Health Concerns

Cholesterol Management…Continued

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Cholesterol Management

Continued

Benefits of Curcumin
Curcumin, also known as turmeric root, an ancient spice in the ginger family, is gaining attention for its positive impact on a number of diseases, including cholesterol reduction. Scientific evidence has been building since the mid-1980s of curcumin’s potential cholesterol-lowering capabilities.

For example, animals fed small doses of curcumin had their cholesterol levels drop by one half (50%) over those that did not receive curcumin. Curcumin reduces cholesterol by interfering with intestinal cholesterol uptake, increasing the conversion of cholesterol into bile acids, and increasing the excretion of bile acids, according to the International Journal of Vitamin Nutritional Research (1991, 61:364-69).

The 1992 Indian Journal of Physiology reported that ten human volunteers taking curcumin showed a 29% increase in beneficial HDL cholesterol in only 7 days. Total cholesterol also fell 11.6% and lipid peroxidation was reduced by 33%.

In January of 1997, the Journal of Molecular Cell Biochemistry reported curcumin has demonstrated, in vivo, the ability to decrease total cholesterol and LDL cholesterol levels in serum and to increase the beneficial HDL cholesterol. “Blood cholesterol was lowered significantly by dietary curcumin in these diabetic animals. Significant decrease in blood triglyceride and phospholipids was also brought about by dietary curcumin in diabetic rats.”

The research has continued and curcumin’s ability to lower blood cholesterol levels was reported in the April 1998 issue of Molecular Cell Biochemistry, and again, later that year, researchers in Biofactors (1998, 8:1-2, 51-57) reported that “curcumin extract may be protective in preventing lipoperoxidation of subcellular membranes.”

Curcumin also provides an additional benefit by potentially reducing the risk of cardiovascular-related disease as it inhibits platelet aggregation and significantly decreases the level of lipid (LDL) peroxidation. “Observation of curcumin’s mechanism of action shows that it blocks the formation of thromboxane A2, a promoter of platelet aggregation, thereby inhibiting abnormal blood clot formation. Curcumin also increases a prostacyclin, a natural inhibitor of platelet aggregation” (Arzneim. Forsch., 1986, 36:715-17).

Benefits of Gugulipid (Commiphora mukul)
This powerful ancient remedy has been re-discovered by Western culture. Gugulipid is made from the resin of the commiphora mukul tree of north central India. Gugulipid (gugulesterones) has been used for thousands of years to alleviate problems associated with obesity, acne, viral infections, and other ailments.

In a study published in 1989 by the Journal of Associated Physicians-India, 125 patients receiving gugulipid showed an 11% decrease in total serum cholesterol, a drop of 16.8% in triglycerides, and a 60% increase in HDL cholesterol within 3 to 4 weeks. Patients with elevated cholesterol levels showed much greater improvement than normal patients.

The study quoted a second trial (included in the article noted above) where 205 patients receiving gugulipid at a dose rate of 25 mg administered 3 times daily showed a 70 to 80% reduction of serum cholesterol, whereas no response was found in the placebo group (Journal of Associated Physicians-India, 1989, 37[5]:328).

A placebo-controlled trial of 40 patients with high blood-fat levels showed a serum cholesterol reduction of 21.75%, with triglycerides being reduced by 27.1% in only 3 weeks, and after continuing the study for 16 weeks it was learned that HDL cholesterol was increased by 35.8% (Journal of Associated Physicians-India, 1989, 37[5]:328).

Benefits of Green Tea
Green tea has been shown to lower “bad” LDL cholesterol and serum triglyceride levels. Further, green tea’s potent antioxidant effects inhibit the oxidation of LDL cholesterol in the arteries, which plays a major contributory role in the formation of atherosclerosis. “There is considerable epidemiological evidence that tea drinking lowers the risk of heart disease” (FEBS Lett., Aug. 1998, 433(1-2):44-46).

The cholesterol-lowering (hypocholesterolemic) effects of green tea (as well as black tea) have been confirmed by both animal and human epidemiological studies. High consumption of green tea by humans, especially more than 10 cups a day, was found to be associated with higher HDLs and lower LDL and VLDL cholesterol, as well as with various biomarkers indicating better liver health. Lower levels of lipid peroxides in the liver are one well-confirmed benefit of green-tea supplementation found in study after study.

