Category: Nutrition

Arthritis

Arthritis

The word arthritis is a combination of two Latin words, “arthro” meaning joint and “itis” meaning inflammation, so inflammation of a joint. Inflammation is defined as swelling, redness and pain but what is actually going on is part of a healing process. Our bodies create swelling and pain while repairing tissue. That in turn provides a sort of protective cast around the injury. Think of an ankle sprain. A ligament has partially torn so the immune system creates inflammation around the injury to limit movement and promote healing. Specific immune cells cause blood vessels to dilate, leaking fluid into the area. Other immune cells called fibroblasts create threads of connective tissue to glue everything together in a random mat of webbing. As healing progresses and the ankle joint begins moving again, the threads that are in the way of movement break, leaving only the threads that hold the joint together. In this way, the damaged ligament is repaired.

About half the formation of those tiny threads happens in the first two to three weeks. That’s why it’s important to begin moving the injured joint as soon as possible. Movement breaks the dysfunctional threads. Many times people immobilize a joint too long after an injury, leaving a spongy, fluid-filled area in and around the joint, limiting movement. For most injuries, we recommend beginning gentle range of motion starting 3-7 days after an injury or surgery.

Osteoarthritis

So that’s the process. What could go wrong? Severe injuries like a spinal disc rupture or repetitive injuries to the same area cause so much damage in need of repair that the tissue can’t repair properly. This results in osteoarthritis, also called “wear and tear arthritis” or the “normal arthritis associated with aging”. Severe or repeated trauma also causes the attachment sites of ligaments to micro-tear away from the bones stimulating the bone to overgrow. That is how those ligamentous attachment sites form “bone spurs”. Eventually, those bone spurs can grow together, fusing the joint or joints. This is common in the aging spine. Thinking back to our earlier discussion, movement breaks those scar tissue threads and helps to preserve motion. That’s why yoga or other stretching routines are helpful in reducing the effects of osteoarthritis. We know that adjusting the spine also restores motion to individual joints. In this office we use an Activator to adjust the spine and other joints because the depth of thrust is small and precisely controlled, restoring motion without risking overstretching ligaments and other connective tissue.

Besides adjusting and yoga, what else helps or hurts? As we age the ability of our immune system to repair joints is diminished. Exercise that repeatedly pounds on joints such as running or tennis may need to be reduced or modified. The damage is too frequent for the repair process to keep up. Just as a person in their twenties can do strength training to build muscle more frequently than someone in their sixties, the same is true for stress on joints. What repairs overnight in a twenty year old requires two nights in a forty year old and three nights in a sixty year old. Good posture and good form are even more essential as we age. Exercises like Pilates, swimming or water aerobics and Tai Chi promote full function without stressing the joints. Losing excess weight can also help. Remember, not moving or spending hours sitting looking at a screen will make the joints degenerate sooner. When we move, the gentle friction stimulates the cells lining joints to produce more lubricating fluid and to thicken the slick cartilage end plates and spinal discs that make movement possible. The body is very economical. If we don’t use it, we lose it.

Osteoarthritis is also more prevalent in some people who have a genetic predisposition. While everyone is subject to wear and tear osteoarthritis, if it is severe in your parents and/or grandparents, you may be wise to limit your intake of certain foods. This is because there is a form of osteoarthritis that seems to be apart of a broader metabolic or auto immune condition. More on that later.

Everyone is an individual but some people with osteoarthritis get relief by avoiding eating nightshade vegetables such as tomatoes, peppers, potatoes, eggplant and so on. Unfortunately about 30% of the commonly consumed vegetables are nightshades. Many are delicious and are likely among your favorite foods. Even some herbal products are nightshades, Ashwaganda and Goji Berries for example. Tobacco is also a nightshade. Of course there are a lot of reasons to avoid tobacco. So what is it about nightshades? They contain alkaloids such as solanine. Belladonna contains high amounts of toxic alkaloids. That’s why it is called “Deadly Nightshade”. For most of us, small amounts of these alkaloids are just fine. If however you suffer from arthritic pain, you can try avoiding nightshades for a week then re-introducing them into your diet. Let any resulting relief and pain be your guide.

While the idea that nightshades can cause arthritis remains controversial, there is a wealth of anecdotal evidence to support it. The best support for the hypothesis is that forage animals that eat nightshades often develop crippling arthritis. This is due to the fact that nightshades contain high amounts of Vitamin D2. This is not the same as the Vitamin D that is good for us and that we make in our skin in response to sunlight. The “good” Vitamin D is known at D3. You might think of D2 as the “evil twin” of Vitamin D3. Instead of moving calcium from the soft tissue to the bone as Vitamin D3 does, Vitamin D2 moves calcium from the bones to the soft tissues, causing calcification of soft tissues, including muscles, tendons, joints, blood vessels and kidneys.

In contrast with Vitamin D2, Vitamin D3 is helpful to prevent osteoarthritis. To quote from the journal of Arthritis Rheumatology, February 2010, “Men with Vitamin D deficiencies are twice as likely to have prevalent radiographic hip OA, and therefore vitamin D therapy to augment skeletal health in the elderly is warranted.”

Vitamin K2 works with Vitamin D3 to move calcium from the arteries and other soft tissue to the bones. You can earn more about K2 in my article on Osteoporosis.

One factor that can help reduce all types of arthritic pain is to reduce intake of salt and MSG. These cause the body to hold more water, including more water, including swelling in the joints.

Another nutritional factor to consider is that connective tissue, spinal discs, joint cartilage and joint fluid is made from chondroitin sulphate and glucosamine sulphate. These nutrients are most readily available from eating animal products or bone broth soup. Ever wonder why a dog will gnaw on the end of a bone? Of course you can also take supplements. Bear in mind if you are vegan, the supplements are likely to be be sourced from connective tissue. An alternative is MSM or Methysulphonylmethane. It can be made in the lab and is a precursor molecule to connective tissue.

What about herbs? Ginger is a strong anti-inflammatory. A compound in ginger is the basis for the drugs, Celebrex, Vioxx and Bextra. Those drugs however, have a black box warning because they cause in increase in heart attack deaths. Ginger on the other hand, has an excellent safety record. In fact, throughout Southeast Asia, where ginger is consumed in large amounts, the people have lower levels of dementia. This is attributed to the anti-inflammatory effects of ginger and other herbs.

How does it work? Let me get technical for a moment. Your body makes pro-inflammatory prostagandins. Ginger works by directly inhibiting prostaglandin synthesis, acting as a COX-1 and COX-2 inhibitor. Ginger also inhibits 5-lipooxygenase, inhibiting the production of leukotrienes. Leukotrienes promote and sustain inflammation and are involved in asthma, allergy, arthritis, cancer, cardiovascular and neurological disease. Ginger also prevents inflammation and pain by inhibiting NF-kappaB, also known as the “master switch” of inflammation. Unlike non-steroidal anti – inflammatories such as ibuprofen, aspirin, etc., ginger does not cause ulcers, heart attack, or kidney failure. In fact, ginger will reduce the risk of ulcer and heart attack.

Turmeric has all the same benefits of ginger and can be used in place of ginger. The Chinese name for turmeric is “yellow ginger”. Turmeric tastes a little bitter, so I find better patient compliance with ginger when taken as a single herb. Turmeric is of course what makes curry yellow, and is the basis of much of Indian cuisine.

Another general dietary strategy to reduce inflammation is to eat more foods high in omega-3 fatty acids and fewer foods high in omega-6 fatty acids. Why? Because omega 3’s feed into the production of anti-inflammatory prostaglandins while omega 6 fatty acids increase the production of pro-inflammatory prostaglandins. How do you know what foods are high in which type of fatty acid? To keep it simple, corn fed animal products and grains are high in omega 6 fats. Cold water fish, flax or chia seeds, many vegetables and pasture raised animal products are high in omega 3’s. Considering that corn is the base of the American food chain. It’s not surprising how much we collectively suffer from inflammatory diseases.

Since osteoarthritis and other types of arthritis are typically seen in the same individuals, the nutritional information above may be applicable even with another arthritic diagnosis. It is also true that these general measures will help with all types of arthritis.

So how do you know if you have osteoarthritis? You may find out because it is seen on an x-ray or other test. It may not be painful. You may also have characteristic nodules on your finger joints called Heberden’s Nodes. These swellings appear on the knuckles closest to the end of your fingers or the next closest ones, not the knuckles where your fingers join your hand.

Heberden’s Nodes

Do not be fooled into thinking that osteoarthritis only occurs in the hand and spine. Osteoarthritis of the knee is the most common form of arthritis in the world, affecting an estimated one third of all adults, though only 15% of those with radiographic findings are symptomatic. Incidence rises with age and is also associated with being overweight.

Acupuncture on Osteoarthritis of Knee

Texter’s Thumb or Radialstyloid Tenosynovitis

An increasingly common form of osteoarthritis is colloquially called, “Texter’s Thumb.” It used to be called “Washer Woman’s Thumb” because women held fabric in a pinch with one hand while scrubbing with the other. It develops through prolonged periods of holding the thumb and one of the fingers together. Holding a cellphone and typing messages with your thumb will lead to this painful condition. Even just holding the phone for hours a day will do it. The pain starts in the wrist closest to where the thumb attaches. Over decades, it will cause fusion of the thumb joint at the wrist and compensatory hypermobility of the joint where the thumb attaches to the palm. Many older people, particularly women, will appear to have their thumb held close to their hand. It’s fused there.

I send texts frequently but I talk them into the phone, not type them. If you have this condition, let us know. There are in-office treatments and followup stretches and exercises that can help.

Gouty Arthritis

The usual location of gouty arthritis is joint where the big toe joins the foot. Gout should however, be suspected in any single joint arthritis. On X-ray, gout displays identifiable proliferative changes. Needle biopsy of the affected joint will confirm the diagnosis if a high concentration of uric acid crystals are found.

 

Known as the “Rich man’s disease, gout is associated with a high purine diet. In all other mammals except primates, uric acid is converted to ascorbic acid. Presumably that enzyme was not needed because our primate ancestors ate a lot of fruit and very little meat.

So what foods are high in purines? All animal products contain purines, so someone suffering from gout should limit the amount of animal product in the diet to between 4 and 6 ounces per day. Some animal products are particularly high in purines. These include organ meats, herring, anchovies, mackerel, beef, pork, lamb, tuna, shrimp, lobster and scallops.

It is also best to reduce saturated fat and alcohol as they interfere with the elimination of uric acid. I suggest eliminating soft drinks and other processed foods as high fructose corn syrup causes the liver to increase uric acid production. Drink plenty of water to eliminate excess uric acid. Cherries, strawberries and blueberries reportedly neutralize uric acid. I have found that Vitamin B5 (Pantothenic acid) can markedly reduce symptoms in an acute attack if taken at a dose of 200 to 500 mg, three times per day.

Rheumatoid Arthritis

This form of arthritis belongs to the rheumatic class of diseases such as Lupus. Unlike osteoarthritis, this is very specifically a heritable auto-immune disorder. There is a blood test to see if you are susceptible and there are other blood tests to determine how severe and in what way it is affecting you. We can order those for you or you can see a rheumatologist.

As opposed to gout, which is typically a single joint arthritis, rheumatoid is a multi joint arthritis. It most characteristically affects the knuckles where the fingers join the hand, the wrists and the finger joints closest to the knuckles as opposed to the joints closest to the ends of the fingers as is the case with osteoarthritis.

Rheumatoid can also affect similar joints in the feet, plus the elbows, knees, hips, etc. Rheumatoid arthritis (RA) is a chronic, progressive disease and can be distinguished from acute viral polyarthritis, which usually resolves in six weeks. You may have noticed an overlap between rheumatoid arthritis and osteoarthritis in that both can affect the middle joints of the fingers. The difference is that while osteoarthritis makes the joint swollen, rheumatoid arthritis erodes those joints. This is very clear on x-ray but can also be seen by a characteristic deviation of the fingers towards the little finger called a “swan neck deformity”.

“Swan Neck Deformity”of Rheumatoid Arthritis

You can also see evidence of “Texter’s Thumb” above

To the touch, swollen tissue in rheumatoid arthritis feels soft and swollen while thickened joints in osteoarthritis feel hard because they are an overgrowth of bone.

A sub type of rheumatoid arthritis is called ankylosing spondylitis. This condition mostly affects men between age 20 and 40 and results in compete fusion of the spine. Because it occurs gradually, it is often missed before fusion is nearly complete.

Nutritionally, it can help to stop eating gluten, all dairy products and bananas. It is difficult to know whether or not you are sensitive to any of these food categories and avoiding them is hard. To figure out if you are sensitive, I recommend stopping one food group at a time for 1-2 weeks then introducing that food in a single meal. So for example, stop having all forms of dairy for two weeks then have a meal consisting of a glass of milk and chunk of cheese. If your symptoms subside then return, that’s your answer. You will have a stronger reaction to the dairy meal this way because your immune system will attack the offending food with renewed vigor after a period of rest. If you are a little bit inflamed all the time, you won’t notice a reaction from continuing to eat an allergen.

It also appears that Vitamin D3 plays a positive role in preventing the genetic expression of rheumatoid arthritis in susceptible individuals, “Vitamin D has immunomodulatory activity relevant to rheumatoid arthritis (RA) and acts by binding nuclear receptors that regulate gene transciption.” i

Rheumatoid arthritis patients seem to have an especially high need for Vitamin D according to a study in Clin Exp Rheumatol. July, 2012. “Vitamin D deficiency is common in patients with RA, even in patients who are regularly using supplements. Vitamin D supplementation is often ineffective even at the recommended dose of 800 IU/day.”ii That 800 units is not sufficient should not be too surprising, as a person who is naked in the tropics will make an estimated 35,000 units per day of Vitamin D3 in their skin.

Besides diet and gentle exercise, what else can a person with rheumatoid arthritis do? Since the immune cells are sensitive to neurotransmitters and other peptide molecules that are released under the influence of emotions, learning to cultivate peaceful, loving feelings may modulate the course of this or any autoimmune disease. Circulating white blood cells know what is going on because they have receptor sites for endorphins, serotonin, oxytocin, adrenaline, etc. When we are stressed, those hormones inform the white cells that we are under attack and they go on the offensive. When we are in love and at peace with the world, our immune cells get the message that everything is fine. Tai Chi, Chi Gung, Yoga, Pilates, meditation, relaxing with your loved ones (including pets), are all ways of calming an autoimmune disease. At the very least, having more pleasure in life is good in and of itself.

Psoriatic Arthritis

Generally, psoriatic arthritis is mild and just affects the distal joints of the fingers and toes. In some cases, it may be severe and affect the spine, hips and other large joints. Usually it is associated with psoriatic skin rash and pitting of the fingernails. The skin sign of psoriasis is red patches of skin with silver flakes peeling off the red patches. People with pitting in the nails are most at risk for psoriatic arthritis. Five percent of people with psoriasis progress to psoriatic arthritis. The disease occurs most often between the ages of 30 and 50.

Pitting of Nails

Psoriatic arthritis is a largely a diagnosis of exclusion. If the rash and pitting of the nails are present in a case of arthritis, then psoriatic arthritis can be presumed. Otherwise, x-ray appearance of the affected joints in conjunction with exclusion of rheumatoid by blood work and gout by aspirating the joint fluid is needed to confirm the diagnosis. Another visible indicator is a “sausage like appearance” of the fingers. The fingers will not only appear swollen, but feel puffy all over, not a firm swelling at the joints as in rheumatoid or a hard bony overgrowth as in osteoarthritis.

People with psoriatic and rheumatoid arthritis often have subtypes of an antibody called HLA-B27. HLA stands for Human Leucocyte Antibody and is similar to the ABO red blood cell testing. HLA types are inherited. Various HLA-B27 subtypes are associated with increased risk of rheumatoid arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, celiac disease and gluten intolerance. Because of the association with celiac disease, people with either psoriatic or any form of rheumatic disease are likely to improve by avoiding gluten-bearing grains.

Hopefully this article has provided you with an understanding of the most common types of arthritis and what you can do at home to feel better. You should also know that we are able to provide considerable relief with treatments performed in this office. Acupuncture can ease pain, reduce swelling and improve your immune response. Joint manipulation can increase range of motion and some specific nutrients or herbal formulas can go along way to reduce pain. Massage and other soft-tissue work can also be a big help. A woman who arrived last week as a new patient with considerable pain, swelling and reduced mobility left our office with half the swelling, pain and motion restriction eliminated just with massage work. Call and make an appointment. We want you to feel better.

i J Rheumatol 2012 Aug 1. Vitamin D Receptor Polymorphism Is Associated with Rheumatoid Arthritis in North American Natives. Hitchon CA, Sun Y, Robinson DB, Peschken CA, Bernstein CN, Siminovitch KA, El-Gabalaww HS.

iiClin Exp Rheumatol. 2012 Jul 4. Determinants and effects of vitamin D supplementation on serum 25-hydroxy-vitamin D levels in patients with rheumatoid arthritis. Varenna M, Manera M, Cantatore FP, Del Puente A, Di Munro O, Malavolta N, Minisola G, Adami S, Sinigaglia L, Rossini M.

Scenic view of Horseshoe Bend

Digestion – What You Need to Know

Digestion – What You Need to Know

 

About 600 million years ago, tube worms evolved and subsequently developed into every animal you can think of from dinosaurs to humans. The “tube” in tube worm is the digestive tract. That should tell us something about how important digestion is to us all. We all have a mouth at one end and an anus at the other with a continuous tube in between to digest our food. Without a digestive tract, we wouldn’t be alive. This article aims to help you understand how yours works and what to do if it isn’t working as well as you’d like. Please read on.

The essential thing to know about your digestive process is that it proceeds from top to bottom in an orderly sequence. You may have been diagnosed or know someone diagnosed with acid reflux or colitis, but to really understand what is happening, you have to take a global view of the entire digestive tract. If you or your doctor treat your stomach as if it was on a separate planet from your pancreas or intestines you will have a host of downstream problems. My first advice is to take a holistic approach.

That digestive sequence actually starts in our mind. We think about food. We see food. We smell food and we start making digestive juices. This is the way it is supposed to work. Far too many of us put food in our mouths while multi-tasking or otherwise distracted. Eating in this way is the start of most digestive problems, including obesity (If you don’t feel satisfied and nourished by your food, you will likely keep eating until your are overly full).

Imagine you are in Europe at a sidewalk cafe. You are with friends, the day is pleasant and you have plenty of time set aside for a relaxed meal. You enjoy an appetizer and then your plate arrives. Your food is beautifully prepared and smells delicious. The aroma wakens your hunger. You bring a bite to your mouth, close your eyes, put down your fork and savor the taste as you slowly chew. Ahh….

In contrast, most meals in America are eaten in the car.

Europeans think our obsession with fast food is ridiculous. Why would you want fast food? Do you want all your pleasures to be over with quickly? What’s the hurry? Eating is a physical and emotional pleasure that we get to enjoy several times per day. Why do we turn it into a quick re-fueling? Life is to be enjoyed.

Okay, okay, you have so much work to do. You don’t have time to enjoy your meals in a relaxed way. Here’s what you can do. At home when you are able, practice this; Make a colorful, flavorful meal with an enticing aroma. Sit down with your plate, close your eyes and relax your breathing. Feel your body relax. Feel your shoulders relax. Feel your abdomen expand as you inhale. Breath ten times. This is a traditional time to give thanks for all that is good in your life. You are shifting from your “fight or flight” nervous system to your “rest and digest” nervous system.

When you open your eyes, look at your food and appreciate the beauty and aliveness on your plate (if you are looking at a plate of mystery meat in greasy grey sauce with a slice of unripe tomato on limp iceberg lettuce, go back to the kitchen and start over. Food should look and smell enticing). Pick up your fork, bring a bite to your mouth, close your eyes and savor the flavor as you chew. After you have liquified and swallowed that bite, open your eyes and have another. A few bites in, you should be able to read or have a conversation without losing that sense of inner peace. I expect you will find that this is a delightful and relaxing experience, one you will want to repeat. I understand that you won’t be able to do this at work, but if you do this at home you may find that just a deep breath and a brief closing of your eyes on the first bite may be enough to trigger this relaxed state of eating while you are at work.

By the way, closing your eyes and putting down your fork is a way to break the habit of constantly searching for the next bite instead of enjoying the one in your mouth. This attitude of being present with your moment to moment experience can be transferred to your every conversation and interaction with the world. Eating can be your daily meditation practice. Fully receiving nourishment from your food can translate into fully receiving the gift of other people and experiences in your life. When someone gives you praise, do you breathe in that praise and own that you are worthy of those words or do you brush it off with, “Oh, that was nothing” or some similar avoidance. If you can’t receive food with grace, how can you say, “Yes I am good/kind/honest” or whatever the praise is about? Practice receiving the nourishment of food and deal with whatever self esteem issues arise. Then take what you have learned and apply it to your relationships.

Next stop – Your Stomach!

Anticipating, smelling and savoring your food increases saliva in your mouth and gastric juices in your stomach. Relaxing while you eat also brings blood to your digestive tract. Chewing your food breaks down cell walls in the food, making the nutrients inside available to be digested. An enzyme in your mouth called salivary amylase begins the process of breaking down starches.

When you swallow, the food travels down your esophagus, through a ring of muscle called the cardiac sphincter (called cardiac because it is close to the heart) and into the stomach. The esophagus is in the cavity containing your heart and lungs, the cardiac sphincter and stomach (and all subsequent digestive organs) are located below your diaphragm in your abdominal cavity. While the job of your teeth and saliva is to grind food into a digestible puree and begin breaking down starches, the job of your stomach is to continue churning and mixing the food with pepsin and hydrochloric acid to begin protein digestion.

