The Metabolism Master: Thyroid Hormone
Thyroid hormone controls your growth and metabolism. It provides energy. If you are low on thyroid you might notice fatigue, sluggishness, intolerance of cold or cold body temperature, thinning hair or dry/brittle hair, dry skin. You might have uncontrollable weight gain or trouble losing weight. You might have constipation. You might be depressed, apathetic, or have “brain fog”.
Your thyroid gland sits in the front part of the neck and makes a thyroid hormone with 4 iodine molecules attached, called T4. This is not the active thyroid hormone. Out in the body, in the muscle, liver, kidney and brain, T4 must have one of its iodine molecules removed to form the active thyroid hormone, called T3. T3 is the form that gets into the body cells to do its work.
The most common textbook form of low thyroid disease is Hashimoto’s. In this case your body makes antibodies against your thyroid that turn the thyroid gland off. We find this most commonly in women, age 30-50, often after pregnancies or around menopause. In recent years we have learned that this condition, like other autoimmune diseases, might be cured if we can find and remove the “trigger” that upset the immune system’s regulating cells. Common triggers are delayed food allergies, heavy metal accumulation or chronic infections.
For various reasons some people do not convert their T4 to T3, and as a result are low on thyroid. So why don’t some people convert T4 to the active T3? The lack of conversion can be due to aging, stress, prolonged illness, toxic metal exposures, other hormone imbalances, nutrient deficiencies and medications, amongst others.
Other people have low thyroid due to iodine deficiency. There is debate as to whether the iodine in our table salt supply is really enough for optimal health. It is estimated that about 8-9% of Americans are low in iodine. Worldwide, low iodine is by far the leading cause of low thyroid function. We recommend simply testing for iodine levels and supplementing higher levels if indicated. This often will improve thyroid function.
Other hormone imbalances can impair thyroid function. Estrogen dominance, high testosterone, or high cortisol, can all impair normal thyroid function. Rather than supplement thyroid hormone it is ideal to “fix” the other hormone problems in these cases.
The standard blood test for diagnosing and monitoring thyroid conditions is thyroid stimulating hormone (TSH) from the pituitary gland. TSH goes up to promote thyroid hormone production in the thyroid. So if TSH is high, it suggests low thyroid, and visa-versa. There is conflicting opinion about how well this test can be trusted. I recommend patients also get a free T4 and free T3 blood test, as well as two tests for antibodies to the thyroid, TPO and thyroglobulin antibody.
Not every low thyroid condition requires thyroid hormone. We strive to correct other imbalances that have led to low thyroid production or resistance to thyroid hormone action. Often Hashimoto’s is curable. Controlling high stress and the associated high stress hormone, cortisol, will improve thyroid function. Eliminating sugar and high glycemic foods from the diet will improve all hormone functions. Eliminating external sources of estrogen-like chemicals (xenoestrogens) will help improve thyroid function. These are only a few examples…
Most physicians use T4 only thyroid hormone for replacement, such as Levothyroid or brand name Synthroid. This is just fine as long as people convert the T4 to the active T3. Some patients do markedly better on forms of thyroid hormone that contain both T4 and T3, such as brand name Armour thyroid.
Aside from feeling poorly, low thyroid will cause a host of diseases to get worse, such as obesity, diabetes or heart disease. Low thyroid also causes problems with the function of other hormones causing them to work poorly. For example, women need thyroid hormone to ovulate and make enough progesterone which is required for a normal menstrual cycle or pregnancy. Men and women need enough thyroid hormone to allow the sex hormones to promote a healthy sex drive. As you can see, thyroid is a critical player in the symphony of hormones.
If you have symptoms of low thyroid and they don’t seem to relate to anything else, then you are very likely low on thyroid hormone. Consider other conditions that mimic low thyroid, such as high cortisol or insulin resistance. But remember, the routine thyroid blood tests might be “normal” but not optimal!
Know the symptoms of low thyroid. If you are suspicious that you have a problem, ask your physician to check the blood tests suggested above. This will give you a starting point for treatment. The blood level may be within the “normal” range, but might need to be adjusted to a higher level to be “normal” for you.
I recommend several books as resources, including “Why Do I Still Have Thyroid Symptoms? When My Lab Tests are Normal” by Datis Kharrazian, and “Stop the Thyroid Madness” by Janie Bowthorpe. One of our most popular free seminars at the IMC is “Low Thyroid: Misunderstood, Misdiagnosed, Missed!” Catch the next live seminar or pick up the DVD version at the IMC.