A Japanese study relates, “Green tea catechin acts to limit the excessive rise in blood cholesterol” based on a series of studies reported in 1996 (Journal Nutritional Science Vitaminol., 32:613).

Additionally, some very exciting results were found when rats were fed 2.5% green tea leaves in their diet. The experimental group showed a drop in total cholesterol, low-density cholesterol, and triglycerides. The body weight of green tea-fed rats was 10 to 18% lower than that of rats not consuming green tea. In addition, the activity of antioxidant enzymes superoxide dismutase (SOD) and catalase, and of anticarcinogenic phase-II enzyme glutathione S-transferase (GST), were significantly higher in the green tea group, as was the glutathione level in the liver. There was no liver or kidney toxicity. Thus, the study demonstrated combined cardiovascular and anticancer effects of green tea.

The relation between green tea consumption and serum lipid concentrations were examined using cross-sectional data on 1306 males in Japan. Results indicated that total cholesterol levels were found to be inversely related to the consumption of green tea. “Adjusted mean concentrations of total cholesterol were significantly lower in men drinking nine cups or more a day than in those consuming zero to two cups a day” (Prev. Med. July 1992, 21(4):526-31). No wonder the Japanese people have the longest life span. Most Japanese sip tea all day long.

Green tea also has been shown to elevate levels of HDL, the good cholesterol that helps remove atherosclerotic plaque from arterial walls. Green tea is a natural ACE inhibitor. This is an extra benefit for those with high cholesterol and blood pressure, as published studies show lowered blood pressure in animals and humans given green tea extracts. We recommend one capsule (350 mg) of green tea 95% extract daily, or drinking one to ten cups of green or black tea a day.

Benefits of Fish Oil
Fish oil has been shown to reduce high levels of triglycerides by an average of 35%. Fish oil does not appear to reduce cholesterol to that extent, but does offer benefits when consumed as part of an integrated therapy.

A study conducted in The Netherlands on mice and published in June 1998 stated, “Triglyceride turnover studies revealed that fish oil significantly decreased the hepatic VLDL-triglyceride production rate (down 60%)” (Journal of Lipid Research (United States), June 1998, 39(6):1181-88).

Another study indicates, “Our results suggest that fish oil lowers plasma lipid levels significantly” (J. Formos. Med. Assoc., Sept. 1997, 96(9):718-26). Investigations published in the American Journal of Clinical Nutrition in 1997 examined the effects of n-3 fatty acids on serum lipid and lipoprotein concentrations in seven species of experimental animals. n-3 Fatty acids consistently lower serum triglyceride concentrations in humans, but not in most animals. These differences between animals and humans may arise from underlying species differences in lipoprotein metabolism.

Scientific studies have demonstrated that alpha-linolenic acid (from flax or perilla oil) reduces the incidence of atherosclerosis, stroke, and second heart attacks. One study showed a 70% reduction in second heart attacks in those consuming this type of fatty acid. Additionally, perilla oil suppresses platelet-activating factor (PAF), a major cause of arterial blood clots that cause heart attacks and strokes. Perilla oil was shown to decrease PAF by 50% in rats, compared with the administration of safflower oil (Journal of Lipid Mediators and Cell Signaling (Netherlands), 1997, 17/3:207-20).

Fish oil and garlic is a beneficial combination: Forty subjects, all with cholesterol over 200 mg/dL, were enrolled in a single-blind, placebo-controlled crossover study to evaluate both fish oil and garlic extract used in a synergistic regimen. Each patient received 1800 mg of fish oil plus 1200 mg of garlic for 1 month. Crossovers were then made to placebos for 1 month. This study found an 11% decrease in cholesterol, a 34% decrease in triglycerides, and a 10% decrease in LDL levels as well as a 19% decrease in HDL risk. Although not significant, there was a trend toward increase in HDL. The doctors concluded by stating

These results suggest that in addition to the known anticoagulant and antioxidant properties of both fish oil and garlic, the combination causes favorable shifts in the lipid subfractions within 1 month. Triglycerides are affected to the largest extent. The cholesterol lowering and improvement in lipid/HDL risk ratios suggests that these combinations may have antiatherosclerotic properties and may protect against the development of coronary artery disease (J. Natl. Med. Assoc., [United States], Oct. 1997, 89[10]:673-78).