The stomach of course, is just a specialized part of your digestive tube. It makes itself into a separate chamber by closing the cardiac sphincter at the upper end and the pyloric sphincter at the lower end. Both those rings of muscle close to trap the food with caustic, protein-digesting fluids in the stomach. The stomach lining isn’t injured by the acid and pepsin. Hydrochloric acid would burn other tissues (as it does in the case of acid reflux into the esophagus and duodenal ulcer in the upper small intestine). So as the stomach fills and the acid is released, the rings of muscle (sphincters) at the cardiac and duodenal ends close off the stomach so it can do its work.

In addition to beginning protein digestion, hydrochloric acid also kills bacteria that may have entered with your food. What if you don’t have enough stomach acid? An article in the Journal of the American Medical Association estimates that 33,000 Americans die every year from hospital acquired pneumonia because they are taking anti-acid medications.i ii Get that? Die from pneumonia. If they had normal stomach acid, the bacteria would have been killed rather than allowed to cause infections (including but not limited to pneumonia).

Many nutrients but most particularly Calcium require hydrochloric acid so that they may be absorbed. That’s why people who take proton pump inhibitors (a very strong class of anti acid) suffer higher rates of osteoporotic fractures. iii

If anti-acid medications are so dangerous, why are they prescribed? Well, they stop the pain of acid reflux (heartburn) and some doctors still think they prevent ulcers. Let’s start with the acid reflux.

It used to be that doctors and laypeople alike thought that the stomach produced too much acid in response to stress. I remember ads on television when I was a kid showing fire in the stomach of a stressed person being extinguished by anti-acids). Doctors however, should have known better. Stress causes a reduction in stomach acid. Remember, stress triggers a fight of flight response. You don’t make acid to digest food when you are fighting or running. Low acid in the stomach from “eating on the run” fails to fully close the cardiac sphincter. Muscular restriction and lack of blood flow in the stomach pushes the food back up the esophagus. The body wasn’t prepared to receive food. The stomach wasn’t relaxed and receptive. The stomach juices weren’t released. The sphincters weren’t closed. The top down, sequence of digestion wasn’t properly started in a person who didn’t take the time to slow down and relax while eating. So yes, eating on the run causes heartburn, but it is not because there is too much stomach acid. Quite the contrary.

So how to address acid reflux? First, eat consciously. Relax and enjoy your food. Second, avoid overeating. When the stomach is over full, the cardiac sphincter can’t contain the excess food. Third, avoid eating anything within four hours of going to bed. When you lie down, food pushes up against your cardiac sphincter in a way that it doesn’t when you are upright. You want your stomach to be empty when you lie down at night. Dinner should not be your heaviest meal of the day and it should not occur late in the day. I understand that for most people, dinner is when you finally relax and can eat a meal in peace. I don’t know how you can re-arrange your schedule to have a relaxed lunch and a light dinner. I just know that you will avoid a lot of digestive problems if you do.

As an example, one of my patients – a successful business man – had been on proton pump inhibitors (Nexium in this case) for about 10 years. It was no longer working. He had terrible stomach pain and acid reflux. My advice was to have only a low fat vegetable soup for dinner and to eat nothing after 6:00 PM. I told him he would continue to have pain for about a week and then it should start to improve. That is exactly what happened. The lining of his esophagus repaired and the pain subsided. He no longer had acid reflux and no longer needed the medication. In a couple of months, he also lost a lot of extra weight.

So what about ulcers? Don’t people need to take anti-acids to prevent ulcers? No. Ulcers are caused by low stomach acid.iv Yes, low stomach acid. This was first discovered in 1982. The mechanism of ulcers is that low stomach acid allows the overgrowth of a bacteria called Helicobacter Pylori (H-Pylori for short).v H-Pylori infection causes ulcers. The most effective treatment of stomach ulcers is antibiotics paired with bismuth (remember Pepto Bismol?). When Australian researchers Barry Marshall and Robin Warren first discovered and promoted the idea that ulcers were the result of H Pylori overgrowth, they were slandered and attacked in the press all around the world by gastroenterologists who saw their livelihoods at risk. Cutting out ulcers was good business. Prescribing antibiotics is not. At this point though, the confirming research is unassailable. In 2005, Marshall and Waren received the Nobel Prize in medicine for their discovery. Again, eating in a relaxed way promotes normal stomach acid. Normal stomach acid suppresses H Pylori and prevents ulcers.

While we’re on the topic of H pylori, it’s worth noting that H. pylori infection is also the cause of gastric and gastroesophageal cancer. Another good reason to take time and enjoy your food.

Where does the food go next?

When the food is sufficiently mixed, churned and exposed to pepsin and hydrochloric acid, the valve at the lower end of the stomach (pyloric sphincter) opens to let a little food at a time move on to the first part of the small intestine known as the duodenum. The beginning part of the duodenum is also where the pancreas and gallbladder contribute their juices to the mix. The valve that releases bile and pancreatic enzymes into the duodenum is triggered to open by contact with acidity in the food leaving the stomach. Again, reduced acid means reduced release of bile and pancreatic enzymes. Each step in digestion is triggered by the preceding step.

Pancreatic enzymes actually do most of the work of digestion. These enzymes digest protein, carbohydrates and fats. The pancreas also releases bicarbonate to neutralize stomach acid. This prevents damage to the small intestine. If there isn’t enough acid to trigger the release of bicarbonate (or if there is a blocage in the pancreatic duct) the excess acid could cause a duodenal ulcer.

From here on down the small intestine, the enzymes break down the food and the nutrients are absorbed into the bloodstream. From there, the nutrients go to your liver and on to the rest of your body.

Speaking of the liver, that is where you produce bile. You can think of bile as a soap. Bile emulsifies fats. In other words, it allows fat to break up into small particles and mix more easily with water. This in turn creates more surface area for the fats to be broken down by pancreatic enzymes. Between meals, bile accumulates in your gallbladder. When food hits your small intestine, the gallbladder contracts and pushes bile out the same tube (common bile duct) as your pancreas and through the same valve (pancreatic sphincter) into your duodenum.

One of the components of bile is cholesterol. Your liver gets rid of excess cholesterol by making it into bile and excreting it into your intestines where it binds with fiber and is carried out to the toilet. If you do not have good digestion and adequate fiber, the cholesterol reabsorbs back into your bloodstream, where it can increase your risk of cardiovascular disease.

In addition to breaking down and absorbing nutrients in your food, the small intestine also produces serotonin, the hormone that makes you feel relaxed and happy after a good meal. This is the same hormone that is potentiated by drugs known as SSRI’s or selective serotonin re-uptake inhibitors. Examples include prozac, celexa and lexapro. As a society, we are heavy consumers of SSRI’s, anti-acids, osteoporosis drugs and fast food. Are you seeing a pattern here?

After most of the nutrition is absorbed in the small intestine, the food moves on through the ileocecal valve to your large intestine. The job of the large intestine is primarily to absorb water and minerals. Most of the good stuff has already been absorbed. I should note that if digestion wasn’t good upstream, there will be too much nutrient available for bacteria in your intestines, leading to inflammation and infection in the colon (colitis/irritable bowel). The bacteria that you want in your large intestine thrives primarily on soluble fiber, the stuff you get from eating your whole grains, beans, fruits and vegetables. Flax meal is also a terrific source of fiber and is effective in lowering your serum cholesterol. Healthy “probiotic” bacteria in your intestines can protect against a host of diseases and help us to digest our food. Taking antibiotics kills those healthy bacteria. Eating too much refined carbohydrate feeds yeasts and unhealthy bacteria. If you have yeast infections, sore throats, etc., you may want to cut down on your consumption of refined carbohydrates.

A side note on that topic is sinus infections. The sinuses are part of the same tube as the digestive tract. Chronic sinusitis is a sign of chronic inflammation in your large intestine. For many of my patients, not eating within four hours of going to bed cures their chronic sinus problems.

So how do you know if your digestion is working well? Here are a few clues:

Pain – There shouldn’t be any. If there is, note the location and what triggers the pain. Tell us or your primary care physician.

Gas – The digestive process produces gas – a lot of it – though most is reabsorbed in your intestine. If you are belching or burping, you are either swallowing air or you don’t have sufficient stomach acid. Slow down, chew well and enjoy your food.

If you are passing intestinal gas, note the smell. If it smells like a rotten egg, that indicates a problem digesting protein. Either you are eating too much or too fast (see above).

If you have copious amounts of odorless intestinal gas, you have consumed too much carbohydrate, particularly a combination of starch and a simpler sugar. Think bread and jam, pastries, cookies, etc. Odorless gas is a result of yeast fermentation. The gas bubbles in beer come from yeast fermentation.

Transit time – Food should pass from your mouth to the toilet in 24 to 36 hours. The average American transit time is 72 hours, meaning the average person is constipated. You can test your transit time by having a meal that includes a lot of beets. Beets will retain much of their color as they pass through your system. The problems associated with constipation are numerous, ranging from acne and hemorrhoids to colon and liver cancer.

Look at your bowel movements – An ideal bowel movement is 12 to 18 inches long, 1 to 1.5 inches thick and comes out easily in one piece. Not too hard or too soft. This should happen at least once per day. It can happen after every meal. Frequent soft bowel movements are diarrhea and can result in malabsorption. If you have diarrhea, try having foods that are warm and soft like soup rather than cold and chewy like salad. Ginger and cinnamon can calm and bring blood to the stomach. If diarrhea persists, talk to your health provider.

Infrequent, hard bowel movements are associated with constipation. If you have constipation, try drinking more water and eating more high fiber foods. Most importantly, try establishing good bowel habits. What that means is setting aside time to defecate. Ideally, sit down on the toilet after breakfast and allow yourself 5-10 minutes to relax and empty your colon. Nothing may happen for several days but if you persist, your body will get that you are serious. I understand you have to get to work or get the kids ready for school, but if you can establish this habit, you will feel better every day. If after breakfast doesn’t work for your schedule, try after dinner. Eating and defecating at regular times helps your whole system.

Normal stool ranges in color from light to dark brown. On any given day the color may be affected by what you ate the day before so some variation in color is not a cause for alarm, particularly if you have no pain or other symptoms.

If your stool is black and sticky like tar, you may have a bleeding ulcer (Digested blood looks black. hemorrhoidal blood is red). A black non-sticky stool may just indicate that you have consumed iron tablets or bismuth (Pepto Bismol). A bleeding ulcer generally includes nausea and stomach pain plus weakness and light-headedness.

If your toilet water has an oily sheen to it, or your stool is grey or clay colored you may have a gallbladder problem. Obstruction of the bile duct is often accompanied by yellowing of the whites of the eyes. Gallstones cause intermittent, cramping pain in the right upper abdomen.

Persistently yellowish stool in an adult may indicate obstructive disease of the pancreas such as pancreatitis or pancreatic cancer but may also indicate a malabsorption syndrome such as celiac disease.

I am not trying to make you obsessive about all this, just trying to give you some tools so you can monitor and report to your doctor any changes you might notice.

Many patients are embarrassed or dismissive about their digestive complaints and fail to mention them but digestion is an important part of your overall health. Remember, we are all just specialized tube worms. Poor digestion means poor quality of life. If you have a problem or question about your digestion, please bring it up next time you are in the office. We want you to feel well. Chiropractic offers manipulative techniques to restore normal position and function to digestive organs. Acupuncture has a wealth of treatment protocols designed to help all kinds of digestive issues. Let us know what we can do to help.

Best,

David Wells, D.C., L.Ac., MS (Nutrition)

 

 

i JAMA. 2009 May 27;301(20):2120-8. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. Herzig SJ, Howell MD, Ngo LH, Marcantonio ER.

ii Chun-Sick Eom, Christie Y. Jeon, Ju-Won Lim, Eun-Geol Cho, Sang Min Park and Kang-Sook Lee. Use of acid-suppressive drugs and risk of pneumonia: systematic review and meta-analysis. CMAJ, December 20, 2010 DOI: 10.1503/cmaj.092129

iii Laura E. Targownik, MD MSHS, Lisa M. Lix, PhD, Colleen J. Metge, PhD, Heather J. Prior, MSc, Stella Leung, Msc. and William D. Leslie MD
Use of proton pump inhibitors and risk of osteoporosis-related fractures CMAJ August 12, 2008 179:319-326; doi:10.1503/cmaj.071330

iv Kusters JG, van Vliet AH, Kuipers EJ (July 2006). “Pathogenesis of Helicobacter pylori Infection”. Clin Microbiol Rev 19 (3): 449–90.

v Therapeurtic Advances in Gastroenterology. Helge Waldum, per Kleveland and Oystein Sordal. Helicobacter pylori and gastric acid: an intimate and reciprocal relationship. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5076771/

Take Care of Your Thyroid – Part Two – Hyperthyroidism

So what exactly is hyperthyroidism?

Your thyroid gland produces a hormone (thyroxin) that sensitives all your cells to the metabolism stimulating effects of adrenal hormones. You can think of thyroid hormone as your body’s metabolic cruise control system. It sets the speed of your metabolism, from how warm you are to how fast your heart beats. While adrenalin comes and goes in spurts, thyroid hormone sets the long-term tempo. Normally, your thyroid gland produces just the right amount of hormone. Hyperthyroidism is an over-production of thyroid hormone, causing an increase in temperature, heart rate, muscle contraction and nerve firing. Too much thyroid hormone therefor causes rapid, irregular pulse rate, low grade fever, muscle trembling, anxiety or panic, irritability and fits of rage. Imagine drinking a whole pot of espresso. It’s not fun. Furthermore, it puts a stress on your heart.  Hyperthyroidism is classified into several types: 

Grave’s disease, 

Hyperfunctioning thyroid nodules (Toxic Thyroid Adenoma and Toxic Multinodular Goiter) and 

Thyroiditis (Hashimoto’s, post-partum and subacute or DeQuervain’s). 

All of these conditions are forms of thyroid autoimmune disease, meaning that your immune system has attacked your own thyroid.  Taken together, thyroid autoimmune diseases affect 7-8% of the population, totaling up to 24 million people in the United States, up to 10% of women and 3% of men.  In other words, hyperthyroidism is a relatively common condition, particularly in women. I also suspect it is under diagnosed for reasons you will read later.

Grave’s disease

At 70 to 80% of all cases of hyperthyroidism, Grave’s disease is the most common form of the disease.  It occurs most frequently in women over the age of 20, occurring in about 2% of this demographic.  

Grave’s disease is an autoimmune disorder.  More than 85% of all autoimmune patients are female.  As part of a broader trend, the incidence of autoimmune disease in general is estimated to be between 14.7 and 23.5% of the population and that incidence is rising.   This increasing incidence is very likely to be due to environmental toxins.

What are the symptoms of Grave’s disease?

Fever, heat intolerance, nervousness, anxiety, insomnia, fits of rage, sweating, tremor, heart palpitations, rapid heart rate and profound fatigue.  In women, menses are scant and infrequent.

Objective signs include fever and an elevated resting heart rate.  I have measured a heart rate of over 120 beats per minute in a patient who was resting in bed.  This went on for a few weeks accompanied by a fever of 99 to 100 degrees.  Even to stand up is exhausting when the body is working that hard to raise metabolism.  As opposed to fever caused by infection where the patient wants to get under the covers and stay warm, in Grave’s disease, the patient has heat intolerance and throws off the sheets.  Sweating occurs to dissipate heat.  In some cases, the patient may also exhibit protruding eyes (exophthalmos).  Swelling of the thyroid gland (goiter) is common in Graves disease. The lack of these signs does not rule out thyroid disease.

Hyper-functioning thyroid nodules (Also known as Toxic Thyroid Adenoma and Toxic Multinodular Goiter)

There are several kinds of thyroid nodules.  They differentiated by whether or not they are actively producing hormones and also by their composition.  Some nodules are mere fluid filled cysts.  Others are filled with a colloid.  The nodules that produce symptoms are doing so because they are producing extra thyroid hormones.  These hyper-functioning thyroid nodules produce symptoms of hyperthyroidism as discussed above.

How are nodules detected?  In a physical exam, the doctor stands behind you and feels the thyroid with his or her fingertips.  The thyroid gland is wrapped around the trachea (windpipe), in the hollow just above the sternum. In a normal person, the thyroid is barely detectable and feels equal when comparing right and left sides.  A nodular thyroid feels lumpy or asymmetrical.  Nodules are generally non-tender, the exception being de Quervain’s thyroiditis. 

Rule out thyroid cancer

While the incidence of thyroid cancer is low, the consequence of failing to detect it early is high.  Only about 5% of palpable thyroid nodules are cancerous.  The warning sign in palpation is that the lump feels hard and attached to deeper tissues.   Your doctor will order other tests if a lump feels suspicious.

Hashimoto’s thyroiditis

Hashimoto’s is a chronic, sub-acute autoimmune destruction of the thyroid gland.  

Hashimoto’s is harder to diagnose because symptoms of Hashimoto’s thyroiditis are symptoms of low thyroid function, namely fatigue, weight gain, low temperature/intolerance to cold, dry skin and hair, frequent heavy menstrual periods, hoarseness and lack of mental clarity. Many doctors do not check for the autoimmune component and just treat it as hypothyroidism.

Goiter is the usual clinical finding in Hashimoto’s, with the thyroid commonly though not always, being 2-3 times it’s normal size.  

Post-partum Thyroiditis

The stresses of pregnancy, childbirth, nursing and early childcare can induce thyroiditis in susceptible women.  Typically, an episode of hyperthyroidism occurs 2-6 months post-partum and resolves without treatment within a year.  About a quarter of these women develop hypothyroidism four or more years later.

Regarding pregnancy, sub-clinical hypothyroidism does not reduce rates of conception but does increase the rate of spontaneous abortion.

Sub-Acute or DeQuervain’s thyroiditis

The etiology of de Quervain’s is thought to be a viral infection.  Being an acute inflammatory condition, the thyroid nodules are tender to palpation.  The thyroid is generally asymmetrically enlarged and firm.  

Symptoms of de Quervain’s are hyperthyroid symptoms while the infection is raging, followed by symptoms of hypothyroidism when the autoimmune damage is done.   Fever can range from 100 to 101 degrees F.  Symptoms may include neck, jaw, throat and ear pain.  It is often confused with upper respiratory or dental infection in the early stages and in fact is often a sequel to an upper respiratory infection.  There may be pain with swallowing or turning the head.   Patients with de Quervain’s are more likely to be profoundly fatigued and confined to bed than those with other forms of thyroid disease.

De Quervain’s is self-limiting, generally resolving within a few months, though chronic hypothyroidism (Hashimoto’s) is a common sequel.  

Lab testing in the acute stage shows elevated T4 and T3 with decreased TSH and elevated ESR (Erythrocyte Sedimentation Rate is a general measure of inflammation).

Differential Diagnosis

If you experience recent onset of extreme fatigue, malaise, heart palpitations, insomnia, emotional instability and tremors, you should ask your doctor to test you for hyperthyroidism. While waiting to see your doctor, start taking and recording your temperature and your pulse rate. A thermometer and pulse oximeter are both readily available at your local drug store. Measure yourself and write down the date and time of your measurements in a notebook or by other means.  Hyperthyroidism causes rapid heart rate and mild fever. Keeping a log of your temperature and pulse will help track the severity of your disease and the progress of your treatment. 

Unless you recently gave birth or are recovering from an infection, you likely have Grave’s disease. Your doctor will palpate your thyroid to check for swelling and also order blood tests to make a differential diagnosis. Most doctors will only order a TSH (Thyroid Stimulating Hormone) to determine whether or not you have hyperthyroidism. They do not typically order tests that quantify the autoimmune component. This is because the treatment for hyperthyroidism is to suppress thyroid hormone production with a bromide based drug or radioactive Iodine, not to try and modify the immune response.  A TSH below 0.3 is indicative of hyperthyroidism. I have listed other tests below that can be helpful in determining what is happening with the immune system and make a more informed differential diagnosis. I order these in addition to TSH, plus T4, T3 and reverse T3 (see prior article on hypothyroidism).

Test nameReference rangeIndication if high
Anti microsomal antibodies< 35 Units/mlAuto immune thyroiditis
Anti-thyroglobulin antibodies> 2 IU/mlThyroid cancer or Hashimoto’s
Thyroid peroxidase antibody> 2 IU/mlHashimoto’s or Grave’s
TSH receptor antibody<10%Grave’s

If you have hyperthyroid signs and symptoms following an acute infection, you would expect the diagnosis to be de Quervain’s hyperthyroidism.  If the onset followed the birth of a child, expect post-partum thyroiditis to be the diagnosis.  Neither de Quervain’s, nor post-partum thyroiditis are known for producing palpable swelling of the thyroid gland.  In lab testing, de Quervain’s patients can also expect an elevated ESR.  In both cases, elevated T3 and T4 with decreased TSH can be expected.

Hashimoto’s is more difficult to diagnose because it develops slowly.  It is an autoimmune thyroiditis but results in more destruction of tissue and therefore the clinical presentation is hypothyroidism.  The patient is cold, tired, has dry skin and thinning hair with a loss of the lateral third of the eyebrows (see article on hypothyroidism).  In her or his case, the thyroid gland is likely to be palpably enlarged and nodular.  Lab tests include elevated anti-microsomal and antithyroglobulin antibodies with decreased peroxidase antibodies.  Because of the possibility of thyroid cancer, I always refer out to her or his primary care physician or a specialist for evaluation in patient’s with thyroid nodules.

