Month: July 2016

Categories
Book review Health

Dealing with Hashimoto’s Disease (Autoimmune Thyroiditis)

Hashimoto’s Disease is the cause of 90-95% of cases of hypothyroidism, or low thyroid. Also known as Hashimoto’s Thyroiditis, it is an autoimmune disease where specific antibodies produced in the body attack the thyroid gland, damaging it and blocking it from producing the thyroid hormones all cells in our bodies need to produce energy.

People who have Hashimoto’s generally have symptoms of low thyroid – fatigue, weight gain, feeling cold, joint and muscle pain, constipation, dry skin and hair, slow heart rate, and more – and they often have other autoimmune diseases as well, such as Type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease or Celiac disease too. In addition to the typical hypothyroid symptoms, patients with Hashimoto’s may have acid reflux, nutrient deficiencies, anemia, intestinal permeability, gut dysbiosis (“bad” gut bacteria), impaired digestion, and inflammation. These symptoms suggest something more is going on…

With Hashimoto’s, as the thyroid gland is destroyed and stored thyroid hormone is released, some people will also experience transient symptoms of high thyroid – sweating, rapid heart beat, nervousness, weight loss, heat intolerance creating confusion and misdiagnoses. Hashimoto’s is the main cause of low thyroid, accounting for 90-95% of cases of hypothyroidism. The thyroid hormone replacement medication, Synthroid (synthetic levothyroxine or T4), is generally the only treatment offered and this medication is one of the most prescribed drugs in North America.

Hashimoto’s disease is diagnosed by doing blood tests. These tests will show an elevated TSH (thyroid stimulating hormone, produced in the pituitary gland in the brain, that pushes the thyroid to produce more thyroid hormone), and the thyroid hormones, T4 and T3, will be normal initially as the thyroid responds to the increased TSH. As the autoimmune damage to the thyroid progresses, levels of these thyroid hormones will start to decrease. The key diagnostic test, though, is for TPOab (anti-Thyroid Peroxidase antibodies), the antibodies that attack Thyroid Peroxidase enzyme, causing damage to the thyroid gland and disrupting production of thyroid hormones.

So far, the only standard treatment offered is replacement of the missing thyroid hormones after the disease has progressed. There is debate whether starting replacement before thyroid hormones actually start to decrease may be beneficial. While replacing thyroid hormone can help make you feel better, it does not address the underlying problem with the immune system or the cause of the disease. Wouldn’t it make more sense to determine what is causing production of antibodies, treat the cause and prevent the damage, rather than simply replace thyroid hormone for the rest of your life?

The causes are elusive, but some of the additional symptoms of Hashimoto’s, over and above those of simple low thyroid, give us some clues. With Hashimoto’s, nutrient deficiencies, food sensitivities, adrenal dysfunction (impaired ability to handle stress), impaired ability to clear away toxins and intestinal permeability are also commonly seen.

Gastroenterologist and autoimmune researcher, Dr. Alessio Fasano, suggests there are three root causes of autoimmunity, and that all three need to be present for autoimmunity to develop:

  1. Genetic predisposition (genes that increase susceptibility)

  2. Exposure to an antigen (a substance that acts as a trigger)

  3. Intestinal permeability (or leaky gut)

You can’t change the genes you inherited, but you can remove triggers or decrease intestinal permeability by improving your gut health. The problem is, the triggers and causes of intestinal permeability are not the same for everyone, making it a challenge to find the root cause.

Triggers that start the autoimmune process could be infection, severe stress, or something that causes an allergic reaction. Reviewing your past to match events with worsening symptoms is one way to identify your trigger; testing for allergens, intestinal parasites or infection is another. Making lifestyle or diet changes, such as eliminating common allergy-causing foods like gluten or dairy, switching to a Paleo diet, or doing a parasite cleanse (consult a healthcare practitioner!) and noting whether your symptoms improve can also be helpful – just keep in mind that it can take 3 to 6 months for these changes to show results. A decrease in TPOab or reduction in the required dose of thyroid supplement would also suggest you are on the right track.

Addressing digestive issues can work to decrease intestinal permeability: ensuring healthy gut bacterial flora, avoiding foods you are allergic or sensitive to, and adding the supplement, L-glutamine (2.5g twice daily increasing gradually to as high as 10g twice daily) and sometimes adding digestive enzymes are often recommended to promote healing of the gut lining.

In my research for this article, I came across a website/blog that appears very complete and well-researched: http://www.thyroidpharmacist.com . It is written by Dr. Izabella Wentz, a pharmacist with Hashimoto’s disease, who treated it successfully with lifestyle and diet changes, and now writes about her experiences, both personal and with patients she has subsequently treated. She emphasizes that it is often difficult to find and remove triggers for the disease, and to correct digestive problems, as the causes can vary from person to person. She warns readers that it can take years, but encourages them to keep experimenting until they find the solutions that improve their health.

