A Naturopathic Approach to Thyroid Dysfunction

The thyroid gland. That little gland on your throat has a mighty role to play, and with us in Southern Ontario living in the ‘goiter belt’ and the thyroids’ delicate nature, dysfunctions of the thyroid are a major concern to Ontarians. 

The thyroid gland is your master regulator of growth and metabolism.  It is involved in weight loss or weight gain, digestion, energy, reflexes, mood – the list goes on, but these are the big ones.  Over 50% of causes are undiagnosed as the medical world is only now acknowledging that testing can lead to false negatives and more credence has to be taken on symptoms than lab numbers.

The Thyroid is more complicated than we give it credit for

TSH (Thyroid stimulating hormone) is the most commonly tested thyroid hormone.  The most active thyroid hormone is T3 however, which can be free or bound, or can be convert to rT3 (reverse T3) which is believed to be metabolically inactive.  The body needs the necessary micronutrients such as iodine and selenium to convert T4 to T3 in the first place, so even if the thyroid is optimally being stimulated by TSH to produce the T4, it doesn’t necessarily mean the correct proportions of the other thyroid hormones are being produced.

Sub clinical hypothyroidism

If your thyroid lab numbers are ‘normal’, but your body says otherwise, you many be suffering from ‘sub clinical hypothyroidism’.  The most common presentation is low energy, cold hands and feet and an inability to lose weight.   See below for other signs and symptoms associated with thyroid issues.

Thyroid and other disease

Its not just about feeling tired and increased weight, but untreated thyroid can lead to cardiac disease, lupus, reproductive difficulties, diabetes, arthritis as well as many other health issues which are associated with a poor functioning thyroid gland. Research has shown that early thyroid treatment can, in many cases, reduce the incidence or severity of these high profile diseases.

Adrenal function and thyroid

The adrenal glands are two little glands that sit on top of your kidneys and help you regulate stress.  The adrenal gland and thyroid work closely together.  In fact, the adrenal-hypothalamus-pituitary loop is the bodies major regulator.  When the body is constantly under stress, this sets off a chronic inflammatory response in the body causing major dysregulation in numerous organs and glands, with the thyroid being one of the most affected.

Infection and Autoimmune thyroid disease

Infectious disease is proving to be a culprit of numerous autoimmune diseases, and Hashimotos thyroiditis is no exception.  EBV (Epstein Barr Virus) has been shown to change the immune status in susceptible individuals.  Other autoimmune conditions EBV is responsible for include systemic lupus erythematosus (SLE), multiple sclerosis (MS), rheumatoid arthritis (RA), Sjögren’s syndrome, and autoimmune hepatitis.  As a side note, EBV and Streptococcus (my personal nemesis, learn more about my experience with PANDAS in my blog) are known co infections, opening the door for even further auto immune conditions, and / or inflammatory conditions, such as neurological conditions (depression and anxiety), cancer, heart disease and diabetes. 

Why didn’t my doctor say anything before

This is a question we commonly get, and the answer is quite simple.  Conventional medicine doesn’t have the tools to support a subclinical thyroid imbalance.  As a matter of fact, even your Naturopath may first want to treat something else, such as your adrenal glands, nutritional status or toxicity level (underlying cause) instead of jumping right at the thyroid.

Thyroid supplementation or medication

There are many choices for thyroid treatment.  Supplementing with the cofactors such as Iodine, selenium, tyrosine are a common first step.  Certain herbs such as Bladderwrack have been shown to support thyroid function, and bio-identical thyroid such as Armour or Natural thyroid can also be extremely helpful.  BUT, like all disorders, treating the underlying cause such as adrenal dysfunction or infection is essential. 

Cause of thyroid dysregulation

The thyroid is very sensitive to chemicals, inflammation, infection, toxins and stress.  As a matter of fact, thyroid replacement has been reported as not beneficial during acute stress.  Lacking needed cofactors such as iodine, selenium, zinc, iron, Vitamin A, and fats are another very common cause.  Finally, genetics plays a leading role so if you have a close family member with thyroid dysfunction, take extra care to ensure you don’t follow the same route. (Naturopathic medicine can help with prevention of turning on those genes).

Medicine has only scratched the surface of this complicated gland, and patients are often reporting symptoms that respond well to thyroid treatment that aren’t on the ‘main list’ of commonly associated signs for thyroid disorder.  If you are starting to feel ‘off’, with low energy, brain fog, digestive issues or difficulty with temperature regulation, talk to your Naturopath about solutions – don’t wait until the lab numbers come back positive, so much can be done to prevent full thyroid disease from developing.