Inset
The next free seminars are “Supplements: Why you need them and how to choose them”, Monday, April 9th, and “Bioidentical Hormone Replacement for Women”, Monday, April 23rd, both at 6pm, at the IMC. Seating is limited so RSVP at 245-6911 or online at rsvp@imcwc.com.
Bio
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call (970) 245-6911 for an appointment or more information.
He is also medical director of Integrative Weight Solutions, a holistic, physician supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.
Heart Health
Warning: FDA approved drug
“Statin drugs can cause diabetes” warns the new FDA labeling of all statin drugs. The latest recommendation is based on two recent studies showing as much as 27% increase in diabetes caused by some statin drugs (JUPITER and PROVE-IT studies). The new labeling also includes warnings of cognitive changes and memory loss. Interestingly, the FDA removed the recommendation for routine blood testing to monitor for the sporadic and rare side effect of liver failure, but added warnings in regard to interactions with other drugs that can increase the risk of muscle injury.
It seems just a few years ago there was a movement to put every overweight kid on statins - and while we’re at it just put statins in the water supply. The big pharma induced love affair with statins is fading and for good reason. These drugs are not the “end all be all” to heart disease prevention and they have significant risks.
Dr Joe Prendergast, acclaimed endocrinologist and a leading researcher in heart disease, sat on the MD advisory board to evaluate the very first statin drugs released to market. After his review of the risks and benefits he personally told me “he’d never use statin drugs” as the risks were too high and there were better alternatives.
Remember about half the people dying from heart disease have normal cholesterol. It ain’t all cholesterol folks! Cholesterol is our friend, precursor to our steroid hormones, and present in every cell membrane. It ONLY makes plaque once it starts to oxidize and cause inflammation. We need to take a broader look at the whole process of artery disease and work to control all levels, including targeted cholesterol management, but also improving the health of the cells that line the arteries, and controlling oxidation, inflammation and blood thickness.
We should start with diet, including plenty of fresh fruits and veggies, healthy oils such as coconut and olive, and lean meat found in fish and wild game or grass-finished livestock or poultry. Daily exercise and maintaining a healthy weight is still the number one way to reduce heart disease, by far! Getting good quality sleep and managing stress are also powerful moves that improve heart health.
Exercise, obesity and heart health
Exercise lowers body weight and watching TV increases body weight – no surprise there – but research now shows we can actually influence the genetic expression of obesity related genes by our behavior! Harvard scientist, Dr Qebin Qi, studied the effects of watching television and exercise on the genetics of obesity. His team analyzed body mass but also the genes that are associated with obesity, and found that watching TV is associated with up-regulation of genes that are associated with obesity, while walking an hour daily actually down-regulates the obesity genes. This is good news for those who “inherit” the tendency to put on weight showing that genetic predisposition is not necessarily pre-determined fate and you can exert control over your genes. This environmental influence on our genetic code is called “epigenetics” and I predict it will be a big player in the future of medicine.
From the “well duh” category, another study showed that physicians who “practice what they preach” are more likely to give health advice. Lead author Dr Olivia Hung from Emory University surveyed 1000 primary care docs and the ones who did not smoke and exercised regularly were much more likely to pass that advice onto patients. None of us are saints, but I want my doctor to set an example for healthy living.
On another positive note, more and more studies are showing that the biggest health benefits from exercise are obtained with simply going from getting no exercise to getting some exercise. Even just a bit of regular walking 30 minutes daily reaps large rewards in preventing high blood pressure, heart attack, stroke, and diabetes.
Fat, but fit, is also making heart health news. Regular exercise, such as walking, will lower disease risk even if no weight is lost. This doesn’t mean ignore being overweight, as losing excess weight also lowers disease risk, but I find it encouraging to note the benefits of modest exercise independent of weight loss.
Heart smart supplements
A study from the Annals of Internal Medicine by Dr Patricia Uber found that cardiologists asked patients about the use of over-the-counter (otc) medications and supplements in only 2% of clinic visits. The cardiology residents did slightly better asking during 16% of visits. The patients were later questioned by the researchers who found 70% of the patients were taking otc meds and supplements.
As the use of complementary and alternative therapies continues to increase doctors have got to at least ask and consider the use of otc supplements by our patients. Believe me, for your doctor to keep track of the risks, benefits and drug interactions involved with various supplements is a challenge. So patients, please, please tell you physicians about your otc supplements and when possible provide ingredient lists and information about the supplement. We appreciate the help!
Taking more than 500mg / day of calcium is associated with a 30% increase in heart attack occurrence, according to a meta-analysis published in the British Medical Journal. Lead author Dr Ian Reid notes “clinicians should tell their patients that, for most older people, the risks of calcium supplements outweigh the benefits. Changing to calcium-rich foods may be appropriate.”