She has written a book about her experiences and strategies to find solutions: Hashimoto’s Thyroiditis: The Root Cause. Her blog also discusses many aspects of the development of Hashimoto’s and approaches to correct the underlying immune dysfunction with good explanations of the reasons for her recommendations.

For example, there is a strong association between development of Hashimoto’s and Celiac diseases, and the two will often occur together, although sometimes without overt symptoms. Absorption of the mineral, selenium, is impaired in Celiac disease and selenium is important in thyroid function. Selenium is also needed for the conversion of low-activity T4 thyroid into T3 thyroid, a form that is 4 times more active. It also protects thyroid cells from oxidative damage caused by hydrogen peroxide that is produced during the normal production of thyroid hormones. So, two of her recommendations to try initially are a gluten free diet to prevent the Celiac process and supplementation with selenium to protect the thyroid gland cells and improve thyroid activity.

Much more research remains to be done in this area and finding the interventions that work for you can take several years, but these changes are safe to try and have the potential to reverse the autoimmune process. I would encourage you to seek a proper diagnosis if you have the symptoms described above, to educate yourself further about options, to consult with a knowledgeable healthcare professional and to work for as long as it takes to improve your health.

Categories
Book review Health

Bacteria for Breakfast, Probiotics for Good Health – A book review

Did you know that at least 90% of our bodies’ cells are not human? They are bacteria that live mostly in our digestive system (about 3 pounds worth!), as well as on our skin, in the lungs, and within the urinary and genital tracts.

These are “good” bacteria that help prevent disease by reducing growth of “bad” bacteria that can cause harm. These good bacteria also produce some nutrients that we need, help digest our food, provide energy in the form of short chain fatty acids, and stimulate our immune systems. And, just being there in sufficient numbers, they crowd out other bacteria that could cause us harm. The make-up of this bacterial flora varies from person to person, and may account for our variable risks for certain diseases.

Pharmacist, Dr. Kelly Dowhower Karpa, wrote Bacteria for Breakfast, Probiotics for Good Health after using probiotics (supplements of good bacteria) to cure her 2-year-old son’s infection of C. Difficile bacteria that was resistant to all antibiotics that his doctors tried. She did extensive research into how these good bacteria keep us healthy before beginning to write and, although some parts of her book are quite technical with explanations designed to answer questions doctors may have, the book is written for the general public. The goal of her book is to educate patients themselves, and to enable them to discuss their gut health with physicians. I will present a brief overview of some of the topics she discusses.

The book focuses on bacteria that live in our digestive systems, from the mouth where they prevent bad breath and dental cavities that can be caused by unfavourable bacteria, to the intestines where imbalances can promote inflammatory diseases. It explains how the stomach is designed to produce acid that kills bacteria that may be in our food but when acid is chronically suppressed with commonly used medications, such as Zantac, Losec (Prilosec), Nexium, etc., or is naturally reduced these bacteria are more likely to survive and the risk of gut infections is increased.

Food allergies can occur when overgrowth of bacteria damages the lining of the bowel, allowing undigested food particles to pass through into the blood stream, triggering allergic reactions to these large proteins that are not normally found in blood (termed “leaky gut syndrome”). This “leakiness” is also associated with inflammation, severe infection, organ failure and even death. Wide-spread activation of the immune system can lead to inflammation, severe allergies, asthma, eczema and even anaphylaxis (a life-threatening allergic response).

The incidence of these immune-related conditions has exploded in the past 50 years, suggesting non-genetic factors are involved. Two major changes are increased hygiene resulting in less exposure to various bacteria, and change in diet with more sterile pre-packaged food and less fresh, fermented and dried foods that would contain various bacteria. Our first exposure to bacteria usually occurs during birth, when passing through the birth canal, so babies born by Cesarian Section do not receive this initial dose of good bacteria and sometimes never develop an ideal gut flora. As well, if the mother has a less than ideal balance of bacteria, then this is what is passed on to the baby.

The effect of our bacterial flora can easily be seen in changes in the daily elimination function of the bowel. After treatment with a course of antibiotics, which kill healthy bacteria along with the infectious bacteria being treated, bowel function often changes with development of either diarrhea or constipation that can be corrected with supplements of good bacteria (probiotics). You may have noticed a difference in your digestion after eating fermented foods that still contain live bacteria. Chronic constipation that is resistant to various laxatives or returns as soon as the laxative is discontinued, will also sometimes respond to a course of probiotics. Keep in mind that probiotic supplements generally contain much more bacteria than you would get in foods like yoghurt, and might be preferred when trying to correct a serious imbalance in gut bacteria.