Although fish oil appears to be beneficial for cholesterol reduction, there is a remaining problem: fish and flax oil, traditional sources of omega-3 fatty acids, can cause gastrointestinal side effects as well a stomach upset. There is good news in this regard; a new source of essential fatty acids, perilla oil, is showing superior health benefits without adverse gastrointestinal side effects. For cardiovascular disease risk reduction, we recommend 6000 mg of perilla oil a day.

Benefits of Vitamin E
To say that vitamin E is very important to our health is an understatement: it is protective against approximately 80 diseases.

The National Institute of Aging, Tufts University, and the University of Arizona, College of Medicine have found that vitamin E may help inhibit and slow the development of LDL oxidation, the progression of cardiovascular-related diseases, and possibly slow aging.

Oxidation of low density lipoprotein is involved in the development of atherosclerotic disease. An extensive study by the National Institute of Aging of 11,178 seniors aged 67 to 109 found that seniors who supplement with vitamin E are less likely to die prematurely. The research, reported in the American Journal of Clinical Nutrition late in 1997, discovered that vitamin E has the ability to stabilize free radicals. Free radicals are unstable oxygen molecules that can break down and degenerate cells, much as oxygen causes rust on iron. Partly caused by increased LDL cholesterol oxidation, free radicals result in increased plaque deposits and restricted blood flow, making them extremely dangerous to the interior of arteries.

A study by the National Institute of Aging found that people who took vitamin E supplementation over a 9-year period (1984 to 1993) had a 27% lower risk of all-cause mortality, a 41% reduction in heart disease risk!

Similarly, Dr. Jeffrey Blumberg, professor of nutrition at Tufts University in Boston, who heads the Antioxidant Research NIH Laboratories found that vitamin E helped prevent exercise-induced muscular damage based on many of the same mechanisms mentioned above, in the publication Advanced Nutrition, 1997. “The potential benefit is great, data are consistent and compelling, and the risk of side effects is essentially nil. It makes a clear case for recommending supplements,” Dr. Blumberg said.

Increased blood cell adhesion to human aortic endothelial cells (ECs) lining veins and arteries is one of the early events in the development of atherogenesis. Investigators in 1997, in the Journal of Thrombosis and Vascular Biology (United States), indicate that vitamin E has an “inhibitory effect” on LDL-induced production of adhesion molecules and adhesion of blood cell to ECs via its antioxidant function and/or its direct regulatory effect on cell adhesion and arteriosclerosis.

The elderly may receive extra value from vitamin E supplementation, as supplementation with 100 IU vitamin E in the elderly has been reported as beneficial in lowering the rate of oxidation of LDL, slowing the progression of atherosclerosis (Atherosclerosis, Sept. 1997, 133[2]:255-63).

Smokers may benefit from long-term vitamin E supplementation, as it has been reported to improve endothelium-dependent relaxation in forearm resistance in vessels of hypercholesterolemic smokers which are characterized by increased levels of auto-antibodies against oxidized LDL. These findings suggest the beneficial effect of vitamin E for subjects with increased exposure to oxidized LDL such as smokers (J. Am. Coll. Cardiol., Feb., 1999, 33[2]:499-505).

Vitamin E may even work as well as some hypocholesterolemic drugs. Results of a study in the Journal of Circulation Research, August 1998, suggest that vitamin E and selenium inhibited atherosclerosis as effectively as an equally hypocholesterolemic dose of the drug probucol.

The recommended dose of vitamin E ranges from 400 to 800 IU a day. Minimum effective dose for selenium supplementation is 200 mcg a day. Selenium works with vitamin E to protect against LDL oxidation.

Benefits of Soy
The FDA has approved soy as a method of lowering the risk of coronary heart disease. For this dietary supplement, one research abstract says it all:

Soy has been a staple part of the Southeastern diet for nearly 5,000 years and is associated with a reduction in the rates of cardiovascular disease, and certain types of cancer. The research is now showing that phyto-chemicals in soy are the mechanism of action responsible (Society for Experimental Biology and Medicine [United States], 1998, 217[3]:386-92).

