Treating an Underactive Thyroid

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The treatment for an underactive thyroid is pretty simple. Levothyroxine is a prescription medication that will work for most people. It takes time to get the dosing adjusted to get the thyroxin blood levels into a normal range. After that, it’s monitored over time and the dose is adjusted when needed.

It’s a simple process, except for those who refuse to take the medication because it’s a chemical sold as a medication. Let’s take a look at that issue.

Levothyroxine versus Thyroxin (T4)

I check the chemical structure of the synthetic and natural forms of thyroxin: they’re chemically identical with the exception of a single ion. Instead of a hydrogen ion in one bond, a sodium ion is used. That’s it. The function is the same. Not similar—the same. Levothyroxine is processed and eliminated the exact same way. While it’s made in a pharmaceutical plant, there’s no substantive difference in chemical structure or function.

There’s no reason to fear taking this medication; I do and Paula does as well. While many medications are completely synthetic and do things the body does not do, this is not one of them. However, for some people, there’s a natural alternative as long as they have no objections to pork products.

Armour Thyroid

Before the invention of levothyroxine, physicians prescribed ground thyroid glands of cows and pigs; pig thyroid is the typical source. The difference between desiccated swine thyroid and levothyroxine is that Armour thyroid contains both T4 and T3 (triiodothyronine.) The problem is that they’re not in the same ratio as found in humans, and that can make regulating thyroid hormone levels tricky.

There is one exception, other than personal preference. I got an email from a long-time reader who said she takes the Armour thyroid because levothyroxine just didn’t work. Since taking the Armour thyroid, her hormone levels are all within range.

Why would that be? My guess is that some people do not convert T4 to T3 effectively; therefore they would need both hormones, and Armour thyroid supplies both.

The Bottom Line

Based on the chemical structure and function, levothyroxine is the logical choice to treat an underactive thyroid. As I stated earlier, one ion does not make this the typical pharmaceutical; it’s as close to nature as I’ve seen. However, for those who cannot get their thyroid under control, it’s nice to have Armour thyroid as an alternative.

If you want to treat an underactive thyroid, those are the choices. There are no dietary supplements that can replace thyroid hormones. The prescription synthetic will work for just about everyone, and it makes no sense to avoid it. The truth is in the chemistry.

What are you prepared to do today?

Dr. Chet

 

Do You Have an Underactive Thyroid?

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The weather in Grand Rapids has taken a turn to winter: from 61 degrees on Tuesday to freezing today. It’s bone chilling with winds at 20 mph and can leave you feeling cold most of the day. But what if you were cold most of the time regardless of the outdoor temperature? That’s just one of the symptoms of an underactive thyroid, also called hypothyroid.

Before I met with a potential coaching client to discuss his nutrition and training, I asked him when he had his last physical and how his health has been. One of the things he mentioned was feeling more fatigued than he had in the past and that it took longer to recover. Fatigue and feeling tired are also symptoms of an underactive thyroid. Those symptoms aren’t always present, and there are other explanations for those symptoms, but hypothyroid is a possibility. Here are some of the other symptoms of an underactive thyroid:

  • Trouble sleeping
  • Difficulty concentrating
  • Weight gain
  • Dry skin and hair
  • Depression, as I mentioned Tuesday
  • For women: frequent, heavy periods
  • Muscle fatigue and painful joints

There could be other explanations, but it’s a place to begin and it’s often part of a routine blood test. Schedule an appointment and have your thyroid levels checked. If your thyroid is underactive, the question I asked Tuesday applies: should you take the medication or are there alternatives? I’ll get into that on Saturday.

What are you prepared to do today?

Dr. Chet

 

What Your Thyroid Does

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A common question: “I’ve just been diagnosed with an underactive thyroid. What can I do? I don’t want to take medication. I want a natural solution.” Usually, there’s a spicy descriptor that precedes the word medication. In response, the Memos this week are about the thyroid: What does it do? What happens if it doesn’t function properly? What are the treatment options?

The thyroid gland is a butterfly-shaped gland that resides on the front of the neck just above the collarbone. The best word to describe what the thyroid does: metabolism. How does it do that? By producing the hormones thyroxine (T4) and triiodothyronine (T3). It’s actually an elegant process that includes the hypothalamus and pituitary glands. The hypothalamus monitors the blood for status reports. When it senses a need for an increase in thyroid hormones, it signals the pituitary and the pituitary releases thyroid stimulating hormone (TSH), which tells the thyroid to increase the release of hormones.

