vegetables

Women whose diets don’t include enough fruits and vegetables may be at increased risk for cervical cancer.

Being Overweight

Overweight women are more likely to develop adenocarcinoma of the cervix.

Long-Term Use of Oral Contraceptives Pills

There is evidence that taking oral contraceptives (OCPs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCPs, but the risk goes back down again after the OCPs are stopped, and returns to normal about 10 years after stopping.

Intrauterine Device (IUD) Use

Some research suggests that women who had ever used an intrauterine device (IUD) had a lower risk of cervical cancer. The effect on risk was seen even in women who had an IUD for less than a year, and the protective effect remained after the IUDs were removed.

Using an IUD might also lower the risk of endometrial (uterine) cancer. However, IUDs do have some risks. A woman interested in using an IUD should first discuss the possible risks and benefits with her doctor. Also, a woman with multiple sexual partners should use condoms to lower her risk of sexually transmitted illnesses no matter what other form of contraception she uses.

Having Multiple Full-Term Pregnancies

Women who have had 3 or more full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is true. Also, studies have pointed to hormonal changes during pregnancy as possibly making women more susceptible to HPV infection or cancer growth. Another thought is that pregnant women might have weaker immune systems, allowing for HPV infection and cancer growth.

Being Younger than 17 at Your First Full-Term Pregnancy

Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older.

Economic Status

Many low-income women do not have easy access to adequate health care services, including Pap tests. This means they may not get screened or treated for cervical pre-cancers.

Diethylstilbestrol (DES)

DES is a hormonal drug that was given to some women between 1940 and 1971 to prevent miscarriage. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected. These types of cancer are extremely rare in women who haven’t been exposed to DES. There is about 1 case of vaginal or cervical clear-cell adenocarcinoma in every 1,000 women whose mothers took DES during pregnancy. This means that about 99.9% of “DES daughters” do not develop these cancers.

DES-related clear cell adenocarcinoma is more common in the vagina than the cervix. The risk appears to be greatest in women whose mothers took the drug during their first 16 weeks of pregnancy. The average age of women diagnosed with DES-related clear-cell adenocarcinoma is 19 years. Since the use of DES during pregnancy was stopped by the FDA in 1971, even the youngest DES daughters are older than 40 − past the age of highest risk. Still, there is no age cut-off when these women are felt to be safe from DES-related cancer. Doctors do not know exactly how long these women will remain at risk.
DES daughters may also be at increased risk of developing squamous cell cancers and pre-cancers of the cervix linked to HPV.

Having a Family History of Cervical Cancer

Cervical cancer may run in some families . If your mother or sister had cervical cancer, your chances of developing the disease are higher than if no one in the family had it. Some researchers suspect that some instances of this familial tendency are caused by an inherited condition that makes some women less able to fight off HPV infection than others. In other instances, women in the same family as a patient already diagnosed could be more likely to have one or more of the other non-genetic risk factors previously described in this section.

Do We Know What Causes Cervical Cancer?

In recent years, there has been a lot of progress in understanding what happens in cells of the cervix when cancer develops. The development of normal human cells mostly depends on the information contained in the cells’ DNA. DNA is the chemical in our cells that makes up our genes, which control how our cells work. We look like our parents because they are the source of our DNA. But DNA affects more than just how we look.

 

Some genes control when cells grow, divide, and die:·

  • Genes that help cells grow, divide, and stay alive are called oncogenes.
  • Genes that help keep cell growth under control or make cells die at the right time are called tumor suppressor genes.

 

Cancers can be caused by DNA mutations (gene defects) that turn on oncogenes or turn off tumor suppressor genes.

 

HPV cause the production of two proteins known as E6 and E7 which turn off some tumor suppressor genes. This may allow the cervical lining cells to grow too much and to develop changes in additional genes, which in some cases will lead to cancer.

 

But HPV is not the only cause of cervical cancer. Most women with HPV don’t get cervical cancer, and certain other risk factors, like smoking and HIV infection, influence which women exposed to HPV are more likely to develop cervical cancer.

Can Cervical Cancer Be Prevented?

The most common form of cervical cancer starts with pre-cancerous changes and there are ways to stop this disease from developing. The first way is to find and treat pre-cancers before they become true cancers, and the second is to prevent the pre-cancers.