Etiology

So how does a patient get autoimmune thyroiditis?  The usual risk factors are genetics, prolonged high stress, female gender, environmental toxins, infections and low Selenium.  Let’s take these one at a time.

Genetics

There is a genetic predisposition to Grave’s disease that can be determined through HLA testing (The association is between HLA B8 and DW3 in Caucasians and DW35 in persons of Japanese descent), however it appears to be triggered by infection, stress and/or environmental toxins. Hashimoto’s also has a genetic pre-disposition.  In Caucasians, the HLA-B8, DR3 haplotype is associated with atrophic autoimmune thyroiditis.  HLA-DR5 is associated with goitrous autoimmune thyroiditis.  There is a high prevalence of autoimmune thyroiditis in Down’s syndrome, Turner’s syndrome and familial Alzheimer’s  further suggesting a genetic susceptibility.

High stress/ Low adrenal function

Stress provokes an increase in metabolic rate so that the person has the energy to deal with the crisis.  To raise metabolism, our bodies produce thyroid hormone, which sensitizes cells to adrenal medullary hormones, epinephrine and norepinephrine.  These are the hormones that increase metabolic rate.  The adrenal cortex produces hormones that balance water, salt, blood sugar, reduce inflammation, etc.  They are cooling, nourishing hormones.  High stress and insufficient adrenal cortical hormones to help the body cope with that stress may allow the development of autoimmune thyroiditis. 

Female Gender

Women are over three times more likely to have autoimmune thyroid disease than men.  The stress of childbirth is also a cause of autoimmune thyroiditis.  Post-partum thyroiditis is an example of the effect of physical stress leading to this condition and is of course, a form of the disease that is limited to women.  

Environmental toxins

The common lab tests for Grave’s and Hashimoto’s disease are antiperoxidase antibodies and anti thyroglobulin antibodies.  Several studies have demonstrated an association between exposure to PCB’s (polychlorinated biphenyls), dioxins, BPA (bisphenol A), perchlorate, DDE, hexachloroenzene and other toxins with elevated levels of these antibodies. 

How big a problem is this?  According to the National Health and Nutrition Examination Survey III, 13% of the total U.S. population is positive for both of these antibodies.  Thirteen percent is over thirty-nine million people!  That’s thirty-nine million Americans, whose immune systems are gunning for their thyroids.  Not all of those people have overt thyroid disease but individuals with both antibodies were 23 times more likely to be clinically hypothyroid and 12 times more likely to have sub-clinical hypothyroidism.  Individuals with both antibodies and a TSH over 2.5 were forty times more likely than the general population to have clinical hypothyroidism.  Remember, a TSH of 2.5 is ideal. In other words, your immune system could be attacking your thyroid and your lab test for thyroid disease could still be normal.

Infections

The last straw (in a patient already burdened with stress and toxins) can be an acute infection.  This would be diagnosed as de Quervain’s hypothyroidism but as you can imagine, the stresses that lead to de Quervain’s are likely to have been present for some time. 

Low Selenium

A little known nutritional factor in autoimmune thyroid disease is Selenium deficiency.  Selenium is a trace mineral.  To understand why Selenium is important, you must first understand that the thyroid gland converts Iodide to Iodine and then attaches Iodine to Tyrosine to make the hormone thyroxine (T4) using hydrogen peroxide, a potent oxidant at both steps.  If you have ever put hydrogen peroxide on a cut, you know that it fizzes as it tears cells apart.  That’s what makes it an effective antibacterial.  To protect your healthy cells, the thyroid produces glutathione peroxidase, a Selenium dependent enzyme.  Glutathione peroxidase neutralizes hydrogen peroxide.  If you are deficient in Selenium, you cannot produce adequate glutathione peroxidase and the resulting excess hydrogen peroxide damages your cells.  In response to this damage, the immune system begins to regard the thyroid gland as a source of trouble and starts coding antibodies against the thyroid.  If you recall, one of those enzymes discussed above is antithyroiperoxidase or anti-TPO.  Is this making sense?

Selenium is so important that the thyroid gland has higher concentrations of Selenium than the liver.  Furthermore, deficiency of Selenium is associated with cancer of the thyroid.  Exposure to chemicals that disrupt the thyroid’s ability to make glutathione peroxidase such as DDT, increase the risk of thyroid cancer.  Prolonged stimulation by high levels of TSH increases cellular differentiation in the thyroid and increases the risk of neoplasia.  High TSH is often a response to low levels of Iodine (see below) and high levels of exposure to toxic chemicals.  Add high TSH to prolonged exposure to thyroid disruptor chemicals and you have a recipe for thyroid cancer.  The rate of thyroid cancer in the United States has more than doubled over the last 30 years.

Clinically, if a hyperthyroid patient takes Iodine without first ensuring adequate levels of Selenium, symptoms are likely to worsen.  Of course, Selenium can be given as a nutritional supplement but the therapeutic range is very small.  The RDA is 400 mcg’s per day and toxicity can occur with as little as 1000 mcg’s per day.  Blood, urine or hair analysis can be performed to determine if the patient has adequate selenium.  The lab I use to test levels of minerals and heavy metals is Doctors Data in Chicago.  

A more traditional East Asian method of supplementing Selenium is to use Huang Chi or Radix Astragalus as this herb contains a concentration of Selenium.  This herb is used in many tonic formulas, notably Ginseng and Astragalus Formula or Bu Zhong Yi Chi Tang.  This is often the best formula for the adrenal deficient patient who is pre-clinical for a thyroid disorder or the patient with Hashimoto’s thyroiditis.  Furthermore, Astragalus Membranous is not only known to raise serum Selenium levels, it also boosts immunity to viral infection by raising levels cytokine and T cell immunity.  By helping to protect the body against infection, it reduces the risk of de Quervain’s thyroiditis.  

Acupuncture and Chinese Medicine

According to the oldest Chinese medicine text, “A superior physician prevents disease.  An inferior physician treats disease”.  Of course, patients don’t usually come in until they are sick but whenever possible, in our office we focus on prevention.  In the pre-clinical stage, we often see patients who are anxious and run down.  They are not yet sick but their lifestyle is spreading their energy too thin.  To these patients, I sometimes relay an old Chinese saying, “If we don’t change direction, we will end up where we are headed”.  Using acupuncture and tonic herbs to relax and strengthen the patient may get their attention so they will be more open to following our advice.  A program of Tai Chi, Chi Gung, yoga or other relaxation techniques and breathing exercises can really help.  We counsel patients to set priorities, accept limits and let go of trying to be and do everything.

Acupuncture can modulate immune response and reduce inflammation in the acute stage of the disease.  In the post-acute hypothyroid stage (Hashimoto’s), acupuncture and tonic herbs can help to modify the immune response and raise metabolism.  Nutritional therapy is also very helpful.

L-Carnitine

During the acute stage of hyperthyroidism, the amino acid L-Carnitine can be used to prevent or minimize the symptoms and physiologic changes associated with elevated levels of T3 and T4.  The dosage required is 2 – 4 grams per day of oral L-Carnitine, given in a divided dose.   

L – Carnitine is a normal amino acid found most abundantly in meats.  The supplemental form is made by bacteria and is easily absorbed and utilized as it is in a free, single amino acid form as opposed to complexes with other amino acids as it is normally found in food.  The mechanism of action for L-Carnitine is that it blocks the uptake of T3 and T4 at the cell nucleus.  Thyroid hormone works by causing transcription of DNA in the cell nucleus that increases receptor sites for catacholamines in the cell membrane.  Without access to the nucleus, T3 and T4 cannot raise metabolism and cause hyperthyroidism.  

Iodine

Since T3 and T4 are made from Iodine, it would be natural to assume that taking Iodine would worsen hyperthyroidism because the body would be able to make more of the hormones.  This is true in the acute stage, particularly if there is a lack of Selenium.  But in the post-acute stage, taking Iodine can actually decrease the levels of antithyroglobulin antibodies and antiperoxidase antibodies found in Hashimoto’s disease.

What to do?

First of all, make an appointment with your doctor. In this office, we are not medical doctors, let alone endocrinologists. We do not prescribe drugs. We offer nutritional support, lifestyle recommendations and supportive care. While it is true that we have helped many patients with thyroid disorders improve their health and it is also true that we provide treatment for aspects of thyroid disease often ignored by medical doctors, there are some cautions to bear in mind. First of all, if your heart rate is above 100 at rest, you may need to take medications to reduce the amount of thyroid hormone produced and reduce its effects on your heart. Secondly, if you have nodules on your thyroid gland, those should be checked for cancer.

The next thing to do is start measure and recording your resting pulse rate and temperature. Make a chart with these headings: Date, Time, Pulse Rate, Temperature, Symptoms. You are the only person who is with you all the time. We doctors are not. By taking an active role in your health, you will notice what helps you and what hurts you. There may be foods that make you better or worse, sleep patterns, stressors, etc. Be an expert in what makes you feel good.

Last, strive to maintain a relaxed, happy mood. Fear and anxiety hurt you. Anger hurts you. These emotional states trigger a flood of hormones that arouse your immune system and cause more destruction. A friend once said, “You can’t afford the luxury of a negative thought.” Sure your spouse may deserve a good tongue lashing but the person who will suffer is you. I have one patient who put her Grave’s disease in remission largely by walking away from everything stressful in life. She won’t even read the news or watch a suspenseful movie. It’s not worth it to her. She is happy gardening, cooking and reading, so that’s where she puts her focus. Does life still bring crisis that must be managed? Of course. We all have major life events that require us to get into high gear. We just don’t have to be in that heightened state all the time. It may be a habit. We may have built our roles and personalities around unsustainable demands.  Many of us are attracted to high stress activities, whether it is completing a big project at work, skiing down a steep hill or engaging in emotional dramas. Adrenaline makes us feel more alive. It may not seem possible to disengage from these high stress activities – that we “have to” do (fill in the blank), but many of them are optional. If you can turn a diagnosis of hyperthyroidism into a change towards a happier, less stressful life, the suffering will at least have meaning and possibly be worthwhile. Let the crisis be an opportunity to create a healthier, happier life.

Wishing you the best of health,

David Wells, D.C., L.Ac., MS (Nutrition).

 

 

 

References:

 Neufeld M, Blizzard RM.  Polyglandular autoimmune diseases. In: Pinchera A, Doniach D, Fenzi GF, eds. Symposium on Autoimmune Aspects of Endocrine Disorders. New York, NY: Academic Press’ 1980:357-365.

 Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med 1996;335:99-107.

 Progress in Autoimmune Diseases Research, NIH Autoimmune Diseases Coordinating Committee, Report to Congress, March, 2005

 Progress in Autoimmune Diseases Research, NIH Autoimmune Diseases Coordinating Committee, Report to Congress, March, 2005

 SEER Fact Sheet Thyroid, NIH 2009, www.cancer.gov

 Othman S, Phillips DIW, Parkes AB, et al. A long-term follow-up of postpartum thyroiditis. Clin Endocrinol (Oxf) 1990;32:559-564. [Medline]

 Pratt D, Novotny M, Kaberlein G, Dudkiewicz A, Gleicher N. Antithyroid antibodies and the association with non-organ specific antibodies in recurrent pregnancy loss. Am J Obstet Gynecol 1993;168:837-841. [Medline]

 Merck Manual, 2010

 Neufeld M, MacLaren N, Blizzard, R.  Autoimmune Polyglandular Syndromes. Pediatric Annals 9:4. 1980. p 48.

 Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med 1996;335:99-107.

 Shnell LM, Gallo MV, Ravenscroft J, DeCaprio AP. Persistent organic pollutants and anti-thyroid peroxidase levels in Akwesane Mohawk youg adults. Environ Res 2009;109:86092.

 Tsuji H, Sato K, Shimono J, et al. Thyroid function in patients with Yusho; 28year follow-up study. Fukuoka Igaku Zasshi 1997;88:231-235. 

 Spencer CA, Hollowells JG, Kazaosyan M, Braverman I.E. National Health and Nutrition Examination Survey III thyroid-stimulating hormone (TSH)-thyroperoxidase antibody relationships demonstrate that TSH upper reference limits may be skewed by occult thyroid dysfunction. J Clin Endocrinol Metab 2007;92:4236-4240.

 Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the U.S. population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab 2007:92:4575-4582.

 Aaseth, J., Frey, H., Glaattre, E., Norheim, G., Ringstad, J. and Thomassen, Y. Selenium Concentrations in the human thyroid gland. Biol. Trace Element Res. 1990:24, 147-152

 Santini F, Vitti P, Ceccarini G, Mammoli C, Rosellini V, Pelosini C, Marsili A, Tonacchera M, Agretti P, Santoni T, Chiovato L, Pinchera A. Endocrinol Invest. 2003 Oct;26(10):950-5.

 Hard GC. Environ Health Perspect. 1998 Aug;106(8):427-36.

 Chen AY, Jemel A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer. 2009;18:784-791.

 Dong Xiang-yu, Ni Qian, Shen Yang. Effect of Astragalus Injection on levels of blood selenium and immunity function in children with viral myocarditis Chinese Journal of Integrative Medicine. Vol 10, No 1, 2004:29-32.

 Benvenga S, Amato A, Calvani M, et al. Effects of carnitine on thyroid hormone action. Ann N Y Acad Sci. 2004 Nov;1033:158-67.

 Benvenga S, Lakshmanan M, Trimarchi F. Carnitine is a naturally occurring inhibitor of thyroid hormone nuclear uptake. Thyroid. 2000 Dec;10(12):1043-50.

 Benvenga S, Ruggeri RM, Russo A, et al. Usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomized, double-blind, placebo-controlled clinical trial. J Clin Endocrinol Metab. 2001 Aug;86(8):3579-94.

 Rink T, Schroth HJ, Holle LH, et al. Effect of iodine and thyroid hormones in the induction and therapy of Hashimoto’s thyroiditis. Nuklearmedizin. 1999;38(5):144-9.

Scenic waterfall in Japanese garden

Take Care of Your Thyroid – Part 1 – Hypothyroidism

Marsha is tired all the time. She wakes up with a dull headache and needs coffee before she can be civil with her husband and kids. Her skin is dry despite practically soaking in lotion. Her hair is getting thinner and more brittle. She has gained a lot of weight and feels cold much of the time, so much so that she wears socks to bed.

Janet also feels tired but in her case, she feels wired and tired. Her pulse is fast and her skin is moist. She feels anxious and irritable. She has a hard time sleeping. What do these two women have in common? They both have thyroid problems.

Of course, men can have thyroid problems too. It’s just a lot more common in women. According to the American Thyroid Association, “Women are five to eight times more likely than men to have thyroid problems.” They go on to say, “One woman in eight will develop a thyroid disorder during her lifetime.”i

The following article will help you understand how your thyroid works, what the lab tests mean and what you can do to improve your thyroid function. I have included enough detail to make you an expert. I suggest you read the whole article, skimming any sections that seem too technical. Take what information you need and can use. You can always come back to this article to answer any questions that may arise.

Please note – I am not an endocrinologist or even a medical doctor.  Use this article as a resource while working with your physician.

Where is my thyroid?

The thyroid gland is located just above the sternum. It is a butterfly shaped gland, wrapped around the trachea. Inside the thyroid are the parathyroid glands. The thyroid is part of the “fight or flight” nerve and hormone system. Thyroid hormones increase energy, speed and body heat. The parathyroids are part of the “rest and digest” system. Parthyroid hormone helps the body to nourish and repair itself, primarily by directing calcium back to the bones when it is not needed elsewhere. The function of the parathyroids has to be replaced in the case of thyroidectomy (removal of the thyroid) because the parathyroids are embedded in the thyroid gland.

What is thyroid hormone made of?

The thyroid gland produces thyroid hormones, primarily T4, though also smaller amounts of T3 and T2 respectively. T4 is made of an amino acid called Tyrosine plus four molecules of the mineral Iodine (Hence the name, T4). T4 is the transport form of the hormone. T3 is Tyrosine plus three Iodine molecules and T2 has two molecules of Iodine. T3 is the active form of the hormone.

One of the causes of hypothyroidism is insufficient Iodine in the diet. Many parts of the world don’t have sufficient Iodine in the soil, so the foods grown in that soil or the animals that depend on that food are deficient in Iodine. People eating those grains, vegetables and animals therefor don’t get enough Iodine. A severe form of mental retardation called Cretinism was common before Iodine was added to salt. Subclinical Iodine deficiency is still common.

The amino acid Tyrosine is a normal component of the diet and should not need to be supplemented, though there are some people with insufficient enzymatic ability to split Tyrosine molecules off from the rest of the protein in their food and thus do have a need for Tyrosine supplementation. These people are the exception and can be identified by testing serum amino acids. Clues that helped me to find Tyrosine deficiency in a few patients were the failure to produce endorphin in response to acupuncture, general lack of zest for life and extreme sensitivity to air pollution. The poor response to acupuncture and lack of joy is because Tyrosine is also needed to make endorphin, dopamine and norepinephrine – hormones that cause pain relief, reward and excitement. The exagerated response to air pollution (extreme fatigue) is because certain pollutants block the conversion of Phenylaline (another amino acid) into Tyrosine, resulting in low levels of the substrate needed to make endorphin, dopamine and norepinephrine as well as thyroxine.

What does thyroid hormone do?

In brief, thyroid hormone raises the metabolic rate of the cells, that is, the rate at which cells burn fat and oxygen to make energy. Thyroid hormone does this by making the cell sensitive to adrenal hormones. Adrenal hormones in turn, speed the metabolic rate.

You might wonder why thyroid hormone is needed since adrenal hormones actually control the burn rate of fat and oxygen. The answer is that adrenal hormones come and go in little spurts that would make your energy level rise and fall like someone driving a car by pumping the gas pedal up and down. Thyroid hormone smoothes and regulates the overall rate of metabolism. If there is not enough thyroid hormone, the “gas” doesn’t reach the “engine”. You can think of thyroid hormone as the “cruise control”, setting the overall rate of energy production.

In general, men have larger adrenal glands and more muscle mass than women and thus can tolerate a lower functioning thyroid and not have symptoms.

How does thyroid hormone get where it needs to go?

Most of the hormone produced by the thyroid gland is in the form of T4 (In fact, fourteen times more T4 than T3). T4 is a very stable form of the hormone, but because T3 is the active form of the hormone, T4 must be converted to T3 in the tissues.

Ninety-nine point five (99.5) percent of the T4 and T3 are bound to proteins called thyroid-binding globulin (TBG), transthyretin (TTR) and albumen. Of these, TBG binds 75% of the thyroid hormone, TTR 20% and 5% is bound to albumin. These are very stable molecules that serve as a reservoir of thyroid hormone outside the thyroid gland itself. If there were no pool of circulating protein-bound thyroid hormones, depletion of the hormones could occur within hours of the thyroid ceasing production. As it is, the thyroid could stop making hormone for 24 hours and amount in the blood would only decrease by 10% and 40% for T4 and T3 respectively. This allows thyroid production to fluctuate without affecting available levels of the hormones. Another advantage to being bound to large protein molecules is that there is less loss of the hormone in the urine than there would otherwise be.

The different carrier proteins also direct the delivery of thyroid hormone to particular parts of the body. Most notably, transthyretin (TTR) delivers thyroid hormone across the blood-brain barrier to the brain and nervous system, and across the placenta to the fetus.

As noted earlier, there is a small amount (0.5%) of unbound T4 and T3 in the bloodstream. The T4 and T3 must become free of the transport protein in order to enter the cells of the target tissues. In lab tests, the free T4 and T3 fractions can be measured separately from total T4 or total T3.

Once at the cell membrane, T4 and T3 must cross the cell membrane with the help of cellular thyroid hormone transporters and then bind to the nuclear thyroid receptors in the nucleus of the cell. Thyroid disruptors like PCB’s, BPA, dioxin and flame-retardants can block crossing the cell membrane.,

Conversion of T4 to T3.

Once inside the cell, T4 must be converted to T3. This occurs with the help of enzymes called deiodinases. There are three types of deiodinase, designated as Type I, II and II Regardless of which type is involved, for deiodination to result in metabolically active T3, one molecule of iodine must be removed from the outer ring of the T4. Removal of an iodine molecule from the inner ring produces an inactive form of T3 called “reverse T3” or rT3. Types I and II produce metabolically active T3. Type III produces rT3. Type III is used to reduce excess levels of T3 in the brain and in the placenta and fetus. Excess T3 could stimulate abnormal cellular differentiation, particularly in the fetus.

Type I deiodinase is produced in the liver, kidney, thyroid, pituitary and heart but primarily in the liver. The liver is thought to be the main source of peripheral T3 production and also the main location for clearance of plasma reverse T3. Type I is the most dependent on adequate selenium levels of the three types.

Type II is produced in the central nervous system, pituitary, skeletal muscle, cardiac muscle and brown adipose tissue. Both Types I and II are blocked by the presence of mercury, arsenic, cadmium, lead, PCB’s, FD&C red dye #3, the pesticide methoxychlor and a UV agent used in sunscreens called octylmethoxycinnamate. Blocking the action of Type I or II deiodinase results in less T3 and thus lowered metabolism.

How does thyroid hormone raise energy level?

T3 increases transcription of beta-adrenergic receptors and decreases transcription of alpha-adrenergic receptors on the cell membrane. Beta-adrenergic receptors bind with circulating catacholamines such as norepinephrine (adrenal hormone), stimulating glycolysis and glycogenolysis (the burning of glucose and glycogen to make energy). In contrast, when catacholamines bind with alpha-adrenergic hormones, metabolism is reduced. Thyroid hormone is also an insulin antagonist. It stimulates lipid turnover, free fatty acid release and cholesterol synthesis. In short, T3 encourages converting both fat and glycogen into energy.