Back to metabolism. That’s the rate at which cells function from calories burned, heart rate, muscle growth and repair, and many other processes. If the thyroid starts to fail, it can wreak havoc just about everywhere in your body. That’s what we’ll talk about on Thursday.

What are you prepared to do today?

Dr. Chet

 

Guidelines for Lowering Your Blood Pressure

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When guidelines for any condition are changed, especially one as common as high blood pressure (HBP), it raises several questions. One question would be: is this is just a way for the medical and pharmaceutical businesses to promote and sell more drugs? Another would be: will this throw more people into the pre-existing condition category and thus hinder their ability to get health insurance? I can’t answer those questions, but I can condense the American Heart Association’s 481-page guidelines to a few points.

Environmental Causes of HBP

The nice thing, if you can call it that, is that most of the causes of HBP, also known as hypertension, are environmental; they’re caused by the way we interact with our environment in a personal way. I’ve listed the causes in the order presented in the AHA’s guidelines; they’re not ranked by significance.

  • Being overweight or obese contributes to HBP. Going back to the insurance actuarial tables, there is a distinct relationship between excess body fat and HBP. This observation has been confirmed in several large epidemiological studies over the years. If you carry extra body weight, your risk for HBP is higher.
  • Excess sodium intake is associated with HBP. The reasons can vary, but let’s look at it this way. Cells must be in a specific ionic balance to function properly. If one ion, sodium, is increased, the body must retain more fluid to keep the ionic balance. When fluid levels go up, there’s an increase in the force exerted against the inside of the arteries to handle the extra fluid. Hence, blood pressure goes up.
  • One that may surprise you is that a decreased potassium level is also associated with HBP. As a nation, we are potassium poor because we don’t consume the necessary plant material in the form of vegetables and fruit. Potassium is also an ion involved in many strategic chemical reactions. Because we take in much more sodium than potassium, the balance is thrown off and BP increases.
  • Fitness level directly affects the cardiovascular system; when fitness declines, everything from the heart’s ability to contract to the number of small blood vessels is modified in a negative way. That can increase BP.
  • Finally, excess alcohol intake is related to an increase in BP. While a little alcohol may be beneficial to help reduce stress levels, too much can increase BP.

Let’s take a look at the treatment recommendations for Elevated and Stage 1 Hypertension.

Treatment Recommendations

The initial recommendations for Elevated BP and HBP Stage 1 are lifestyle recommendations. The goal in both cases is to see how the person responds to lifestyle changes first before any medications are recommended.

There is one exception: if the person’s 10-year risk for a heart attack and stroke is greater than 10%, the recommendation is lifestyle plus medication. You can take this assessment at the link in the second reference to determine your risk. However, most physicians will give you three to six months to change your lifestyle, and then reassess whether you need the medication at all.

The important point is that it’s lifestyle change that’s recommended first, not medications. So how are you going to reduce your risk?

Lifestyle Modifications to Lower BP

  • Lose weight. There’s no single correct way to do that. Use the DASH Diet or go low fat, follow the USDA MyPlate plan or go ketogenic, use the AHA guidelines or go low carb. Whatever you can do to lose weight and keep it off, do it. For every kilo (2.2 pounds) you lose, you can expect BP to decrease by 1 mmHg, both systolic and diastolic (top and bottom numbers).
  • Eat healthier by following the DASH Diet. It focuses on vegetables, healthier fats, more fruit, nuts, fish, and whole grains. You can expect to decrease BP from 3 to 11 mmHG.
  • Reduce sodium intake to 1,500 mg per day. If that’s too difficult, shoot for a reduction of 1,000 mg per day from your current intake. Expect to reduce BP between 2 and 6 mmHg.
  • Increase potassium intake by eating more foods containing potassium—and the best source is most vegetables. It’s more than just eating bananas! Expect to reduce BP by 2 to 5 mmHg.
  • Exercise regularly and that means 4 to 5 days per week. Aerobic gets the biggest results, but weight training and even isometric exercise will reduce BP between 4 and 8 mmHg. Fun activities like dancing, tennis, and playing with the grandkids count as exercise if you keep moving and increase your heart rate.
  • Reduce excess alcohol intake. Men should have no more than two drinks per day while women should have no more than one. Expect to reduce BP 3 to 4 mmHg.

