Author: Siddarth Goel

  • Understanding The Root Causes Of Hypothyroidism

    Understanding The Root Causes Of Hypothyroidism

    Thyroid is a butterfly-shaped endocrine gland located in the throat. Thyroid related imbalances are perhaps the most common hormonal imbalances in our society. Conservative estimates put people suffering from thyroid issues at well over 200 million!!! And a vast majority of these are women. Over half of these are undiagnosed and many more may not be treated properly.

    The thyroid hormones (T4 and T3) affect the functioning of every cell, tissue and organ in the body. Their level determines the rate at which the body produces and uses energy. In other words, the metabolic rate is largely decided by the thyroid levels. T4 is largely inactive and must be converted into T3 to be effectively used by the body. This conversion happens in other organs, primarily in the liver, kidneys and muscles.

    Some of the key symptoms of hypothyroidism are:

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    • Slower metabolism leading to weight gain (also insulin resistance)
    • Feeling cold (when others are not)
    • Cholesterol imbalances
    • Poor digestion including constipation
    • Poor Brain function leading to poor memory, brain fog, etc
    • Heart health and function
    • Slower muscular response and low stamina
    • Dry skin and hair fall
    • Irregular periods
    • Suboptimal immune function
    • PMS, Low sex drive, Infertility
    • Mood swing
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    Feedback Loop

    Secretion of the thyroid hormones is controlled by a feedback loop. When the brain (hypothalamus) senses low levels it secretes thyroid-releasing hormone (TRH), which in turn, stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH). This then signals the thyroid to produce more T4 and T3 (about 80% is T4). As T4 and T3 levels increase, the secretion of TRH reduces leading
    to lower TSH. This leads to the thyroid gland also reducing the production of the two hormones.

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    Conventional Approach

    Generally, hypothyroidism is approached as a very simple problem. Most of the time only TSH levels are tested. Sometimes T4 is also included. After this, a certain dose of the T4 hormone is prescribed. The dosage is re-evaluated once or twice a year based on TSH and T4 levels. The real active hormone which is T3 is almost never taken into consideration.

    We need to understand that thyroid function is way more complex than just TSH or T4 and hence this approach is woefully inadequate!

    Thyroid function can be mediated via stress, nutritional deficiencies, toxicity, and autoimmunity. All of these need to be evaluated and addressed to reverse hypothyroidism.

    Let us look at some important factors impacting thyroid function:

    • Deficiencies can impair the body’s ability to produce T4 as well as convert T4 to T3. Iodine, selenium, and protein are needed for T4 production.
    • T4 to T3 conversion also needs Iron, Selenium, Vitamin A, and Zinc.
    • Toxins like chlorine, fluorine, bromine, lead, mercury, etc can affect both thyroid production and conversion.
    • Stress reduces the conversion of T4 to T3. T4 is the inactive form while T3 is the active one.
    • In auto-immunity, the body’s immune system itself can damage the thyroid gland thereby impacting the body’s ability to produce T4.
    • Between 80-90% of the hormone produced by the Thyroid gland is T4. It is an inactive form. To be useful it needs to be converted into T3. This conversion happens in many different parts of the body and can be affected by a variety of factors. The liver and kidney convert t4 to t3 (or rt3) for circulation. The deficiency of zinc, iron, selenium, and vitamin A can affect the conversion. Brain, heart, and skeletal muscles do the intracellular conversion (and this does not get captured in lab tests).
    • Also, T3 needs to enter the cells to be effective. This is also impacted by a variety of factors including stress.
    • Another form of T3 is known as Reverse T3. rT3 blocks the action of T3. Stress can increase the conversion of t4 to rt3 – thereby effectively reducing T3 availability. This is a double whammy – not only do T3 levels reduce, but rT3 also occupies the T3 receptors thereby further reducing the effect of T3.
    • Inflammation can reduce T3 intracellularly while serum T3 remains the same. In fact, TSH can even reduce hence we never get to understand why we feel all the symptoms of hypothyroidism.