 

Finding cervical pre-cancers

A well-proven way to prevent cervical cancer is to have testing (screening) to find pre-cancers before they can turn into invasive cancer. The Pap test (or Pap smear) and the HPV test are used for this. If a pre-cancer is found it can be treated, stopping cervical cancer before it really starts. Most invasive cervical cancers are found in women who have not had regular Pap tests.

 

The Pap test is a procedure used to collect cells from the cervix so that they can be looked at under a microscope to find cancer and pre-cancer. These cells can also be used for HPV testing. A Pap test can be done during a pelvic exam, but not all pelvic exams include a Pap test.

 

An HPV test can be done on the same sample of cells collected from the Pap test.

 

Things to do to prevent pre-cancers:

  • Get an HPV vaccine
  • Test for HPV
  • Do not smoke
  • Use condoms

 

For more information visit the American College of Obstetricians and Gynecologists website.

 

 

Testing For Adrenal Fatigue

November 27, 2017

Diagnosing Adrenal Fatigue from a single test or symptom is very difficult. To make an accurate diagnosis, it is important to look at a range of tests, sometimes conducted multiple times, and take note of every symptom. This requires experience and a thorough knowledge of the various systems in your body, as well as patience. It may require two or three visits to the doctor before you can be sure that you have adrenal fatigue.

Testing for adrenal fatigue can take several forms. First we have the standard hormone tests, which include testing for cortisol and various thyroid hormones. Then we have the tests that tend to look at the ratios of various hormones and neurotransmitters, in order to get a better idea of how are feeling. And lastly we have a set of more subjective physical tests, which were mostly developed in the early days of adrenal fatigue diagnosis.

To diagnose adrenal fatigue correctly requires using a combination of lab testing and patient feedback.

The major lab test used to diagnose adrenal fatigue is cortisol. But there is more than one type of cortisol testing, and the correct interpretation of results is also important. Taking a single measurement, or even a 24-hour average, is not enough. The best cortisol tests take 4 individual samples at various points of the day and then map your cortisol levels over the course of a 24-hour cycle. Our cortisol levels vary dramatically, starting high when we wake up and then tapering off until they reach their lowest point late at night. This usually represents approximately an 80% drop, which is perfectly normal. Your healthcare professional needs to see not just your average cortisol level, but also the size of the morning spike and how sharply it drops off afterwards. Interpreting the results correctly can be difficult. The reference ranges supplied by labs are so wide that they only flag up extremely low cortisol levels. Your doctor will need to look at the levels provided and make his or her own judgment. This is where the importance of using an optimal range, rather than the reference range, becomes clear. Lastly, your health care professional should be aware that more than one cortisol test will be necessary during your treatment for adrenal fatigue. Once you have been diagnosed and started on a treatment course, saliva cortisol testing is a good way to monitor progress as your cortisol levels begin to return to normal.

ACTH Challenge

This is another kind of cortisol test that can be very useful. First, your baseline cortisol levels are measured. Then, a dose of ACTH (adrenal corticotrophic hormone) is injected. Finally, your cortisol levels are measured again. The ACTH has the effect of stimulating your adrenal hormone output, just like it would if you were placed in a stressful situation. This test allows you to see the response of your adrenals to stress. If your cortisol exhibits a healthy spike higher (at least double in a blood test), your adrenals are probably in reasonably good shape. If the spike in cortisol is not so large, this suggests adrenal insufficiency.

Thyroid Tests

The complexity of the human body means that one part of the endocrine system cannot exist independently of another part. In reality, there are connections and relationships that exist between every system in the body, and a weakness in one area can easily translate into changes in another. In the case of adrenal fatigue, it has been shown that a weakening in the hypothalamus and pituitary gland can lead to lower thyroid function. In other words, if your blood tests suggest mild hypothyroidism, the underlying problem might actually be adrenal fatigue. There are a number of different tests for thyroid function, all blood tests. As with the cortisol test, your doctor should be looking beyond the reference ranges provided by the lab. In fact, these days it’s very common for someone to be diagnosed with mild hypothyroidism even if all their results are within the range.