Additionally, thyroid hormone maintains calcium mobilization and is necessary for the contractility of mysosin filaments in the muscles. It is necessary for central nervous system, skeletal and sexual maturation and is also required for protein synthesis and the formation of apoenzymes.

From this it is easy to understand how lack of thyroid hormone activity causes poor muscle and ligament development, low energy, cold body temperature, inability to think clearly, accumulation of fat, etc. Beyond the obvious, energy is required to power every metabolic process. Low energy equals reduced health in every respect.

How is the production of thyroid hormone regulated?

The short answer is that the pituitary produces a hormone called thyroid-stimulating hormone or TSH, which in turn stimulates the thyroid to produce more thyroid hormones. The production of TSH is in turn regulated by hypothalamus. The hypothalamus makes thyroid-releasing hormone (TRH). TRH causes the pituitary to produce TSH.

The hypothalamus is in turn influenced by the weather (prolonged cold causes increases in TRH production), the amount of circulating iodine in the blood, fasting (lowers metabolism to conserve energy) and other factors. Think of the hypothalamus as a little lab in your head, constantly measuring blood chemistry and other information and deciding what hormones are needed. The hypothalamus sends this information to the pituitary. In turn, the pituitary issues the orders to the glands to make appropriate amounts of hormones needed to deal with current environmental conditions.

With such a beautifully balanced system, what can possibly go wrong?

Hmm, let me count the ways…

Excluding pathology such as tumors of the pituitary, genetic abnormalities, infectious disease, etc., the most common conditions of the thyroid are hypothyroidism and hyperthyroidism. Let’s start with hypothyroidism.

Hypothyroidism

Hypothyroid means low-functioning thyroid. Remember, a low functioning thyroid results in low energy production. Hypothyroidism can be caused by

  1. Inadequate stimulation by the pituitary.
  2. Inadequate production of T4 by the thyroid gland (Primary hypothyroidism).
  3. Inadequate conversion of T4 to T3 in the tissues (Peripheral thyroid resistance).
  4. Auto-immune destruction of the thyroid gland or its hormones (covered in a following section).

Let’s take these one at a time.

Inadequate stimulation by the pituitary.

The pituitary produces thyroid-stimulating hormone (TSH). The normal range for TSH in the blood is .4 – 4.5 mlU/L. Symptoms of hypothyroidism in patients whose blood levels of TSH are under .4 indicate under-production of TSH by the pituitary. Blood levels of TSH over 4.5 in persons with symptoms of hypothyroidism indicate that the patient’s thyroid gland is not responding to the TSH.

It should be noted that the current lab standard of up to 4.5 mU/L may be missing many people who are clinically hypothyroid. The National Academy of Clinical Endocrinology recommended in 2002 that the target TSH level for thyroxine replacement should be between 0.3 and 3.0 mU/L. Adopting this new guideline would bring the number of people with abnormal thyroid function to as much as 20 percent of all adults, up from 4.6 percent under the current guidelines. In guidelines published by the National Academy of Clinical Biochemistry the report states, “In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 because 95 percent of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mU/L”.

What does TSH do?

TSH stimulates a plasma membrane transport system called NIS that allows sodium to be pumped out of the cell and iodine pumped in to the cell. This allows the cell to concentrate iodine 20 to 40 times more than the level found in the plasma. A number of thyroid disruptors, chiefly perchlorate, thiocyanate, bromate and nitrate, compete with iodine for binding to the NIS protein. This competition results in less iodine getting into the follicular thyroid cell and thus less production of thyroid hormones.

Inadequate production of T4 by the thyroid gland.

To produce thyroid hormones, the thyroid gland must have adequate supplies of iodine, protein (chiefly Tyrosine) and several co-factors, including selenium, zinc, Vitamins C, A, E, B12 and alpha-lipoic acid (also known as ALA or Thioctic Acid). The most common limiting factor is Iodine.

Iodine

For over fifty years, iodine deficiency has been known to be the primary cause of hypothyroidism. While most people believe that iodized salt has solved the problem of iodine deficiency in this country, many researchers do not believe this to be the case. For one thing, only about half the population uses iodized salt. For another, many people are on low-salt diets. More importantly, iodization of salt assumes the standard need for iodine to be 150 micrograms per dilution for adults. Compare this to the average ingestion of 13.8 mg Iodine consumed in Japan. Best case, the average American is getting 1 percent of the Iodine as the average Japanese person.

Bromine

A further problem with Iodine is that we are no longer getting Iodine in all our baked goods. Up until the 1980’s, Iodine was added to flour to strengthen the dough and allow for greater rise. So for example, in the 1960’s a slice of bread contained 150 micrograms of Iodine. Since the 1980’s, Iodine has largley been replaced with Bromine. The National Health and Nutrition Survey (NHANES) found that Iodine levels have declined 50% in the United States during the period from 1971 to 2000. Worse, Bromine binds to the same receptor sites as Iodine but Bromine is a carcinogen. Since the breasts, ovaries and prostate (in addition to the thyroid gland) concentrate Iodine or Bromine, this may be at least partially responsible for the increased rates of cancer in these organs since the 1980’s. Fortunately, England and Canada ban the use of Bromate in flour and California lists it as a carcinogen. For this reason, many bakers and millers (such as King Arthur Flour) only use iodated flour.ii

Halogens

Bromine is one of a group of similar chemicals. Iodine, Bromine, Fluorine and Chlorine are collectively known as halogens (Latin for “Salt formers”). These molecules share characteristics that make them able to interact with the same receptor sites in the body. What this means is that in place of Iodine, one of these other molecules can bind to that spot, preventing Iodine from doing it’s job.

Bromine (also bromate or bromide) is not only found in breadstuffs, it is in flame-retardants and thus is found in most furniture fabrics, carpeting, etc. It is used as a fumigant on crops and also a disinfectant in swimming pools. It can also be found in sodas and many prescription items.

Fluoride is added to the water supply and to toothpaste. In addition to interfering with thyroid hormone function, fluoride is implicated in causing rickets, hip fractures, bone cancer and death. Sodium fluoride is used as rat poison.

Chlorine is a widely used disinfectant (also added to our water supply), is in many cleaning products (such as Cloroxtm) and is found in many pesticides and other environmental pollutants. These pollutants are ubiquitous. One study of 5,994 Texans found that 99.5% of those tested had significant levels of organochlorine pesticide (DDE) residues in their blood. An Environmental Working Group study tested cord blood from 10 infants born in US hospitals in 2004. A total of 287 toxic compounds were found, including 147 PCB’s (polychlorinated biphenyls) and 212 chlorinated pesticides. These toxins bio-accumulate in the fat stores of the body, becoming increasingly concentrated with age.

Thiocyanates

Thiocyanate inhibits Iodine uptake into the thyroid by interfering with the NIS. The half-life of thiocyanate is around six days. Brassica family vegetables (broccoli cauliflower) contain thiocyanate. Thiocyanate is reduced by cooking and only about half of it is absorbed in the GI tract. Cigarettes on the other hand are a greater source of thiocyanate. The breast milk of smokers has been found to have four times more thiocyanate than that of non-smokers and half as much Iodine. The take-home message is to avoid smoking and second-hand smoke, and to cook brassica family vegetables.

Nitrates

Nitrates are found in many good foods such as lettuce, beans, squash, beets and carrots. Nitrites are added as a preservative to prepared meats and fish, and nitrate runoff from agriculture is in the water supply. Nitrates also interfere with Iodine uptake by the thyroid but their half-life is about five hours. Cooking also reduces the nitrate content of vegetables. Using a water filter and cooking vegetables can reduce nitrate load. Consuming additional Iodine can counter the effects of thiocyanates and nitrates.

Inadequate conversion of T4 to T3 in the tissues.

As discussed earlier, conversion of T4 to T3 requires a selenium-dependent enzyme called I 5’ deiodinase (Type I). Deficiency of selenium can result in a lack of this enzyme and as a result, a lack of T3 despite normal circulating levels of T4. Besides selenium deficiency, many other substances can block the activity of I 5’ deiodinase, including cigarette smoke, pesticides, plastics, heavy metals and even some foods.

Of the factors listed above, the most important blockers are the heavy metals, mercury, cadmium and arsenic). This is because these heavy metals bind with the enzyme I 5’ deiodinase and prevent it from removing one iodine from the appropriate ring of the Tyrosine-Iodine complex (T4). While healthy foods like tofu and broccoli weakly bind with the enzyme, heavy metals form very tight bonds that are slow to release. The half time of mercury excretion from the body is over two years. That means if you are exposed to mercury today, in two years, half of it will still be in your body. In four years, one quarter of that mercury will still be in your body!

After iodine deficiency, the most important nutrient deficiency is selenium. This is because the enzyme I 5’ deoiodinase is made from selenium. Deficiency can cause a “14-fold decrease” in T4 to T3 conversion.iii Though Selenium deficiency must be severe to cause a deficiency of I 5’ deiodinase,iv insufficient Selenium increases risk of auto-immune thyroiditis because Selenium is needed to make the protective anti-oxidant enzyme glutathione peroxidase.

The next most important group of thyroid disrupters is plastics and pesticides such as DDE, BPA, Dioxin, bromates, etc. These also have a very long life. For example, DDE, a breakdown product of DDT (which was banned in 1972) has been found in samples of breast milk around the world, sometimes at levels exceeding what would be allowed on the market in a commercial milk product. These toxins accumulate in fat stores and concentrate up the food chain, ultimately in animal products that we consume.

There is some evidence that elevated levels of the stress hormone cortisol and also of insulin can inhibit the conversion of T4 to T3.v

Auto-immune destruction of the thyroid gland or its hormones.

Hypothyroidism is frequently the result of auto-immune destruction of the thyroid gland or it’s products. The auto-immune diseases of the thyroid are Grave’s disease and Hashimoto’s thyroiditis. The lab tests to detect and monitor these conditions are anti-thyroglobin antibodies and antimicrosomal antibodies.

What are the symptoms of hypothyroidism?

Since thyroid hormone is necessary to make energy, the primary symptoms are fatigue and cold. However, thyroid hormones have many other direct effects and also affect activity of other hormones.

I created a symptom survey to use with my patients. The way I use this survey is to total the answers in the “Yes” column. A total score over 10 is suggestive of hypothyroidism. Count the number of “Yes” answers. A number greater than 10 suggests further investigation is warranted.

I am tired much of the timeYesNo
I often have headaches in the morning that wear off during the dayYesNo
My skin is dryYesNo
My hair is thinYesNo
I feel stiff and achy in the morningYesNo
I waer socks to bed to keep my feet warmYesNo
I use moisturizing lotion on my arms, legs or bodyYesNo
I have difficulty losing weight or avoiding weight gainYesNo
I tend towards constipation (less than one bowel movement a day)YesNo
My fingernails are brittleYesNo
I am not very interested in sexYesNo
My hair seems thin and breaks easilyYesNo
I feel depressedYesNo
I have difficulty thinking quicklyYesNo
My reaction time seems slowYesNo
Moderate exercise makes me short of breathYesNo
I feel achy and stiff unless I exercise or take a hot shower or bathYesNo
My skin feels puffy or swollenYesNo
I feel best with more than 8 hours of sleep per nightYesNo
I feel heart palpitations or have been told I have mitral vale prolapseYesNo
I have to urinate frequently (more than 6 times per day)YesNo
I have difficulty remembering thingsYesNo
The outer third of my eyebrows has thinned or disappearedYesNo
My pulse rate is below 65 even though I don’t exercise extensivelyYesNo
I feel sleepy during the dayYesNo
I need coffee, cola or tea to think clearly in the morningYesNo
My feet and ankles appear puffy or swollenYesNo
My knees lock when I stand (rather than being slightly flexed)YesNo
I feel light-headed if I stand up too quicklyYesNo
I am double jointed (such as bend my thumb back towards my wrist or do the splits)YesNo
(Men only) I have difficulty achieving or maintaining an erectionYesNo
(Women only) I have very painful menstrual crampsYesNo

Beyond symptoms, how do we test for it?

Blood work

The most commonly used test is Thyroid Stimulating Hormone or TSH. This test measures the amount of TSH produced by your pituitary gland because presumably, the pituitary knows how much thyroid hormone you need. Doctors use this test to determine the correct dose of thyroid hormone to prescribe. If the TSH is high, this means that your pituitary is trying to raise your thyroid hormone production. If it is low, this means the pituitary is trying to reduce the amount of thyroid hormone production. As noted above, the ideal range of TSH is around .4 to 3.0 (not the upper limit of 4.5 recommended by most labs). In fact, for women wishing to become pregnant, a TSH greater than 2.5 is associated with implantation failure and early pregnancy loss.vi,vii

Most medical doctors begin by ordering a TSH. If that is normal, they generally look no further because the indication for prescribing replacement hormone is a high TSH. If the TSH is high (indicating that the pituitary thinks that thyroid hormone levels are low), then the doctor will likely order a T4 test next.

A more comprehensive panel may include; Free T4, Free T3, Thyroid Binding Globulin (TBG) and reverse T3 ( rT3). This gives a much fuller picture of where the dysfunction exists. Remember, T4 is the transport form of the hormone while T3 is the active form. While they are each bound to globulin (protein) they are not metabolically available. That’s why testing Free T4 and Free T3 gives a picture of the levels of hormone actually interacting with cells. Even this picture can be misleading because some of the T3 may be the inactive, reverse T3 (rT3) form because the deiodinase enzyme was disrupted by exposure to heavy metals, plastics or other pollutants. If rT3 is elevated, hair Mercury levels (Doctors Data) and serum GSH are additional tests that may be employed.

If auto-immune thyroid disease is suspected, these additional tests may be ordered;

Anti-Thyroperoxidase (TPO) Antibodies, TSH receptor antibodies (TRAb) and antithyrogobulin antibodies (Tg). particularly if the patient has hypothyroid symptoms despite normal TSH, Free T4 and T3 tests.

Physical exam

  • The single most distinguishing sign of advanced hypothyroidism is thinning or loss of the lateral third of the eyebrows. This can advance to the point that only the medial third of the eyebrow remains.
  • Thinning of head hair, both in terms of the number of hairs and the thickness of each individual hair is another strong indication.
  • Dry skin is most readily seen on the calves and forearms, though frequently, the earliest indicator is dry, cracked heels.
  • Obesity is another possible indicator, particularly if accompanied by fluid swelling in the feet and legs.
  • Ligamentous laxity is another sign. You can test the tone of the ligaments by asking the patient to bend their thumb backwards or touch their palms to the floor.
  • When testing reflexes, you may note slow reflexes in hypothyroid individuals.
  • Low blood pressure is another sign. This can be felt in the pulse but can be quantified with a blood pressure cuff. A further test is to take blood pressure lying down, then standing. In a normal person, the blood pressure will not fall when rising from a lying to standing position and may in fact rise 5 mm Hg. In someone with adrenal fatigue/hypothyroidism/poor sympathetic tone (or a number of other medical conditions) the blood pressure will drop when rising to a standing position. A systolic drop of 20 points or a diastolic drop of 10 points is defined as orthostatic hypotension.viii (A drop of 20 points may indicate Cushing’s Syndrome (excessive cortisol production). Additional signs associated with Cushings Syndrome include a round or “moon” face, fat deposited above the collarbone and in the upper back “dowager’s hump”, dark pigmentation in the creases of the hands, purple stretch marks, obesity in the trunk but muscle loss in the arms and legs).ix
  • Heart palpitations. More than two “skipped beats” per minute is abnormal and may be due to hypothyroidism.
  • Multiple areas of point tenderness. Hypothyroidism is essentially the same as chronic fatigue syndrome and fibromyalgia.x

Basal Temperature

By far the most important test of all is to take your temperature every morning when you wake up and write down the number. Do this every morning for at least a week.

Normal temperature is 98.6 degrees. The range of normal is a full degree plus or minus 98.6. If the your temperature is consistently below 97.6, a hypo-metabolic condition is present. After a few days or weeks of intervention, this test can be repeated to get an indication of whether or not the treatment is working.

This test is cheap, effective and empowers you to track your progress. The importance of this test is that, regardless of blood test results to the contrary, if the temperature is low, the metabolism is low. An analogy I use is that, “You can measure the gas or oil in your car but if the engine is cold, it isn’t running”. If the temperature is low and you don’t feel good, keep looking until you find the problem.

(In the 1970’s, the basal temperature test was popularized by Broda Barnes MD, whose books, “Hypothyroidism – the Unsuspected Illness” and “The Riddle of Heart Attacks Solved” posited that as much as 40% of the US population was suffering from hypothyroidism and that cardiovascular disease, including high cholesterol is a result of hypothyroidism.)

Differential nutritional diagnosis

To treat the hypothyroidism nutritionally, we need to understand thyroid hormone deficiency from a biochemical point of view. That understanding allows us to diagnose and intervene in a more holistic way. The main nutritional interventions are to screen for and treat iodine deficiency and/or halogen excess, to screen for and treat problems with conversion of T4 to T3, chiefly heavy metal intoxication, and to screen for and treat organochlorine toxicity. We should also determine if the hypothyroidism is due to auto-immune thyroid disease such as Grave’s or Hashimoto’s.

Iodine deficiency/Halogen excess

Iodine deficiency can be screened using hair or whole blood trace-mineral analysis. These are also useful tests to screen for selenium and zinc deficiency as well as toxic amounts of mercury, arsenic, cadmium and lead. A more specific test for Iodine deficiency and halogen excess is the Urine Halides test. In this test (available through Doctor’s Data in Chicago), patients take 50 mg of Iodine by mouth, then collect their urine for 24 hours and send a sample to the lab. This test assumes that if the patient has all the Iodine needed, he or she will excrete 90% of the ingested Iodine in the urine. Greater percentages of iodine retained by the body suggest greater levels of Iodine deficiency.

T4 to T3 conversion

If T4 is not being converted to T3 by Type I or II deiodinases, Type III deiodinase will convert T4 to reverse T3 (rT3). A blood test for rT3 can be ordered from many labs.

Remember, converting T4 to T3 requires a selenium-dependent enzyme (Type II or II deiodinase). Tissue samples (hair or blood) can be examined by atomic absorption mass spectrometry to determine levels of normal nutrients such as selenium and also toxic elements such as mercury. These tests are also performed by Doctor’s Data. You can order test kits by calling 800-323-2784.

GSH

An indirect way to measure the level of organochlorine burden (from pesticides, plastics, flame retardants, etc.) is to measure GSH (Glutathione). GSH is the most abundant and most important intracellular antioxidant. GSH is involved in the detoxification of heavy metals, toxic halides and organochlorines. A low level of GSH implicates a high body burden of these toxins and predicts a difficult detoxification process. Doctor’s Data offers a blood test to accurately assess GSH levels. If levels are found to be low, supplementation with whey protein, alpha lipoic acid, curcumin, magnesium and N-Acetyl Cysteine (NAC) have been found to effectively increase GSH levels.

Supplementation and detoxification

In addition to drinking more water, consuming more fiber, getting aerobic exercise and taking the GSH supporting nutrients listed above, there are other nutritional interventions that may help protect and repair your thyroid funciton.

Iodine

If Iodine levels are sub-optimal and other halides are high, the best treatment is to supplement with Iodine, either as tablets or as Lugol’s Solution. Lugol’s is potassium iodide in water. It was first compounded in 1829 and has been used as an antibiotic and disinfectant ever since. One drop of 5% Lugol’s Solution contains about 6.25 mg of Iodine. It is available over the counter in Canada and Mexico or online. Tablets equivalent to two drops of Lugol’s Solution are available under the trade name Iodoraltm. Dr David Brownstein MD uses between one and four tablets of Iodoral with his patients, dosed according to results of the Urine Halides test. I never use more than one per day.

Many people consume seaweeds (nori, kelp, hijiki, wakame) to get Iodine. These are available in Japanese restaurants, grocery stores and as powdered supplements. Seaweeds are a source of Iodine and other nutrients, including compounds that aid in detoxification. Unfortunately, they also contain Bromine. For that reason, I don’t recommend them as a treatment or preventative for hypothyroidism.

Unrefined salt such as sea salt is also helpful in eliminating toxic halides. Salt is mostly Sodium Chloride. The chloride portion can displace other toxic Chlorine compounds in the body. Sea salt contains all 72 minerals found in the sea and in your bloodstream in roughly the same proportions as are found in your blood. Traditional Asian foods that utilize sea salt are Miso and Tamari. These foods are made by combining beans, grains and sea salt in a jar and allowing them to ferment. The fermentation process forms complexes of the salts with the proteins of the beans and grains. Excess salt can cause high blood pressure, so again, I don’t think salt is as good as taking Iodine. With both salt and seaweeds, use them to taste, not as a medicine.

Heavy metal detox

Similar to the way halides like Bromine bind to receptors meant for Iodine, the heavy metals, Mercury, Arsenic and Cadmium bind to receptors meant for Selenium and Zinc. Raising levels of Selenium and Zinc helps to displace heavy metals. GSH precursors like whey protein and alpha lipoic acid can allow metal detoxification with minimal side effects.

Supportive strategies include increasing dietary fiber, exercise, drinking water and sweating. Increasing dietary fiber traps toxins excreted by the liver through the bile. Exercise mobilizes fats, increasing turnover and release of stored toxins. Water dilutes toxins, facilitating elimination through the kidneys and skin. Sweating is a great way to eliminate toxins. Many holistic practitioners use far infrared saunas and other means to increase sweating.

Caffeine and Caffeine Substitutes.

