Wednesday, March 25, 2015

Could It Be My Thyroid?

Hypothyroidism symptoms can mimic many other disorders, with fatigue, dry skin, changes in hair texture, and weight gain as the early symptoms. If your hormones are declining, these symptoms may sound familiar.

Hashimoto thyroiditis is an autoimmune disease of the thyroid and is the most common cause of hypothyroidism in the United States in patients over 6 years old. Originally thought to be rare, the incidence seems to be increasing, and it has probably been under diagnosed. It is 15 to 20 times more common in women than men.

On initial exam, simple thyroid testing may present as normal. Thyroid testing can include TSH (Thyroid Stimulating Hormone), T3, T4, and if ordered separately, Thyroid Antibody Testing. Usually, TSH is elevated in Hashimoto patients because the body is desperately trying to keep the thyroid levels normal in the serum, so Thyroid Stimulating Hormone is increased by the body and lab values will detect this. The trick is that in some individuals, TSH levels will appear normal, and even 10 to 15% of Hashimoto patients can test negative for thyroid antibodies.

This is when a good patient history can help. Make sure that your doctor knows if your mom, aunt, or other relatives were diagnosed with low thyroid. Treatment is simply taking supplemental thyroid for the majority of patients and this continues for life. If this is not effective, some patients may require dessicated thyroid or even compounded low dose naltrexone therapy to help balance the immune system cell response.

We recently had a patient with normal thyroid levels who was treated with hormone therapy but continued to have symptoms. Fortunately, the patient remembered her family history and asked her doctor to run thyroid antibody testing. She tested positive for thyroid antibodies, and was started on thyroid medication and is feeling much better.

The bottom line is that we are all more than the sum of our lab values. It is important to be an active partner on your health care team. Make sure that your doctor knows your full family history.

Healthy living with John Hollis Pharmacy!

Friday, March 20, 2015

Stress and Dementia

I have to veer slightly off topic today as I found a troubling article in the Wall Street Journal that arrested my attention. We all know that stress is bad for us and we know the detrimental impact on immunity and blood pressure and chronic disease states. This has always disturbed me; however, new information points to a relationship between stress and dementia.

This news should not be surprising based on information we already have. I think it comes down to this: dementia scares me. Other disease states can be managed, and while not always pleasant, symptoms can be diminished. Dementia is a beast.

Apparently, with uncontrollable stress, there is a significant increase in risk for developing dementia and other memory-related illnesses. Research using brain scans shows us that branches of brain cells can shrink and even disappear after traumatic events.

Neuroplasticity is the term to remember. This refers to the ability of the brain to regroup and form new neural connections. The brain is dynamic and damage can be reversed. The recipe for doing this will sound familiar:

Get the sleep you need.
Drink plenty of water.
Eat a healthy diet.
Manage your stress by reducing multi-tasking.
Get outdoors whenever possible.
Limit electronics.

Remember that your cell phone is not an appendage. We survived for many years without 24/7 connectivity. We all need downtime. Reverse that damage! Remember that a little stress keeps us sharp. Unmanageable stress is a killer.

More on stress management to follow!

Healthy living with John Hollis Pharmacy!

Wednesday, March 11, 2015

Adrenal Fatigue: Fact or Fiction?

We are hearing from more patients who are concerned about "adrenal fatigue." The symptoms can include:


-body aches

-sleep disturbances

-weight loss or gain

-dry skin

-low sex drive

While adrenal fatigue is not an accepted medical diagnosis, alternative healthcare providers have estimated that it impacts up to 80% of the population and is a treatable condition. This is a huge disconnect, so let’s start with background information. The adrenal glands are composed of two parts: the adrenal medulla, which secretes epinephrine, norepinephrine and dopamine and then, the adrenal cortex, which releases aldosterone, cortisol, corticosterone and androgens (sex hormones). Epinephrine is also known as adrenalin and helps produce the "fight or flight response" in the body. It increases alertness, moves the body’s attention away from digestion and prepares it for a quick run, and stimulates heart rate. Norepinephrine is the precursor for epinephrine, and a depletion of norepinephrine is associated with depression. Cortisol prepares the body for stress and can concentrate fat stores in the abdominal area.

In adrenal fatigue, the theory is that the body is in a constant state of stress. This, in turn, depletes the adrenals of the normal operating levels of neurotransmitters with resulting symptoms of fatigue, sleep disturbances, and weight changes among others. Diagnosis is usually made with salivary testing and treatment often involves adrenal supplements.

We recognize that patients are coming in with very real symptoms that are often untreated with conventional means. One of the primary reasons for undertreatment is that our current medical system does not allow enough time for patients to review lifestyle, dietary habits, and other contributing issues during a 15-minute appointment. Decades ago, the family practitioner could more accurately diagnosis patients because of the communal relationship…when Jane Doe complained of a lack of energy and sleep loss, the doctor could take her level of community involvement, her concern over an aging parent and her anxiety over a rebellious teen into the equation. Our stress-laden, transient 21st century lifestyle has replaced community relationships, and it is to our detriment. So, what to do?

First, get a good medical evaluation with blood (serum) testing including vitamin D, vitamin B12 and homocysteine levels along with electrolytes, cholesterol and standard testing. This does need to be fasting. Many treatable diagnoses can mimic adrenal fatigue, so these need to be addressed first. Also, realize that accurate saliva testing for cortisol needs to be taken between 11 pm and midnight for greatest accuracy according to Dr. Andrew Weill. These are the lowest levels of the 24-hour period and can give the most accurate picture for treatment.

Avoid adrenal supplements as too much cortisol can result in either depression or osteoporosis, and do not use the Internet for diagnosis or treatment of this, even though the ads are tempting!

For further treatment, a comprehensive lifestyle evaluation is necessary. Most women should be on additional B12 1000 mcg at least once daily. Our ability to absorb B12 decreases with age, and the popular gluten free and vegetarian diets can provide insufficient B12.

We will explore each of these suggestions in depth in the weeks to come, but for a quick overview:

-Limiting stress (I know easier said than done!) is essential

- Adequate sleep is vital

-Prayer and/or meditation is a proven stress reducer

-Eating a balanced diet and avoiding sugar can get you started

-Turning off the news and turning on relaxing music or music that makes you sing will help.

Pay attention to your body and listen to the messages…. We have enough stress inducers all around us. Unplug and go outside for a walk. The answer is not as simple as cutting out sugar and going outside for exercise but this is the start. More to follow!

Healthy for life with John Hollis Pharmacy!