TSH

Thyroid stimulating hormone is produced by the pituitary gland in response to instructions from the hypothalamus. As its name suggests, TSH stimulates the thyroid to produce T3 and T4, the two most important thyroid hormones. The level of TSH is inversely proportional to the activity of your thyroid. If your thyroid is producing lots of T3 and T4, your pituitary gland produces less TSH (because the thyroid needs to be stimulated less). Conversely, if you are hypothyroid then your TSH is likely to be high, as your brain is telling the thyroid to produce more hormones. This is the same kind of feedback loop that exists for many other hormones in the body, including cortisol. In the case of adrenal fatigue, the  thyroid is often performing weakly, so they will typically have a TSH reading of above 2.0. Note that the reference range provided by the lab will usually be around 0.50 – 4.50. Once again you can see the importance of looking for an optimal level rather than just blindly following the lab ranges.

Free T3 (FT3)

This is a test that is rarely conducted by doctors, and even then usually only on hyperthyroid patients. However, it can give a useful insight into the overall function of the thyroid. When used in conjunction with the other thyroid tests, this helps to give a complete picture of why the thyroid is underperforming. Optimal values should be somewhere in the 300-450 pg/ml range. However, the typical lab range allows values as low as 230 pg/ml.

Free T4 (FT4)

Similarly to T3, this hormone is produced when TSH stimulates the thyroid. Your thyroid makes much more T4 than T3, but T4 tends to have less of an effect on the body than T3. If your thyroid is producing too little T4, often your TSH level will be higher. This test measures Free T4, which is ‘unbound’ and available for immediate use.

Total Thyroxine (TT4)

This test should be used along with the free T4. While Free T4 measures the amount of unbound and available T4 in your blood, whereas total thyroxine includes the amount of T4 that is bound to carrier proteins (essentially held ‘in reserve’). Using this test together with the free T4 test can tell you how much T4 is available for your body to use, and how much is being held in reserve.

Cortisol / DHEA Ratio

This test tells us which point along the adrenal fatigue pathway the patient might have reached. In the initial stages of a stress reaction both cortisol and DHEA will be high. But as the body begins to struggle to produce sufficient stress hormones, DHEA levels start to fall. Put very simply, this is because the stress hormone production ‘steals’ resources from the sex hormone production. Further on in the development of adrenal fatigue, cortisol levels will begin to drop too.

17-HP / Cortisol Ratio

17-hydroxyprogesterone (17-HP) is a precursor to cortisol, in other words one of the ‘raw materials’ that the body uses to create cortisol. With adrenal fatigue, it is common to see higher levels of 17-HP vs. cortisol, as the adrenals struggle to make this conversion happen.

Neurotransmitter Testing

Neurotransmitters are chemical messengers that transmit messages between our cells and, just like cortisol, they can become depleted after long periods of stress. With recent developments in testing procedures it is now possible to compare a patient’s neurotransmitter levels to a reference range for healthy patients. This test is usually conducted first thing in the morning and is best accomplished via a urine test. It is only available from a small number of labs.

Alternative Tests

When adrenal fatigue was first diagnosed many of these tests did not even exist. To help provide a diagnosis, doctors developed a series of more physical tests that can be conducted quickly in a doctor’s clinic or at home. These tests are clearly much less accurate than the blood, saliva and urine tests mentioned above, and positive results may reflect other health problems besides Adrenal Fatigue. However, they can be a useful diagnostic tool in combination with all the other evidence provided.

The Iris Contraction Test

First described by Dr. Arroyo in 1924, this test measures the contraction of the iris in response to repeated exposure to dark light. In those with weakened adrenal function, the theory goes that the iris will be unable to maintain its contraction for long. To conduct the test, sit in a darkened room, in front of a mirror. Take a flashlight and shine it across your eye, from the side of your face. In a hypoadrenal state, your pupil will not be able to hold onto its contraction for more than 2 minutes and thus will begin to dilate despite light repeatedly shining on it. In those with healthy adrenals, the contraction should last much longer.

Postural Low Blood Pressure

When we stand up, those of us who are in good health experience an almost immediate rise in blood pressure. In contrast, with adrenal fatigue, there is little or no change in blood pressure, or even a slight fall. In very general terms, a larger drop in blood pressure signifies a more severe case of adrenal fatigue.

