Common problem, commonly overlooked

Are you tired, constipated, mildly depressed, struggling to lose weight, with dry skin? You may suffer from hypothyroidism — an underactive thyroid.

Problem: the above symptoms may have other causes. Another problem: rigid blood test interpretation can lead to a missed diagnosis of hypothyroidism.

Your thyroid gland
Your thyroid is a butterfly-shaped gland at the base of your neck. It regulates your body’s energy production.
Your thyroid gland produces thyroid hormone (no surprise there). “T4” is the storage form. T4 is converted to “T3” in the thyroid, liver, brain and other tissues. T3 is the active form, 200 times stronger than T4.

The importance of TSH
TSH, made by the pituitary gland in the brain, stands for thyroid stimulating hormone. If your thyroid is sluggish, your pituitary produces more TSH, a kind of kick in the pants for the thyroid. The TSH blood test is the most useful test for thyroid function.

What causes a sluggish thyroid?
A common cause is autoimmune. Your immune system thinks your thyroid belongs to someone else and starts attacking it. This is called Hashimoto’s thyroiditis.
Other causes? Stress can suppress your thyroid. Sometimes large amounts of soy products, peanuts or raw cruciferous vegetables (broccoli, cabbage, brussels sprouts) may slow down the thyroid, although this is controversial.

Why is the diagnosis missed?
There is disagreement over what TSH level signifies disease. Some doctors believe your thyroid is OK, regardless of symptoms, if your TSH is below 5.0. Many specialists regard 3.0 and below as normal. They will sometimes treat patients until it’s below 1.0, if necessary.

Treatment options
Most specialists, including some holistic-minded doctors, use synthetic T4. Response is slow so your doctor will wait 6 – 8 weeks before checking your TSH again.
Nutritional support can help. Selenium (200 micrograms a day) and adequate Vitamin D levels are important. Iodine is often used. Stress reduction, as with most health problems, is essential. Nutritional support and stress reduction are all some  need.

What about T3?
Some folks feel better with a small dose of T3. T3 alone or with antidepressants may help in depression. And some respond best to Armour Thyroid, which has both T4 and T3 (from ground up pig thyroids).
The use of T3 is controversial because most studies show little benefit. The studies, however, are inconclusive. I find T3 has a useful role in some patients.
A small number of people have trouble converting T4 to T3. A low free T3 blood value in someone with suspicious symptoms may respond to treatment.

” Take-home message
Know and understand the meaning of your TSH level. Is it between 5.0 and 3.0? Do you also have symptoms? Then treatment may help. See a thyroid specialist. They take a broader, less dogmatic approach.

COMPLEMENTARY MEDICINE SERIES
Homeopathy
Safe healing or magical fantasy?

Homeopathy is a system of medicine using highly dilute substances to stimulate the body’s own healing powers.
It was created by Samuel Hahnemann (1755 – 1843) an eccentric genius German doctor.

He originally experimented with the idea of like vs. like. He treated malaria with cinchona bark, which  provokes malaria-like symptoms.

The idea of diluting preparations came later. Material derived from plants, animals, or minerals is successively diluted and shaken in water, often till there’s no molecule of the original substance left.
The water retains an imprint of the original substance. This imprint is reflected in the water’s molecular arrangement, which guides the body’s own healing mechanisms.

Controversial, to say the least!
Although homeopathy is safe and often effective, many doctors become angry when discussing it. They say it can’t work because nobody knows how it works. Their remarks are usually primitive and unedifying… not in the spirit of open-minded scientific inquiry. The totality of evidence suggests that meaningful healing beyond placebo does occur.

What’s it like to be treated?
Homeopathy is individualized. Your first visit will last an hour or more. Homeopaths want to learn all about you before they prescribe the right remedy.

A single dose may take care of the problem. Within a day or so of taking a remedy, some people feel worse. This is called an aggravation and is well described in the literature. I have observed it myself.

Then many folks start feeling better over several days, as though they are getting well on their own. More acute conditions such as colds, fevers, earaches and infant colic can improve in minutes or hours.

Sometimes it may be the detailed history taking and attention, rather than the remedy itself, that confers the benefit. Instead of dismissing this, however, I regard it as a great advantage, since the patient gets better without risk of side effects.

