Wednesday, May 17, 2006

Diet and the risk of thyroid cancer

Diet and the risk of thyroid cancer

Because thyroid cancer is more common in areas where goiter and iodine deficiency are endemic, it has been hypothesized that dietary factors, especially iodine intake, may influence the risk of this cancer. Nutritional factors unrelated to iodine deficiency may also play a role in its causation.

A population-based case-control study of diet and thyroid cancer was conducted in two regions of Sweden and Norway. The study populations included Norwegians living in coastal areas with an iodine-rich diet and a high incidence of thyroid cancer in the 1970s, and Swedes from areas with and without a high incidence of goiter. The study population consisted of 246 cases and 440 age- and gender-matched controls; dietary data were obtained by food frequency questionnaire.

Residence in areas of endemic goiter in Sweden was associated with an elevated risk of thyroid cancer, especially among women. Among persons who had ever lived in such areas, high consumption of cruciferous vegetables was associated with increased risk. Regardless of area of residence, high consumption of butter and cheese was associated with significantly increased thyroid cancer risk. There was a weak inverse association with consumption of iodized salt in Norway. Among women, the regular use of vitamin A, C, or E supplements was associated with decreased risk.

The results of this study indicate that environmental and dietary factors -- including some factors unrelated to goiter, such as intake of dairy fit, may influence the risk of thyroid cancer.

Thyroid gland

Thyroid gland and the environment

Well-recognized thyroid expert, Broda Barnes, MD, estimated approximately 40% of the American adult population suffers from undiagnosed hypothyroidism. Subnormal thyroid function appears to be a risk factor for cancer. Iodine is a major component of the thyroid gland. Improper thyroid function, be it hypothyroid, or hyperthyroid, appears to be a risk factor for cancer among the general population. (1)

Iodine deficiency has been associated with breast cancer risk. Iodine deficiency can be a matter of geography, or induced by any number of environmental stressors. Dr. Bernard Eskin, Director of Endocrinology in the Department of Obstetrics and Gynecology at the Medical College of Philadelphia found an association between iodine deficiency and breast cancer. Dr. Eskin's research uncovered a high incidence of breast cancer in iodine poor areas of the United States, Poland, Switzerland, and Austria, where goiter is also predominant. Japan and Iceland have the world's lowest rates of goiter and breast cancer deaths. Iodine rich sea vegetables are important staples of Japanese cuisine, and iodine rich seafood makes up a large part of the Icelandic diet. (1)

In addition to dietary deficiencies, thyroid function can be adversely affected by drugs, chemical pollutants, and radiation exposure. (1)

Drugs and Chemicals

Manmade compounds also assault the thyroid gland. Thyroid function can be suppressed by certain drugs and chemicals--antidiabetic and sulfa drugs; barbiturates that contain cyanide; prednisone; estrogen (birth control pills and hormone replacement therapy); some cough medicines; the antidepressant lithium; aspirin and other salicylate painkillers; and thousands of chemical food additives in processed food. (1,2)

Perchlorate is a potent environmental toxin that inhibits iodine uptake by the thyroid gland. Perchlorate is a by-product of synthetic fertilizers and solid propellants for rockets, missiles, and fireworks. Perchlorate salts are a component of airbag inflators. It has been leached into surface and underground water supplies. (1)

Pesticides used on domestic and international air flights pose an additional risk to thyroid suppression. Tralomethrin, a commonly used airline pesticide spray, contains bromide, which caused thyroid disease in animal studies. (1)

Fluoride

"Statistics show that populations drinking fluoridated water have universally lower thyroid levels," states Jerry Mittelman, DDS, editor of The Holistic Dental Digest PLUS. Fluoride is an intensely controversial subject, praised by some for protecting against tooth decay, and condemned by others as a major risk factor for cancer, arthritis, osteoporosis, and hypothyroidism. (3,4)

It is almost impossible to avoid fluoride in our culture. Fluoride is added to more than half the municipal water supplies in the US. Bottled juices, soft drinks, iced teas, wine coolers, jellies, and other processed foods are often made with fluoridated water. If consumers wish to know if their favorite brand of bottled or canned beverage is made with fluoridated water, they must call the company and ask.

Nearly all supermarket brands of toothpastes, and many brands sold in health food stores contain fluoride. However, it is possible to find some brands of toothpaste in health food stores that do not contain fluoride.

Our exposure to fluoride can start during infancy, and in some cases in utero. Some brands of baby foods contain high levels of fluoride. Children may be given fluoride tablets or rinses at school, or by their dentist. (5)

Studies done with Danish female cryolite workers showed fluorosis in the teeth of offspring that had been nursed, raising the possibility that fluoride can even be passed through breast milk. Cryolite is a compound of aluminum, sodium and fluorine. There are animal studies that show fluoride's effect on fertility and that it easily crosses the placenta. Richard Foulkes, MD, indicates that, "after 46 years of fluoridating drinking water, no study had taken place on the effect of fluoride on the developing fetus!" (6) How long-term exposure to fluoride may affect the thyroid glands of Americans is not known, nor does there seem to be much interest in finding out.

Tobacco and Alcohol

One of the nasty ingredients in cigarette smoke is thyocyanide, a strong thyroid inhibitor that further compounds the many health risks of heavy smokers and those around them. Smoking harms the thyroid gland by decreasing the thyroid's ability to secrete hormones, and by limiting the hormones' action. Smokers are more prone to have enlarged thyroid glands indicating subclinical hypothyroidism. (1)

Alcohol is a highly refined carbohydrate, and requires the whole complement of B vitamins for proper metabolism. A deficiency of B-6 reduces the thyroid's ability to convent iodine into thyroid hormone. (1)

Soy and Other Foods

Some foods including soy, walnuts, cabbage, cauliflower, and kale can contribute to low thyroid function if eaten frequently, and in large amounts. Hypothyroid individuals are advised to consume these items cautiously until their condition is corrected with supplemental thyroid medication. (1)

Many health-conscious Americans are reducing their consumption of meat and dairy products. Instead of making some serious dietary changes, such as consuming more pure water, vegetables, and fruits, they are merely switching over to soy meat substitutes, soymilk substitutes, soy cheese substitutes, and soy ice cream substitutes.