Any one of these lifestyle changes doesn’t seem too hard, but you’ll get the best results by combining a few changes. As always, I’d advise a stepwise approach: change one thing, and a week or two later change another one. If you do that and stick with it, you can reduce your BP by 10 to 15 mmHg and that will get you into the desirable range—no medication necessary.

The Bottom Line

I think the new guidelines for diagnosing and treating BP are spot on. The emphasis is on lifestyle first and foremost, so these guidelines have put the ball squarely in your hands. Take the ball and run: change your lifestyle, for good. The real benefits will be how much better you’ll feel and the knowledge that you’ve reduced your risk of heart disease and stroke considerably.

What are you prepared to do today?

Dr. Chet

 

References:
1. Hypertension. 2017;00:e000-e000.
2. http://www.cvriskcalculator.com.

 

Blood Pressure: Getting It Right

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The change in the clinical guidelines for diagnosing high blood pressure, as described in Tuesday’s memo, requires that your BP reading is done correctly. That could be a problem.

In a JAMA Medical News report published in August, medical students were asked to take the BP of volunteers. Only one out of 159 got all the steps correctly. It’s not that they were poor at the actual mechanics of taking the BP, but they didn’t follow all 11 steps. Yes, 11 steps. Here they are:

  1. Five minutes of rest; that eliminates the rise in BP from getting to the office, checking in, getting weighed, etc. This is the step most often missed.
  2. The correct size cuff should be used. If your upper arms are large, and the nurse or doctor doesn’t use a large cuff, your BP reading will be higher. That’s because the bladder inside the cuff will have an artificially high pressure, which is reflected in the reading.
  3. The cuff should be placed over a bare arm, not over clothing. It’s your job to remember to wear something with a loose sleeve that won’t get in the way.
  4. The arm should be supported on a desk or a table, not hanging free.
  5. The patient should be asked not to talk. The doctor has to be able to hear the sounds clearly to get an accurate reading. This is not the time to discuss new restaurants.
  6. Legs should be uncrossed because that can affect blood flow.
  7. Feet should be flat on the floor.
  8. No reading or cell phones during measurement. There are a couple of reasons for this one. Holding the phone or book is an isometric contraction albeit a small one; nevertheless, it can raise the BP reading. The other reason is that if you’re checking email or something like that, it can affect your reading if your heart rate gets elevated.
  9. The BP in both arms should be checked.
  10. The arm with the higher reading should be noted.
  11. Finally, the physician should note in the records which arm is to be used in future readings.

Who knew taking a BP was so complicated? The photo above gets at least three steps wrong. Now that you know, you can make sure you do your part whether you’re told to or not.

But what’s going to happen if you hit higher numbers? I know many people suspect this is just a way to push more BP meds. We’ll look at treatment regulations on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA Online. Abassi 08-30-2017.

 

Do You Have High Blood Pressure?

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On Monday November 13, you may have awakened with normal blood pressure, and by that afternoon, you may have joined the ranks of those with high blood pressure (HBP). That’s when the American Heart Association (AHA) released their new HBP clinical practice guidelines at their national conference. With the new guidelines, close to half of all adults will be diagnosed with HBP.

The guidelines are the topic for this week’s Memos. I downloaded the entire document—all 481 pages—and three important parts warrant discussion. The first is AHA’s new guidelines for diagnosing HBP, and those numbers are in the graphic above.

While there are numerous questions, the first one is this: is your BP being taken correctly? That’s the topic for Thursday’s Memo, and you’ll be surprised at how often it’s done poorly.

What are you prepared to do today?

Dr. Chet

 

Reference: Hypertension. 2017;00:e000-e000.

 

Thanksgiving Wishes

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I got a few questions about the safety of microwaving after my Memos on nutrients in broccoli. In doing the research, I saw no evidence that there were any changes to the chemical composition of the vegetables. The science clearly demonstrates that the phytonutrients were not altered nor decreased. I know the Internet says crazy stuff about microwaves, but the science just doesn’t support any negative effects on the food itself.