As noted earlier, caffeine acts in a manner similar to thyroid hormone. Many undiagnosed hypometabolic people depend on coffee to wake up and do their work. In a perfect world, they might instead get 8 hours of sleep or reduce their stress, though I understand that is very unlikely to happen. I suggest that we think of coffee as a drug to palliate the effects of high stress and not enough sleep. Like all drugs, coffee has it’s side effects. Many people rely on coffee, caffeinated soft drinks, etc. to get through their day. If you need caffeine, I recommend green tea or chocolate instead of coffee or colas. Also, for people with intact thyroid glands that are just not performing up to par, the less we rely on taking thyroid hormone substitutes like caffeine, the less we are asking our thyroid glands to do on their own. Your thyroid will produce less thyroxine if you are drinking coffee or colas. This is not to say that anyone should quit drinking coffee suddenly. I am only suggesting that we take the lowest effective dose to maintain healthy function and that we choose the stimulant with the least side effects.

Green Tea

Other strategies include using chlorophyll and foods that contain chlorophyll to increase excretion of fat-soluble toxins in the feces. Additionally, polyphenols in white and green tea have been shown to increase the excretion of fecal fat, carrying those toxins out of the body. Green tea has a long history of safe use in Asian cuisine and medicine. In addition to helping to excrete toxins, the caffeine in tea acts like T3. This is because caffeine increases the circulating levels of the catacholamines epinephrine and norepinephrine and increases their intracellular effects. The intracellular effect occurs because caffeine inhibits the intracellular enzyme (phosphodiesterase) that inactivates cAMP (cyclic adenosine monophosphate). Less inhibition means less breakdown of cAMP. The resulting increase in cAMP prolongs the effects of catacholamines.

This means tea can be a helpful transition to a healthy metabolic state. You can use green tea to help you feel better while working to improve your thyroid function. However, any form of caffeine, including chocolate, can lose its beneficial functions when used regularly because the body adapts and becomes dependent. For that reason, I suggest only using caffeine as needed.

Green tea raises metabolic rate in an amount greater than can be attributed to its caffeine content. This may be due to the epigallocatechin gallate found in green tea. That compound plus theoflavins in green tea are thought to be responsible for reported anti-cancer effects.

Green or white tea is a far better source of caffeine than coffee for a variety of reasons. For one, the caffeine in tea is bound in a double molecule that has to disassociate before it can interact with your body. This makes the caffeine in green tea hit your system in a time-released manner compared to coffee. Coffee is not bound as a double molecule. Furthermore, coffee has a number of additional compounds that cause other health problems, everything from bladder irritation to irregular heartbeats.

Chocolate

Chocolate is in my opinion, even better. While the caffeine in coffee reaches peak levels in 30-60 and has a half-life of 2.5 to 5 hours, the half life of theobromine (the caffeine like substance in chocolate) reaches peak levels in 2-3 hours and has a half life of 7-12 hours. This is in part because it is fat-soluble rather than water soluble like coffee. Chocolate is also about a tenth as potent as coffee.

Additionally, very dark chocolate has many health benefits. A Canadian study of 44,500 people found that those who ate one serving of chocolate per week were 22% less likely to have a stroke than people who ate none.xi Even eating up to 100 grams of chocolate per day is linked to a lower risk of heart disease and stroke.xii Also, consuming chocolate also improves athletic performance in cyclists, probably due to the flavenoids in chocolate that enhance the release of nitric oxide in the blood vessels.xiii Nitric oxide dilates blood vessels and reduces oxidative damage in the blood vessels.

Prevention

Avoiding tobacco smoke, using a water filter for all drinking and cooking water, using only organic fruits, vegetables and grains wherever possible, using iodinated bakery products can help prevent ingestion of thyroid disruptors. Goitrogenic foods should be eaten with moderation. These include soy, flax, kale, canola oil, and raw cruciferous vegetables such as broccoli, bok choy, cauliflower, cabbage, brussels sprouts, mustard greens and others. The cruciferous vegetables are healthy foods but should be eaten cooked rather than raw. Ground flax seed can be very effective in lowering your serum choleterol and reducing the risk of hormone dependent cancers, but I wouldn’t recommend more than 1 TBS per day. There is no reason to consume Canola oil other than it is added to so many prepared foods and is thus very hard to avoid. Additional measures include avoiding toxic chemicals like cleaning products and pesticides and using a sauna or exercise to increase sweating.

Acupuncture and Chinese herbs

Acupuncture is known to normalize neurotransmitters, cytokines, hormones and thus most bodily functions.xiv Traditional Chinese methods of point selection customized according to patient syndrome are the best guide in this regard. Moxa (a hot coal of Artemesia Vulgaris) is traditionally applied near REN4-6, ST36, SP6 and on the back at UB23 and GV4, with additional points added based on syndrome differentiation.

Many tonic formulas raise metabolic activity. In traditional Chinese medicine, symptoms and signs are the basis for prescribing, not lab tests. My favorite formula for hypometabolism (thyroid and/or adrenal insufficiency) is Ginseng and Astragalus (Bu Zhong Yi Chi Tang). It was traditionally used for weakness and fatigue after an illness.xv One of it’s indications is faintness upon rising from a recumbant or sitting position (blood pressure drop). The Astragalus in this formula also provides a lot of Selenium. Glutathione Peroxidase is a Selenium dependent enzyme that protects the thyroid gland from oxidative damage, reducing the risk of auto-immune thyroid disease. The whole formula is as follows:

Huang Qi (Radix Astragali)

Zhi Gan Cao (Radix and Rhizoma Glycyrrhizae Prep)

Bai Zhu (Rhizoma Atractylodis Macro)

Ren Shen (Radix and Rhizoma Ginseng)

Dang Gui (Radix Angelica Sinensis)

Chen Pi (Pericarpium Citri Reticulatae)

Sheng Ma (Rhizoma Cimicifugae)

Chai Hu (Radix Buplerui)

Shen Jiang (Rhizoma Zingiberis Recens)

Da Zhao (Fructus Jujubae)

The licorice (Glycyrrhizae) in this formula slows the breakdown of cortisol, delaying the onset of fatigue.

From a Chinese medicine perspective, thyroid hormone insufficiency is functionally equivalent to Chi Xu (energy deficiency) and Yang Xu (heat deficiency) with further diferentiation possible according to affected organ systems, i.e., Spleen Qi Xu would include digestive symptoms such as bloating, loose stools, hemorroids, poor appetite/craving for sweets in addition to the other symptoms associated with hypothyroidism.

Summary

The best way to get started is to take the symptom survey above and if your score suggests a problem, start measuring your basal temperature. If your temperature is consistently below 97.6, schedule a meeting with your doctor and bring the results of your basal temperature and symptom survey. You can then discuss whether lab testing would be appropriate.

In terms of labs, a TSH is helpful, but a panel including TSH, T4, T3, rT3, would give a fuller picture. If rT3 is elevated, consider the Hair Mineral Analysis (includes heavy metals) and Urine Iodine tests, both from Doctor’s Data. Adding GSH to the blood testing would quantify the ability of the body to deal with toxic load. Auto antibody tests could be added if auto-immune thyroid disease is suspected.

Nutritional treatment strategies including hair sample testing for deficiency of Iodine, Selenium, and Zinc, as well s testing for excess of the heavy metals Mercury, Arsenic and Cadmium. Iodine sufficiency can be tested more reliably with a provoked urine test. If mineral deficiencies are noted, supplementation can then be taken with re-testing six to twelve months later.

If heavy metals were found or if GSH blood levels were found to be low, detoxification with water, fiber, supplementation with whey protein, alpha lipoic acid, curcumin, magnesium and N-Acetyl Cysteine (NAC) may be helpful.

In all cases, mild aerobic exercise is recommended, starting slow and building up gradually. If you feel exhausted the day after exercise, you did too much. Cut your exercise level to the point that you feel better the next day, but by all means, don’t stop exercising.

Small amounts of coffee, tea or chocolate may be needed to get you through your day while your thyroid is getting stronger, but the ultimate goal is to minimize dependency. Chinese herbs may also provide a bridge to wellness, but again should not be used long term.

Getting 8 hours of sleep will cure many people of mild hypothyroidism.

If you are reasonably healthy and want to raise your metabolic rate, exposure to cold can be helpful. Like exercise, this has to be started slow and increased slowly.

Continue measuring your temperature and pulse rate to evaluate your progress. The goal is to get your temperature to 98.6 when you awake in the morning, without raising your pulse rate above 72 bmp. You will be able to track the effects of any changes you make in your daily routine, sleep, exercise, caffeine, supplements, etc. My goal in writing this article is to empower you to do the things you can do and assist your doctor in helping you to recover.

Best,

David Wells, D.C., L.Ac. MS (Nutrition).

 

 

 

 

 

ihttps://www.thyroid.org/media-main/press-room/

iihttps://www.kingarthurflour.com/professional/bromate.html

iiihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1148561/

ivhttps://www.ncbi.nlm.nih.gov/pubmed/10875250

vhttps://www.ncbi.nlm.nih.gov/pubmed/2838733

vi Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.

Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, Pearce EN, Soldin OP, Sullivan S, Wiersinga W, American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and P ostpartum.

Thyroid. 2011 Oct; 21(10):1081-125.

vii Subclinical hypothyroidism and pregnancy outcomes.

Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG

Obstet Gynecol. 2005 Feb; 105(2):239-45.

viiihttps://www.aafp.org/afp/2011/0901/p527.html

ixhttps://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

xMetabolic Treatment of Fibromyalgia John Lowe, D.C. 2000

xihttps://www.aan.com/PressRoom/Home/PressRelease/799

xiihttps://heart.bmj.com/content/101/16/1279

xiiihttps://jissn.biomedcentral.com/articles/10.1186/s12970-015-0106-7

xivhttps://www.evidencebasedacupuncture.org/present-research/acupuncture-scientific-evidence/

xvhttp://www.acupuncture.com/herbs/buzhongyi.htm

Japanese maple tree

Take Charge of your Waistline

Measuring your waistline is a lot easier and cheaper to do (not to mention less painful) than getting your cholesterol tested, but it reveals much the same information. As a consumer of health care, I’ve always wanted to have simple, do it at home tests and treatments for health conditions. Here is one I want to share with you.

As an absolute measure, the waistline for women should not exceed 35 inches. For men, the upper limit is 40 inches. Why is that? The Nurses Health Study was one of the largest and longest studies that looked at the relationship between waist size and death from heart disease in middle aged women. This 16 year study of 44,000 women found that women with waist sizes of 35 inches or higher had nearly double the risk of dying from heart disease compared to women who reported the lowest waist sizes (28 inches or less). Double.i

Furthermore, women with the largest waists had a similarly high risk of death from cancer and from any cause compared to women with the smallest waists. The risks increased steadily with every added inch around the waist.

Having normal weight and a large waistline doesn’t help. In fact, normal weight women with a waist of 35 inches or higher had three times the risk of death from heart disease compared to normal weight women whose waists were smaller than 35 inches. Triple.

As long as you have your tape measure out, let’s talk about waist to hip ratio. If you measure your waist and your hips, you can compare the numbers and come up with your waist to hip ratio.

Waist/Hip Ratio

The World Health Organization states that abdominal obesity is defined as a waist to hip ratio above .90 for males and above .85 for females. The gender difference is because women normally have larger hips than men.

The ratio is: Waist in inches divided by Hips in inches.

As an example, a woman with a 28 inch waist and 36 inch hips would have a ratio of 28/36 = .77 (well below .85). As you can imagine, she would be considered attractive. This is because we are wired to see that fertility and better health outcomes are expected with a healthy waist to hip ratio. If a larger woman had measurements of a 32 inch waist and 44 inch hips, the ratio would be 32/44 = .72  (an even better ratio). As you can see, a ratio accounts for various sized people. It’s only when the ratio approaches equal, or that the waist is larger than the hips that we get into trouble. In the first example above, suppose the woman with the 36 inch hips gained weight to where her waist was 34 inches and her hips were 37 inches. 34/37 = .92 (This is above the safe limit of .85).

 

Despite the angst many women feel about having large hips, they represent no adverse health outcomes. Hips (under the influence of progesterone) store water and fat because childbirth and nursing require a lot of both. Big hips aren’t a problem for your health and in most cultures are considered sexy (for good reason because again, they signal fertility).

After smoking, abdominal obesity is the single greatest modifiable risk factor for all the major killer diseases of modern times. Most premature deaths are related to metabolic syndrome. Waist measurement and waist to hip ratio are the easiest ways to monitor these risks.

So how do we measure?

You will need a cloth tape measure (Metal tape measures just don’t conform well enough to your shape). To measure your waist, slide your hands down your sides to reach your last rib. This should be the narrowest part of your waist. Note that this is above the level of your navel, not at the waistline of your jeans. Wrap the tape around at this circumference and take your measurement.

To measure your hips, find the bones at the sides of your hips and wrap the tape around at that level. Keeping the tape level will include much of the muscular part of your butt. The fattier part of your butt (if you have that) will be below this level.

The fact that you will always use bony landmarks to measure yourself means that your measurements can be consistent over time. I wouldn’t recommend measuring yourself more than once a week as changes happen very slowly. As you can read from the statistics above, these are very important measurements for a long life and good health.

Body Mass Index.

Another commonly used measure is Body Mass Index (BMI). This is the measure used by the government and life insurance companies use to determine whether you are underweight, normal, obese or morbidly obese. The formula compares your height and weight. This method has advantages and disadvantages. A disadvantage is that very muscular individuals like weightlifters are classified as obese using this method, even though they may have very low body fat. They just have more muscle than most people. Not a problem. Muscle is like money in your metabolic bank.

BMI does however have a couple of advantages. One is that it is easy to get the information. The average person usually knows their height and weight. The big advantage though is that it is more accurate for the morbidly obese compared to measuring waist and hips. This is because as individuals get fatter, their abdomen sags below the belt line. To learn your BMI, fill in the fields below:

 

The normal BMI for men and women is between 18.5 and 24.9. If you fall into this range, congratulations – keep up the healthy lifestyle.

If your BMI is below 18.5, you are considered underweight. This is not good. There are increased risks of premature death associated with being underweight. Sometimes underweight is caused by other conditions such as anorexia, malnutrition/malabsorption syndromes, smoking, cancer, lung or gastrointestinal disease. There is such a thing as being too thin.

If your BMI is between 25 and 30, you are considered to be overweight. Health risks increase with increasing weight. A BMI of 25 to 27.5 is associated with a 7% increase in the risk of premature death. A BMI of 27.5 to 30 correlates with a 20% higher risk.

If your BMI is between 30 and 39.5, you are classified as obese. A BMI between 30 and 35 equals a 45% increase in risk of premature death. A BMI of 35 to 40 is associated with a 94% increased risk of premature death!

If your BMI is over 40, you are classified as morbidly obese. BMI in the range of 40 to 60 equals a nearly three fold increase in the risk of premature death.ii

Body Composition

Perhaps the best measure of fitness is found by looking at the ratio between your weight and your waistline. This is particularly important for people who begin exercising and find that though their “clothes fit better”, they haven’t lost much if any weight. The reason this frequently happens is because muscle weighs more than fat. If exercise helps you to gain muscle while losing fat, your weight on the bathroom scale will not reflect your fat loss. This can be discouraging.

The most important measure of fat loss is reduction in waistline. Muscle gain will be reflected in increases in the chest, arms, back, butt and legs – not in the waist. In fact, increasing muscle tone in the abdomen will make the waist a little smaller. You can measure the girth of your arms and legs to track specific increases in muscle size if you are a bodybuilder, but for most of us, the simplest measure is overall weight compared to waistline. That way, we can know our percentage of body fat and our percentage of lean mass.  Let’s try this out;

 

Most people rely on the bathroom scale to measure success in getting to a healthy weight. This can be dangerous. If you lose weight without reducing your waistline, you are losing muscle mass. Muscle is what burns fat. The less muscle you have, the less fat you burn. This is why people who go on starvation diets generally end up fatter than they started once they start eating normally. Their burn rate has decreased.

I suggest you enter a target weight (such as from when you felt your best or from the BMI calculator) into the Body Composition calculator above and see what that does to your body fat percent. Then enter progressively lower waistlines until you get to a healthy percentage of body fat. The calculator will show you how much muscle you have to gain and how much fat you have to lose. Remember, your target waistline is the most important part of this equation. This knowledge can help you to plan a good diet and exercise program and also help you to track how well you are reaching your goals.

So what is a good level of  body fat? The answer is different for men and women. The following ranges are suggested by the American Council on Fitness.

First, there is an essential amount of body fat, without which your body would not function well. For men, that amount is between 2 and 5%. For women, it is between 10 to 13%.

Competitive athletes aim for a body fat range of 6 – 13% in men and 14 – 20% for women.

Fit individuals range from 14 – 17% body fat in men and 21 – 24% in women.

The average persons body fat  ranges from 18 – 24% in men and 25 – 31% in women.

Obese men have greater than 25% body fat and obese women have greater than 32% body fat.

Some authorities suggest that the percentage of body fat normally goes up as we age. I’m sure it does, just as surely as tree rings add girth to trees with every passing year, but I don’t know that it’s helpful. Every extra pound of fat adds 3 to 7 miles of blood vessels that our hearts have to push against. That can’t be good.

Come back to this site as often as you like to track your progress. Changing your body composition is challenging. All of us at Wells Chiropractic wish you the best in achieving your health goals.

David Wells, D.C., L.Ac., MS (Nutrition)

i Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women.

ii  https://www.hsph.harvard.edu/news/press-releases/overweight-obesity-mortality-risk/

 

Japanese maple over pond

Cardiovascular and Metabolic Disease

What You Need to Know to Prevent Cardiovascular and Metabolic Disease
by David Wells, D.C., L.Ac., M.S. (Nutrition)

Four centuries ago the English physician, Thomas Sydenham MD (1624 to1689) said, “A man is as old as his arteries.” That statement is as true today as it was then. Our lives are utterly dependent on the 1,800 gallons of blood pumped through our arteries each day. This miracle of oxygen delivery is so critical that we can only survive minutes without it, yet the gradual decline in our circulatory system is barely noticed. To understand how our circulatory system ages and what we can do to slow that aging process, we must first understand how it works.

The heart and blood vessels are not two separate systems like a pump and a hose. It is better to think of the blood vessels as a continuation of the heart. That is, the heart contracts, pumping the blood out into the aorta (the first artery). The aorta swells like a balloon to accommodate all that blood and then it contracts back to it’s original shape, squeezing the blood forward. This process continues as the blood divides into progressively smaller arteries until the blood vessels (by this point called capillaries) are so small that individual blood cells can only fit into these tiny passageways in single file. At this micro level, the oxygen is released from the red blood cells into the tissue cells that line the capillaries. Every single cell in your body whether it is in your muscles or your brain, is adjacent to a capillary. The oxygen given up by the blood cells is replaced with carbon dioxide released by the tissue cells and carried back to the lungs to be exchanged for more oxygen. That way, every cell is provided with fresh oxygen and other nutrients while the carbon dioxide and other wastes are carried away. Pretty amazing. It’s like 24-hour room service to trillions of cells.

On the return trip from the capillaries, the returning blood collects in progressively larger vessels called veins. The pulse pressure from the heart is no longer sufficient to propel the blood back to the heart, but each vein has one-way valves pointing towards the heart. As our skeletal muscles contract, pressure from those contractions pushes the blood back first to the lungs and then on to the heart. The whole system of heart, blood vessels, muscles, etc works together in a coordinated way to circulate the blood. The arteries must be elastic and strong to propel the blood on it’s way from the heart to the tissues. Skeletal muscle contraction is needed to the return the blood to the heart. This last point explains why the muscles of the lower leg are sometimes referred to as “the second heart.” Calf contraction (such as in walking) takes a load off the heart by propelling the venous return of blood to the heart. That’s one reason why walking is so good for your heart.

Tip number 1 walk 30 minutes or more per day.

So what happens in aging? To understand that, it helps to know a little about the structure of the arteries. The arteries are made of three layers. The innermost layer is called the “intima”. To help remember the name, think of this inner lining as being “intimate” with the blood itself. The endothelial cells that line the intima sense changes in the blood and send signals to the middle layer to help the artery adapt to those changes. The middle layer is called the “media” and is made up of concentric rings of smooth muscle cells that contract to propel the blood forward. The outer layer is composed mainly of connective tissue and is called the “adventitia”.

In aging, the intima thickens, stiffens and accumulates plaque. The plaque is made primarily of scar tissue and cholesterol. We’ll get back to how that happens in a moment. Stiffening of the artery wall puts more load on the heart and may eventually cause it to fail. Stiffening also creates more resistance to the flow of blood and raises blood pressure. The plaque can thicken to the point of blocking an artery or a chunk of plaque may break off and cause a stroke or pulmonary embolism. An embolism is a clot that can block a blood vessel causing death to the tissues deprived of oxygen by the blockage. How this happens and what you can do to prevent it is the subject of the article (Hint, the answer is not cholesterol).

What causes thickening of the intima and plaque formation?
In a word, the answer is inflammation. What then causes inflammation? Exposure to oxidants like smoke (everything from cigarettes to pollution), rancid polyunsaturated fats and fried foods, numerous chemicals (everything from solvents, paints, plastics, gasoline, cleaning products, etc), obesity, diabetes and oddly enough, even the iron in your blood that carries oxygen to your tissues.

The way all these diverse substances provoke inflammation is a chemical reaction called oxidation. To illustrate what oxidation looks like, pour some hydrogen peroxide on your toothbrush. You will see a fizzing cluster of bubbles form on your toothbrush. What’s happening? Peroxide is an unstable combination of hydrogen and oxygen (H2O2). Peroxide tries to become stable (H2O and O2) by ripping apart bacterial cells on your toothbrush to grab an extra molecule of oxygen. That’s what creates the fizzing bubbles of water and oxygen. It also creates dead bacteria because the peroxide rips oxygen molecules away from their cell membranes.