Most of the soy raised in this country has been for animal consumption. The agricultural industry has been quick to recognize that human consumption opens up vast new markets for their soy crop. Every health magazine touts the benefits of soy products informing the reader how Japanese have such a low incidence of breast and other cancers, and that Japanese diets contain more soy than do Americans. The Japanese use small amounts of fermented soy products in their diets, and drink green tea, not soymilk. Also missing in this health discussion is the fact that Japanese consume a great deal more iodine rich sea vegetables than do Americans. Iodine is very supportive of healthy thyroid function. This may be the real reason the Japanese have a lower incidence of breast cancer. We're not likely to see the sea vegetable industry duel it out with the soy industry. Let the consumer beware.

Soy has been known to interfere with thyroid function for over 60 years. What are often referred to as the beneficial isoflavones have been identified as the goitrogenic component of soy. The soy industry acknowledges that soy can depress thyroid function, but only when there is a lack of iodine. A patient consuming a soy protein dietary supplement was reported by the University of Alabama at Birmingham, to have a decrease in thyroxine absorption. The patient was taking thyroid hormones following thyroid surgery. When the patient consumed soy she required higher oral doses of thyroid hormone. (7)

The Weston Price Foundation warns that, "Soy phytoestrogens are potent antithyroid agents that cause hypothyroidism and may cause thyroid cancer. Soy foods can stimulate the growth of estrogen dependent tumors.... Soy phytoestrogens disrupt endocrine function and have the potential to cause infertility and to promote breast cancer in adult women." (8)

This is not to say that all soy is bad. Some women find a welcome relief from menopausal symptoms when consuming a moderate amount of soy products. Soybeans have been genetically modified to tolerate increased doses of the herbicide, Roundup. When purchasing any soy food try to get organic, or non-GMO soy products.

Radiation

The connection between radiation exposure and thyroid cancer is well established. Less well known is the connection between radiation exposure and breast cancer. Women who received X-irradiation for tuberculosis, scoliosis, acne, postpartum breast swelling, and benign breast disease have an increased incidence of breast cancer. Even "routine" chest or dental X-rays are not completely risk-free. (9)

Women who receive significant radiation before age 20 are more likely to develop breast cancer before age 35. Radiation-induced breast cancer is increased when exposure occurs in adolescence and early childhood. Japanese women who survived the atomic bomb have an increased incidence of breast cancer. Strontium 90 is deposited in bones and teeth. Cesium 137 and its isotopes concentrate in soft tissue like the breast, liver, spleen and muscles. Radioactive iodine is taken up by the thyroid gland. (9)

In the summer of 1997 the media carried a story about above ground testing of nuclear bombs in Nevada from 1951 to 1958, which exposed 160 million Americans to radiation fallout as it traveled on air currents across the nation. The invisible radioactive particulate matter precipitated down with rain on areas as far away as New York, Massachusetts, Tennessee, North and South Dakota, Idaho and Montana. The National Cancer Institute (NCI) estimated that Iodine 131 fallout from the bomb tests could result in 11,000 to 212,000 thyroid cancers in Americans in the following years. (9)

We do not know how many hundreds of thousands of Americans may have developed impaired or reduced thyroid function, nor do we know how many cancers may have resulted from impaired thyroid function resulting from bomb test fallout.

Women living on Long Island, (New York) have among the nation's highest incidence of breast cancer. Long Island is situated in very close proximity to four nuclear power reactors in New London and Middletown, Connecticut, and Peekskill, New York, with the Brookhaven nuclear lab right in the middle of Long Island. Increases in breast cancer deaths in both Long Island counties parallel the increase in breast cancer deaths in Connecticut, where two reactors are located. (9)

There is sufficient data to substantiate the breast cancer-radiation connection, but it is continually ignored. Most of the physicists and MDs who were hired by the government to research the radiation cancer connection during the 1950s and 1960s were let go, or had their funding cut when the results showed a clear connection between radiation exposure and cancer formation. Janette D. Sherman, MD, author of Life's Delicate Balance: Causes and Prevention of Breast Cancer, is herself an early radiation researcher. She points out that she and her esteemed colleagues in the field of radiation research, John Gofman, PhD, MD, Jay Gould, PhD, Ernest Sternglass, PhD, Rosalie Bertell, PhD, are all approaching, or in their eighth decade of life, and she worries about who will continue their work.

While we no longer have above ground testing of nuclear bombs in this country, Americans are exposed to consistent and steady fallout from properly operating nuclear plants, which by design release radioactive steam on a periodic basis to reduce pressure build-up. At a conference sponsored by the Cancer Awareness Coalition, February 1995, this was explained by physicist, Dr. Ernest Sternglass, who informed that all nuclear power plants operate on a design principle formulated in the 1950s, even though our understanding of the health effects from airborne radioactive particulate matter has progressed greatly in the 50 years since then. Added to this are the cumulative exposures from multiple medical and dental X-rays.

Dr. Mittleman commented on a study indicating a possible link between dental X-rays to pregnant women and low birth-weight babies. Causality was not proven, but it does raise another question about what sort of damage might result to the newborn's thyroid gland from the mother's exposure to dental or medical X-rays. (3)

As editor of the Holistic Dental Digest PLUS newsletter, Dr. Mittleman strongly advises that a thyroid collar be used in addition to the usual protective drape when dental X-rays are taken. Another unanswered question remains about how many patients did not, and still do not, receive proper protection to the thyroid area when undergoing dental X-rays.