Hypothyroidism symptoms

·        weak slow heart beat

·        muscular weakness and constant fatigue

·        sensitivity to cold

·        thick puffy skin and/or dry skin

·        slowed mental processes and poor memory

·        constipation

·        goitre (increased size of the thyroid)

Hyperthyroidism symptoms

·        rapid forceful heartbeat

·        tremor

·        muscular weakness

·        weight loss in spite of increased appetite

·        restlessness, anxiety and sleeplessness

·        profuse sweating and heat intolerance

·        diarrhea

·        eye changes

·        goitre (increased size of the thyroid)

Ref (A possible link between the Epstein-Barr virus infection and autoimmune thyroid disorders) (A possible link between the Epstein-Barr virus infection and autoimmune thyroid disorders) (Anna Dittfeld, 2016)

Jumping on the Dot Journal Bandwagon

Gratitude journaling is a key component to mental health, something we should all be doing daily.  

As is taking a few minutes each day to reflect on what went well and what we can improve.  Making to do lists, and carrying those that need to over to the next day and tracking important (or not so important but interesting) things in our lives all help us stay organized and on top of things.  Finally but possibly most important, having a creative outlet adds the fun into our life.  

This is why I love the idea of ‘Bullet’ or Dot Journaling.  A colleague showed me her dot journal at a conference we attended a few weeks ago, and I fell in love – thank you Dr. Lisa Watson.

Now, Lisa, as well as being a fabulous ND, is also an artist.  So she quickly assured me that mine won’t be as super fantastic as hers, and that it doesn’t need to be.  A few simple concepts and bam, you are off the races keeping all your thoughts, hopes, to-do lists and happy moments all in one place.

I’m starting slowly, but can see how this could easily become an addiction.  As you peruse the internet you will see countless sites, blogs and boards devoted to this really cool concept.  

Here is a great infographic I found to help you get started.  

So, go buy yourself a journal and happy bulleting!  Keep me posted on your progress.

Theories behind PANDAS and why I think this happened to us

A perfect storm Inflammation (Sam suddenly started drinking milk, something she had never done before which we know she is sensitive to = immunological activation + inflammation).  This also affected her gut health which is strongly correlated with immune and neurological function.

Sam caught Strep which began molecular mimicry and overactivation of the immune system.  Molecular mimicry is when antibodies intended for foreign proteins and invaders may cause lesions and pathology in healthy tissue (nerve cells). These now act as ‘neurotoxins’ in the brain.

 “PANDAS is believed to be caused in part by molecular mimicry – the neurological symptoms being a result of GABHS antibodies acting against an individual’s basal ganglia and neural tissue”

General stress so that there are less resources available for the body to deal with the gut, immune and inflammation issues mentioned above.  High cortisol levels and hormones in general (starting grade 6 – I took Sam to Universal studios for her birthday Sept. 15^th – 18^th, so the stress of coming back to reality, starting Grade 6, so many kids / social situation to deal with after the summer of general ease, school work, hormones etc).

Energetically, some would (and have) say this happened for my journey to be a better doctor and Naturopath.  Navigating the school and medical system to access resources, REALLY understanding what parents are going through, and I'll admit, it's been a while since we've been gluten and dairy free, so even navigating the grocery stores.  I 'know' what to do yes, but the learning curve of applying it all again.

The plan

1.      Anti-microbials

2.      Anti-inflammatory lifestyle (no gluten, no dairy, no corn, no sugar)

3.      Treat the gut

4.      Decrease neurotoxins

5.      Anxiety strategies

6.      Home schooling for 4-6 weeks (who knew YRDSB did this)

A glimmer of hope through the hell – PANDAS confirmed

For the past 4 weeks, my family has been living through hell.  Our strong, independent daughter had turned into a scared, aggressive ‘wild animal’ overnight.  Each morning I would wake in a panic, what would this day bring?  The psychologists assured me forcing her to school each day was necessary, “you must fight anxiety with exposure, even if for 30 minutes” – but each exposure made the situation worse.  She went from extreme depression, to extreme anxiety to panic, aggression and opposition defiance, the symptoms getting worse.  Planning the follow day became a nightmare, would she go to school? what class? we can’t leave her alone so who will take off work?  I stopped booking patients and making any plans.  And although “mental health affects us all, let’s talk” is a common slogan – the stigma and embarrassment makes it hard to talk about.  I’m a Naturopath who FOCUSES on anxiety, how can my own child be this out of control?  How could I not have seen the signs?  From someone who never takes their children to the doctor I was having 3-4 appointments weekly with different specialists, private school, home schools, teachers – anything to help us dig ourselves out of the hell and start on a new path. 

It took 3 weeks before I could even start to tell my friends and family about what we were going through.  Finally, I broke down in tears in front on a colleague and friend, who once I told my story said “Deb – your daughter has PANDAS.  Test her for strep”.  A few days later, sure enough, Samantha tested positive for streptococcus.  Thank god there is a reason for this extreme abnormal behaviour, PANDAS is now part of my story, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus’. 