A similar process happens in our arteries. Exposure of the intima to any oxidative chemicals (also known as free-radicals) causes cells lining the intima to be ripped apart. To repair that damage, the immune system uses specialized cells called fibroblasts that make fibers of scar tissue to bind the damaged area back together. Picture stitching a wound together. That repair process is provoked by the chemistry of inflammation. After stitching the damaged area back together, the fibroblasts grab cholesterol from the bloodstream to pack it into the spaces between the fibers of scar tissue. Why do the fibroblasts pack cholesterol into the spaces between fibers of the scar? The cholesterol forms a smoother surface on the scar, reducing turbulence in the blood. Since turbulence can form clots in the blood, this is a good thing. That is why plaque is made of scar tissue and cholesterol. Over time, the scar tissue calcifies and hardens like bone (see my article on osteoporosis for more on that).

Cholesterol
So cholesterol is just a building material? Yes, in fact it is one of the most common building materials in the body. Every cell membrane is made of cholesterol (plus omega-3 fats and a few other things). It is a building material like a brick (solid, water-proof and stable). It is also the base molecule of all steroid hormones like estrogen, testosterone, prednisone, cortisol, etc. Even vitamin D is made from it. The myelin sheaths that insulate all our nerves are made from it. The brain is almost 50 percent cholesterol. Cholesterol is not some evil foreign substance. We make cholesterol in our liver because we need it. That’s right, ninety percent of the cholesterol in our bodies is made in our livers. Only ten percent comes from our food.

So why are doctors always trying to get us to reduce our cholesterol levels? The reason is that elevated serum cholesterol is associated with increased risk of death due to cardiovascular disease. However, association is not the same as cause. To illustrate this idea, imagine you find a dead bird on the sidewalk. On closer examination, you see that there are ants eating the bird. Do you assume that the ants killed the bird? No, you don’t. Even if every time you see a dead bird on the sidewalk and there are ants eating it, you don’t assume that the ants killed the bird. Why? Because ants don’t fly and aren’t able to kill a bird. The same is true of cholesterol. Just as the presence of ants confirms that the bird is dead, elevated cholesterol confirms that the body is out of balance.

Elevated cholesterol is one of the markers of what has been referred to as “metabolic syndrome”. Other markers include elevated triglycerides (another kind of fat) and blood sugar, high blood pressure and increased waistline. In other words, the most common reason for elevated cholesterol is eating more calories than you are burning. There can be a number of reasons for this imbalance. One of those reasons is low thyroid (not enough calories burned). Lack of exercise is another (again, not enough calories burned). Too many sweet tasting foods, particularly those made with high fructose corn syrup is another (too many calories consumed). High stress plays a role (greater demand for cortisol, requiring greater production of cholesterol). Not enough fiber in the diet (fiber carries cholesterol out in the stool). The answer is less likely to be that you ate too much cholesterol. It is certainly not because you have a deficiency of statin drugs (more on that later).

Tip number 2 check your thyroid health and metabolic rate by checking your basal temperature.
Tip number 3 increase exercise.
Tip number 4 avoid sweets, especially those made from high fructose corn syrup such as in soft drinks.
Tip number 5 manage your stress through exercise, life changes, Tai Chi or Yoga, vacations, rest and adding more pleasure to your life.
Tip number 6 eat large salads and flax meal to increase your fiber intake.

Metabolic Syndrome
While you don’t hear much about this by name, this is what’s killing the majority of people in the industrialized world. The names we know metabolic syndrome by are heart disease, stroke, diabetes, cancer and obesity. Together these diseases kill over half (around fifty-five percent) of people in the United States.i Metabolic syndrome is a disease of affluence. It is only possible in a society that can afford to eat more and move less. Most of human history was spent working very hard to get enough to eat, so we are strongly programmed to like the taste of high calorie foods. If you had to run down an antelope for dinner, you would also appreciate rest and relaxation. To this day, people in the Third World burn a lot more calories than we do just trying to stay alive and they don’t get nearly as much to eat as we do. Also, the foods they do eat are high in fiber, vitamins, minerals and other nutrients – not high in sugar and fat. We have solved the problem of getting enough to eat and enough rest. Now we have the problem of getting too much to eat and too little physical activity.

The simplest measure of metabolic syndrome is your waistline. If you do nothing else with this article, get out a tape and measure yourself at the waist and the hips. Your waist should be ten percent smaller than your hips if you are a man and twenty percent smaller if you are a woman. When your waist gets bigger than this ratio, you have a significantly increased risk of getting diabetes, cancer, stroke or heart disease. In the Nurses Health Study, women who had the highest waist sizes – 35 inches or more – had nearly double the risk of dying from heart disease compared to women who had waist sizes less than 28 inches.i How long has it been since your waist was that much smaller than your hips? Think about it. The visceral fat packed around the waist is like dynamite. I see a lot of suicide bombers walking around every day. In fact, according to the CDC nearly three-quarters of men and more than 60% of woman are obese or overweight.ii

Tip number seven Measure your waistline.

So how do you measure yourself? Slide your hands down your sides until you come to the bottom rib. This is your waist. It is above, not below your navel. Wrap a cloth tape measure around yourself at this level and write down the measurement. Then, slide your hands down farther to find the widest point of your hips. Your hips should feel firm because the widest point are comprised of the bones of your hips. Wrap the tape around that area and write down that measurement. Now divide the waist measurement by the hip measurement and subtract the total from 100 to get the percent difference. So for example, if a woman measures her waist at 32 inches and hips at 40 inches, here’s how the formula looks: 32/40 = 80. 100 – 80 = 20. So the answer is twenty percent.

Another way to look at it is if your hips are forty inches, your waist should be thirty-two inches or less. So if you are up to thirty-four inches, you have two inches to lose. How many pounds is that? It’s around four pounds per inch but pounds aren’t the goal, inches are. If you were lose two inches off your waist but not lose any weight, then it is likely that you lost eight pounds of fat and gained eight pounds of muscle. That would be fabulous. So focus more on losing inches from your waist and less on losing pounds. If you lost eight pounds but your waist remained the same, that would be a disaster as it would mean you lost eight pounds of muscle. Since muscle is what burns fat, people who lose muscle in a weight loss program will gain back more weight as soon as they begin to eat anywhere near enough to satisfy their hunger. That is how extreme dieting causes extreme weight gain.

Besides the waist to hip ratio, there is an absolute upper limit to waist size to prevent all these deadly diseases. For men, that upper limit is 40 inches. For women, it is 35 inches.

“Losing inches is hard,” people say. Yes it is, but there is no better way to prevent the major killer diseases. I frequently hear, “Can’t I just take a pill to lower my cholesterol?” The answer is “Taking a pill will not help you to avoid heart disease, stroke, diabetes and cancer.”

Cholesterol lowering drugs.
Before going on, I want to repeat that cholesterol is not the problem, inflammation is the problem. Despite that, researchers have developed drugs to lower serum (blood) cholesterol in the assumption that this will lower the risk of death from heart disease (Kill the ants to save the birds?). What these drugs actually do is lower a number on a lab test without providing significant protection. They also cause serious harm.

To hear all the breathless reports on the miracles of statin drugs, you would think everyone needs to take them. You would think they will save your life or at least substantially lower your risk of death. They do not. At best, they provide a mild benefit for a subset of middle-aged men who are at high risk of heart attack. To listen to the hype, you would assume that they cut your risk of death by 80% or 50% or at least the 20% commonly attributed to placebo effect. This is not the case. One of the strongest studies in support of statins was the WOSCOPS study. This study of middle aged men treated with Pravastatin showed a 0.6% reduction in death rate. Given the price of the drug and the number of men who would have to take it to get a benefit, that would amount to 1.2 million dollars to extend one man’s life by five years.

Zero point six percent! This is the life saving, miracle drug that everyone needs to take? In my opinion, it is only a life-saving miracle for the pharmaceutical industry. Statin drugs generate 29 billion dollars a year for the drug companies. We hear a lot of press about statins. We don’t hear much about cheap, natural alternatives. How much do you think the lettuce lobby spends on advertising? Or, the flax meal consortium? Not much, I’d guess.

Combining the results of many studies gives a more accurate picture by creating a greater sample size. This is called a meta-analysis. The largest such study, a 2010 meta analysis of 65,229 participants, did not find a reduced death rate in those at high risk but without prior cardiovascular disease, for those who took statin drugs.ii

Having failed to prove that statins lower the risk of death due to heart attack, drug company researchers looked for another justification for the use of statins. Normally, researchers investigate a question without prior bias. Research may be called, “Study to determine if statins lower the risk of death” for example. That was not the case in this study. The name “Jupiter” study stands for Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin. In other words, the title of the study reveals that the researchers were biased in their intention to find a justification for the use of statins.

Despite the glowing press reports, the Jupiter Study, found that statins did not significantly lower the overall death rate in the men (that’s right, it too wasn’t tested on women) who participated in the study. There was a reduction in non-fatal cardiac events in the statin versus placebo group and the overall rate of cardiovascular deaths were lower, 0.45% for the statin group versus 0.85% for the placebo group. This was reported as “cutting the death rate in half” by the press but what was not reported is that the death rate from all causes was 27% higher in the statin group.iii In fact, there were more fatal heart attacks in the Crestor group (9 versus 6) than in the placebo group.

Something else buried in the fine print of the study is that the placebo and statin groups were not equal. The placebo group had 51 more subjects with a family history of premature coronary heart disease than the statin group. Also, there were 71 more patients in the placebo group than the statin group that had Metabolic Syndrome. These are the two greatest risk factors for dying of a heart attack. One last note on the study relates to cost. If you have to treat 180 people to prevent one death from a heart attack, factoring in the price of the product means that it would cost about $500,000 to prevent one death. If that half million were used to combat smoking or obesity, far more lives could be saved.

How did we get to this point of thinking that reducing cholesterol was going to reduce heart attack risk? Back in the 1950’s, Broda Barnes, MD wrote a book called The Riddle of Heart Attacks Solved. In it, he pointed to research showing that rabbits fed a high cholesterol diet showed no change in their health despite the fact that cholesterol is not a normal part of their diet (How’s that square with all the advice to lower your dietary cholesterol?). The research did show that when the thyroid glands of the rabbits were removed, they became obese, developed fatty deposits in their arteries and died of cardiovascular disease. When thyroid hormone was given to the surviving rabbits, the arteries cleared and their health returned to normal. In his practice, Dr. Barnes found that normalizing metabolism prevented heart disease. He primarily treated his patients using Armour Thyroid (porcine thyroid tissue). He diagnosed by asking his patients to take their temperature every morning. He adjusted the dose of the thyroid medicine to normalize their temperature at 98.6 degrees. His work was generally ignored by the medical profession and the public.

The person who really brought cholesterol to the public’s attention was Nathan Pritikin. Beginning in the early 1980’s, the Pritikin Center helped many people restore their health by teaching that a low fat, low calorie diet combined with a lot of mild aerobic exercise could dramatically reduce the risk of death from heart attack, stroke, diabetes and cancer. Pritikin’s program made the news and put the word “cholesterol” on everyone’s lips. But who wants to exercise and eat salad? The drug companies saw an opportunity.

A few years prior, in 1976, a Japanese researcher named Akira Endo found a compound in red rice yeast that interfered with the liver enzyme that produces both cholesterol and coenzyme Q10. This inhibitor is called mevastatin. In 1979, researchers at Merck isolated lovastatin from another fungus. By 1987, Merck used that research to develop the first statin drug, Lipitor. Merck patented the right to co-market their drug with CoQ10 but never did, effectively preventing any other drug manufacturer from doing so as it would be a patent infringement. In my opinion that was a crime against humanity.

What is CoQ10? It is an enzyme that is needed by the body to burn fat and oxygen to make energy. Without CoQ10, all cells would die. This was proved by the statin drug, BayCol (made by the Bayer company). BayCol was so effective at blocking the liver enzyme making both cholesterol and CoQ10 that the muscle cells in the people who took the drug died in massive numbers. So quickly did the cells die, that the waste products of these dead cells clogged up the kidneys of these patients and they died of kidney failure. After 52 confirmed deaths, BayCol was removed from the market.iv The next strongest statin drug is Crestor, the one used in the Jupiter Study.

One of the best known side effects of statin drugs is pain, weakness and muscle wasting, particularly in the legs. This is undoubtably due to the lack of CoQ10. It’s worth noting that CoQ10 is used to treat weakness of the heart muscle. It stands to reason that if the muscles of the leg are getting smaller and weaker from being deprived of CoQ10, so is the heart. The heart is after all, a big muscle. How’s that for a drug that’s supposed to save us from dying of a heart attack?

The risk of weakening the heart muscle is not just theoretical. Statins were first approved in 1987. From 1989 to 1997 the rate of heart failure in this country doubled.vi Statins may have slightly reduced the rate of non-fatal heart attacks but increased rates of death from heart failure. Heart failure doesn’t kill you all at once either. Have you ever heard the term “cardiac cripple?” That term describes a person with heart failure who is unable to walk or do many activities of daily living because their heart is so weak.

How common is the risk of muscle deterioration? The risk of catastrophic destruction of muscle tissue (rhabdomyolysis), which can lead to kidney failure and death is 61 out of every 1,000 patients who take doses of 80 mg of Lipitor. Simvistatin in doses as low as 20 mg can cause muscle destruction if taken with a common blood pressure medication, amiodirone or if it is taken within days after consuming grapefruit or grapefruit juice. The drug companies would have us believe that the side effect of muscle pain and weakness occur in around two to three percent of patients. Dr Beatrice Golomb MD, PhD is currently conducting a study. She has found that 98% of patients taking Lipitor and about a third of patients taking Mevachor (a lower dose statin) suffered from muscle problems.vii

What other side effects do statins have? How about decreased cognitive ability? “There are reports about memory loss, forgetfulness and confusion in all users of all statin products and in all age groups.”viii Studies have shown 100% of people on statin drugs show cognitive decline. Many have also suffered total or partial amnesia and other memory problems. Early tests on non-statin, cholesterol-lowering drugs found a doubling of the risk for violent death or suicide.ix This is likely because the brain is dependent on cholesterol for healthy functioning. Low cholesterol is associated with depression and rage.

Perhaps the most frightening degenerative disease of the nervous system is Lou Gherig’s Disease or Amyotrophic Lateral Sclerosis. There is now evidence showing an increased incidence of that devastating illness linked to the use of statin drugs.x The number of cases is small, but it reinforces the idea that statins are not good for the nervous system.

Why is this? As it turns out, one of the functions of cholesterol is to cement together the synapses in the brain as they form memory. Too little cholesterol in the brain is a problem.

What else? It turns out that statins also increase the risk for cataracts. This is important because cataracts are one of the leading causes of blindness. Statin users have “a 27% higher chance of cataracts than non-users.”xi

How about diabetes? According to the British Medical Journal, statins increase the risk of diabetes by up to 22%xii In the Jupiter Study, the increased risk was 27%., more than wiping out any gains in heart attack risk.

What about statins for women? For the most part, statins have not been tested in women. However, one study to specifically test statins in post menopausal women was the ASCOT study. The results of that study were that women who took statins had a 10% increase in heart attacks compared to those who took the placebo.xiii The MEGA study, a prevastatin trial, found substantially increased risk of heart disease and stroke in women under the age of 60.xiv

Speaking of women, what about risk of fetal abnormalities? Statin drugs are classified as a “pregnancy CategoryX” medication because they are known to cause serious birth defects. No woman of childbearing age should ever take statin drugs.xv Very few doctors seem to be aware of that. The drug companies are pushing for younger and younger people to take statins as a “preventative medicine”. Pfizer has even introduced a kid-friendly, chewable form of Lipitor! No kidding. Considering that children’s brains are still developing and that many of them will someday become pregnant, this is akin to genocide.

Some of the lesser side effects noted in the Physicians Desk Reference include sleep problems, sexual function problems, fatigue, dizziness and a sense of detachment, swelling, shortness of breath, vision changes, changes in temperature regulation, weight change, hunger, breast enlargement, blood sugar changes, dry skin, rashes, blood pressure changes, nausea, upset stomach, bleeding, and ringing in ears or other noises.

Still not convinced? It gets worse. The strongest predictor of death due to heart attack is the degree to which the coronary arteries are calcified.xvi A 2012 study published in the journal Diabetes Care found that those who used the most statin drugs showed the greatest increase in calcification of the coronary arteries!xvii Wow. More statins equals more plaque equals more heart attacks. That is exactly the opposite of what we are led to believe. Conversely, Vitamin K2 actually removes calcium from arterial plaque and reduces death rate from heart disease by 50%. For more on that, see my article on osteoporosis.

To sum up, statins don’t reduce your risk of death but they guarantee that you will be weaker, fatter and dumber. That’s what every aging person wants, right? Despite that, statins are the number one class of drugs prescribed in America. What can you do about it?

Tip number 8 If you are on statins, ask your doctor if you can get off. In the meantime, take CoQ10.

The irony of all of this is that there is no evidence that cholesterol causes heart disease. Elevated cholesterol is merely the evidence of metabolic syndrome. Pritikin used cholesterol levels to track progress in his program because it is more convenient and less expensive than angiography or ultrasound to track the actual amount of plaque in the arteries. Remember, the ants didn’t kill the bird. A more reliable and readily available predictor of cardiovascular risk is your waistline. Of course, there is no money to be made in empowering people to measure their waist and improving their own health through diet, exercise and lifestyle. Taking a drug to make your lab test look better is far more profitable but simply lulls everyone into complacency. “Pass me another slice of cake. My cholesterol numbers are good!”

So if statins aren’t the answer, what is? To answer that question, it’s best to go back to our discussion on how plaque forms in response to oxidation.

Oxidative Damage to the Arteries
So to review, oxidation damages the inner lining of arteries. Immune cells called fibroblasts repair that damage using scar tissue and cholesterol. The scar tissue eventually calcifies. The blood vessels no longer expand and contract to push the blood forward and instead are stiff and resistant to the flow of blood, putting stress on the heart and raising blood pressure. The blood vessels continue to narrow, reducing the supply of oxygen. If that lack of oxygen is to the muscle of the heart, the heart can be damaged or fail completely. If a chunk of plaque breaks off and blocks the blood supply to the brain, we call that loss of function a stroke or cerebral vascular accident (CVA). If the clot lodges in the lung, it is called pulmonary embolism. Anywhere a clot blocks blood delivery, tissue dies. If enough critical tissue dies, you die. I assume that you, like me don’t want that to happen anytime soon if at all.

So what can we do? First of all, stop ingesting chemicals that cause inflammation. Second, take nutrients that reduce inflammation. If you had a headache from hitting yourself in the head with a brick, the first thing to do would be to put down the brick. Next, you would apply an ice pack to your head. Sounds obvious right?

What are the causes of inflammation? If you smoke, the single biggest change you can make is to stop hitting yourself in the head….. oh, I mean stop smoking. If you work around toxic chemicals like a nail salon or welding shop, be sure you have good ventilation. To a lesser degree of importance, if you are putting artificial anything in or on your body – yes that includes most perfumes, hair products and other fragrances – stop it. If your food has a list of ingredients that require a degree in chemistry to understand, stop eating it. An apple does not have a list of ingredients. It is an apple. Same with any other real food. As the author Michael Pollan said, “If your grandmother wouldn’t recognize it, it isn’t food.”

Tip number 9 Reduce your exposure to toxic chemicals.

Reduce sugar in the diet
Driven largely by the abundance of cheap, government-subsidized corn sugar, Americans now consume more refined sugar than anyone ever has before. How much? Between 150 and 170 pounds of sugar per person, per year according to the US Department of Agriculture. To make this easier to visualize, picture 6 cups of sugar per week. I know I am not eating that much sugar, so someone is eating my share, probably in the form soft drinks loaded with high-fructose corn syrup. Soft drinks are the largest source of hidden sugars in the American diet. A 20 oz soft drink contains between 15 and 18 teaspoons of sugar. My beverage of choice is water.

Most prepared foods are also loaded with sugar. For instance, there is 1 teaspoon of sugar in every tablespoon of ketchup. Six ounces of fruit flavored yogurt can have 7 teaspoons of sugar. Before it was sweetened, yogurt was known as a “health food”. Other former health foods such as granola are often now heavily sugared. Products marketed as “Low Fat” or “Diet” have often replaced fat with sugar. Why? Because sugar tastes good. We are genetically programmed to like a sweet taste because it was once rare. It isn’t rare any longer. Too much sugar is killing us. Perhaps that’s why the Jack La Lanne (the man who made exercise a household word) once said, “If it tastes good – spit it out.”

Of the different forms of sugar, fructose is the most damaging. I’m not talking about the fructose that you might get by eating an apple. I’m talking about fructose that is added to sodas and other prepared foods. Fructose causes you liver to make fat, raise your triglycerides, cause insulin resistance and obesity.iii A high fructose diet causes fat to deposit around the heart and internal organs.iv Daily consumption of the amount of fructose in 2 and a half cans of soda causes a 28 to 87% increase in the risk of high blood pressure.

Tip number 10 Avoid sodas and other foods with high-fructose corn syrup.

Are you getting to much sugar?
If you are eating like most people, i.e. refined grains and sugars, then the answer is yes. But what if you are being more careful with your diet? How can you be sure you are careful enough? One way is to test your blood. The common tests are fasting glucose and hemoglobin A1c. It may also be necessary to test your blood sugar with a finger prick 30 minutes and 2 hours after eating to see how your body responds to sugar in your foods.