This health consumer always marvels at how radiologists and X-ray technicians attempt to reassure patients by claiming how much less dosage the newest state of the art technology uses. What they are not saying is how hazardous the dosage was from older equipment, and how quickly today's state of the art, low dose technology will soon be replaced by even newer technology using even less radiation, rendering today's equipment out of date. Not every hospital, X-ray lab, or dental office has the most up-to-date equipment, and consumers are clueless about how old the technology is, or how much radiation they are being exposed to when they receive X-rays, or how much damage is being done to their entire bodies as well as their thyroid gland.

Wake me up

Wake me up: how one tired mom found energy through diet, supplements and relaxation

I was yawning, starting to count zzz's, and it was only 10:00 a.m. All I'd done was make oatmeal and get my 3-year-old dressed. I knew I'd be wiped out the first months of my daughter Chloe's life, but no one told me that I would be tired for years.

I'd had my thyroid tested and blood work done; I knew I wasn't dying. But not only was I tired of being tired, my friends and family were getting fed up with my constant plea for more sleep. It was time to get to the bottom of my never-ending desire to hit the hay. I decided to consult several holistic experts.

help! a tiger stalks me!

By answering many pointed questions from Laurie Steelsmith, ND, author of Natural Choices for Women's Health, I discovered that I was actually leading a pretty high-paced, stressful life. Although no longer working full-time at an office, I put in many hours (and late nights) as a freelance writer and editor. And when not working, I was mothering Chloe. There wasn't much time for relaxation. Add two moves in one year, and I guess my life painted a pretty intense picture. What I didn't realize--until Steelsmith said so--was that all this stress was making me tired--really tired.

I thought that Steelsmith was going to give me all kinds of ways to rev up my energy, but she did the opposite: She told me to chill out. "We all need a balance of yin (quiet, inward) and yang (active fire) energies for optimal energy and performance," she said. Apparently I was uber-yang. My stress was described as a tiger stalking me all day--agitated and anxious with shallow breathing.

The solution? I needed to balance my yin and yang energies--and, oh yes, get my adrenals working again. The adrenal glands, part of the endocrine system that regulates hormone production, play a large role with fatigue and stress, Steelsmith said. When stressed, our adrenal glands release cortisol, a hormone that helps us cope by giving us energy and allowing us to focus. Because I'd been consistently stressed since Chloe's birth, my adrenal glands responded by producing a constant stream of cortisol, which had become depleted, contributing to my fatigue.

The good news was that I could allow my adrenals to replenish themselves by incorporating some quieting activities into my hectic lifestyle, such as adding yoga and gentle bicycling to my five-day exercise regimen, Steelsmith said.

In addition to the relaxation, several herbs and supplements would help get my adrenals up and running again. Steelsmith suggested the following:

* Vitamin C (1,000-2,000 mg daily), because when stressed, we lose more through the urine.

* [B.sub.5], which helps manufacture adrenal hormones (should be taken as part of a B complex because taking an extra B vitamin can potentially create a deficiency of another B vitamin).

* Ginseng to help my body respond better to stress so that my adrenals are not so taxed.

* A daily multivitamin to give my body a nutrient policy because, when under chronic stress, we need more nutritional support.

Apparently my little caffeine habit wasn't helping my fatigue in the long run either. I usually began the day with black tea and most afternoons enjoyed a cup of java or a latte. Steelsmith wanted me to get off the caffeine entirely. "Caffeine gives you the feeling that you have lots of energy when you don't, and you end up having to continue on it all day," she said. It can also contribute to anxiety. If I weaned my system off the stuff, I would feel a lot calmer and more centered and would have more energy she said.

you are what you eat (and when you eat)

I thought that I ate fairly well--organic when possible, no red meat and minimal processed foods. But after meeting with Jennifer Workman, MS, RD, author of Stop Your Cravings: Satisfy Your Tastes Without Sacrificing Your Health, we determined that there were some not-so-great things about my diet that were probably contributing to my fatigue.

We began with breakfast. For years, breakfast for me has been a smoothie made with an apple, a banana, blueberries and rice or soy milk. What I thought was the ultimate healthy beginning to my day might actually have been the culprit for my 10:00 a.m. crash. Because my shake had very little protein in it, Workman pointed out, my blood sugar was probably plunging at mid-morning, making me tired.

To remedy this I simply needed to eat protein, carbs and fat at each meal, according to Workman. At breakfast, I could add protein powder to my smoothie and try other things such as cream of quinoa mixed with nuts, nut butters on whole grain breads and turkey breakfast sausages.

To keep up energy levels, Workman suggested eating five meals a day--and four small meals and a bigger meal at lunch. "If you go for longer than three hours without food, your blood sugar will begin to drop, fatigue sets in and your brain turns off," she said.

My lunches, usually something cold that I ate standing up, were not cutting it either. "Our culture rushes through lunch. Americans are always running; if you don't take 20 or 30 minutes to sit down and eat and then take a little rest, you crash," Workman said. She suggested that I find a variety of nourishing foods that would sustain me until I next ate. "A quarter cup of tuna salad or hummus, or black bean dip with cheese, for example."

Workman also wanted me to take a tablespoon of omega-3 fatty acids daily. (I had thought I was doing a good thing by taking a 1,000-mg fish oil capsule every day, but apparently I needed about three times that amount.) "When you get your omega-3 oils and protein intake where they should be, it helps cut down on cravings because they both help keep your blood sugar levels stable," Workman said.

Like Steelsmith, Workman also advocated an after-lunch 10-minute nap to calm down my nervous system and prevent afternoon sleepiness. I started to get the message.

homeopathy and the right side of the brain

I wanted to see what insights into my fatigue a homeopath might offer. Lauri Grossman, DC, a practicing homeopath, emphasized looking at what was causing the fatigue and not simply treating the symptoms.

We talked about my life prior to having Chloe. As a full-time staff editor, I was constantly engaging my left brain with focus and details. Motherhood, on the other hand, shifted me overnight to using the right brain--the source of creativity and empathy. Could nuturing my daughter actually be adding to my fatigue? Yes, Grossman said. "It takes time and energy to shift to using these skills with our children." She suggested I try engaging in art, storytelling or listening to music to enhance my right-brain functions.