This is a very simple test to do at home. Use your regular blood pressure monitor and check your blood pressure while lying down. Then stand up and conduct the test again.

Hormonal Mood Disorders

October 17, 2017

FADS AND OVER-DIAGNOSIS

Over the past several decades psychiatric diagnostic acumen has improved significantly. However, more and more people seem to carry psychiatric diagnoses that are inaccurate and have negative consequences. Additionally, it seems that fads in psychiatric diagnosis come and go.  Likely they satisfy a deep-felt need to explain, or at least label, unexplainable human deviance. In recent years, the pace has accelerated and false ‘epidemics’ have come to involve an increasing proportion of the population. We are now in the midst of at least three such epidemics – autism, attention deficit disorder & childhood bipolar disorder. Estimates suggest that in any given year, 25% of the population (almost 60 million people) has a diagnosable mental disorder. A study showed that, by age thirty-two, 50% of the general population will ‘qualified’ for an anxiety disorder and 40% for depression. Imagine what the percentages will be by the time these people hit fifty, or sixty-five or eighty?  In this brave new world of psychiatric over-diagnosis, will anyone get through life without a mental disorder?

What accounts for the upsurge in diagnosis?  It is unlikely that we can blame it on our brains. Human physiology changes very slowly.  Could it be caused by our stressful society? There is no good reason to believe that life is any harder now than in the past.  It is more likely we are a more pampered and protected generation than ever before. Most likely that these ‘epidemics’ are caused by changing diagnostic fashions – in other words, people don’t change, the labels do. There are no objective tests in psychiatry –  no X-ray, laboratory, or exam finding – that say definitively that someone does or does not have a mental disorder.  Other factors contributing to the increase include:

1) DSM manuals being sold to more ‘ordinary’ people than to mental health professions.  This has made psychiatric diagnosis accessible to the general public, allowing self-diagnosis.

2) Definitional thresholds may be set too low. We seem to worry more about missing cases than about casting too wide a net and capturing people who do not require a diagnosis.

3) The pharmaceutical industry over-utilizes marketing. Drug companies are skilled at mounting a full court press that includes ‘educating’ doctors, ‘supporting’ advocacy groups, controlling research, and direct-to-the-consumer advertising.

4) Patient and family advocacy groups call attention to neglected needs (lobbying for clinical, school, and research programs; reducing stigma; and promoting group and community support). Advocating for those with a disorder can spill-over and promote the spread of the disorder to others who are mislabeled.

5) Recent ‘epidemics’ have occurred mostly in childhood disorders.  Perhaps a contributing factor is that the provision of special educational services often requires a DSM diagnosis?

6) The internet provides a wealth of information and creates a network of ‘informed consumers’.  Disorder-focused web-sites provide an attractive forum & support system that draws people who inaccurately self ‘over-diagnose’.

7) The media both feeds off of and feeds public interest. It is not uncommon for the media to become obsessed with one or another celebrity whose public meltdown seems related to a real or imagined mental disorder. An example is the Tiger Woods media frenzy which will likely lead to an ‘epidemic’ of sexual addiction.  Popular movies can also be contagious:  Sybil helped cause a fad in multiple personality disorder.

8) We live in a society that is intolerant of normal individual difference. What was once accepted as aches and pains of everyday life is now labeled a mental disorder. Eccentrics who would have been accepted on their own terms are now labeled Asperger’s and in need of intervention. Criminal behavior has been medicalized (rape as a psychiatric disorder) because prison sentences are too short and such labeling allows for indefinite psychiatric commitment.

Despite all this uncertainty about diagnosis of mental health disorders, a few certainties exist.  There is sufficient research to indicate that a significant subset of people diagnosed with mental health disorders, in fact, have hormone imbalances. The connections between hormones and the brain is undeniable. Hormones impact brain chemistry and circuitry, and hence influence emotions, mood and behavior.