Let’s look at these tests one at a time. Hemoglobin A1c is a good measure of your average blood sugar over time. The test is based on the fact that sugar damages proteins through a process called cross-linking or glycation. You can think of glycation as being similar to cooking. Proteins harden and become dysfunctional. These dysfunctional proteins are called Advanced Glycation End-products – AGE for short because they are a hallmark of aging tissue. In fact, advanced glycation end products are associated with atherosclerosis, kidney disease, dementia, neuropathy, cataracts and elevated blood pressure.

So what does this have to do with A1c? Elevated blood sugar damages the hemoglobin in your red blood cells. Since each blood cell lasts about 90 days, the damage to a random sample of blood cells is a pretty good, three month moving average of your blood sugar levels. The higher your average blood sugars, the more damage to your hemoglobin. The American Diabetic Association says that a hemoglobin A1c level below 6 is normal, between 6 and 6.4 is pre-diabetes and anything higher than 6.4 is full blown diabetes. As with many blood tests however, there is a difference between “normal” and ideal.

An ideal hemoglobin A1c is between 4.6 and 5.3. This equals an estimated average blood glucose of 86 to 105mg/dl. As blood glucose rises from 4.6 to 5.6 you double your the risk of cardiovascular disease.v Furthermore, an article in the New England Journal of Medicine reported that compared with people who had an average blood glucose of 100, those with an average blood glucose of 115 had an 18% increase in the risk of dementia.vi Brain cells, like blood cells are also damaged by glycation.

While the A1c test is a really good measure of average blood glucose, it is not infallible and should not be used alone. For one thing, the number will appear low (false good news) if you are anemic. This means that many menstruating women will get an erroneous (falsely comforting) reading.

Perhaps the most common lab test is the fasting blood sugar. The ADA (American Diabetic Association) normal for this test is anything under 100mg/dl but ideally, it should be under 86mg/dl. Why? Because people with fasting blood glucose levels above 85mg/dl have increased risk of cardiovascular disease and diabetes. A 22 year study of nearly 2,000 men found that those with fasting glucose greater than 85m/dl have a 40% increased risk of death from cardiovascular disease.vii Another study showed those with a fasting level of 95mg/dl have three times the risk of developing diabetes as those whose level is below 90.viii Remember, these people have “normal’ levels according to your lab and the ADA.

The last test is harder but may be the most important if you have concerns about developing diabetes, heart disease or dementia. I’m speaking of testing your blood glucose 30 minutes and 2 hours after a meal. This is what diabetics do, using a finger prick and test strip to monitor glucose in response to food and exercise. When I say it is harder, that is because the test has to be performed more often and of course, it involves pricking yourself.

Why do this? Your blood sugar levels normally rise after a meal. Ideally, they rise to about 125mg/dl at peak, then drop under 100mg/dl by two hours after a meal. If it rises above 140 and stays there, glycation damage is occurring in the nerves, blood vessels, eyes, brain and kidneys. Remember, glycation = aging. If you wish to be healthy in your later years, making sure you have normal blood sugar is worth doing.

So what can be done if your blood sugar is too high? Obviously, limiting quick carbohydrates is a good start. Combining what carbohydrates you do eat with fat, protein and fiber to slow absorption can also help. Some people find they need to fast or go on a ketogenic (extreme low carb diet) for a short period of time. Another strategy is to use exercise to build muscle and to deplete muscle stores of glycogen (stored sugar). When you have depleted your muscles of glycogen, you can absorb glucose into the cells without needing insulin. I have had two Type 1 diabetic patients who have controlled their diabetes without using insulin. One was a dancer and the other walked several hours a day.

Tip number 11 Know your blood sugar levels and bring them into the ideal range.

Limit Omega-6 fats fats
Another big source of inflammation is fried or rancid oils, particularly seed oils like Canola, safflower, sunflower or corn oil. You can assume that any seed oil is rancid just from the manufacturing process. Most processed foods are made from Canola or corn oil. That’s another reason not to eat them. The first reason is that they are “processed”, meaning that all the good nutrients have been removed to make them shelf stable. Generally they are high in sugar, salt and all those unpronounceable chemical additives and preservatives. If it comes in a package or a can, you probably don’t want it.

What’s the matter with these supposedly healthy seed oils like Canola or corn oil? Manufacturers and advertisers have long promoted the health benefits of these oils because they contain polyunsaturated omega-6 fatty acids.” While it is true that omega-6 fatty acids are essential, they cause inflammation and we are already getting way too much of them. It’s almost impossible to not eat too much omega-6 fats. They are in every food that comes from a seed (like bread and other flour products) and all animals that eat seeds like corn. That would be all of them, except the few animals that freely roam a pasture, eating bugs and grass and weeds. All the beef, chicken, dairy products, pork, eggs, etc. we eat are from animals that were fed corn. These animals and animal products are loaded with omega-6 fats. Even salmon is now “farm raised” meaning the fish are fed corn! Since the majority of the food we eat is grains or animals fed grains, particularly corn, we are getting way too much omega-6 fats. We don’t need more in the form of seed oils.

I mentioned that omega-6 fats cause inflammation. That means that every disease that ends with “itis” is made worse with omega-6 fats. Inflammation is also the source of pain. More omega-6 fats equals more pain. Yum, pass the French fries!

Besides making us feel miserable, why are these oils bad for our arteries? Polyunsaturated fats have lots (“poly”means many) of open, or “unsaturated” bonds. These open bonds are looking for a hydrogen to grab and bind to themselves. Kind of like magnets picking up iron filings. They can suck hydrogen ions out of your artery walls, creating little rips in the fabric of your blood vessels.

Tip number 12 Avoid polyunsaturated oils and the products made from them. That’s just about all processed foods because these oils are cheap.

Oddly enough, the “bad” saturated fats that these polyunsaturated fats have replaced are not reactive. They don’t rip up your cells. People in this country have been told to avoid animal fat like lard or butter and instead eat fats made from seed oils. Take a look at how heart disease and cancer (that’s another story) have gone up in this country since we have shifted to eating more polyunsaturated seed oils. This shift is particularly bad for any oil that is heated. The more you heat a polyunsaturated fat, the more oxygen it picks up. This makes it even more reactive. If you heat up a saturated fat, nothing happens. It has no open bonds to react to anything.

My grandmother (like everyone else in her generation and for generations before her) kept a can of animal fat (usually captured when cooking meat) on the stove. That lard was used to grease the pan when cooking anything. It was never refrigerated. It couldn’t spoil. In moderation, it wasn’t harmful.

The best saturated fats to eat are coconut oil and butter. This is because they are short-chain saturated fats. Short chain means that they are 12 carbons long instead of 18 carbons long. Our bodies and every other animal we eat makes 18 carbon chain fats. This is what we use to make cell membranes and everything else in our bodies. 12 carbon chain fats are useless building materials – like a 6 foot long sheet of plywood in a house that has standard 8 foot tall walls. They are like scraps. Our bodies burn them up to keep us warm. We don’t store them to any degree. Eating them is very unlikely to make us fat and they don’t go rancid or cause inflammation in our bodies.

Tip number 13 It’s okay to eat saturated fats, particularly butter and coconut oil.

What other fats are good?
In addition to the short chain saturated fats listed above, fats with fewer open bonds are also good. These include olive oil, avocado and nuts. Most of these contain monounsaturated fatty acids, meaning that they have only one (“mono” means single) open bond. This means that there are fewer potential sites of oxidative damage and free radical production. While these monounsaturated fats are usually non-essential omega-9 fats, they are still an important source of calories and micronutrients.

Consider how olive oil is green in color and has a distinct smell and flavor. The color, smell and flavor is provided by minerals, vitamins and flavenoids that are important for good health. They also protect the oil from oxidation. Now compare that with the lack of color, flavor and smell in commercially prepared seed oils such as Canola, safflower or corn oil. All of the healthful nutrients have been stripped out of those oils leaving only the calories. This is comparable to how all the nutritional value of whole grains and molasses have been stripped out to make white flour and white sugar.

Like olive oil, nuts have their own distinct flavor, smell and color. It’s easy to tell the difference between an almond and a pecan. Nuts also have a lot of fiber. Avocados contain a lot of Vitamins A and E. Real food has flavor – not a list of ingredients.

Interestingly, macadamia nuts contain large amounts of omega-7 fatty acids. These fatty acids have been shown to reduce C-reactive protein (a measure of inflammation) triglycerides and LDL (“bad”) cholesterol. Omega 7’s also improve insulin sensitivity and cause an increase in fat metabolism by increasing the enzymes that help to burn fat.ix

Tip number 14 Eat nuts, avocados and olive oil instead of refined seed oils.

Essential fats
Our bodies cannot make omega-6 and omega-3 fatty acids. We must eat them. As I discussed above, we already get too much omega-6 fatty acids. They are pro-inflammatory and are found in abundance in all foods made from grains or from the animals that eat grains. What about omega-3 fatty acids?

These are also essential and are harder to come by. The highest food source is cold water fish like salmon (wild caught – not farmed), sardines, cod and halibut. The highest non-animal source is flax and chia seeds. Animals that wander around the pasture and eat grasses and bugs also have high amounts of omega-3 fats. The cattle eaten by cowboys in the 1800’s had omega-3 fatty acid levels comparable to salmon. This of course was ruined by feeding corn to cattle, which in addition to making their milk and meat full of inflammatory omega-6 fats, also makes the cattle sick so they have to take antibiotics. This practice is breeding “super bugs” that threaten to make all our antibiotics ineffective. While “pastured” meats are still expensive and harder to find, more stores are offering high omega-3 eggs from pastured chickens. You’ll notice that the color of the yolks are much richer as well due to the increased amounts of vitamin A.

So why do we need omega-3 fats? Omega-3 fats are flexible and impart that flexibility to our arteries. In fact, they add flexibility and porosity to every cell in your body. Each cell is enclosed in a cell membrane. These membranes selectively allow nutrients and wastes to move in and out of the cells. These membranes are made from cholesterol and omega-3 fats.

Like I mentioned earlier, cholesterol is used as a building block. Cholesterol is impermeable to water. If the entire cell membrane were made of cholesterol, nothing water soluble would get in or out of the cell. Nutrients couldn’t get in and waste products couldn’t get out. Cholesterol is very stable. It melts at 298 degrees F. which never happens in a living body. So in addition to the solid wall provided by cholesterol, cell membranes need to have passageways to get nutrients in and waste products out of the cell. That’s where omega-3 fats are particularly useful. Their very shape is twisted and angled like kinky hair. They can’t line up next to each other or anything else. There are gaps all around omega-3 fats. Therefore, every part of the cell membrane that is made of an omega-3 fat has space between the kinks that allow the exchange of nutrients and wastes across the membrane.

In addition to allowing each cell to “breathe”, ingest and excrete, omega-3 fats make cell membranes flexible. If you remember my description of how the heart and arteries expand and contract to pump the blood, you can appreciate how flexibility or the lack of it affects how well the arteries work.

Omega-3 fatty acids are also essential for brain function. All neurotransmitters are made from omega-3 fats. You literally cannot think, feel or function without omega-3 fats in your brain. Insufficient omega-3 fats is associated with low IQ, behavioral problems and many other conditions of the brain and nervous system. I consume them every day.

Tip number 15 Eat cold water fish, flax, chia and pastured animals, or eggs, butter, cheese, etc from pastured animals.

Iron
An oxidant that’s harder to avoid is Iron. We need Iron in our red blood cells to carry Oxygen. Iron is really great at carrying Oxygen because it has 4 open bonds. The problem is that too much Iron can cause oxidative damage to our blood vessels. How do we know this is true?

Women who are menstruating have a lower risk of heart attack than men of the same age until two years after they stop menstruating. This is still falsely used as a rationale for women to take female hormones after menopause. Men who are vegetarians such as Seventh Day Adventists have the same low risk of heart disease as menstruating women. It isn’t because they are taking female hormones. They aren’t eating meat. Meat has high levels of Iron. Men who eat meat but give blood 4 times per year have the same reduced risk of heart disease as menstruating women or vegetarian men. Get the picture? It’s the Iron. According to a study in the America Journal of Epidemiology, “blood donors had a 88% reduced risk of acute myocardial infarction compared with non-blood donors.” x

By the way, some of my patients use reddish colored salts like Himalayan or Celtic salt for it’s supposed health benefits. What makes the salt red or pink is Iron. Skip it unless you are menstruating and need Iron.

Tip number 16 Limit or avoid red meat. If you eat red meat, give blood.

Homocysteine
Another source of inflammation is an amino acid called Homocysteine, a metabolite produced in the incomplete conversion of the amino acid Methionine to the amino acid Cysteine. If you have adequate amounts of Folic acid and Vitamin B6, the conversion of Methionine to Cysteine will be complete and you will not accumulate high levels of Homocysteine.

Why is elevated Homocysteine important? Homocysteine is easily oxidized and produces Superoxide and Peroxinitrite. These potent free radicals inhibit Nitric Oxide (more on Nitric Oxide later) and damage the endothelium (inner lining of the blood vessels). Elevated Homocysteine is also associated with apoptosis (death) of muscle cells adjacent to plaque, contributing to rupture and thromboembolism. Elevated serum Homocysteine is found in 40% of patients diagnosed with premature coronary artery disease or recurrent venous thrombosis.

Tip number 17 Make sure you have adequate levels of Vitamin B6 and Folic acid.

What else helps reduce Homocysteine? Get more of your protein from plants and less from meats. “High animal-protein diet was positively associated with high tHcy (Homocysteine) concentrations, whereas high plant-protein diet was inversely associated with tHcy concentrations” xi

Tip number 18 Eat less animal protein and more plant protein.

How do you know if you have high levels of Homocysteine?
There is an inexpensive blood test.
The optimal range is 10 – 12
Moderate elevation 15 – 30
Intermediate 30 – 100
Severe > 100

Nitric oxide
If I had to name a single molecule that is wonderful for the arteries, it would be Nitric Oxide. Why is that? Nitric Oxide dilates capillaries, delivering more blood to the heart and other muscles. This lowers blood pressure and allows the heart and skeletal muscles to produce more energy. The other great thing about Nitric Oxide is that it is an anti-oxidant that prevents the initiation of atherosclerosis. It does so by preventing foam cells from infiltrating the tunica intima. In other words, Nitric Oxide prevents oxidative damage to the inner lining of the blood vessels.

Where do we get it? Nitric Oxide is produced in the vascular endothelium (and also the oral cavity). This production is stimulated by thyroid hormone and also by exercise. The amino acid Arginine converts to Citrulline which converts to Nitric Oxide with the help of Folic Acid and Vitamin C. A high food source of Arginine is nuts. A high food source of Citruline is watermelon rind. You can also purchase nutritional supplements of Arginine and/or Citruline. Some of the better products come with Folic Acid and B12.

Some Nitric Oxide is also produced by bacteria in the oral cavity. Mouthwash kills the bacteria. Mouth breathing prevents inhalation of the Nitric Oxide. If you aren’t breathing through your nose, you are losing out on some of your Nitric Oxide. Check if you have a sinus infection or other airway obstruction.

The largest amount of Nitric Oxide is produced in the inner lining of your blood vessels and that production is driven by circulating levels of thyroid hormone. Production of thyroid hormone declines with age. Incidence of high blood pressure and atherosclerosis rises with age. Coincidence? Not likely. Improving thyroid health is covered in another article.

Something we can control is our level of exercise. Production of Nitric Oxide rises with exercise.xii This is one of the reasons exercise is so helpful in preventing cardiovascular disease.

Exposure to sunlight also causes the release of Nitric Oxide from our skin. A number of foods (notably beets) contain nitrites. These Nitric Oxide precursors are stored in the skin and converted to Nitric Oxide when exposed to ultraviolet light (UVA) from the sun. I have found my systolic blood pressure drop 15-20 points after less than 10 minutes of sun exposure. My rule of thumb for sun exposure is to only expose myself when my shadow is as long as I am tall. I also wear a hat to cover my face as my face is always getting at least indirect sun exposure.  Sunlight ages the skin and is a risk for melanoma and other skin conditions but is essential for producing Vitamin D and producing Nitric Oxide. I don’t use sunscreen as it gives a false sense of security and contains chemicals that according to the Environmental Working Group may be hazardous. I would rather wear a hat or long sleeves when in bright sun. In the winter or in the morning or late afternoon when the angle of the sun is low, I expose my body to the sun as it causes the production of melanin to the point of creating a tan, not a sunburn. The melanin in our skin is our best sunscreen.

Nitric Oxide is impaired by high levels of glucose or fructose.xiii As mentioned earlier, high levels of blood sugar cause advanced glycation end-products that destroy tissue and account for why diabetics have damage to their arteries, nerves, eyes and internal organs.xiv

So what can we do?

Tip number 19 Exercise at least 30 minutes per day, at least 5 days per week.
Tip number 20 Get adequate Folic Acid and Vitamin C.
Tip number 21 Eat nuts and/or take Arginine and/or Citrulline supplements.
Tip number 22 If you are a mouth breather, see and EENT and get your airway evaluated.
Tip number 23 Consider not using an alcohol based mouthwash.

How can you tell if you have high levels of inflammation?
There is a simple and inexpensive blood test called C-Reactive Protein or CRP. A slightly more expensive and accurate version of this test is called high sensitivity C-Reactive Protein or hCRP.

Tip number 24 Get tested for hCRP

What can you do for high levels of inflammation?
First of all, follow the steps listed above. If you still have too much inflammation, or if you just want to be proactive, try taking curcumin, the active ingredient in turmeric. You can take it as a supplement or as part of your daily diet. The best way to prepare it as a food is to heat turmeric in coconut oil with a little black pepper to increase absorption. Think South Asian cuisine. Saute turmeric, black pepper, garlic, chiles and other spices in coconut oil. Then add vegetables and meat or beans. It’s what’s for dinner! By the way, ginger is a related plant and has the same active ingredient. Making ginger tea or eating jerk sauce in Caribbean cooking has a similar effect.

Tip number 25 Take turmeric is you still have markers of inflammation.

I hope that this article empowers you to prevent disease and add years of health to your life. I know that what I have written can all seem overwhelming and technical. I put in a lot of detail so you can come back and get more later. You don’t have to do it all now. Take any one tip and make a change. The life you save could be your own.

Best,
David Wells, D.C., L.Ac.

References
i Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause cardiovascular, and cancer mortality: sixteen years of follow-up in US women.
ii https://www.cdc.gov/nchs/fastats/obesity-overweight.htm
iii Dietary Fructose Consumption Among US Children and Adults: The Third National Health and Nutrition Examination Survey. Medscape J Med. 2008; 10(7): 160. Published online 2008 Jul 9.
iv J Clin Invest. 2009 May;119(5):1322-34. doi: 10.1172/JCI37385. Epub 2009 Apr 20. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans.
v Glycemic Control and Coronary Heart Disease Risk in Persons With and Without DiabetesThe Atherosclerosis Risk in Communities Study
vi Glucose Levels and Risk of Dementia
Paul K. Crane, M.D., M.P.H., Rod Walker, M.S., Rebecca A. Hubbard, Ph.D., Ge Li, M.D., Ph.D., David M. Nathan, M.D., Hui Zheng, Ph.D., Sebastien Haneuse, Ph.D., Suzanne Craft, Ph.D., Thomas J. Montine, M.D., Ph.D., Steven E. Kahn, M.B., Ch.B., Wayne McCormick, M.D., M.P.H., Susan M. McCurry, Ph.D., James D. Bowen, M.D., and Eric B. Larson, M.D., M.P.H.
N Engl J Med 2013; 369:540-548August 8, 2013DOI: 10.1056/NEJMoa1215740
vii Bjornholt JV, Erikssen G, Aaser E, et al. Fasting blood glucose: an underestimated risk factor for cardiovasculardeath. Results from a 22-year follow-up of health nondiabetic men. Diabetes Care. 1999 Jan;22(1):45-9.
viii N Engl J Med. 2005 Oct 6;353(14):1454-62. Normal fasting plasma glucose levels and type 2 diabetes in young men. Tirosh A1, Shai I, Tekes-Manova D, Israeli E, Pereg D, Shochat T, Kochba I, Rudich A; Israeli Diabetes Research Group.
ix Bernstein AM, Roizen MF, Marintez L. Purified palmitoleic acid for the reduction of high-sensitivity C-ractive protein and serum lipids: a double-blinded, randomized, placebo controlled study. J Clin Lipidol. 2014;8(6):612-7
x Https://www.ncbi.hlm.nih.gov/pubmed/9737556
xi Journal ListNutr Jv.12;2013PMC4176105
xii J Cardiovascular Risk. 1994 Aug;1(2):173-8
xiii Kimura C, Oike M, Koyama T, Ito Y. Impairment of endothelial nitric oxide production by acute glucose overload. Am J Physiol Endocrinol Metab. 2001 Jan;280(1):E171-8
xiv Vlassara H. Advanced glycation end-products and atherosclerosis. Ann Med. 1996 Oct;28(5):419-26.

Coral camelia bloom

Nutrition and Osteoporosis

Nutrition and Osteoporosis

What You Need To Know (and maybe a little more).

I am frequently asked, “Do I need to take calcium supplements to keep my bones strong?” The short answer is “probably no”, but I wish to take this opportunity to give a more thorough answer than “yes” or “no”. I believe in empowering you with the knowledge to take care of yourself. So here’s the long answer (If you are short of time, skip to the recommendations section at the end).