Grossman thought that along with my diet redux, and herbs and supplements, a homeopathic remedy might help alleviate my fatigue. She suggested the following:

* Sepia for exhaustion that lasts all day and for postpartum depression

* Gelsemium for physical exhaustion with tired muscles and drowsiness

* China for exhaustion and sensitivity to touch

alive and kicking

After several weeks of following my experts' advice, I did feel less tired. What was working?

Eating more, for starters. I discovered that I really hadn't been having anything substantial for breakfast and lunch and used to compensate with a large dinner and evening snacks. I have a better energy level when I take the time to eat a balanced breakfast and lunch.

Although I am not entirely off the caffeine, I notice that when I drink green tea in the afternoon, I don't crash.

It's difficult to say yet whether the ginseng and other supplements are helping, but I assume they are and that they will help more after time.

I'm relaxing more, which is the most difficult part for me. I rest after lunch and let my husband take my daughter to preschool more often; I'll opt for a yoga class instead of a spinning class.

I think letting go has been the biggest lesson of my quest. I didn't realize how stressed I was and how it was truly sapping my energy. Although I sometimes still see the tiger's stripes out of the corner of my eye as he turns to chase me, I am learning to get out of his path.

Is your diet making you sick?

Is your diet making you sick? If you're suffering from headaches, depression or hair loss, your food choices may be to blame

Before you blame your chronic headaches on stress or chalk up your constant colds to a weak immune system, you may want to examine your diet. "Many women think that pain or other symptoms, like mood swings and hair loss, are the result of a serious medical condition, when something far more simple is the cause: their eating habits," says Gail Frank, R.D., Dr.P.H., a professor of nutrition at California State University, Long Beach, and a spokeswoman for the American Dietetic Association. "It's important to remember that everything you consume will affect your body, from your skin to your digestive system." That's not to say symptoms like stomach cramps or depression don't warrant a doctor's visit. But before you schedule one, you'll want to take an inventory of what you've been eating--or not eating--and consider making an appointment with a dietitian too. (For a recommendation, visit eatright.org.) On the following pages, top medical and nutrition experts point out the links between six common problems and poor dietary habits, and tell you how to get your diet--and your health--back on track.

Problem Weakness, fatigue

Possible cause A low-calorie diet

Dipping below your daily calorie needs (more on that later) is a major health no-no. "Your body uses food as fuel," Frank explains. "If you're not eating enough, your system slows down and begins to burn muscle tissue for energy, which is a large part of why you may feel weak, tired or lightheaded." Experts suggest consuming 1,800-2,400 calories a day, depending on your height, weight and activity level.

Cure Visit Shape.com/calories to calculate your individual daily calorie needs. If you're trying to lose weight, talk to a dietitian about your eating habits, Frank advises. But keep in mind that no matter how much weight you want to lose, you should never drop below 1,200 calories a day.

When to see a doctor If you start eating more but still have a hard time performing everyday activities, such as walking or concentrating. You could have a virus such as Epstein-Barr or mononucleosis, or another serious condition such as depression.

Problem Mood swings, short-term depression, increased appetite

Possible cause A high-protein, low-carb diet

Consuming fewer than 50 grams of carbs a day can lead to a decrease in serotonin, the brain chemical that regulates both mood and appetite, according to two studies from the Massachusetts Institute of Technology in Cambridge. "A dip in serotonin means that you're more vulnerable to mood swings and even a depressed mood--and that you may not experience a 'full' feeling after eating," explains Judith Wurtman, Ph.D., MIT scientist and a co-author of both studies. "On the other hand, carbohydrates help stimulate serotonin production. After you eat them, your mood improves and you feel sated." If that isn't reason enough to jump off the low-carb wagon, a study from RVA University in Copenhagen, Denmark, shows that people on low-carbohydrate, high-protein diets report more muscle cramps, weakness and diarrhea than individuals on lowfat diets.

Cure To keep your blood sugar stable, preventing crashes that lead to mood swings and shakiness, eat a diet that's rich in complex carbohydrates (aim for at least five servings a day from sources like whole-grain pasta, brown rice and vegetables) as well as protein and unsaturated fats (found in fish, olive oil and nuts).

When to see a doctor If binge eating, mood swings or depression lasts more than two weeks, see a physician and/or psychologist, who can determine whether you have a more serious condition.

Problem Headaches

Possible cause Trigger foods

Headaches--believed to be caused by swelling blood vessels in the head--can be triggered by alcohol, caffeinated beverages, cheese, deli meats, chocolate, nuts, foods with MSG and even bananas, says David Buchholz, M.D., associate professor of neurology at Baltimore-based Johns Hopkins University and author of Heal Your Headache (Workman, 2002). "Some people [react] to chemicals in certain foods," he explains. "For example, tyramine [found in red wine and aged cheese] is a common irritant."

Cure Buchholz suggests that when a headache strikes, write down everything you've eaten that day. If your list contains one of the foods mentioned above, avoid eating it for several weeks. Then, slowly reintroduce it; if you eat or drink it again and your headache returns, you've found your culprit.

When to see a doctor If your headache is so painful and sudden that you can't function normally. Keep in mind that some people suffer from chronic headaches--often called migraines--for no apparent reason. A headache specialist can help determine the best course of treatment.

Problem Digestive troubles

Possible cause Not consuming enough fiber, or eating foods you can't tolerate

Women often blame gastrointestinal problems like pain, diarrhea and constipation on a "sensitive stomach," says Susan Lucak, M.D., a gastroenterologist and assistant professor of clinical medicine at Columbia-Presbyterian Medical Center in New York City. "More often than not, their diet lacks fiber, which cleanses the system and regulates bowel movements." Many women may not realize their stomach problems are the result of an intolerance, either to wheat or, more commonly, dairy: "Twenty-three percent of Americans can't digest lactose, the sugar found in milk. When they consume dairy products, they may experience bloating, gas or diarrhea," Lucak says.