I’m not a fan of cooking elaborate meals in a microwave because the heat is not distributed equally, but for steaming veggies and reheating leftovers, no problem. If you really want to maximize your nutrients, save any of the water remaining in the pans or containers for making soup. If minerals or other nutrients leach out, that’s where they’ll be.

Happy Thanksgiving!

Paula and I would like to wish you all a very Happy Thanksgiving. Because this is a busy time of the year, this will be the only Memo this week. Enjoy family and friends—and make sure you eat your vegetables, no matter how you decide to prepare them.

And here’s a tip for easier digestion: abide by the Golden Rule of dinnertime and don’t discuss politics or religion. Especially this year.

What are you prepared to do today?

Dr. Chet

 

The Bottom Line on Chlorpyrifos

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Today’s health news is full of controversy, some based on reality but most not. Typically, I would have concluded that the op-ed piece was just that: an opinion that exaggerated the facts to put forth a specific point of view. But before I go further, let me be clear: I’m not in favor of any pesticides if they can possibly be avoided. But we also live with the necessity of feeding billions of people and can’t afford to lose crops; we judge fruits and vegetables by appearance because we no longer know the grower personally. There may be some chemicals that are necessary to get that done. The issue comes down to the question of safety. That’s where all the research I read comes into play.

PON1

When I attempted to find the statistics on chlorpyrifos, I came across a large body of research that examined how organophosphates such as chlorpyrifos were eliminated by the body. The paraoxonase 1 gene (PON1) makes enzymes that help the liver and kidney detoxify chemicals such as chlorpyrifos (1). Research on several groups of subjects show that if exposure doesn’t exceed the detoxification capacity of the body, the current tolerance limits are safe for most people.

The problem is similar to what we find in other genes: there are mutations of the PON1 gene that affect the ability of the gene to produce enough enzymes to detoxify the body effectively (2). If the body isn’t able to detoxify itself, the amounts of chlorpyrifos in the body can exceed safe levels. That means that those with the PON1 mutation may be most at risk for chlorpyrifos exposure.

Or maybe not. Again it comes down to exposure. In a study of farm workers chronically exposed to chlorpyrifos, there was no difference in the gene mutations with the ability to detoxify (3). In another study, blood samples with normal and mutated PON1 genes were exposed to high and low levels of chlorpyrifos; the high levels negatively affected the mutated version of the PON1. The low levels, reflective of typical environmental exposure, showed no negative effect (4).

The issue is one of exposure, whether someone has the PON1 mutation or not. Research shows that mothers and children who live in agricultural areas are more at risk to having higher levels of organophosphates in their systems. What isn’t clear is the impact of genetic mutations that result in health issues.

In a recently published paper, researchers found that infants born to mothers with the PON1 mutation and exposed to environmental organophosphates had smaller head circumferences relative to size (5). Whether that translates to reduced IQ or other neurological conditions remains to be seen.

The Impact of Nutrients on Chlorpyrifos Exposure

Several studies demonstrated potential benefits of nutrients on chlorpyrifos exposure. PON1 is also related to cardiovascular health. In a study of over 400 subjects, those subjects with a mutated version of the PON1 gene and with higher amounts of polyphenols from fruit and vegetable intake did better in measures of cardiovascular risk such as high cholesterol (6).

In another study, subjects who consumed organic honey as a supplement experienced less damage and better DNA repair after chronic exposure to organophosphates (7). The polyphenols in the honey were identified as the primary factor related to the repair process.

Finally, in a study of pregnant women and their offspring, researchers examined the affect of folic acid intake in those women who were and were not exposed to organophosphates (8). Those who had a greater than 800 mcg intake during their first month of pregnancy when exposed to pesticides had fewer children with autism spectrum disorder.

While all of this research is recent, it seems clear that nutrients can have a positive impact on people who are exposed to organophosphates such as chlorpyrifos and other pesticides.

The Bottom Line

When I began the research on one statement in an op-ed piece, I never imagined it would end up here, but you go where the research takes you. While this research trip took us to the USDA, the PON1 gene, and some nutrients that can be protective against exposure to chlorpyrifos, one fact I was unable to find was that we are exposed to excess amounts from the fruits and vegetables we eat. That statement in the op-ed was false. But in that journey, we learned a lot. It’s not where you begin; it’s where you finish.