Diets rich in soy protein can protect against the development of atherosclerosis. The mechanisms of action of soy protein include cholesterol lowering, inhibition of LDL oxidation, protection against the development of atherosclerosis, and reduction in risk of thrombosis. The active constituents in soy responsible for these benefits are the isoflavones genistein, daidzein, and glycitein. In a study to determine whether soy isoflavones would protect against atherosclerosis in mice, it was reported that mice fed a soy diet averaged 30% lower cholesterol (J. Nutr. [United States], June 1998, 128[6]:954-59).

In a study in Metabolism, June 1997, investigations suggest that dietary soybean protein has a beneficial effect on cardiovascular risk factors. According to another study completed at about the same time, “Potential mechanisms by which soy isoflavones might prevent atherosclerosis include a beneficial effect on plasma lipid concentrations, antioxidant effects, antiproliferative and antimigratory effects on smooth muscle cells, effects on thrombus formation, and maintenance of normal vascular reactivity” (American Journal of Clinical Nutrition, Dec. 1988, 68[6] Suppl., 1390S-93S).

Postmenopausal women may also benefit from intake of soy protein, and it is suggested to be beneficial by researchers in a 1998 issue of American Journal of Clinical Nutrition for diseases and the risk factors (cholesterol) associated with cardiovascular disease.

Adding to the evidence that soy is beneficial, conclusions of a September 1998 Journal of Nutrition study are that “the efficacy of the American Hospital Association Step I cholesterol-lowering diet can be improved with the addition of soy protein.” If you want to reduce your disease risk to heart disease and avoid elevated cholesterol levels, it is recommended that you take soy.

Summary

Diseases associated with high cholesterol (and fats) are the number one killer. Fats also play a key role in the incidence of cancers and many other degenerative diseases. Cholesterol exists only in animal tissues, therefore, one’s diet is an important first step in its control. For some people, however, limiting fat and cholesterol intake alone is not enough to reduce serum cholesterol to safe levels because of their own liver’s production of excess cholesterol. The use of supplements to augment dietary modification can help reduce cholesterol without the side effects of many drugs.

The effectiveness of any cholesterol-reduction therapy varies considerably between individuals. The nutrients we recommend have not only been shown to lower cholesterol, but also protect against cardiovascular disease by other mechanisms such as inhibition of cholesterol-oxidizing free radicals and abnormal blood clots inside arteries (thrombosis).

The following nutritional supplements offer synergistic benefits to assist dietary modification to reduce total serum cholesterol and elevate HDL cholesterol:

  • Policosanol – take one tablet twice per day with meals: one in the afternoon and one in the evening. Or Sytrinol – one capsule twice daily. Note:Do not take if it causes your cholesterol to drop below 180 mg/dL
  • Fiber – 4 to 6 grams before any high-fat meal.
  • Chitosan – three to six 500-mg chitosan capsules and one 1000 mg ascorbic acid capsule right before a high-fat meal.
  • Niacin – 1500 to 3000 mg a day (if tolerable).
  • Artichoke extract – 300 mg, 3 times a day.
  • Garlic – 600 to 4800 mg a day.
  • Curcumin – 900 to 1800 mg a day.
  • Gugulipid – 140 mg 1 to 2 times a day.
  • Green tea – 725 mg a day of green tea, 98% polyphenol extract.
  • Perilla oil – 6000 mg a day. We suggest taking six 1000-mg gel caps daily. If triglycerides are high, consider taking 4-8 softgels of fish oil (EPA/DHA).
  • Vitamin E – 400 to 800 IU daily
  • Soy protein extract – 2 heaping teaspoons (5 to 6 grams) of soy powder daily.
  • Selenium – 200 to 600 mcg daily.

Caution: Anyone who is seeking to use dietary supplements to lower high cholesterol must verify efficacy by having a cholesterol blood test 45 to 60 days after initiating a nutritional regimen. If supplements fail to work, cholesterol-lowering drugs should be considered. While blood testing is not mandatory for healthy people seeking to reduce their risk of heart attack or stroke, it is recommended that everyone have an annual blood test to establish a benchmark giving you the ability to monitor and optimize your life extension program.