Cure Pay attention to whether there's a link between certain foods you eat and your symptoms, and if there is, make changes to your diet. Aim for 25-35 grams of fiber a day, to keep you regular. Good sources include whole-wheat breads and cereals, beans and vegetables.

When to see a doctor If you experience severe stomach pain or vomiting, or if any symptom such as constipation or diarrhea lasts more than three days and/or is accompanied by weight loss or gain, you could have irritable bowel syndrome (IBS) or celiac disease, a disorder in which the lining of the small intestine becomes inflamed from foods that contain gluten, such as bread and other wheat products.

Problem Hair loss

Possible cause A diet too low in calories, protein, iron or vitamins A and C

If you're not eating right, your locks will show it. "Hair is made of protein, which your body produces when you're healthy and following a balanced diet," says Megan Majernik, R.D., a clinical dietitian at Mount Sinai Medical Center in Chicago. But consuming too few calories or simply skimping on protein, iron and vitamins, especially A and C, which are crucial for cell growth, means your system won't have the energy and nutrients it needs to create hair.

Cure To keep your hair healthy and strong, be sure you're eating enough calories. Also, aim for 700 micrograms of vitamin A a day (good sources include leafy green vegetables like spinach, as well as eggs and dairy products) and 65 milligrams of vitamin C daily (citrus fruits like tangerines, strawberries and red bell peppers provide a good dose).

When to see a doctor If your hair falls out rapidly or in clumps. You could have a thyroid condition; both hypothyroidism (when the body produces too little thyroid hormone) and hyperthyroidism (when the body produces too much) can be culprits. Studies have shown that consuming too much vitamin A, although rare, can also lead to hair loss. In addition, sudden physical trauma--including extreme nutritional changes--can cause your hair follicles to release "telogen" hairs, those that are in the resting stage of the growth cycle.

Problem PMS (Premenstrual syndrome)

Possible cause Too much sodium, sugar or caffeine, or too little fiber.

As tempting as it is, chowing down on potato chips and espresso ice cream before your period can exacerbate and even cause PMS symptoms. Specifically, sodium can cause bloating, while caffeine and sugar may induce mood swings. Lack of fiber may also be behind your constipation or diarrhea that often occur before your period, says Diana Taylor, R.N., Ph.D., in Taking Back the Month: A Personalized Solution for Managing PMS and Enhancing Your Health (Perigee, 2003). "Excessive sugar is particularly problematic, because it sends your blood sugar soaring, only to come crashing down an hour later," Frank agrees. "That's when you become ravenous--and, often, cranky."

Cure To help combat PMS, consume 25-35 grams of fiber daily, try to limit yourself to one caffeinated beverage a day and keep your daily sodium intake below 1,500 milligrams. No more than 25 percent of your total calories should come from added sugars that are found in junk food. You may also want to up your calcium intake to at least 1,000 grams a day; several studies, including one recently published in the Journal of American College of Nutrition, report that calcium from supplements or food may help ease PMS symptoms.

When to see a doctor If your mood swings become extreme and are accompanied by depression or feelings of suicide, you may be suffering from premenstrual dysphoric disorder, a more severe form of PMS that's treatable with medication. You should also contact your gynecologist or physician if symptoms like headaches or cramps render you unable to function normally.

protocols for treating an under active thyroid

protocols for treating an under active thyroid—despite normal blood tests - Highly Effective Treatments for Pain and Fatigue

We are constantly learning powerful new tricks for treating hypothyroidism and there are many reasonable treatment approaches. Our treatment protocol information checklist for patients (see below) gives the "nuts and bolts" of some approaches. Non-prescribing practitioners can get prescriptions for lab tests for their patients by having them go to www.vitality101.com (click on "online program," then laboratory requisition form." We do not charge for this. We feel patients are entitled to get whatever non-invasive tests they want). They can then take the lab requisition to their local lab.

Thyroid Hormone

Most non-holistic doctors prescribe T4 (Synthroid) to treat an under active thyroid. T4, though, is fairly inactive until the body converts it into T3, or activated thyroid hormone. If the problem is only with the thyroid gland itself, prescribing Synthroid will work just fine. However, if the body has trouble turning inactive T4 into active T3, taking Synthroid can make the problem worse. Because of this problem, many CAM physicians prefer to use Armour Thyroid, which is a mix of T4 and T3. I find Armour to be far superior to Synthroid.

Why might the body have trouble making active T3 from inactive T47 During periods when the body wants to conserve energy (for example, during times of infection or famine--which is how the body views an overly restricted diet), the body slows down metabolism. It does this by decreasing the production of active T3 from T4, which is turned into inactive "reverse T3" instead. The body may get "stuck" in this mode, and becomes unable to make adequate T3.

I prefer to start with a trial of Armour thyroid. I begin with 1/4 grain (15 milligrams) a day and increase it to 1/2 grain (30 milligrams) a day in one week. Then, I increase it by 1/4 to 1/2 grain each two to six weeks until the patient finds a dose that feels best. If the patient is shaky, hyper, or has a racing heart (for example, a resting pulse over 90 beats per minute), lower the dose. I check a free T4 about one month after the 2, 3-1/2, and 5 grain levels are reached. Do not check a TSH test. It will be low (because of the hypothalamic dysfunction) even if the patient is on inadequate thyroid replacement. Adjust the thyroid slowly to the dose that feels the best to the patient, while making certain to remain within normal range for blood free T4 levels. When on a stable dose, consider checking the thyroid blood levels every 6-12 months. Although many patients can stop taking thyroid Zhormone after twelve to twenty-four months (unless they have Hashimoto's Thyroiditis-check a TPO Antibody to look for this), they can stay on Armour Thyroid or Synthroid for as long as it is needed.