Dr. Karpa also explains an additional hypothesis for how bacteria may increase our risk for disease in detail with supporting evidence from studies. Although complex, I will try to explain this briefly…

The gastrointestinal tract is considered to be the largest immune system organ, and it communicates with the immune system throughout the body by producing immune particles called cytokines. Good bacteria activate the immune system, by stimulating production of cytokines that create a low-level inflammation. Some of these cytokines also enable production of the thick layer of mucous that protects the cells that line our digestive system. Still other cytokines are produced that limit the amount of inflammation that is created.

If we do not have the correct balance of cytokine-producing bacteria, we could be missing the protective mucous layer (allowing damage to occur in the intestinal wall with resulting leakage of undigested food proteins), we could be lacking enough stimulation of the immune system (leading to poor protection against common infections) or we could become less able to block excessive inflammation (leading to autoimmune diseases like allergies, asthma, inflammatory bowel disease, rheumatoid arthritis, etc.). The book cites many examples of improvement in chronic health conditions with adequate supplementation of probiotics (or good bacteria) and explains in detail how changes in gut flora are connected with various health conditions.

Disturbed gut flora has been described as potentially playing a critical role in the development of various autoimmune diseases (where the body’s immune system attacks an organ system) such as:

  • Inflammatory bowel disease

  • Type 1 diabetes

  • Rheumatoid arthritis

  • Hashimoto’s Disease (thyroiditis)

The book also briefly describes the benefit that some patients experience by also adding pancreatic enzymes or plant enzymes to help digest food, leading to a reduction in food allergies presumably by increasing the breakdown of proteins they contain. This might be another avenue to discuss with your physician if you have chronic severe food allergies.

As a pharmacist, I believe it is preferable to prevent disease or to treat the root cause, if possible, rather than to simply control the symptoms. I think this is why I found this subject fascinating and wanted to share a little of this information with you.

Other recent research I have stumbled across, suggests that gut bacteria may also be associated with changes in the frontal lobe of the brain that could be associated with autism or schizophrenia. Another report suggests a possible association between gut bacteria and the ability to create the protective myelin sheath (the covering that insulates nerve cells) that is destroyed in degenerative nerve diseases like Multiple Sclerosis. Probiotics have even been noted to increase the beneficial effect of vaccines. So you can easily see that many problems may originate with imbalances in the digestive system’s bacteria, and research continues to look for these associations and how they occur.

If you are interested in reading further, here is information on the book I have reviewed:

Bacteria for Breakfast; Probiotics for Good Health, Dr. Kelly Dowhower Karpa, Trafford Publishing, ISBN 1-4120-0925-0.

Categories
Health

FINGERNAILS… What they can tell you about your health

Grooves, streaks, colour and splits in our fingernails… they all give us clues about the state of our health. Changes in your nails may even be a signal to see your doctor right away! Here is what I learned from Mayo Clinic, WebMD, Boots, and skincare.about.com about how our health affects fingernail growth and appearance…. and ways to correct minor problems.

Pale nails can simply be linked to aging, but they can also be a sign of a serious problem, such as anemia, heart failure, liver disease or malnutrition.

White nails, also known as “Terry’s nails”, are nails that are mostly white but with darker rims. They can be caused by liver disease, such as hepatitis, heart failure or diabetes.

Yellowed nails can be caused by smoking or using dark coloured nail polish without a protective base coat underneath. However, yellow discolouring can also be caused by a fungal infection. If this is the cause, you may also see separation of the nail from the nail bed, nail thickening and crumbling of the nail as the infection progresses. Yellowed nails can also occasionally be associated with thyroid disease, lung disease (such as chronic bronchitis), swelling of the hands (lymphedema), or psoriasis.

Bluish nails can indicate the body is lacking oxygen. Hospitals will often request that nail polish be removed before surgery so natural nail colour can be checked as an indication of oxygen levels during the procedure. Lung problems like emphysema and some heart problems can also be associated with bluish nails.

Rippled or pitted nails may be an early sign of psoriasis, or other connective tissue diseases. These can also be a sign of alopecia areata, an autoimmune disease that causes hair loss. With pitted nails, the skin under the nail may also appear reddish brown.

Cracked nails or nails that split in layers have been connected with thyroid disease. However if yellowish colour is also present, cracking may be due to a fungal infection.

Puffiness around the nail is known as inflammation of the nail fold. This can because by lupus or another connective tissue disorder but can also be caused by infection. Try a non-prescription antibiotic but, if not improved within 2 or 3 days, see your doctor.