PUBERTY

For many adolescents, the first exposure to the mood-changing impact of hormones is puberty. Pubertal girls and boys can experience significant upheaval due to constant emotional ups and downs, irritability, depression, anxiety, brain fog, and moodiness. Boys can have additional symptoms of anger with rising and fluctuating testosterone. At the beginning of puberty, the brain releases GnRH, which triggers secretion of FSH and LH. In girls, FSH and LH instruct the ovaries to begin producing estrogen. In boys, the same hormones initiate production of testosterone. Many of the mood swings that teens experience are caused by fluctuations in these hormones. These same teen hormones will also affect the way they think about dating and sex. Teens become more interested in sex, sometimes to the point of obsession, as hormones kick into gear. Many adolescents feel that these hormone-related changes are weird or unnatural.

In adolescent girls, hormonal disorders are often overlooked because we tend to focus on the time they begin menstruating.  We forget that long before a girl undergoes menarche, a variety of other changes occur that commence with hormone fluctuations:  thelarche (breast development), pubarche (pubic hair growth), and the pubertal growth spurt. In considering anger, mood swings, and changes in behavior, we must consider their relationship to these other hormone-mediated events.

PREMENSTRUAL SYNDROME (PMS) AND PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

PMS affects up to 85% of women. Irritability, tension, and dysphoria are the most consistently described symptoms. Women whose affective symptoms are especially severe may meet criteria for PMDD, which occurs in 2-10% of women. PMDD is a serious, disabling condition that can rob a woman of her functioning every month. PMS and PMDD are cyclical, with symptoms arising during the luteal phase of the menstrual cycle and lasting until the onset of menstrual flow. Prior to ovulation, estrogen rises, while during the luteal phase following ovulation, progesterone rises. Immediately before the onset of menstruation, estrogen and progesterone both decrease.  The tricky part about PMS and PMDD is that they are not always exactly the week before bleeding, nor do they last exactly a week.  It is further complicated in women who do not have the ‘classic’ 28-day cycle.

Arguably the most frequent, popular and incorrect diagnose associated with puberty is bipolar disorder, in all of its subtypes and flavors. It seems that any adolescent who is moody, angry, or temperamental is labeled bipolar. Bipolar disorder and PMS/PMDD have many similar symptoms. Both are characterized by cycling moods, including severe depression. There are hundreds, if not thousands, of adolescents running around with this diagnosis, yet many of them have never had a manic episode, which is the hallmark of bipolar disorder. Many of these kids have never had anything other than irritability. Load them up with cocktails of anxiolytics, antidepressants or medications like Seroquel, Depakote, Abilify, Lithium, Klonopin & Trazadone and their symptoms go away.  The proof is NOT in the pudding. All that is proven is that one’s affect can be obliterated by harsh medication cocktails.  But being incapacitated by medications does not prove bipolarity. This confusion is tragic because these therapies are often ineffective and more damaging, with serious long-term side effects in the form of obesity, metabolic syndrome, diabetes, sexual dysfunction & movement disorders.

After careful evaluation and consideration, these patients need to be detoxified from their toxic cocktails. Once these medications have worn off, consider a tailored titration onto a pulse pattern of a SSRI or Wellbutrin to control the PMS.  Sometimes Monoamine Oxidase Inhibitors (MAOI’s) are used because it is the surge in MAO that occurs abruptly when a woman’s estrogen drops.  The MAO is the enzyme that degrades all biogenic amines – dopamine, serotonin, norepinephrine, etc. and induces the moodiness and symptoms of PMS/PMDD.  These patients should also be started on therapies designed to suppress cyclical hormonal changes (suppress ovulation). Longstanding ‘bipolar depression’ often disappears when the premenstrual cycle is suppressed.

POLYCYSTIC OVARIAN SYNDROME (PCOS)

The subset of girls who will eventually be diagnosed with PCOS creates an even bigger set-up for misdiagnosis.  Most PCOS patients are diagnosed after menarche – in other words, adolescents diagnosed with mental health disorders, who have PCOS, often haven’t been diagnosed with PCOS yet. PCOS is characterized by irregular menses, elevated testosterones, masculinization, hirsutism, weight gain, metabolic disturbances and many other features. These patients have significant hormone fluctuations without a menstrual cycle. They have florid mood swings, affective dysregulation, depression, impulsivity, suicidal gestures…the whole gamut. True psychotic symptoms are rare.  Most mood medications these girls are started on cause weight gain and some directly increase blood glucose and all of this is quite bad for a PCOS patient.