One can also try prescribing Synthroid (T4). One hundred micrograms (0.1 milligrams) of Synthroid ~ 1 1/4 grain (75 mg) of Armour Thyroid. Often, one hormone treatment works when the other does not. Adjust the dose as above.

Another approach, used by the research center of John Lowe, DC in Boulder, is to use the T3 in the short acting form (Cytomel-by prescription) only in the morning. He feels that FMS patients have "thyroid resistance"--that is, it takes a much higher level of thyroid to obtain the normal effect. Even though the body may only make about 25 to 30 micrograms of T3 a day, his studies found it took an average of 125mcg a day to make FMS patients feel healthy. Try giving the full dose of thyroid in the morning or half the dose twice a day to see which feels best (Dr. Lowe generally gives the full dose in the AM). Do not give thyroid hormone within several hours of iron or calcium, or the patient won't absorb the thyroid. This is one reason these 2 nutrients are left out of the vitamin powder. Take thyroid on an empty stomach (for example, first thing in the morning).

Unfortunately, many doctors are (incorrectly) trained to stop increasing the dosage of thyroid hormone once an individual's thyroid tests are in the "normal" range--even if the dose is inadequate for that person. Even the guidelines of the conservative National Association of Clinical Biochemistry-which sets guidelines for performing lab testing--notes "In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5.... A serum TSH result between .5 and 2.0 ... [and] a serum FT4 in the upper third of the reference interval is the therapeutic target for L-T4 replacement therapy when patients have hypothyroidism." (www.nacb.org/lmpg/ thyroid_LMPG_PDF.stm). In addition, the American Association of Clinical Endocrinologists has lowered the upper limit of normal for TSH to 3.0 (www.aace.com/pub/tam2003/press.php)

Potential Side Effects

If someone has blockages in the arteries that feed the heart and is on the verge of a heart attack, taking thyroid hormone can trigger a heart attack or angina, just like exercise could. Thyroid treatment can trigger heart palpitations as well. These are usually benign, but atrial fibrillation is possible. Because of this concern, and because using T3 or treating for hypothyroidism with a normal blood test is still controversial, I often recommend that patients at significant risks of angina--people who smoke, have high blood pressure, are over forty-five years old, have cholesterol levels over 260, and a family history of heart attacks in individuals under sixty-five years old--have an exercise treadmill test done before treatment, even if they can't complete the test.

To put the risk in perspective, in the many hundreds (and perhaps thousands) of patients that I have put on thyroid, I don't remember any having a heart attack or dangerous problems from taking it. In the long run, I suspect thyroid treatment is more likely to decrease one's risk of heart disease by lowering cholesterol.

The other main concern is that excess thyroid hormone can cause osteoporosis (bone thinning). In my research, I have seen no studies showing any increase in osteoporosis in pre-menopausal women if one keeps the Free T4 thyroid blood levels in the normal range. I do not consider TSH to be a reliable monitor of thyroid levels in CFIDS/ FMS because of hypothalamic dysfunction. We don't know for sure if keeping the T3 level above normal in FMS patients with thyroid resistance worsens the osteoporosis already commonly seen in CFIDS/ FMS, but this has not been a problem. If you need to keep T3 or T4 above the upper limit of normal, you should consider a DEXA (osteoporosis) scan each six to twelve months. If this is showing osteoporosis, lower the thyroid dose. If this is not possible, consider other osteoporosis prevention measures.

Below is the section from the preprinted treatment protocol we use with our patients. The full treatment protocol with over 150 treatments listed by category can be seen at www.endfatigue.com. Click on the "treatment protocol" link (on the far left, bottom button). If you would like a free copy of the file with the complete treatment protocol and the patient questionnaire, which you are welcome to use in your practice (both of which will save you an incredible amount of time)

Hormonal Treatments--Patient info sheet

Thyroid supplementation--several studies show that thyroid therapies can be very helpful in CFIDS/FMS--even if your blood tests are normal. This treatment is, however, very controversial--even though it's usually very safe. Ail treatments (even aspirin) can cause problems in some people though. The main risks of thyroid treatment are:

1. Triggering caffeine-like anxiety or palpitations. If this happens cut back the dose and increase by 1/2 to 1 tablet each 6 to 8 weeks (as is comfortable) or slower. Sometimes taking vitamin B1 (thiamine) 100 to 200mg a day will also help.

2. Exercise (i.e., climbing steps), if one is on the edge of having a heart attack or severe 'racing heart' (atrial fibrillation), thyroid hormone can trigger it. In the long run though, I suspect thyroid may decrease the risk of heart disease. If you have chest pain, go to the emergency room and/or call your family doctor. It will likely be chest muscle pain (not dangerous) but better safe than sorry. To put it in perspective, I've never seen this happen despite treating many hundreds of patients with thyroid. Increasing your thyroid dose to levels above the upper limit of the normal range may accelerate Osteoporosis (which is already common in CFIDS/FMS). Because of this, you need to check your thyroid (Free T4--not TSH) levels after 4 to 8 weeks on your optimum dose of thyroid hormone. All this having been said, we find treatments with thyroid hormone to be safer than Aspirin and Motrin. If you have risk factors or Angina, do an exercise stress test to make sure your heart is healthy before beginning thyroid treatment. These risk factors include: 1. Diabetes, 2. Elevated cholesterol, 3. Hypertension, 4. Smoking, 5. Personal or family history of Angina, 6. Gout, 7. Age over 50 years old.

There are several forms of thyroid hormone, and one kind will often work when the other does not. Do not take thyroid within 6 hours of iron or calcium supplements or you won't absorb the thyroid.

Synthroid (Rx)--(L-Thyroxine) 50mcg--(100mcg=.1mg)

* Armour Thyroid (Rx)--30mg (1/2 grain = 30mg) (natural thyroid glandular). If (Cortef) is checked, begin the Cortef and/or adrenal support 1-7 days before starting the thyroid.