Four final points:

  • I think the ban on chlorpyrifos should be reinstated. Tolerance limits doesn’t mean it’s safe for everyone, and not every harmful impact has been examined.
  • Whether the discontinuance is reinstated or not, eat your fruits and vegetables after you wash them carefully. The value of the nutrients for your health exceeds any risk from chemicals that may be present.
  • Add some extra insurance by taking your supplements.
  • If you’re a golfer, you may want to learn the course’s pesticide schedule and avoid those days.

What are you prepared to do today?

Dr. Chet

 

References:
1. www.ncbi.nlm.nih.gov/gene/5444.
2. Toxicology. 2013 May 10;307:115-22. doi: 10.1016/j.tox.2012.07.011.
3. Toxicol Appl Pharmacol. 2012;265(3):308-15. doi:10.1016/j.taap.2012.08.031.
4. Toxicol Lett. 2014 Oct 1;230(1):57-61. doi: 10.1016/j.toxlet.2014.07.029.
5. Ann Glob Health. 2016; 82(1): 100–110. doi:10.1016/j.aogh.2016.01.009.
6. J Transl Med. 2016 Jun 23;14(1):186. doi: 10.1186/s12967-016-0941-6.
7. Mol Nutr Food Res. 2016 Oct;60(10):2243-2255.
8. Environ Health Perspect. 2017 Sep 8;125(9):097007. doi: 10.1289/EHP604.

 

Chlorpyrifos: Checking the Statistics

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When I began my research, the one statistic I had to check was that fruits and vegetables contained 140 times the amounts safe for 1–2 year old (1). Was it sensational or based in science? I’m good at what I do, but I couldn’t find it anywhere. I did find a lot of interesting studies but not that. I finally wrote the author of the op-ed piece; I didn’t get an answer from him, but I got one from his research assistant who gave me the precise source of the statistic.

Sure enough, page six of the EPA report (2) listed the claim of 140 times the safe amount—except that was not exactly what the EPA found in fruits and vegetables. It was a hypothetical amount that applied to the 100th percentile of potential intake. I spent several days and examined dozens of related articles just to figure out how the number was derived. What I can tell you is that it does not reflect what the exposure may be on the fruits and vegetables children or adults actually consume.

I found that number because every year, the USDA publishes a summary of the pesticides found on and in foods as part of the Pesticide Program (3). This report is the basis for the Environmental Work Group’s Dirty Dozen vegetables and fruits you shouldn’t eat. I examined the data for chlorpyrifos, and here’s what I found:

  • 9,843 samples of 19 fruits and vegetables were analyzed
  • 84 samples contained chlorpyrifos
  • 1 sample out of 84 exceeded the EPA tolerance levels

The amounts actually tested by the EPA did not come close to what was reported in the op-ed piece or what was published in the Registration Review by the EPA Committee. But I found a lot more than that, and I’ll get to that on Saturday

What are you prepared to do today?

Dr. Chet

 

References:
1. Nicholas Kristof. The New York Times. October 28, 2017.
2. EPA. 11/2016. Chlorpyrifos: Revised Human Health Risk Assessment for Registration Review.
3. www.ams.usda.gov/datasets/pdp

 

A Pesticide Story

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It’s not where you begin; it’s where you end up.

Pesticides are designed to kill bugs on our farms, in our homes, and in our yards. One such pesticide is chlorpyrifos, an organophosphate pesticide. It’s a very effective nerve toxin that will essentially kill anything with a nervous system if the exposure is high enough. It was eliminated for in-home and yard use years ago but is still used as a farm pesticide as well as on golf courses and other open areas.

Paula forwarded an op-ed piece from the New York Times that talked about a recent EPA decision to ban this pesticide for all uses; the decision was overturned by the current administration. After years of investigation by numerous scientists that concluded that chlorpyrifos was potentially too toxic, use is going to continue. One statistic in the article that stuck out to me was that the EPA had found levels on fruits and vegetables at levels 140 times what was determined to be safe for children 1–2 years old.

I can’t feed my grandson Riley vegetables and fruits that can harm him, so I had to check that out. I don’t care about the political intrigue; I’m concerned about what’s safe for you as readers and your families as well as my family. But as I said in my opening sentence, where I began is not as important as where I finished. This week will show how complicated eating in the 21st century can be.

What are you prepared to do today?

Dr. Chet

 

References: Nicholas Kristof. The New York Times. October 28, 2017