Dark streaks that run the length of the nail could be caused by melanoma under the nail – see your doctor as soon as possible!

Nail biting (onchophagia) or picking can be just an old habit but could also be a sign of persistent anxiety or obsessive-compulsive disorder.

Nail separation, known as oncholysis, can be caused by injury or infection, or by a reaction to a product such as a nail hardener or adhesive. Thyroid disease or psoriasis can also cause detached nails.

Beau’s lines are indentations that run across the nails. Interruption of nail growth by injury or severe illness, such as high fever or pneumonia, can be a cause. Uncontrolled diabetes, zinc deficiency or chemotherapy treatment can also cause Beau’s lines.

Spoon nails, or koilonychia, are soft nails that scoop outwards. These are often a sign of either too little iron (iron deficiency anemia) or too much iron (hemochromatosis). Spoon nails can also be associated with heart disease and hypothyroidism.

Nail clubbing, is the enlargement of the tips of the fingers with nails that curve over the fingertips, a condition that develops over the course of years. It’s the result of low oxygen in the blood and could be a sign of lung disease. Nail clubbing is also associated with inflammatory bowel disease, cardiovascular disease, liver disease and AIDS.

Lengthwise ridges in nails are very common and appear more frequently as people age. They are generally caused by a lack of moisture so applying oil or lotion around the nails often can help prevent this problem. You can also smooth ridges away with a nail file (four sided nail buffers are recommended) – just be cautious not to file too hard or too long, as this may cause irritation or inflammation of the nail bed and excessive thinning of the nail.

So, that problem with your nails may be a cosmetic issue or it could be a signal of a serious health problem. It’s probably a good idea to discuss it with your doctor at your next visit, just to be sure!

Presuming a serious underlying disease is not causing your nail problem, here are four key nutrients you can add to your diet to improve the health of your nails…

  1. Protein – Nails are made of keratin, a protein. If meat, eggs and other protein-rich foods are part of your regular diet… no worries! But if you are a strict vegan, make sure you have adequate vegetable protein sources, such as quinoa, beans, and tofu, included every day.

  2. Zinc – A lack of dietary zinc can result in weak, slow growing nails with white spots. Sources of zinc include oysters, pumpkin seeds, sesame seeds, lamb, beef and oats.

  3. Iron – As discussed above, a lack of iron can result in thin, curved nails with ridges. In addition to red meat, leafy greens (e.g. spinach and kale), and shellfish are good sources of iron.

  4. Biotin – One of the B-vitamins, biotin, promotes healthy cell growth and metabolism of protein-building amino acids, and these promote healthy nails and hair. Biotin is found in swiss chard, eggs, wheat germ, whole grains, and salmon.

And, if it seems too difficult to add foods with these nutrients to your diet, there are supplements available that contain what you need. Ask your pharmacist or a pharmacy cosmetic specialist!

Categories
Health

Is Your Memory a Little Foggy?

I’ll bet you’ve gone to a room to get something, only to have no idea what it was when you arrived there… It’s enough to make you wonder if you’re losing your memory! But I’ll also bet you were thinking about something else more important at the time that had nothing to do with the item you were looking for…

Even though you’re not aware of it, your brain is constantly deciding what information is more important and prioritizing the formation of new memory circuits for this information, at the expense of remembering what it was that you wanted in that room.

How Does Memory Work?

Your brain actually changes when you learn something new or have a new experience, forming new connections between brain cells or neurons. This is called “neuroplasticity”.

Memories are formed in 3 stages:

  • Stabilization is the initial encoding of a memory that takes only 6 milliseconds (0.006 seconds!). This encoding happens when you decide to get something from another room.

  • Enhancement is the process of consolidation of the memory that occurs over minutes, several hours or days (depending on how complex the memory is). When you’re busy thinking about something else, the memory for what you wanted to get doesn’t get enhanced properly for easy retrieval. However, when you stop and think for a minute or two, you can usually find the initial encoding of the memory for the thing you wanted…

  • Integration is the process of connecting recent memories into existing memory networks and takes hours to years. Integrating new memories with old ones helps us recall the information more quickly. This might be the stage where you connect the memories of how often you are forgetting what you were looking for, and start to wonder if you’re losing your memory!

  • Reconsolidation is the retrieval of a consolidated memory into short term or working memory. At this stage, new information and experiences can “interfere”, altering the memory. This is called “retroactive interference” and is important in eyewitness testimonies in court proceedings. If, for example, you were the victim of a robbery, it might be a good idea to write down your memories right away to prevent this from happening.