    Tests we should actually do to decode the root causes of Hypothyroidism

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    If we really want to understand what is happening with our thyroid we need to test for TSH, Total T4, Total T3, Free T3, Reverse T3 and the two main antibodies which are Anti-TPO and Anti-TG. In addition to these thyroid tests, it is also a good idea to test for nutritional deficiencies like vitamins, iron, iodine, selenium, zinc, and toxins like lead mercury, flourine, etc. Only if we run all these tests we can spot where the dysfunction lies.

    In this blog on hypothyroidism, we focussed on the main factors that cause and aggravate hypothyroidism In the next blog on hypothyroidism, we will tell you about the strategies to reverse hypothyroidism.

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    References:

    1. Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism. H F Escobar-Morreale , F E del Rey, M J Obregón, G M de Escobar –https://pubmed.ncbi.nlm.nih.gov/8641203/
    2. Effect of treatment of overt hypothyroidism on insulin resistance. Aml Mohamed Nada – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746089/
    3. Endocrine function in mercury exposed chloralkali workers. L Barregård, G Lindstedt, A Schütz, and G Sällsten – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1128033/

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  • Kidney Stones-How Can You Prevent Them & Get Rid of Them?

    Kidney Stones-How Can You Prevent Them & Get Rid of Them?

    Kidney stones are a common and one of the most painful problems. It often leads to pretty expensive treatment options. What makes it much worse is that for a majority of people the stones recur every few years. This is simply because they fail to understand and address the underlying root causes.

    Prevalent treatments for kidney stones include shockwave therapy, laparoscopic surgery and ureteroscopy. Certain medicines are used to relax the muscles of the ureter, helping the stone pass out more easily.

    So let us understand why kidney stones happen? What causes them? And what can we do to avoid as well as get rid of them?

    DEHYDRATION – Before we start delving into this topic, let us remember that the single most important reason for kidney stones is dehydration. Due to low water consumption, the volume of urine decreases, making it more concentrated. This obviously increases the chances of stones getting precipitated. For those with a tendency to get kidney stones, drinking 2-3 litres of water per day is a must. This figure needs to be adapted for lifestyle factors like ambient temperature, job profile etc. For example, a person who is into sales and has to spend a lot of time daily commuting between meetings requires a much higher water intake compared to someone else whose job involves working on a computer in an airconditioned environment.

    About 80% of kidney stones are of the calcium oxalate variety. So we need to pay attention to factors affecting the metabolism of these two constituents. Here are some of the important factors that impact calcium and oxalate levels.

    MAGNESIUM – Sufficient magnesium is critical for ensuring proper utilization of calcium. Magnesium is also one of the most common deficiencies found in our population today.

    It is helpful to take a magnesium supplement while consciously increasing the consumption of foods that are rich in magnesium (e.g. pumpkin seeds, cashews, green leafy vegetables, organic peanuts, etc.).

    If taking supplements, target to keep the levels in the upper third of the reference range. It is best to use chelated forms as they are better absorbed. If constipation is also present, consider using the citrate form (it can also be in combination with another well-absorbed form such as magnesium glycinate).

    POTASSIUM – Potassium supplementation is quite useful for patients with uric acid based stones. (Potassium should be avoided by people on certain medications like certain diuretics prescribed for hypertension). Potassium citrate is one of the more useful forms of potassium as the citrate is also useful in this condition. 200 mg can be taken daily.

    VITAMIN K2 – K2 is critical to ensure that calcium from food/supplements is taken up into bones instead of ending up in circulation and being excreted from the kidneys. If calcium remains in blood circulation there are higher chances of it reacting and forming stones. Vitamin K2 prevents this from happening. For prevention, up to 90 mcg of vitamin K2 of the MK-7 variety can be taken daily. Dosage can be increased in the case of active stones. (people on blood thinners should avoid taking K2).

    B VITAMINS, B6 – Adequate levels of all B vitamins is very important. Of special note is B6 as it is key for glutathione synthesis, oxalate metabolism and nerve health. These vitamins should be the ‘active’ type as not everyone’s body is good at converting them to active forms. E.g. for B6 the correct form is P5P and not pyridoxine. It is important to note that we need all the B vitamins to be in the upper third of the reference range. It is not good enough to have them just above the bottom of the reference range. (This is generally applicable for most nutrients).