In what may be a colossal case of “missing the forest for the trees” it seems we’ve been recommending way too much calcium for modest benefits in bone health against the backdrop of a vitamin D deficiency epidemic. Very recent research on vitamin K, especially the K2 form, is shedding even more light on why calcium may end up in the artery wall instead of our bones. We need vitamin D to absorb calcium, but it’s vitamin K that turns on the protein in the bone that allows calcium to be deposited into bone, while also turning on signals in the artery wall keep to calcium away. Stay tuned for new guidelines on calcium dosing. In the meantime have your serum vitamin D level checked as the odds are you are low. And research shows taking at least 45 mcg/day of vitamin K2 lowers the risk of artery disease.
Better screening, better treatment
How can we really know if we are doing ok when it comes to heart disease? What steps can we take to better analyze and promote artery health? I recommend looking for plaque and looking at markers of artery health. Consider getting a cardiac CT scan to see if you have any calcium in the coronary arteries. A simple ultrasound can look for plaque in the bigger arteries. Newer technology allows us to test for central artery blood pressure, a great marker for measuring artery health, with a simple 15 minute in-office test.
If we find significant artery plaque, then we do better blood tests to figure out exactly why the plaque if forming. With more thorough information about the whole blood / artery system I’m able to prescribe more specific and successful treatments. Using proven treatments that include lifestyle habits, natural supplements and medications, we are getting a better handle on heart disease.
Inset
The next free seminars are “Adrenal Fatigue” Monday, March 26th, and “Supplements: Why you need them and how to choose them”, Monday, April 9th, both at 6pm, at the IMC. Seating is limited so RSVP at 245-6911 or online at rsvp@imcwc.com.
Bio
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call (970) 245-6911 for an appointment or more information.
He is also medical director of Integrative Weight Solutions, a holistic, physician supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.
Stress and Adrenal Fatigue
We come equipped with a marvelous emergency response system that allows us to fight for our life or run for our life. Known as the “fight or flight” response this innate hormone response gave primitive-man the energy to “fight the saber-toothed tiger”.
In today’s complex world it seems we are always “fighting imaginary tigers” or “running from imaginary bears” and our adrenal gland is paying the price. A poor diet with too much sugar, starch, and caffeine will make matters worse. Add poor sleep to the mix and our recipe for adrenal fatigue is nearly complete!
The adrenal glands make our stress hormones. They are located on top of our kidneys and when we are stressed they pump out our “fight-or-flight” hormones. If we had to march for days without food and water it is the adrenal gland that would keep us going. Normally the adrenal gland comes into play during a time of stress, such as a mentally challenging time where we need extreme attention, in a fight, during infection or surgery, with sleep deprivation, or similar situations that stress our body.
With “adrenal fatigue” we are mostly referring to cortisol, which is a steroid hormone that helps raise our blood sugar, regulate our immune system, control inflammation, affect the tone of the heart and blood vessels, and stimulate the brain. It plays a very important role in energy production and many people with chronic fatigue are low in their production of cortisol.
The response to chronic stress - first defined as occurring in three stages by Hans Selye as alarm, resistance and exhaustion - typically results in abnormal adrenal function and adrenal fatigue, as well as abnormal cognitive, metabolic, energy, endurance, immune and glycemic function.
People with low cortisol often complain of fatigue. They frequently have a really hard time getting going in the morning and feel tired even though they slept plenty of hours. They might complain of being overwhelmed with everyday chores and even enjoyable activities feel like a burden. Sometimes depression and low sex drive are symptoms of adrenal fatigue. Inability to handle stress is a common feature. They sometimes are prone to low blood sugar, getting weak, shaky, sweaty and light-headed if they go without eating for long. Or they might be prone to light-headed spells reflecting low blood pressure. Some people are prone to frequent infections or prolonged time to recovery.
Cortisol is a diurnal (daytime) hormone, meaning it has wide swings in the levels from day to night. It is normally at its peak within 30-90 minutes after awakening in the morning and then drops to a lower level throughout the day.
We often see patients complaining of daytime fatigue combined with insomnia. These patients usually have low cortisol in the day with a spike toward evening – which is the reverse of the normal pattern. As such patients may get a “second wind” after dinner and be full of energy at bedtime. We call this “wired but tired”. In many of these cases the nocturnal (night) hormone melatonin is also reversed, being low during the middle of the night when it is supposed to be at its peak. These patients will not be helped with their sleep disturbance until the abnormal cortisol response is tamed.