PREGNANCY AND POSTPARTUM

Pregnancy and postpartum are other key times when mind and hormones intersect. Some women have their first experience with significant moodiness, emotional ups and downs, and frank depression during or after pregnancy. Postnatal depression and psychosis are key mental illnesses that have a major hormonal component to their onset and course. This is thought to be triggered by the sudden, rapid drop in the high levels of pregnancy hormones shortly after birth.

MENOPAUSE

The next commonly recognized — but not well-understood — time, is broadly referred to as ‘menopause’. Broadly, because the term isn’t really used properly. Menopause is a single moment in time when a woman has not had a period for a full year. In the United States, the average age is 51. But most symptoms associated with menopause — erratic periods, hot flashes, mood swings, sleep disturbances, mental fog and decreasing mental focus, weight redistribution, decreasing motivation, diminished exercise endurance, muscle & joint aches, diminished exercise recovery, headaches, and changes in sex drive— take place during perimenopause — the time before menopause — when testosterone, estrogen and progesterone can go up and down erratically. These fluctuations can actually start as early as late thirties.  During this transition, women experience major hormonal shifts. During this time, women are 14 times more likely to experience depression. It affects women differently than other types of depression, causing anger, irritability, poor concentration, memory difficulties, low self-esteem, poor sleep and weight gain. Perimenopausal depression isn’t well recognized and is often poorly treated with standard antidepressants. Women with this type of depression respond better to hormone treatments.

DIAGNOSIS

Diagnosis of hormone-responsive depression should be made through the patient’s history and not through the measurement of hormonal levels, since hormonal levels in premenopausal women are typically normal. Instead, carefully consider the patient’s history that point to hormonally based depression.

  • A history of mild or severe PMS as a teenager
  • Relief of depressive symptoms during pregnancy
  • Postpartum depression, with new-onset or newly recurring depressive symptoms
  • Recurrence of premenstrual depression following resumption of menstruation after delivery
  • Worsening of premenstrual depression with age, blending into the menopausal transition and becoming less cyclical thereafter
  • Coexistence of cyclical somatic symptoms, such as menstrual migraine, bloating, or mastalgia, which are not associated with bipolar disorder
  • Runs of 5 to 20 euthymic days per month
  • Recurrent episodes of depression, often severe and related to menstrual periods, but without episodes of mania

Beyond the patient’s personal history, family history can shed light on the origin of depressive symptoms. If the mother and sisters also suffer from PMS and postnatal depression, it can be suggestive of a familial hormonal basis for the symptoms. Alternatively, a history of bipolar disorder and suicide in male relatives would suggest mixed etiology.

MEN & HORMONES

Low testosterone leads to andropause, which can result in erectile problems, diminished libido, decreased muscle strength and decreased bone mass. To complicate matters, testosterone is converted to estradiol in men (via aromatase enzyme). So, testosterone exerts its effects independently (as itself) and indirectly via conversion to estrogen. Too much estrogen can lead to excess breast tissue, depression or mood swings. Too little estrogen contributes to mood disturbances, low sex drive, decreased motivation and diminished ability to retain muscle mass. Fluctuating estrogen levels, also cause mood swings, which further complicate the picture.  A discernable PMS pattern of behavior is often recognized with these fluctuations. If all this wasn’t complicated enough, the relationship between E and T is also very important, especially with regard to mood changes. Altered estrogen/testosterone ratio (both too high and too low) can cause problems with memory function, depression, irritability, sleep, fatigue and occasionally even hot flashes/sweats.

After seeing a series of men diagnosed with a putative mental health disorder, prescribed all of the usual drugs, there is a discernable pattern of diminished libido, sexual dysfunction, subtle feminization and new/strange sexual thoughts & fantasies.  Initially, these were considered  medication side effects. However, evaluation of hormone levels indicates relative to absolute hypogonadism. Furthermore, these findings are not attributable to psychiatric drugs because this phenomenon is also seen in men who present with similar complaints and no prior treatment with these mood medications. In addition to having low testosterone levels, these men often have high normal or abnormal estrogen levels.  If these men are weaned off mood medications and started on testosterone replacement, their moodiness, irritability, insomnia and other symptoms resolve as they are re-masculinized & estrogen levels fall.