While it is true that bones contain much of the calcium in our bodies, and it is also true that bones tend to lose calcium and become weaker and more prone to fracture with age, it is not true that our bones fracture because of a lack of calcium. If you were to grind up a calcium tablet, you would hold a soft pile of powder in your hand. What gives bone structural integrity and flexibility, is the matrix of connective tissue and living cells that holds the calcium in place. Calcium by itself is like bricks without mortar.

Anatomically, bones are composed of:
1. The very hard outer surface (periosteum),
2. The fairly hard material that makes up the bulk of the bone (compact bone),
3. The softer inner marrow where blood cells and immune cells are made.

Bone is about one-third living cells. The rest is calcium phosphate, calcium carbonate and other minerals embedded in a mesh of tough, dense connective tissue. Though the other minerals make up a smaller proportion of the total mineral content in bone than does calcium, they are, nonetheless, essential. We are only as strong as our weakest link.

Why should we care about our bones? Thin bones (osteopenia) and porous bones (osteoporosis) are at greater risk of fracture than healthy bones. The National Osteoporosis Foundation says that “osteoporosis causes more than 1.5 million fractures annually: 700,000 vertebral, 300,000 hip, 250,000 wrist and 300,000 fractures at other sites”.i Furthermore, “an average of 24 percent of hip fracture patients aged 50 and over die in the year following their fracture.”ii Our bones reach their maximum strength in our early twenties and decline steadily every year thereafter.

Back to calcium. Yes, calcium is an important component of bone, but it is only necessary to supplement calcium if your diet is deficient in calcium relative to your needs. You may have read that the Recommended Daily Allowance (RDA) for calcium set by the United States government is 1,200 mg per day for women. However, a Swedish study of 61,433 women over a period of 19 years found that those taking 750 mg per day of calcium had the lowest risk of fracture. Increasing calcium intake beyond 750 mg did not confer additional benefit and in fact was associated with increased risk of fracture!iii A pregnant or lactating woman may need to take supplemental calcium because her need is high, but the average person eating a varied, whole-food diet should not need supplemental calcium. Of course, it is true that most Americans aren’t eating a varied, whole-food diet but even so, the calcium that comes in food is generally better absorbed than the calcium that comes in pills. Therefore, it is far better to change your diet than to take a pill.

Speaking of pills, most calcium pills are made from ground-up limestone. This is calcium carbonate from shells of ancient sea life that piled up on the ocean floor. Over millions of years of tons of compressive force these shells became the white cliffs of Dover or the Dolomite mountains. A lot of stomach acid is required to break down and absorb this form of calcium. This last fact is why “Tums” is such a terrible way to supplement calcium. The large amount of calcium in Tums neutralizes stomach acid, preventing absorption.

Just to expand on that topic for a moment, stomach acid declines as we ageiv. Could this be the reason for osteoporosis? Yes, lack of stomach acid does cause osteoporosis. That’s why people taking proton pump inhibitors to reduce acid reflux suffer from more spinal fractures than the average person.v It is likely why osteoporosis is more common as we age. It is also why many traditional cultures start the meal with an appetizer that stimulates the production of acid.

So Tip Number 1 is to eat whole foods in a relaxed, slow manner, following the customs of almost any traditional culture (starting the meal with appetizers that are sour, bitter or spicy).

Eating this way may also eliminate the need for the drugs to reduce acid reflux. Wait a minute! Stimulating acid production reduces acid reflux?

A curious thing about stomach acid is that the symptoms of “acid reflux” or GERD are actually caused by low acid, not by the high acid that most people assume is the cause. Adequate stomach acid is needed to close the ring of muscle (cardiac sphincter) that separates the stomach from the tube leading to it (the esophagus). Insufficient stomach acid (or simply eating too much) allows the food to push up into the esophagus. The esophagus cannot tolerate even a low amount of acid and so it will burn on contact with the mildly acidic food. This is how low stomach acid causes heartburn.

Hydrochloric acid (stomach acid) is of course needed to digest our food. Without it, we cannot digest and absorb protein, calcium, Vitamin B12 or a host of other nutrients. Hydrochloric acid is also needed to kill bacteria and other pathogens in the food. That’s why people on drugs to reduce stomach acid (proton pump inhibitors) are more likely to get pneumoniavi. One study found that 33,000 deaths a year are due to pneumonia acquired as a result of taking acid-reducing proton pump medicationsvii.

An even more important pathogen that flourishes in the stomach when there is insufficient acid is Helicobacter Pylori (known as H. pylori for short). Overgrowth of H. pylori due to insufficient stomach acid is the cause of stomach ulcers, gastritis, reflux, GERD and esophageal cancer.viii How common is this? It is estimated that 20 percent of individuals under the age of 40 are infected with H. pylori and 50 percent to 60 percent of individuals over the age of 60 are infected.ix Wow! That is really common. Remember, taking drugs that reduce stomach acid actually increases the risk of H. pylori infection, which in turn increases the risk of reflux, GERD, esophageal cancer, osteoporosis and pneumonia.

By the way, I noted earlier that low stomach acid impairs the absorption of Vitamin B12x. Lack of B12 is implicated in Alzheimer’s disease and heart diseasexi. Add that to the list of reasons to take care of your stomach without relying on anti-acid drugs. To learn more, read Your Bones: How You Can Prevent Osteoporosis & Have Strong Bones for Life Naturally by Lara Pizzorno and Jonathan Wright, M.D.

So, if you have enough calcium in your diet, how do you get it to become bone? I have seen many x-rays of patients whose bones in the lower back look osteoporotic, but their abdominal aorta looks calcified. The calcium that should be in the bones is not in the bone, but is in the blood vessels instead. Taking more calcium, without directing where it goes will only worsen the hardening of the arteries and stiffness in the muscles. This situation is more common than you would think. Plenty of calcium, but it is in the wrong places.

The arrows in the x-ray above are pointing to the abdominal aorta. It should not be visible. The reason we can see it is that it is calcified.

How does this happen? In addition to its role in bone, calcium helps nerves and muscles fire faster and stronger. When we are alert and active, calcium is drawn from the bones and directed to the soft tissues to help with these vital functions. The movement of calcium from the bones to the soft tissues is accomplished with the help of “fight or flight” hormones. At the end of the day, we are supposed to relax and let the “rest and digest” hormones (principally calcitonin from the thyroid gland) put the calcium back in the bones. That way, we rest comfortably at night (no twitching muscles or disturbed sleep). Picture for a moment, a traditional hunter-gatherer, farmer or laborer. Most of the day was consumed with routine physical activities. Probably a lot of sunlight, as these labors took place out doors. At night, a little story around the campfire after dinner for the hunter-gatherer, perhaps reading a book or having a nice conversation before going to bed in more recent times. How does this compare to our modern lives? We wake up to an alarm clock, grab some caffeine on the run, suffer high-stress all day, which we continue into the night with late emails, bills to pay and perhaps some graphic violence on the evening news before falling exhausted into bed. When are those “rest and digest” hormones going to be stimulated? The fight or flight hormones are turned on all the time. We can live life in the fast lane, but where are we going?

Tip Number 2: stop all work activities and overly stimulating television by dinnertime. Reconnect with your spouse. Read a book. Take a walk after dinner. Get creative. This is a time to nurture yourself and relax.

Let’s take a look at the effect of our ancestor’s labors on their bone density. The hard physical work of hunting or farming stresses and compresses the bones, stimulating the bone-forming cells (osteoblasts) to make more bone. That is why exercise is recommended to prevent osteoporosis (More on that later). As a rule, most of our ancestor’s work was done outdoors. Sun exposure causes the body to make Vitamin D in the skin, which helps move calcium into the bones, making the bones stronger. How much Vitamin D does a person make in their skin? Vacationers in Hawaii make 10,000 to 25,000 units of vitamin D in their skin per day.xii How much is that compared to what we normally get? The National Health and Nutrition Examination Survey found that over fifty million children and adolescents are getting below the recommended daily requirement of vitamin D.xiii How much is recommended? The United States government says that the Recommended Daily Allowance is 600 units. If that sounds low to you, that’s because it probably is. Research shows that an adequate supplemental intake to achieve optimal serum levels is a little over 2,000 IU’s per day.xiv

How can you know the right amount for you? There is a blood test for vitamin D that you can take to find out if you are deficient. You want to score on the high end of normal because even within the normal range, there is a strong correlation between lower (though still normal) levels of vitamin D and a host of diseases, including colon and breast cancer, xv xvi multiple sclerosis, Alzheimer’s, Parkinson’s disease, schizophrenia, diabetes, autoimmune disorders, hypertension, atherosclerosis and muscle weakness.xvii It is best to be sure that you have plenty of D, but not too much.xviii There is an optimal dose for you.

Tip Number 3 Take the blood test to check your vitamin D levels.

Is sunlight a safe way to get vitamin D? Yes, but only in the early morning or late afternoon. The sun’s rays can cause free-radical damage to your skin. Damage to the collagen in skin causes wrinkles. Damage to the DNA of skin cells can cause skin cancer. The cancer-causing rays are diminished by passing through the atmosphere. In the early morning or late afternoon, or midday during the winter, the sun’s rays are weakened by passing through more atmosphere than during the middle of a summer day. Melanin in the skin (the pigment that gives our skin color) is an antioxidant that protects against skin cancer. In other words, having a tan is protective. Eating fruits and vegetables that are rich in colorful antioxidants also protects against free-radical damage from the sun. Sunscreen unfortunately does not provide protection. After 20 to 30 minutes, the protective chemicals in sunscreen actually become free-radicals themselves.xix Furthermore, they provide a false sense of security, leading people to stay out in the sun longer than is safe. I recommend wearing a hat to protect the face and neck while getting some early morning or late afternoon sun to gradually build a tan. Stay out of the sun during the middle of the day or wear protective clothing and a broad-brimmed hat.

Tip Number 4 Get sunlight safely, several times a week if possible.

What about dietary sources of vitamin D? The highest food sources are oily fish such as salmon and swordfish, with lesser amounts in sardines, tuna and other fish. Unfortunately, those top predator fish contain large amounts of mercury.xx This is especially true of swordfish. Sardines have much lower levels of mercury because they aren’t so high on the food chain. There is some Vitamin D in meat, milk and eggs, but not very much. Land animals aren’t nearly as good a source because they are mainly composed of saturated fats and cholesterol, while the fish oil sources are very high in essential omega-3 fatty acids. These omega-3 fats are necessary to reduce blood pressure and risk of heart disease,xxi as well as improving cognitive function. The food source I recommend is Nordic Naturals cod liver oil, because it is certified mercury free.

Tip Number 5 Take one tablespoon of cod liver oil daily. In addition to providing essential omega-3 fatty acids, cod liver oil contains 1,360 IU’s of Vitamin D per tablespoon.xxii

What about all the hard work our ancestors performed? How does that help? Everyone knows that weight-bearing exercise is necessary to build and maintain bone.xxiii Why is that? The answer is that bone is continually remodeled by two types of cells. One of the cells continually eats bone. These are called osteoclasts. The other type of cell continually makes new bone. These are called osteoblasts. The eaters keep nibbling away all the time. Kind of like the adage, “Rust never sleeps”. The blasts (builders) work in response to electrical impulses created by compression on the bone. For instance, if you are walking, the compressive forces on the bones of your legs, hips and spine stimulates the blasts to make those bones stronger. To maintain the strength of bones in the arms, weight-lifting or pushups may be needed. The beauty of the way these cells work is that the bone is continually remade to serve the functions we do every day. If you were to lie in bed for an extended period of time, your bones would become weaker. It’s as if your body is saying, “If you don’t need that calcium in the bone, we’ll just use it for something else”. The body is very economical. It doesn’t maintain tissue that you aren’t using. Our bodies are active, dynamic processes, not things. We are verbs, not nouns.

This process works to our advantage. If we break a bone and it sets crooked, the “blasts” will keep strengthening where the compressive forces are and the “clasts” will keep eating the parts where there is no functional stress. This will eventually remodel the bone to become straight. (By the way, the only tissues the body keeps that are not functional are scar tissue and fat. This is because these tissues do not require energy to be maintained.)

Tip Number 6 Perform weight-bearing exercise at least three times a week.

I mentioned caffeine above. Caffeine acts like a fight or flight hormone. Drinking coffee and to a lesser extent, tea or decaf, is like taking liquid stress hormones. Caffeine moves calcium from your bones to your soft tissues. Caffeinated soft drinks are even worse. Not only do they contain caffeine and diabetes-inducing amounts of sugar, but they also have phosphoric or carbonic acid, which is what makes them fizzy. These acids dissolve calcium. If you have a child’s discarded tooth available, try dropping it into a coke and see what happens. It will dissolve and disappear pretty quickly. Tip Number Seven: Stay away from coffee and sodas.

What about drugs to strengthen bone? The bisphosphonate drugs (such as Fosomax, Boniva, etc.) commonly prescribed to treat or prevent osteoporosis work by killing osteoclasts. These drugs were originally developed to treat a kind of bone cancer called Paget’s Disease, which is a form of cancer involving over-production of osteoclasts. In other words, these drugs were a form of chemotherapy. Their half-life is ten years.xxiv In other words, ten years after taking one of these drugs, half of it is still in your system. “Okay,” you say. “So these are strong medicines. Why not take them? So what if they kill off the bone-destroying osteoclasts. What’s wrong with that?”

The problem with killing off the osteoclasts is that they are necessary for bone health. One of the functions the “clasts” perform is to keep the canals in the bone open so nutrients and wastes from the living cells in bone can flow freely. Without osteoclasts, the bone gradually becomes harder and more brittle because it is dying.xxv The bone looks better on a bone density test because it has a higher mineral content. Initially, a low dose of the drug may be helpful but continued use of bisphosphonates does not give increased benefits.xxvi The bone density test provides a false sense of reassurance at your annual physical, but harder is not always better. To get a sense of what I am talking about, imagine trying to break the “wishbone” of a turkey on Thanksgiving Day. The bone is so flexible, it is very hard to break. Wait a few days for the bone to dry out and it snaps easily. A dead bone is more brittle than living tissue. The osteoclasts that are killed by bisphosphonate drugs are needed for healthy bone remodeling. This is well stated in the Journal of Endocrinology and Metabolism, “Microcracks occur in normal bone after the kind of stresses encountered in day-to-day life. These cracks are detected by the osteocytes, which initiate a bone-remodeling unit to repair the damage. If bone resorption is strongly inhibited, the damage can’t be repaired because the osteoclasts won’t dissolve the bone.”xxvii Imagine you need to remodel your kitchen but you can’t take out the old cabinets or flooring. Putting more cabinets on top of the old ones doesn’t make sense, but that’s what you get with bisphosphanate drugs.
This bone weakening is not just theoretical. A known side-effect of bisphosphonate drugs is “osteornecrosis of the jaw”. Let’s break down that word. “Osteo” means bone. “Necrosis” means death. It is reportedly rare but I have seen two cases among my patients. Dentists I have talked with report they have seen it as well. A study in the Journal of Oral Maxillofacial Surgery reported that while most cases were due to high intravenous doses of bisphosphonates for cancer therapy, some were due to long-term oral use for osteoporosis.xxviii

Tip Number 8 Seriously question your doctor about your need for bisphosphonate drugs if they are prescribed.

I mentioned earlier that calcium isn’t the only material that makes up bone. Trace elements and other nutrients are needed to make and strengthen bone. Chief among these minerals is magnesium. Magnesium is the third most abundant mineral in your body and a very important element in bone. Trace elements needed for healthy bone formation include boron, strontium and silicon (More on these in a moment).

Magnesium is found in chlorophyll, so any colorful vegetable or fruit provides magnesium. Magnesium does compete with calcium for absorption, so excessive amounts such as found in laxatives can be harmful to calcium levels. Does magnesium increase bone density? Yes it does. One study showed a 1 to 8 percent rise in bone density when taking magnesium supplements.xxix Other studies show that severe magnesium deficiency “causes impaired bone growth, osteopenia and skeletal fragility.” xxx The average American diet is deficient in magnesium but then again, it is deficient in most nutrients. Once again, eat whole foods. I also suggest taking supplemental magnesium. I have been taking 200 mg magnesium gluconate twice a day since the early 1980s. It keeps my mind calm and muscles relaxed. How much should you take? Your body can only absorb so much magnesium at a time from your intestines. If you take more that what you need, the magnesium remaining in your intestines will attract water to itself and pass as loose stools or diarhea. Many clinicians recommend taking just short of that effect to find the optimal dose.

Magnesium is also great for insomnia. It helps prevent restless leg syndrome, muscle cramps, heart palpitations and of course constipation. Please note that magnesium is needed by your body to convert Vitamin D to the active form. If you increase your Vitamin D intake, you may need to increase your magnesium intake as well or you could suffer heart palpitations from magnesium deficiency.

Tip Number 9 Take magnesium citrate or gluconate (not oxide) 200 to 400 mg per day, or up to bowel tolerance.

Boron stimulates bone forming cells (osteoblast) and inhibits bone destroying cells (osteoclasts).xxxi Boron stabilizes and extends the half-life of vitamin D and estrogen.xxxii Furthermore, post-menopausal women who took 3 mg supplemental boron per day showed improved retention of calcium and magnesium in their kidneys.xxxiii Three milligrams isn’t much, but about half the population of the United States gets less than 1 mg boron per day.xxxiv Boron is found in raisins, almonds, hazel nuts, avocado, cashews, dates, peanut butter, Brazil nuts, walnuts, dried apricots, red kidney beans and many other foods.xxxv

Strontium is a trace element that has been proven to be very beneficial in preventing and treating osteoporosis. A research study published in the Journal of Clinical Endocrinology and Metabolism found a “39 percent reduction in vertebral fractures and a 36 percent risk reduction in hip fracture in post menopausal women over a 3-year time period. Bone mineral density increased 8.2 percent at the femoral neck and 9.8 percent at the hip.”xxxvi Strontium ranelate has been patented in Europe as a drug but is available over the counter as a nutritional supplement in this country, usually as strontium citrate or gluconate. It competes with calcium for absorption so is best taken at a different meal. Foods high in strontium include, whole grains, seafood, poultry, meats, vegetables and legumes.

Another mineral of interest is silicon. Studies have shown that 40 mg a day of dietary silicon or more is associated with increased bone density.xxxvii The average daily intake for women is around 18 mg. It is higher for men on average because it is contained in beer and men drink more beer. Before you think I’m advocated drinking a lot of beer, let me note that dietary sources include whole grains, carrots and green beans.

In addition to Vitamin D3 (the “Sunshine Vitamin”), there is another vitamin critical to bone health. That vitamin is K2 or menaquinone. This nutrient is very exciting because it not only helps to build bone, it does so by removing calcium from arteries and other places where it is causing problems. It is so effective in reducing plaque in the arteries that a 10-year study of 4,800 fifty-five-year-olds found that vitamin K2 reduced cardiac deaths by 50 percent and “all cause mortality” by 25 percent. This research is known as the Rotterdam Studyxxxviii. This correlates well with a Japanese study that found Vitamin K2 is effective as drugs in preventing osteoporotic fractures.xxxix Additionally, Vitamin K2 has been found to reduce risk of prostate cancer by 35 percentxl, Non-Hodgkins Lymphoma by 45 percentxli and hepatocellular carcinoma by 20 percentxlii.

How do you get K2? The highest food source is a Japanese food called natto. It is a slimy fermented soybean dish that I tried once (and will never try again). It is also found in fermented curds, cheeses, fish and high fat meats, dairy and eggs from pasture-raised animals. The lowest levels of Vitamin K2 were found in people who consumed the most polyunsaturated fatty acids (such as Canola oil). Smokers had the very lowest levels of K2, regardless of what they ate. The FDA recommends 90 mcg (micrograms) for women and 120 mcg for men, but researchers treating cancer have used doses as high as 45 mg (that’s 45,000 mcg) per day with good results and no side effects.xliii

I am currently taking liquid Vitamin K2 from Thorne Research. Each drop is 1 mg (1,000 mcg). I find it the easiest way to take K2, especially since I don’t eat a lot of high fat meats, cheeses or natto. Tip Number Ten: Take one drop of Thorne Vitamin K2 per day.

There is a blood test that indirectly measures Vitamin K2 deficiency. It is called uncarboxylated osteocalcin. It is a direct measure of how well the body is forming bone. However, since there appears to be no downside for overdosing Vitamin K2, I recommend taking at least 1 drop of the liquid Vitamin K2 from Thorne Research.

So in summary,
1. Eat a variety of whole foods in a relaxed manner. Use appetizers and seasonings that stimulate your appetite.
2. Take a walk or engage in another relaxing activity after dinner.
3. Get tested for your blood level of Vitamin D.
4. Get some late afternoon or early morning sunshine. Wear a hat rather than sunscreen.
5. Take one tablespoon of cod liver oil per day.
6. Do weight-bearing exercise at least three times a week.
7. Avoid coffee and carbonated beverages.
8. Question any recommendation to take bisphosphonate drugs, particularly more than a few years.
9. Consider taking 200 – 400 mg magnesium gluconate or citrate per day.
10. To get boron, strontium, silicon and other nutrients, eat whole foods. Remember, real food doesn’t have ingredients. If your grandmother wouldn’t recognize it, it isn’t food. This may require more money, time and effort (such as going to the Farmer’s Market and learning to cook from scratch, but it is worth it. The extra money will be saved in doctors bills and the extra time spent will be regained in years of good health).
11. Take one drop per day of Thorne Vitamin K2.

I hope you found this article informative and useful. I apologize if it is too technical, but I want to be accurate and I trust you have the intelligence to understand it. Thank you for reading it through.

Warmest regards,
David Wells, D.C., L.Ac., MS Nutrition

References
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