Safe and Cheap
People treated with homeopathy tend not to suffer side effects or die as a result. The British, French and Germans are more open to homeopathy than Americans.

Given how inexpensive and safe homeopathy is, you’d think we’d use it more often.

Consider
homeopathy
if you have …

Homeopathy is especially good for allergies, colds, sore throats,  skin problems,  digestive complaints, chronic pain, musculoskeletal problems and many children’s illnesses.  Most homeopaths would say this list is too short!
If you have a good homeopath nearby, you may be better off seeking treatment with her (or him) than a regular doctor, especially if your condition hasn’t gotten better with treatment.

READ THIS BOOK
HEALING WITH HOMEOPATHY
The Complete Guide
By America’s Leading Researchers of Homeopathic Medicine Note: They take care of patients, too!
Easy-to-read.

10 good reasons to exercise

You and I both know exercise is good for you.  But how much exercise?  What kind?  Does science give us clear answers?  Or must we rely on educated guesswork and individual experience?
Science doesn’t give us all the answers.  It does, however, offer useful principles.
More important, ask your self why you want to exercise.  Are you seeking better health, improved performance or appearance, more social contacts, the joy of play or a combination of the above?

The Best Exercise…
The best exercise is the exercise you’ll do.  Three hours a week on a treadmill may be OK for some.  But what about dancing, gardening or regular walks with a friend?  Add the outdoors and friends. Learn that exercise can be more than burning calories and firming flab.  Here are ten important benefits of exercise:

#1  Lose weight
Burns calories and stimulates hormones that reduce fat and build muscle.  Strength training builds calorie burning muscle you’d otherwise lose.  It also makes some folks feel just great!  You’ll also notice everyday household tasks indoors and out become easier.

#2  Promote heart health
Helps prevent heart disease.  If you have it, protects from worsening. Up to 50% reduction of further events — may be better than drugs!

#3  Lessen depression
Helpful by itself.  Now a mainstream recommendation.  Sometimes even more effective in combination with drugs or therapy.  Unlike drugs, exercise confers general health benefits with minimal side effects and little risk of harm!

#4  Strengthen bones
Can help prevent bone mass loss.  Strength training is especially useful in this regard.
More important: exercise reduces fall risk, the major cause of life threatening hip fractures.
Consider Tai Chi for improving balance, as well as overall health.

#5  Protect against arthritis
The best protection for an arthritic knee?  Strong leg muscles.
#6  Lower risk of dementia
Even 30 minutes a day of vigorous extra walking can make a difference.  Furthermore, strength training helps you maintain everyday function as you get older.

#7 Improve fibromyalgia
Individualized programs of low to moderate intensity exercise may work as well as anything, including drugs and therapy.  Yoga, with its low intensity exercise, breathing and meditation reduces the pain, fatigue and sleep problems associated with fibromyalgia.

#8  Calm asthma
Especially for people with mild to moderate disease.  Regular exercise can reduce inhaler use.

#9  Helps fight diabetes
Exercise improves your muscle cells’ sensitivity to insulin (less insulin required to transport sugar from the blood into the cell where it’s burned as energy).  It also protects you from heart disease, one main complication of diabetes.

#10  Improve function in old age
Strength training especially.  Just getting around and everyday lifting  become easier.
Studies from Tufts University show it’s never too late, even if you’re 90!  Pumping iron in your 40’s and 50’s appears to predict higher level of functioning in your 70’ and 80’s!

My Recommendation:
#1  Enjoy yourself!  If you’re not going to find some combination of enjoyment and fulfillment in a program, then come up with  a new program!

#2 Include strength training.     Try combining free weights and machines.  2 to 3 times a week.  Obvious as it seems, adding weight to your workouts (progressive resistance) is the key to progress.  Be sure to take a break every 6 to 8 weeks . Then start again at a lower weight. Your body will recharge itself, you’ll avoid getting stale and stuck, and make better progress in the long run!