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Thyroid Regulation

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Millions of Americans suffer from fatigue, weight gain, depression, and cognitive impairment. Many believe that they have no choice but to accept these seemingly “age-related” declines in quality of life.

Underactive thyroid (hypothyroidism) is often overlooked or misdiagnosed and can be the underlying cause of these symptoms. Patients and their doctors often disregard these common signs of thyroid hormone deficiency, mistaking them for normal aging.1

Overactive thyroid (hyperthyroidism) afflicts fewer people than hypothyroidism, yet the symptoms can be equally devastating. Subclinical hyperthyroidism, characterized by suppressed thyroid stimulating hormone (TSH) levels accompanied by normal thyroid hormones (T4 and T3) levels,2 has been associated with increased rates of cardiovascular disease; arrhythmia in particular.3 Overt hyperthyroidism compromises bone health,4 elevates blood glucose levels,5 and often causes anxiety.6

Fortunately, a simple blood test for TSH, T3 and T4 can reveal an underlying thyroid condition and help direct treatment to improve the symptoms.1, 2

In this protocol we will discuss the function and regulation of the thyroid gland, and the systemic implications of both hypothyroidism and hyperthyroidism. We will examine the importance of proper testing and interpretation of thyroid hormone levels and reveal natural approaches for maintaining optimal thyroid hormone levels.
Role of the Thyroid

The thyroid is a butterfly-shaped organ located just below the Adam’s apple in the neck. Made up of small sacs, this gland is filled with an iodine-rich protein called thyroglobulin along with the thyroid hormones thyroxine (T4) and small amounts of triiodothyronine (T3).

The primary function of these two hormones is to regulate metabolism by controlling the rate at which the body converts oxygen and calories to energy. In fact, the metabolic rate of every cell in the body is regulated by thyroid hormones, primarily T3.7

In healthy individuals the gland is imperceptible to the touch. A visibly enlarged thyroid gland is referred to as a goiter. Historically, goiter was most frequently caused by a lack of dietary iodine. 8 However, in countries where salt is iodized, goiter of iodine deficiency is rare.
Thyroid Regulation

The production of T4 and T3 in the thyroid gland is regulated by the hypothalamus and pituitary gland. To ensure stable levels of thyroid hormones, the hypothalamus monitors circulating thyroid hormone levels and responds to low levels by releasing thyrotropin-releasing hormone (TRH). This TRH then stimulates the pituitary to release thyroid stimulating hormone (TSH).9,10 When thyroid hormone levels increase, production of TSH decreases, which in turn slows the release of new hormone from the thyroid gland.

Cold temperatures can also increase TRH levels. This is thought to be an intrinsic mechanism that helps keep us warm in cold weather.11

Elevated levels of cortisol, as seen during stress and in conditions such as Cushing’s syndrome, lowers TRH, TSH and thyroid hormone levels as well.12,13

The thyroid gland needs iodine and the amino acid L-tyrosine to make T4 and T3. A diet deficient in iodine can limit how much T4 the thyroid gland can produce and lead to hypothyroidism.14

T3 is the biologically active form of thyroid hormone. The majority of T3 is produced in the peripheral tissues by conversion of T4 to T3 by a selenium-dependent enzyme. Various factors including nutrient deficiencies, drugs, and chemical toxicity may interfere with conversion of T4 to T3.15

Another related enzyme converts T4 to an inactive form of T3 called reverse T3 (rT3). Reverse T3 does not have thyroid hormone activity; instead it blocks the thyroid hormone receptors in the cell hindering action of regular T3.16

Ninety-nine percent of circulating thyroid hormones are bound to carrier proteins, rendering them metabolically inactive. The remaining “free” thyroid hormone, the majority of which is T3, binds to and activates thyroid hormone receptors, exerting biological activity.17 Very small changes in the amount of carrier proteins will affect the percentage of unbound hormones. Oral contraceptives, pregnancy, and conventional female hormone replacement therapy may increase thyroid carrier protein levels and, thereby, lower the amount of free thyroid hormone available.18
Thyroid Dysfunction
Hyperthyroidism