For each of these 3 forms, take 1/2 tablet each morning on an empty stomach for 1 week and then 1 tablet each morning. Increase by 1/2 to 1 tablet each 2 to 6 weeks (till you're on 3 tablets or the dose that feels best). Check a repeat Free T4 blood level when you're on 3 tablets a day (or your optimum dose) for 4 weeks. If okay, you can continue to raise the dose by 1/2 to 1 tablet each morning each 6 to 9 weeks to a maximum of 5 a day and then recheck the Free T4 4 weeks later. Adjust it to the dose that feels the best (lower the dose if shaky or if your resting pulse is regularly over 88/minute). Do not go over 5 tablets a day without discussing it with your doctor. When on your optimum dose, you can often get a single tablet at that strength. If your energy wanes too early in the day, you can also take part of your thyroid dose between 11 a.m. and 3p.m. OR

Iodine--1500mcg a day for 2 months (if you have daytime body temperatures under 98.3 degrees). May flare Hashimoto's Thyroiditis.

Thyroid Glandulars--mg capsules in the morning and at noon. Thyroid L-Tyrosine by Enzymatic Therapies or Thyrosine Complex by PhytoPharmica. Take 1-2 capsules up to 3 times a day.

Desiccated Thyroid--130mg from www.nutri-meds.com--it is over-the-counter. 1/2-2 tablets each morning (caution--contains active thyroid hormone. Use only under a doctor's supervision).

Thyrolar (Rx)--1/2 (this equals T4 25mcg plus T3 6.25mcg)

* Cytomel (Pure active T3) (Rx)--5 and 25mcg tablets. Using this treatment is controversial, but can be very helpful. In Fibromyalgia, resistance to normal thyroid doses may occur and patients often need very high levels of T3 Thyroid to improve. Dr. John Lowe's research group feels that the average dose needed in FMS is 75-125mcg each morning--much higher than your body's normal production of 25 mcg/day. Because we are often going above normal levels with T3, the risks/side effects noted above increase. Because of this, if you have risk factors, it is more important to consider an exercise stress test to make sure your heart is healthy (i.e., no underlying Angina) before beginning this protocol. Also, consider a Dexa (Osteoporosis) Scan each 6 to 18 months while on treatment. There may be initial bone loss the first year, then increased bone density. This having been said, in our experience this treatment has been quite safe and, in some FMS patients, dramatically effective. Begin with 5mcg each morning and continue to increase by 5mcg each 3 days until you're at 75mcg a day and then increase by 5mcg a day each 2 to 6 weeks until (whichever comes first):

1. You reach 125mcg each morning (or 60mcg if you're over 50 years old unless approved by your physician).

2. You feel healthy.

3. You get shakiness, worsening significant palpitations (occasional "flip flops" are common), anxiety, racing heart, sweating or other uncomfortable side effects. If this happens, lower the dose a bit for 2-4 weeks and then try raising the dose again till you note significant improvement without uncomfortable side effects or you tried to raise it 3 times and still became shaky/hyper.

Blood tests for thyroid hormone or TSH are not reliable or useful on this regimen. If you feel no better even on the maximum dose, taper off (decrease by 5mcg each 3 days until you're at 15mcg a day. Take 15mcg a day for 3 weeks and then drop to 5mcg a day for 3 weeks--then stop).

After being on treatment for 3 to 6 months, some patients can

lower the T3 dose or stop it. Feel free to try dropping the dose. If you feel better initially and then worse (beginning more than 4 weeks after starting a new dose), you probably need to lower the dose. If you lose too much weight, try to eat more (and discuss this with your physician).

I think you will find that treating subclinical hypothyroidism (i.e.--low thyroid with normal labs) can have a dramatically beneficial effect in your patients' lives. If they are tired, achy, cold intolerant, and/or have weight gain--think low thyroid! I feel that, in the absence of cardiac risk factors, a therapeutic trial is the best way to tell. Dr. Richard Shames is an excellent thyroid expert (author of Thyroid Power) who can consult with your patient by phone (707-823-2077) and help you optimize your patient's thyroid treatment. In addition, Mary Shomon has a superb on-line support group, books, and newsletter for you and your patients as well (see www.thyroid-info.com/ contact.htm). Have fun watching your "untreatable" patients get well!

Thyroid function tests

Thyroid function tests

Definition

Thyroid function tests are blood tests used to evaluate how effectively the thyroid gland is working. These tests include the thyroid-stimulating hormone test (TSH), the thyroxine test (T4), the triiodothyronine test (T3), the thyroxine-binding globulin test (TBG), the triiodothyronine resin uptake test (T3RU), and the long-acting thyroid stimulator test (LATS).

Purpose

Thyroid function tests are used to:

Precautions

Thyroid treatment must be stopped one month before blood is drawn for a thyroxine (T4) test.

Steroids, propranolol (Inderal), cholestryamine (Questran), and other medications that may influence thyroid activity are usually stopped before a triiodothyronine (T3) test.

Estrogens, anabolic steroids, phenytoin, and thyroid medications may be discontinued prior to a thyroxine-binding globulin (TBG) test. The laboratory analyzing the blood sample must be told if the patient cannot stop taking any of these medications. Some patients will be told to take these medications as usual so that the doctor can determine how they affect thyroxine-binding globulin.

Patients are asked not to take estrogens, androgens, phenytoin (Dilantin), salicylates, and thyroid medications before having a triiodothyronine resin uptake (T3RU) test.

Prior to taking a long-acting thyroid stimulant (LATS) test, the patient will probably be told to stop taking all drugs that could affect test results.

Description

Most doctors consider the sensitive thyroid-stimulating hormone (TSH) test to be the most accurate measure of thyroid activity. By measuring the level of TSH, doctors can determine even small problems in thyroid activity. Because this test is sensitive, abnormalities in thyroid function can be determined before a patient complains of symptoms.