We begin treatment today and the research and battle begins.

Are you full of Cr@#p? Step one to Healthy Living: Robust Digestion

In order to produce heart beat, breaths, energy in the form of ATP (the list goes on) our body is constantly producing waste, toxic waste*.  Good news, our bodies are also constantly eliminating this waste.  as long as Good In = Bad out all is well and we are in ‘homeostasis”.  But, in most of us, our BAD IN is on the rise.  I used to ask my patients how many bowel movements they had per day, looking for the perfect answer of 2-3 a day, 1 after each meal, and so rarely got it, that I now ask, “How many bowel movements do you have a week”.  With 5 now the norm.  Quite literally my friends, we are now a society that is full of crap.

 Why is this the case?  Poor food choices, inflammation, dysbiosis, slowing down of our metabolism, slowing down of our organ processes, inefficient elimination pathways producing generally sluggishness.  And for those of you thinking, oh, all I need is a coffee (or a glass of milk…or any substance typically on the ‘food that causes inflammation and sensitivities list) and I’m as regular as clock work – think again.  That coffee does the trick because it is irritating the mucous membranes, causing inflammation – so yes, its helping to some degree, but it is not indicative of a healthy robust digestive system. 

The first step for any wellness program is to create a healthy digestive track, with a minimum of 2 bowel movements daily, well formed, no heart burn, or gas, or bloating – even if those things are now ‘common’ doesn’t mean that that in normal.

Examples of potentially dangerous toxins / free radicals: *Ammonia, aldehydes, alcohols, hydroxyl radical, superoxide anion radical, hydrogen peroxide, oxygen singlet, hypochlorite, nitric oxide, homocysteine, cardon dioxide, bilirubin, adducts (often implicated in Fatty Liver disease).

Eating a healthy diet, exercising and still not losing weight?

We have always known that stress leads to weight grain, and at the very least inability to lose weight.  Knowing that cortisol  is our body's 'stress hormone' it has taken a big part of the blame so far, but now we can add another stress hormone to the list of culprits - ANGPTL8 or betatrophin.

A new study shows that stress causes a hormone ANGPTL8, also knows as betatrophin to be release.  Betatrophin is a protein that regulates fat metabolism by decreasing the expression of a fat fighting enzyme, called adipocyte triglyceride lipase.

Just one more reason that stress management is so important when it comes to weight loss, as are setting realistic expectations.  I see so many patients come into my office who are exhausted, stressed out and anxious, but what they want to work on is weight loss.

It's pretty hard to talk someone who is hell bent on trying to lose weight to switch their focus to increasing energy and stress management, but it's all about removing the root cause, and once the root cause is discovered and removed, results will follow.

It also gives one more argument for stress reduction.  I have recently started getting my patients to spend a few minutes each day doing HeartMath breathing using the EmWave pro.  I first read about HeartMath from an author writing about Weight loss, how he has his patients do heart math breathing before each meal.  If you haven't had a chance to do it, come on in to the clinic and give it a try.










Reference
BBA Molecular and Cell Biology of Lipids February 2016: 1861(2); 130-137

No Fish Oil or Green Leafy Vegetables?!!

 A patient came to see me today who has metabolic syndrome, the whole gamut of high waist: hip ratio, high blood pressure, fatty liver and diabetes.  She told me she had seen a dietitian who told her to avoid fats – including omega 3 FISH OIL, and to not have any green leafy vegetables.  I’m shocked that in today’s society, we know the fat myth has been debunked numerous times, yet, low fat, high grain diets are still being touted as the healthiest – even to diabetic patients!

Every cell in the human body is surrounded by fat – we NEED fat!  Fat then goes on to make our prostaglandins, our leukotrienes and our hormones.  Not only a vital part of communication, but 60% of the dry weight of the brain is fat, our nerves need fat to transmit signals and yes, its an energy source as well. 

Each one of us is different, and there is no one size fits all diet.  This patient was feeling constantly light headed and hungry with this low protein, low fat, high grain diet – and no wonder, the foundation of each meal was grains – oatmeal for breakfast and “whole grain” bread for lunch and dinner.  As a diabetic patient, with blood type O, the high grain diet is not in her best interested.  A higher protein, higher ‘healthy’ fat diet is needed for optimal health. 

There have definitely been patients who I have taken off raw green leafy vegetables for one reason or another.  But diabetes, high blood pressure and fatty liver were not the reasons.  Green leafy vegetables reduce toxins in the liver and promote liver enzyme production.    Liver enzymes protect the liver and rid it of foreign particles, including toxins and fat deposits. Salad greens--dandelions, endive and chicory--and artichokes stimulate bile flow in the liver. Bile is the secretion that assists the body with fat digestion.

So yes, enjoy your avocado, olive oil, and green leafy vegetables with fatty liver – your liver will thank you.