Addison’s disease is the conventional medical syndrome of low cortisol in which people produce no cortisol at all. Without cortisol replacement they will die. Adrenal fatigue refers to people that can make enough cortisol to sustain life, but not nearly the optimal amount to promote health and wellness.
Standard testing might include giving an IV infusion of the pituitary hormone that normally stimulates more cortisol production (ACTH) then measuring to see if cortisol doubles or triples in the bloodstream. This is called an ACTH stimulation test. Another method is to measure cortisol in a 24 hour urine collection as a means to quantify the amount made over time.
We often recommend a salivary cortisol test in which the patient simply collects saliva at different times during the day, such as 8 am, noon, 4 and 8 pm. In this manner we can see what the cortisol level is doing throughout the day and it is very convenient for patients. It also minimizes the possibility of stress causing a sort of false elevation in cortisol beyond what we think is a baseline – driving to the lab and getting poked with a needle will normally raise cortisol!
Adrenal fatigue is a controversial area in medicine. Not all physicians will recognize the diagnosis and the standard tests for cortisol might miss adrenal fatigue. Since cortisol normally varies so much through the day it is important to check the level at different times.
Treating adrenal fatigue involves lifestyle modifications that include improving diet, exercise, and stress management. We usually suggest acupuncture and relaxing activities such as meditation, yoga or tai chi. I recommend all my patients undergoing treatment read “Adrenal Fatigue” by Dr James Wilson. It is well written and covers the topic thoroughly, especially the lifestyle issues.
The supplements used for adrenal fatigue are designed to support, fortify and restore adrenal function, and fall into 3 basic categories:
glandular extracts which are taken from adrenal gland tissue with the actual hormones taken out, providing the nucleic acids, proteins and building blocks for cortisol production
herbal extracts with adaptogenic properties designed to support and nourish healthy, balanced adrenal gland function
vitamins designed to enhance energy production and adrenal function
In severe cases we will add cortisol hormone in physiologic doses. We are always addressing the underlying issues that may have contributed to the adrenal fatigue, such as other hormone imbalances including menopause or low thyroid disorders, inflammatory processes such as impaired gut function or delayed food allergies, chronic infections or heavy metal toxicities. In time the natural supplements or the cortisol can usually be weaned off of as the adrenal gland recovers. Sometimes patients need cortisol forever as the adrenal gland is not capable of recovery.
Adrenal fatigue is one of the most under-recognized conditions in our society. If you suffer from vague symptoms of fatigue, poor sleep, or just not feeling up to par then consider the supporting role your adrenal gland plays in overall health. A simple saliva test, a few lifestyle changes and a little nutritional support may be all your adrenal system needs to help get you back on track.
Inset
The next free seminars are “Adrenal Fatigue” Monday, March 26th, and “Supplements: Why you need them and how to choose them”, Monday, April 9th, both at 6pm, at the IMC. Seating is limited so RSVP at 245-6911 or online at HYPERLINK "mailto:rsvp@imcwc.com" rsvp@imcwc.com.
Bio
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado ( HYPERLINK "http://www.imcwc.com" www.imcwc.com). Call (970) 245-6911 for an appointment or more information.
He is also medical director of Integrative Weight Solutions, a holistic, physician supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see HYPERLINK "http://www.integrativeweightsolutions.com" www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.
The iPixel RevolutionLaser Skin Care just got easierBy Erin Larson, CLS and Scott Rollins, MDIf you want to take years off your skin age, reduce sun damage, smooth wrinkles and fine lines, tighten and tone, then the time is now to consider laser skin treatment. Remarkable results from the latest generation of carbon dioxide powered lasers just got faster and easier with a revolutionary handpiece called iPixel. Faster treatment, better coverage and less downtime are making the iPixel the gold standard in laser skin care.How Lasers WorkFirst of all, lasers work by transferring energy in the form of light into the skin where that light energy is absorbed by tissue and converted to heat. Different wavelengths of light are absorbed by different colors and will penetrate to different depths. The exact wavelength of light determines what part of the skin is treated. Some lasers use a crystal to separate out only the desired wavelength of light. More powerful lasers use carbon dioxide (CO2) to power the laser energy.Shorter wavelengths of laser light will target the surface of the skin, treating brown spots, broken capillaries or fine wrinkles. Using relatively low-energy, short wavelength light, imperfections such as the redness of rosacea, superficial blood vessels, color imperfections, age spots and other discolored signs of photoaging can be gently heated and eliminated, replaced by newer, younger looking skin. This 20 minute “photo rejuvenation” procedure is so quick and easy it can be done over a lunch break as it does not require any medications or downtime for recovery. Tattoo removal and hair removal require