In hyperthyroidism, the thyroid gland produces too much thyroid hormone, which can significantly accelerate the body’s metabolism. Typical symptoms of hyperthyroidism include sudden weight loss, a rapid heartbeat, sweating, nervousness or irritability. Hyperthyroidism affects about one percent of the population.19

Extreme hyperthyroidism, or thyrotoxicosis, can culminate in what’s referred to as “thyroid storm”.20 In this medical emergency, patients suffer from elevated heart rates and blood pressure, extreme exhaustion, and high fever. Thyroid storm sharply increases a patient’s risk for stroke and heart attack, and is fatal for up to 50% of patients, even with the best medical care.21
Hyperthyroidism: What you need to know

Hyperthyroidism is usually caused by Graves’ disease characterized by symptoms such as rapid heartbeat, sweating, nervousness, tremors, muscle weakness, sleep difficulties, increased appetite and sudden weight loss.22 Affected individuals can also experience thyroid storm—a potentially deadly medical emergency.23

Medical Treatment of Grave’s disease 24

* Anti-thyroid drugs, such as methimazole or proplythiouracil, inhibit the production of T3.
* Radioactive iodine, which causes destruction of the overactive thyroid gland.
* Surgical removal of the thyroid gland (thyroidectomy).
* Βeta-blockers may be used to control the high blood pressure and increased heart rate associated with hyperthyroidism.

Nutritional Support of Hyperthyroidism

* Increased thyroid activity increases loss of L-carnitine through the urine. Individuals suffering from hyperthyroidism may, therefore, require supplemental L-carnitine.25
* L-carnitine supplementation helped prevent or reverse muscle weakness and other symptoms in individuals suffering from hyperthyroidism. Clinical trials have shown that doses of 2,000-4,000 mg/day of L-carnitine are helpful in individuals who suffer from hyperthyroidism.26
* Passion flower (Passiflora incarnata ) and valerian (Valeriana officinalis) are botanicals that have a calming effect on the nervous system27,28 and thus may help control the symptoms of an overactive thyroid.

Hypothyroidism

Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormones, characterized by a reduction in metabolic rate. The main symptoms of hypothyroidism are fatigue, weakness, increased sensitivity to cold, constipation, unexplained weight gain, dry skin, hair loss or coarse dry hair, muscle cramps and depression. However, most symptoms take years to develop. The slower the metabolism gets, the more obvious the signs and symptoms will become. If hypothyroidism goes untreated, the signs and symptoms could become severe, such as a swollen thyroid gland (goiter), slow thought processes, or dementia. 29

Subclinical hypothyroidism, an often under-diagnosed thyroid disorder, manifests as elevated TSH, normal T4 and normal T3 levels.30 Individuals with subclinical hypothyroidism are at greater risk for developing overt hypothyroidism.31 An August 2010 study reported that 8.3% of women with no history of thyroid disease suffer from subclinical hypothyroidism.32 An article in the American Family Physician in 2005 estimated that about 20% of women over the age of 60 suffer from subclinical hypothyroidism.33

There is evidence that the standard blood TSH test reference range may cause many cases of hypothyroidism to be missed. Most physicians accept a reference range for TSH between 0.45 and 4.5 mU/L to indicate normal thyroid function. In reality, though, a TSH reading of more than 2.0 may indicate lower-than-optimal thyroid hormone levels.34

According to a study reported in Lancet, various TSH levels that fall within normal range are associated with adverse health outcomes.26

* TSH greater than 2.0: increased 20-year risk of hypothyroidism and increased risk of thyroid autoimmune disease
* TSH between 2.0 and 4.0: hypercholesterolemia and cholesterol levels decline in response to T4 therapy
* TSH greater than 4.0: greater risk of heart disease

There is another and separate problem brought on by these overly broad normal ranges for TSH. People already diagnosed and being treated for hypothyroidism are often not taking correct doses of thyroid replacement hormone. A November 2010 study reported that about 37% of people being treated for hypothyroidism were taking incorrect doses, about half too much and another half too little hormone.35
Consequences of Hypothyroidism