TSH "tells" the thyroid gland to secrete the hormones thyroxine (T4) and triiodothyronine (T3). Before TSH tests were used, standard blood tests measured levels of T4 and T3 to determine if the thyroid gland was working properly. The triiodothyrine (T3) test measures the amount of this hormone in the blood. T3 is normally present in very small amounts, but has a significant impact on metabolism. It is the active component of thyroid hormone.

The thyroxine-binding globulin (TBG) test measures blood levels of this substance, which is manufactured in the liver. TBG binds to T3 and T4, prevents the kidneys from flushing the hormones from the blood, and releases them when and where they are needed to regulate body functions.

The triiodothyronine resin uptake (T3RU) test measures blood T4 levels. Laboratory analysis of this test takes several days, and it is used less often than tests whose results are available more quickly.

The long-acting thyroid stimulator (LATS) test shows whether blood contains long-acting thyroid stimulator. Not normally present in blood, LATS causes the thyroid to produce and secrete abnormally high amounts of hormones.

It takes only minutes for a nurse or medical technician to collect the blood needed for these blood tests. A needle is inserted into a vein, usually in the forearm, and a small amount of blood is collected and sent to a laboratory for testing. The patient will usually feel minor discomfort from the "stick" of the needle.

Preparation

There is no need to make any changes in diet or activities. The patient may be asked to stop taking certain medications until after the test is performed.

Aftercare

Warm compresses can be used to relieve swelling or discomfort at the site of the puncture. With a doctor's approval, the patient may start taking medications stopped before the test.

Normal results

Not all laboratories measure or record thyroid hormone levels the same way. Each laboratory will provide a range of values that are considered normal for each test. Some acceptable ranges are listed below.

Thyroid hormones

Thyroid hormones

Definition

Thyroid hormones are artificially made hormones that make up for a lack of natural hormones produced by the thyroid gland.

Purpose

The thyroid gland, a butterfly-shaped structure in the lower part of the neck, normally produces a hormone called thyroxine. This hormone controls the rate of metabolism -- all the physical and chemical processes that occur in cells to allow growth and maintain body functions. When the thyroid gland does not produce enough thyroxine, body processes slow down. People with underactive thyroid glands feel unusually tired and may gain weight, even though they eat less. They may also have trouble staying warm and may have other symptoms, such as dry skin, dry hair, and a puffy face. By making up for the lack of natural thyroxine and bringing the rate of metabolism back to normal, artificially made thyroid hormone improves these symptoms.

Thyroid hormones also may be used to treat goiter (enlarged thyroid gland) and certain types of thyroid cancer.

Description

Thyroid hormones, also called thyroid drugs, are available only with a physician's prescription. They are sold in tablet form. A commonly used thyroid hormone is levothyroxine (Synthroid, Levoxyl, Levothroid).

Recommended dosage

For adults and teenagers, the usual starting dose of levothyroxine tablets is 0.0125 mg (12.5 micrograms) to 0.05 mg (50 micrograms) per day. The physician who prescribes the medicine may gradually increase the dose over time.

For children, the dose depends on body weight and must be determined by a physician.

Taking thyroid hormones exactly as directed is very important. The physician who prescribes the medicine will figure out exactly how much of the medicine a patient needs. Taking too much or too little can make the thyroid gland overactive or underactive.

This medicine should be taken at the same time every day.

Precautions

People who take thyroid hormones because their thyroid glands do not produce enough natural hormone may need to take the medicine for the rest of their lives. Seeing a physician regularly while taking this medicine is important. The physician will make sure that the medicine is working and that the dosage is correct.

In patients with certain kinds of heart disease, this medicine may cause chest pains and shortness of breath during exercise. People who have this problem should be careful not to exert themselves too much.

Anyone who is taking thyroid hormones should be sure to tell the health care professional in charge before having any surgical or dental procedures or receiving emergency treatment.

This medicine is safe to take during pregnancy, but the dosage may need to be changed. Women who are pregnant should check with their physicians to make sure they are taking the proper dosage.

Anyone who has had unusual reactions to thyroid hormones in the past should let his or her physician know before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

Before using thyroid hormones, people with any of these medical problems should make sure their physicians are aware of their conditions:

  • Heart disease
  • High blood pressure
  • Hardening of the arteries
  • Diabetes
  • History of overactive thyroid
  • Underactive adrenal gland
  • Underactive pituitary gland.

Side effects

This medicine usually does not cause side effects if the dosage is right. Certain symptoms may be signs that the dose needs to be changed. Check with a physician if any of these symptoms occur:

  • Headache
  • Fever
  • Diarrhea
  • Vomiting
  • Changes in appetite
  • Weight loss
  • Changes in menstrual period
  • Tremors of the hands
  • Leg cramps
  • Increased sensitivity to heat
  • Sweating
  • Irritability
  • Nervousness
  • Sleep problems.

Other side effects are possible. Anyone who has unusual symptoms while taking thyroid hormones should get in touch with his or her physician.

Interactions

Thyroid hormones may interact with other medicines. This may increase or decrease the effects of the thyroid medicine and may interfere with treatment. Anyone who takes thyroid hormones should not take any other prescription or nonprescription (over-the-counter) medicines without the approval of his or her physician. Among the drugs that may interact with thyroid hormones are:

  • Medicine for colds, hay fever, and other allergies
  • Medicine for asthma and other breathing problems
  • Medicine for diabetes
  • Blood thinners
  • Amphetamines
  • Diet pills (appetite suppressants)
  • Cholesterol-lowering drugs such as cholestyramine (Questran) and colestipol (Colestid).

Key Terms

Adrenal glands
A pair of glands located next to the kidneys. The adrenal glands produce hormones that control many body functions.
Hormone
A chemical that is produced in one part of the body and then travels through the bloodstream to another part of the body where it has its effect.
Pituitary gland
A pea-sized gland at the base of the brain that produces many hormones that affect growth and body functions.