a wavelength of light that is absorbed by the color found in the tattoo or hair. Darker colors are more treatable with laser as the dark color absorbs the light energy and converts it to heat. The laser energy literally breaks down tattoo ink so that is absorbed by the body and disappears. For hair removal, the laser energy knocks out the hair follicle along with the root, making laser the premiere treatment for hair removal. Forget waxing and plucking - this simple and quick treatment can put an end to the hassle of treating unwanted body hair. Skin tightening is ideal for targeting those telltale signs of aging, including jowl and neck laxity, sagginess under the eyes, droopy brow lines, and nasolabial folds. Now the laser energy is absorbed in deeper skin layers causing heat-induced collagen shrinkage and micro-thermal injury as well as dermal regeneration, repair (healing) and remodeling. Skin tightening produces dramatic, yet comfortable deep dermal heating without damage to the surface epidermis. The result is a tighter, smoother and fresher appearance to the skin.Fractional Laser treatmentsFor more significant wrinkling, discolored and sagging skin the laser treatment needs to deliver energy to even deeper layers of collagen. In years past the only laser treatments for deep collagen restoration involved a more destructive process called “ablation” in which the entire skin surface was treated leading to a complete stripping of the outer layer of skin which involves a higher risk of infection and more downtime for healing. Seeking a less invasive and simpler approach for these more aggressive treatments laser companies developed technologies that allow treating only a fraction of the skin at deeper levels while leaving most of the surface skin intact. This is called “fractional” resurfacing.Different from previous laser technologies, with fractional resurfacing only a tiny proportion of the skin receives the laser light. The laser delivers a series of closely spaced laser spots to the skin while simultaneously preserving the normal healthy skin between. By leaving mostly healthy skin this results in rapid healing following the laser treatment. Fractional lasers strive to achieve the skin improvements obtained with ablative lasers without the associated side effects or downtime.Pixel and the new iPixelBy splitting the laser into a 7x7 or 9x9 array of pixels we can effectively treat the deeper dermal layers while only disturbing 15% - 20% of the surface of the skin. This creates an ablative heat channel at the pixel area - a micro-injury - without disturbing the surrounding tissue. Those micro-injured areas start the process of healing and the untreated area acts as a reservoir for rapid healing. As collagen remodels, skin tightens and texture improves.Pixel is the name given to the laser handpiece that delivers a 7x7 or 9x9 grid of laser energy. Each pulse of laser light leaves a 7x7 “stamp” showing where the laser energy has been emitted into the skin. The Pixel handpiece is then lifted and precisely moved to the next spot to treat, with a slight overlap onto the last treatment spot, thus leaving a smooth and even coverage over the entire treatment area. iPixel is a new laser handpiece that revolutionizes fractional laser treatment. Instead of a trigger on the laser handpiece that controls each pulse of laser light the iPixel uses a small wheel that controls the rapid firing of the laser. Instead of a 7x7 grid of energy with each pull of the handpiece trigger and each pulse of the laser the iPixel leaves a 1x7 grid with each tiny roll of the wheel allowing a smooth continuous path of treatment across the skin. This simple advance in handpiece technology means a much faster, more comfortable and more thorough treatment for patients. For those patients with mild to moderate wrinkling the erbium crystal laser is powerful enough to produce great results with 3-4 treatments that require a few days recovery. For patients with moderate to severe deep wrinkling who wish to avoid surgical procedures but desire a youthful, refreshed skin tone, Pixel CO2 skin resurfacing is the ideal choice. CO2 skin resurfacing fell out of favor years ago due to the treatment's long downtimes and risk of complications. Now with the Pixel CO2, you can get the fabulous results only available with CO2 but with a considerable reduction in downtime. In fact, with Pixel CO2, the average patient will only see about 3 to 5 days of minor social downtime.The iPixel handpiece is revolutionary in that it literally cuts treatment time in half yet allows for smoother more even coverage of the laser energy. This means less discomfort for patients along with a superior outcome. Visit www.bellezzalaser.com to watch one of our actual treatments using the iPixel handpiece. If you are considering a laser skin procedure then please don’t settle for less. Ask about the new gold standard, the iPixel. To learn more about iPixel and the many laser treatments available call Bellezza Laser Aesthetics at 254-1195 and schedule a free consultation with one of our laser specialists. The next free seminars are “Adrenal Fatigue” Monday, March 19th, and “Supplements: Why you need them and how to choose them”, Monday, March 26th, 6pm, at the IMC. Seating is limited so RSVP at 245-6911 or online at rsvp@imcwc.com.BioScott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call (970) 245-6911 for an appointment or more information. He is also medical director of Integrative Weight Solutions, a holistic, physician supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.