Gastrointestinal problems: Hypothyroidism is a common cause of constipation. Constipation in hypothyroidism may result from diminished motility of the intestines. In some cases, this can lead to intestinal obstruction or abnormal enlargement of the colon.36 Hypothyroidism is also associated with decreased motility in the esophagus, which causes difficulty swallowing, heartburn, indigestion, nausea, or vomiting. Abdominal discomfort, flatulence, and bloating occur in those with small intestinal bacterial growth secondary to poor digestion.31

Depression and psychiatric disorders: Panic disorders, depression, and changes in cognition are frequently associated with thyroid disorders.37 Hypothyroidism is often misdiagnosed as depression.38 A study published in 2002 suggests that that thyroid function is especially important for bipolar patients: “Our results suggest that nearly three-quarters of patients with bipolar disorder have a thyroid profile that may be suboptimal for antidepressant response.” 39

Cognitive decline: Patients with low thyroid function can suffer from slowed thinking, delayed processing of information, difficulty recalling names, etc.40 Patients with subclinical hypothyroidism show signs of decreased working memory,41 and decreased speed of sensory and cognitive processing.42 An evaluation of thyroid hormones along with TSH may help avoid misdiagnosis as being depressed. 43

Cardiovascular Disease: Hypothyroidism and subclinical hypothyroidism are associated with increased levels of blood cholesterol, increased blood pressure, and increased risk of cardiovascular disease. 44 Even those with subclinical hypothyroidism were almost 3.4 times as likely to develop cardiovascular disease than those with healthy thyroid function.45

* High blood pressure: Hypertension is relatively common among patients with hypothyroidism. In a 1983 study, 14.8% of patients with hypothyroidism had high blood pressure, compared with 5.5% of patients with normal thyroid function. 46 “Hypothyroidism has been recognized as a cause of secondary hypertension. Previous studies … have demonstrated elevated blood pressure values. Increased peripheral vascular resistance and low cardiac output has been suggested to be the possible link between hypothyroidism and diastolic hypertension.” 47
* High cholesterol and atherosclerosis: “Overt hypothyroidism is characterized by hypercholesterolemia and a marked increase in low-density lipoproteins (LDL) and apolipoprotein B” 48 These changes accelerate atherosclerosis, which causes coronary artery disease.43 The risk of heart disease increases proportionally with increasing TSH, even in subclinical hypothyroidism.49 Hypothyroidism that is caused by autoimmune reactions is associated with stiffening of the blood vessels. 50 Thyroid hormone replacement may slow the progression of coronary heart disease by inhibiting the progression of plaques.51,52
* Homocysteine: Treating hypothyroid patients with thyroid hormone replacement might attenuate homocysteine levels, an independent risk factor for cardiovascular disease: “A strong inverse relationship between homocysteine and free thyroid hormones confirms the effect of thyroid hormones on homocysteine metabolism.” 53
* Elevated C-reactive protein: Overt and subclinical hypothyroidism are both associated with increased levels of low-grade inflammation, as indicated by elevated C-reactive protein (CRP). A 2003 clinic study observed that CRP values increased with progressive thyroid failure and suggested it may count as an additional risk factor for the development of coronary heart disease in hypothyroid patients. 54

Metabolic Syndrome: In a study of more than 1,500 subjects, researchers found that those with metabolic syndrome had statistically significantly higher TSH levels (meaning lower thyroid hormone output) than healthy control subjects. Subclinical hypothyroidism was also correlated with elevated triglyceride levels and increased blood pressure. Slight increases in TSH may put people at higher risk for metabolic syndrome. 55

Reproductive system problems: In women, hypothyroidism is associated with menstrual irregularities and infertility.56 Proper treatment can restore a normal menstrual cycle and improve fertility. 57

Fatigue and weakness: The well known and common symptoms of hypothyroidism, such as chilliness, weight gain, paresthesia (tingling or crawling sensation in the skin) and cramps are often absent in elderly patients compared with younger patients, fatigue and weakness are common in hypothyroid patients.58
Testing Thyroid Function

Thyroid stimulating hormone (TSH) level is the most common test for screening for thyroid dysfunction. In the last decade the diagnostic strategy for using TSH measurements has changed as a result of the sensitivity improvements in these assays. It is now recognized that the TSH measurement is a more sensitive test than T4 for detecting both hypo- and hyperthyroidism. 59 As a result, some countries now promote a TSH-first strategy for diagnosing thyroid dysfunction in patients. 60