When considering testosterone replacement in men, avoid topical preparations (when possible) if concerned about increased conversion of testosterone into estrogen.  The enzyme that coverts testosterone into estrogen is found in increased quantities in adipose tissue.  Use of injectable long-acting, slow-release testosterone works best for these men.

OTHER HORMONES INVOLVED IN MOOD

In addition to our male & female hormones, there are other hormonal imbalances that can have profound effects on mood.

Thyroid issues are an often overlooked, hormonally-triggered cause of symptoms. When the thyroid becomes overactive – hyperthyroidism — symptoms can include anxiety, insomnia, moodiness, panic attacks, and depression. Some men and women have even been mistakenly misdiagnosed as having panic disorder or anorexia, before properly diagnosed with an overactive thyroid. An underactive thyroid — hypothyroidism — can cause depression, moodiness, fatigue, and anxiety.

While conventional doctors often rush to prescribe antidepressants, it is essential to routinely check patients for thyroid imbalances prior to prescribing any medication for depression or other mood disorders. Interestingly, one symptom of undiagnosed hypothyroidism is depression that does not respond to antidepressant therapy. Thyroid problems are also more likely to show up during periods of hormonal flux – puberty, pregnancy, post-partum, perimenopause, menopause and andropause — which makes it even more important to have a full thyroid evaluation done if you experience depression or anxiety during these times of life.

Adrenal issues — imbalances in the body’s stress hormones adrenaline and cortisol, and the precursor hormone DHEA — can cause a variety of symptoms that seem to be mental health-related, including depression, anxiety, and insomnia. In patients that have experienced trauma or violence, chronically elevated levels of cortisol can result, causing significant mental illness at any time in a person’s life. High cortisol levels have huge impacts on many brain regions, resulting in rage, suicidal thoughts, obesity & infertility. A chronic excess of stress hormones can make you feel jittery, anxious, unable to sleep, and irritable. A chronic deficiency of stress hormones can make you feel sluggish, tired (even after sleep), moody, depressed, and have difficulty concentrating. Daily fluctuations and imbalances can cause a mix of these symptoms.

TRANSGENDER PATIENTS

Hormone replacement is also often part of the transition process for transgender patients. This is, yet, another area where hormones and mood intersect. Many transgender patients experience dysphoria, or psychological distress due to the discrepancy between the sex they were assigned at birth and their gender identity. There is a high prevalence of depression, anxiety & suicidal thoughts.

Hormones help align physical characteristics with gender identity. Many individuals report hormone therapy is extremely beneficial because it enables them to maintain a physical appearance that more closely matches their gender identity, thus increasing their comfort with their physical appearance and decreasing dysphoria & distress. The effects on physical characteristics from HRT can usually be seen in one to three years, but a person receiving hormones will continue taking them for the rest of their life in order to maintain the effects. Research shows that HRT significantly reduces depression, anxiety, and sensitivity, along with feelings of hostility. Additionally, HRT often has the effect of increasing self-esteem and feelings of attractiveness. During gender transition, people who receive hormones typically experience a second puberty, during which secondary sex characteristics change to align with gender identity.

Trans-women receive estrogen in addition to antiandrogens to block testosterone. Trans-men take testosterone, which stops the menstrual cycle, lowers voice, and facilitates facial hair growth, though there may be other effects as well. Non-binary individuals (those whose gender is not specifically male or female) take hormones to produce characteristics that align with their identity or eliminate characteristics causing distress/dysphoria.

It is essential to remember that it is not possible to choose which characteristics result from HRT, and hormone therapy will affect people in different ways. Because of this, the initiation of hormone replacement can also increase feelings of dysphoria and distress.  Many transgender patients don’t quite know what to expect.  Often the changes in hormones they experience from replacement do not yield results that they anticipated or have side effects that were not considered.  For the reason, it is essential to counsel these patients thoroughly before initiating a regimen.

THE TAKE HOME MESSAGE

Before you go down the road of antidepressants and/or anti-anxiety medications, make sure you take a complete medical history, assess symptoms, do a thorough clinical exam, and run comprehensive blood testing to evaluate and diagnose any hormone balances. Unlike most medications and supplements that support and balance hormones, antidepressants and anti-anxiety medications often have significant side effects, and frequently don’t even resolve your symptoms if the underlying cause is a hormonal issue.