Factors that affect your memory

Neuroscience, the study of the brain and nervous system, has identified 10 factors that help rehabilitation of people with brain damage. These factors were also found to affect memory in healthy people.

  1. Brain circuits that are not being used begin to degrade over time, so when it comes to memory, “use it or lose it”!

  2. “Cognitive training”, using memory techniques such as repeating out loud, using imagery, etc. helps improve memory.

  3. Learning a new skill or information produces significant changes in patterns of connections between neurons in the brain, not seen with repetition of known behavior. Our brains continue to grow and develop if we practice life long learning.

  4. Repetition may be required to induce long lasting memories, and makes it easier to retrieve and process information needed for a task. Repetition also makes memory retrieval faster and more automatic.

  5. Intensity and emotional involvement increase the degree of long-term memory formation. Memories from early childhood are often associated with a time of emotion.

  6. New learning brain cell connections are more likely to degrade more quickly. Stable consolidation of memories requires time. Summarizing what you’ve just learned helps to enhance memory formation and is a common technique used in adult learning programs.

  7. The more important you judge the information to be, the more likely you are to remember, encode and recall it. Often this judgment is an unconscious one.

  8. Aging causes a reduction in the ability to form new connections in the brain. New connections can still be formed but may be less profound or slower to form than in the younger brain. Older folks just need to work a little harder at it!

  9. “Transference” can occur, where the formation of one set of connections can increase the ability to form new, similar connections. Behaviours similar to those we already know are easier to learn.

  10. “Interference” can also occur. Having strong circuits for one brain activity can potentially interfere with formation of new memories that use the same circuitry, disrupting learning and task performance. These last 2 factors may explain why we find some things easier to learn than others.

How can you improve your memory?

Chronic and acute stress has negative effects on memory. When we’re stressed, we produce increased amounts of cortisol, the stress hormone that is known to affect memory negatively. So, decreasing stress often helps to improve memory.

Attention is crucial to processing information and forming memories so focusing on information helps you to remember it better.

Sleep and even daytime naps enhance the processing of memories into a more consolidated form. Sleep disruption, with less time in deeper stages of sleep, affects this processing of memories and memory function the following day. Interestingly, Alzheimer’s Disease (AD) patients have more sleep disruption than healthy elderly adults, and increased time in the deeper stages of sleep improves memory in these patients. The AD drug, donepezil, was found to increase time spent in deep sleep in a study in healthy adults.

Another study found caffeine helps memory more in sleep-deprived people than in those who had a good night’s sleep. Interestingly, sleep deprived people in this study were also more likely to believe their memories were correct, when they were actually wrong.

Nicotine was also found to improve learning and memory tasks in a study setting in Alzheimer’s, schizophrenia and ADHD patients. This is certainly not a reason to start smoking, but might explain the high smoking rates found in patients with schizophrenia.

And what about diet? Sugar may have a positive impact on memory, but not in young adults. Animal studies suggest that saturated fats, hydrogenated (trans) fats and high cholesterol diets may impair memory. Human studies suggest that saturated fats, high cholesterol and high calorie diets deficient in vitamins and antioxidants tend to promote Alzheimer’s Disease, whereas diets with good fats (omega-3’s and mono- and polyunsaturated fats) may decrease risk.

Studies found that exercise speeds mental processes and enhances memory storage and retrieval. Exercise also lowers levels of the stress hormone, cortisol, so may enhance memory by this mechanism also.

Inhaling oxygen before a word list recall test improved memory, although only short term. Blood oxygen saturation and heart rate are correlated – increased heart rate is associated with improved memory in the short term, so an increased heart rate from exercise could be helping boost memory. However, oxygen seems to only help with forming memories, not with recall, so exercise should theoretically help more before you study than before your test.

Music training, for example piano lessons, was noted to improve memory in adults and children. Learning a new language is also reported to improve brain function and memory.

I had many women clients with low levels of progesterone report that their memory for words and names improved when they started using progesterone cream. In contrast, allopregnanolone, the hormone produced when progesterone is broken down, seems to make memory worse. Large amounts of allopregnanolone are produced when progesterone is taken by mouth causing drowsiness not seen with the cream form. This has created conflicting results to studies of progesterone and memory, but my clinical experience suggests that progesterone itself improves memory recall, specifically for words and names.

So, focus on what you want to remember and use memory-enhancing tricks like repeating or associating facts with imagery. Consciously decide which information is important for you to remember. Get your rest and deal with the stress in your life as a strategy to improve your memory. And, if you do happen to have a rough night, that coffee the next day probably will help your memory!

And, did you notice that I bolded some key words to draw attention to them and help you to remember? 🙂 Have a memorable day!