#3  Aerobics:  New guidelines suggest 30 minutes 5X a week.  Even a brisk walk improves health. Aim to burn an extra 1500 – 2000 calories a week.  Remember, one pound off equals about 3500 calories burned.  Tip:  Get a pedometer to measure steps per day walking.

Looking for a
personal trainer?
Look for NSCA (National Strength Conditioning Association) or ACSM (American College of Sports Medicine) qualifications.

Recommended Reading
Strong Women Stay Young
by Miriam E. Nelson Ph.D. and
Sarah Wernick Ph.D.
Strength Training Past 50
by Wayne L. Westcott Ph.D.
Weight Training Made Easy
by Joyce Vederal, Ph.D.

WHATS NEW

medicine chest
Crestor damage
Crestor is a cholesterol lowering “statin” drug like Lipitor. A new analysis shows that side effects, especially muscle pains, happen more often than with other “statin” drugs.
Crestor is a new drug that does the same things that already existing drugs do. Because it’s new, we don’t know if it reduces heart attacks or death. Crestor’s side effect rate is somewhat higher than other “statins”, although the risk of life-threatening side effects is a mere 1 in 35,865. Because the FDA claimed it was just as safe as the others, some are up in arms. It will probably be taken off the market.

supplements
Magnesium for all
Magnesium is a workhorse mineral. It plays a key role in 100’s of reactions in the body. Supplemental magnesium helps in migraines, fibromyalgia, diabetes, heart arrhythmias, osteoporosis and muscle cramps.

Why so useful? Maybe because most of us don’t get enough in the first place. I frequently prescribe it, especially for constipation ! It’s safe and natural without the adverse consequences of the usual over-the-counter remedies. Try magnesium citrate (better absorbed than the oxide form) 400 – 800 mg a day. You can push it higher. It’s quite safe, but please make sure and discuss it with your doctor before starting it.

your brain
Homocysteine and dementia
Several studies indicate that high levels of homocysteine (> 14) are a risk factor for dementia. The homocysteine may damage the lining of blood vessels in the brains and compromise circulation. High homocysteine is also associated with increased heart disease risk and osteoporosis.

There is no proof yet that lowering homocysteine prevents dementia.  Those studies are in the works. In the meantime… 1,000 to 2,000 micrograms of folate (a cheap, safe B-vitamin) taken with B-12 (100 micrograms) and B-6 (50 – 100 milligrams) can bring homocysteine levels to below 9 in most folks. It’s safe and cheap, so why wait?

pain update
Morphine and Neurontin
Neuropathic pain is the curse of diabetics and people with chronic sciatica, among others. Combining morphine and neurontin can work better than either drug alone, according to a recent Canadian study.

In fact, pain experts frequently use the two together. Two benefits: better overall relief and reduced dosage needs for each individual drugs. Both of these drugs – as drugs go — are safe and often quite effective, in my experience. Both make you sleepy. If they are the right drugs for your pain, however, you may feel relatively little drowsiness, just much less disabling, unpleasant pain!

Integrative medicine
The best of conventional and alternative medicine. Based on good science, with your safety always in mind.

BOOKS THAT STIR THE POT

Osteoporosis
Are thin bones the problem? Are drugs the answer?

Bone loss — 0.5 to 1.5% a year — is a normal part of aging.  At age 50, 20% of women have osteoporosis, 40% have osteopenia, a less severe degree of bone thinning.
Osteoporosis results mainly from lower estrogen levels after menopause and reduced absorption of calcium with aging.

Fractures
the problem

Thin bones themselves are not the primary problem.  Fractures, especially hip fractures, are the big problem.  1 in 4 people with a hip fracture die within a year.  Only 15% are walking on their own in 6 months. 2 of 3 hip fractures occur in folks over 80 years of age.

A bone density test can show whether you have osteoporosis or osteopenia.

We like to think taking care of our bones is a matter of getting a bone density test, starting a drug if necessary, and taking extra calcium.  Not the case.

In fact, bone density predicts only one sixth the fracture risk.  Other factors just as important are muscle weakness, drug side effects, poor vision and cigarette smoking.If you’re small boned or your mother or sister had a hip fracture, you’re also at greater risk.