    VITAMIN D – People with a tendency to get kidney stones should be careful while taking vitamin D supplements as it increases the absorption of calcium into the body. It also uses up the magnesium present in the body so less is available to ensure proper utilization of calcium.

    AVOID BLACK TEA – It is very important to avoid all black teas as they are a rich source of oxalates. As we saw earlier, nearly 80% of the stones are of the oxalate variety. Hence drinking black tea can aggravate the problem significantly.

    AVOID OXALATE RICH FOODS – Foods like spinach, beets, almonds, groundnuts, chocolates, etc. have a good amount of oxalates and should be avoided or consumed in moderation by people susceptible to kidney stones.

    AVOID PURINE RICH FOODS – Another common food ingredient that can cause kidney stones is purine. This is generally connected with the uric acid variety of stones. Some foods high in purines are red and a few other types of meat, some seafood varieties, all alcoholic beverages, mushrooms, green peas, cauliflower, etc.

    Fresh LEMON JUICE is one of the simplest tools to both prevent the recurrence of stones as also to get rid of active stones. The juice of half a lemon can be taken twice a day to prevent a recurrence. While for existing stones one can consume the juice of 4 lemons per day. The high citric acid content binds with extra calcium and prevents it from precipitating in the form of stones.

    INSULIN RESISTANCE & INFLAMMATION – Insulin resistance and chronic inflammation often play a key role in this dynamic and must be addressed for any long-lasting solution. Very often insulin resistance and prediabetes are present to an appreciable extent in kidney stone patients. The most important and easiest steps are to eliminate all sugars and refined carbohydrates.

    It is well known that diabetics are at a higher risk for kidney stones because elevated blood sugar is highly oxidising in nature and damages the kidneys.

    LIVER & BILE – Overall liver health and quality of bile also have an impact on kidney stones. Sluggish bile flow is also a common contributor to stone formation. Also individuals whose gallbladders have been removed are at a higher risk. These dynamics ensure that enough bile is not available for fat digestion. This unabsorbed fat readily binds with calcium in the gut. Hence calcium is not available for binding with oxalates, which then readily get absorbed by the gut.

    YEAST – Certain yeast species (such as candida aspergillus) produce oxalates as part of their metabolic processes. So people with yeast overgrowths can struggle with excessive oxalate levels (also causing issues with the urinary/vaginal tract and elsewhere in the body).

    OXALOBACTER – Oxalobacter formigenes is a commensal bacteria (found in a healthy gut). It metabolises oxalates thereby reducing the amount in the body. If this is low in numbers or activity then oxalates can build up in the system.

    I hope this article gives some useful insight into the various causes and solutions for kidney stones.

    Please leave your thoughts in the comments section below.

    REFERENCES

    Trinchieri, A., Esposito, N., & Castelnuovo, C. (2009). Dissolution of radiolucent renal stones by oral alkalinization with potassium citrate/potassium bicarbonate. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica, 81(3), 188–191.
    Reddy, S. K., Shaik, A. B., & Bokkisam, S. (2014). Effect of Potassium Magnesium Citrate and Vitamin B-6 Prophylaxis for Recurrent and Multiple Calcium Oxalate and Phosphate Urolithiasis. Korean Journal of Urology, 55(6), 411. https://doi.org/10.4111/kju.2014.55.6.411
    di Tommaso, L., Tolomelli, B., Mezzini, R., Marchetti, M., Cenacchi, G., Foschini, M., & Mancini, A. (2002b). Renal calcium phosphate and oxalate deposition in prolonged vitamin B6 deficiency: studies on a rat model of urolithiasis. BJU International, 89(6), 571–575. https://doi.org/10.1046/j.1464-410x.2002.02670.x
    Marickar Y. M. (2009). Calcium oxalate stone and gout. Urological research, 37(6), 345–347. https://doi.org/10.1007/s00240-009-0218-0
    Einollahi, B., Naghii, M. R., & Sepandi, M. (2013). Association of nonalcoholic fatty liver disease (NAFLD) with urolithiasis. Endocrine regulations, 47(1), 27–32. https://doi.org/10.4149/endo_2013_01_27

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