Drugs are overrated
Fosamax and Actonel are the drugs usually used for osteoporosis.  They disturb normal bone “turnover”.  Working in tandem, one type of cell absorbs bone, another type builds it.  These drugs slow down the cells that absorb bone.

You must treat 88 women with osteoporosis for over 4 years with Fosamax at a cost of over $300,000 to prevent one hip fracture.   With Actonel, to prevent one hip fracture, you must treat 100 women with severe osteoporosis who have also had a spine fracture for one year.  Not very impressive.  Quite costly!

Although these drugs increase bone density in the short term, a recent study of women on these drugs for over five years shows an overall destruction of bone. So don’t take for over 5 years.

Exercise and eat right

On the other hand, 90% of hip fractures result from falls.  When you stay nimble with exercise — dancing, yoga, tai chi, strength training with weights, walking — studies show a reduction in falls.

We also know the importance of good diet — whole grains, adequate protein, fruits and vegetables — not necessarily lots of dairy foods, accordingto most studies.

Calcium is less important than vitamin D, which helps you absorb calcium. Make sure your Vit D level is above 30 nanograms per milliliter.

You shouldn’t need more than 1000 milligrams of calcium a day by supplement (take one with magnesium) and 1000 units of Vitamin D, unless you’re correcting a deficiency (up to 2000 units a day).

” Take-home message
You and your doctor may decide on a drug.  But without proper exercise and diet, you’ll miss the boat!

READ THIS BOOK
FOOD and
OUR BONES
The Natural Way to Prevent Osteoporosis
By Annemarie Colbin —
a pioneering nutritional health expert.

Your Questions Answered

Gingko and Bleeding

Q: I’m 62 years old. My father had Alzheimer’s Disease. I’m afraid of getting it myself. I want to start gingko, but I hear it can cause bleeding. Is this true.

A: Gingko does have some mild blood thinning effects at the usual daily doses of 120 mg to 240 mg. There are eight case reports in the literature of serious bleeding associated with gingko. Four of these cases involved other agents that also could have been a factor. The evidence for bleeding is not overwhelming. Furthermore, a careful recent study showed that Gingko had no effect on PT and INR measurements, which go up as blood becomes thinner (coumadin increases PT and INR)  With widespread use of gingko in this country, it does not appear to pose a notable bleeding problem.

There are two exceptions: #1) If you are on the blood thinner coumadin, all bets are off. I do not recommend it. #2) Other supplements have blood thinning effects — ginger, garlic, turmeric, fish oil, and high dose vitamin E (> 400 units a day). It is not unusual for some people to be taking all of these . . . plus an aspirin! Ask yourself why you are taking a supplement — to support good health or to address a health problem? Do you really need a supplement? Does your doctor know what you are taking? Does your doctor understand and have experience with these supplements?

More important, can gingko help preserve your memory. The answer: “We don’t really know…yet!” There is a study underway of healthy folks that should give us an answer in a few years. We do know some people suffer from an age associated memory decline that increases risk of dementia. I suspect such people — and you may be one of them — can benefit from the neuroprotective effects of gingko . . . at 240 mg a day. So I wouldn’t tell you to stop taking it. I recommend the Nature’s Way Gingkold. This is a German pharmaceutical product used in studies, whose quality is assured.

Migraines and
Sinus Headaches

Q: I keep getting sinus headaches with a lot of nasal congestion. I end up on antibiotics — four times in the last three months. My symptoms improve but then they come back.  When I was younger I used to get headaches.  I am otherwise healthy.

A: Your sinus infections and sinus headaches may be migraines headaches.  It is not uncommon for symptoms like yours to be misdiagnosed and treated with antibiotics . . . sometimes repeatedly.  Your history of headaches when younger suggests you may actually suffer  from migraines,not sinus infections.  Do you also have a family history of migraines? This is still another clue that may point to migraines rather than sinus infection.

I suggest you have your doctor give you a migraine medication such as Imitrex or Axert.  Be aware, however, that overuse of any migraine medication (2x a week or more) can lead to a rebound headache, which requires a different treatment strategy.  Usually steroids like prednisone for up to a week.  Valium can be helpful as well.  Neurologists generally have more training in treating headaches, so consider seeing one if you become frustrated.