In 2008 many labs adopted the reference range for TSH, 0.45 to 4.50 μIU/mL, recommended by both the Endocrine Society and the American Medical Association. Although this range is an improvement over the previous 0.45-5.5 mIU/L, it is still considered too broad by many clinicians. 59, 60, 61

The American Association of Clinical Endocrinologists now recommends an upper limit of 3.0 mIU/L.61 The guidelines for diagnosing thyroid disease from The National Academy of Clinical Biochemistry point out that “more than 95% of normal individuals have TSH levels below 2.5 [mIU/L].. 62 This panel suggests that the upper limit of TSH should be reduced to 2.5 mIU/L.63

On the other hand, current studies also suggest that TSH values below the normal range may represent thyroid hormone excess and, in elderly patients, might be associated with an increased risk of death due to cardiovascular disease. 64, 65

Life Extension suggests an optimal level of TSH between 1.0 and 2.0 mIU/L, as some studies have noted that a TSH above 2.0 may be associated with adverse cardiovascular risk factors. 26 In addition, a TSH between 1.0 and 2.0mIU/L has been associated with the lowest subsequent incidence of abnormal thyroid function.66

However, while a measure of TSH alone is a useful screening tool in assessing thyroid function, Life Extension advocates additional testing, including Free T3 and T4 levels, to provide a more complete evaluation of the thyroid.

Note: TSH values do fluctuate with time of day, infection, and various other factors. In a 2007 survey published in the Archives of Internal Medicine, values spontaneously returned to normal in more than 50% of patients with abnormal TSH levels when the test was repeated at a later date.67 No single measurement of TSH should be considered diagnostic.

Basal Body Temperature: An alternative method for assessing thyroid status that was widely used in the past, before the development of accurate thyroid function blood tests, is the basal body temperature test. The temperature is taken when the body is at complete rest, immediately after waking and before beginning any activity. The normal basal temperature is 97.6-98.2ºF, and some alternative practitioners believe that a 5-day consecutive temperature reading below 97.6 ºF is indicative of hypothyroidism. One study showed a significant correlation between the basal body temperature and low thyroid function in whiplash patients. The authors of this study conclude that basal body temperature “seems to be a sensitive screening test, in combination with laboratory analysis, for the hypothyroidism seen after whiplash trauma.”68 However, there are many reasons for alteration of basal body temperature, a thyroid panel blood test should be taken to accurately evaluate the thyroid function.

Tests for T4 and T3: Thyroid hormones can be tested in both their free and protein-bound forms. Tests for the protein-bound forms and unbound form of T4 or T3 are generally referred to as Total T4 or Total T3 respectively; unbound forms are called Free T4 and Free T3. Each of these tests gives information about how the body is making, activating, and responding to thyroid hormone. Levels of free T3 and T4 will be below normal in clinical hypothyroidism. In subclinical hypothyroidism the TSH will be elevated while the thyroid hormone levels are still in the normal reference range.

Reverse T3: Certain individuals with apparently normal T4 and T3 hormone levels still display the classic symptoms of hypothyroidism. This may be due to an excessive production of reverseT3 (rT3). rT3 is inactive and may interfere with the action of T3 in the body. Stress and extreme exercise may play a role in lowering thyroid hormone action by suppressing production of TSH and T3 and elevating rT3 levels.69,70

Autoimmune antibodies: When evaluating the thyroid it is also important to consider that the most common cause of overt hypothyroidism in the United States is an autoimmune disorder known as Hashimoto’s thyroiditis.71 In this condition the body produces antibodies to the thyroid gland and damage the gland. Hashimoto’s thyroiditis is diagnosed by standard thyroid testing in conjunction with testing for the presence of these antibodies called antithyroglobulin antibodies (AgAb) and thyroperoxidase antibodies (TPOAb). Some people with celiac disease or sensitivity to gluten are at increased risk for developing autoimmune thyroid disease and should be evaluated.72

Elevated thyroid antibodies are often associated with chronic urticaria, also called hives. Studies report that as many as 57.4% of patients with hives have the presence of anti-thyroid antibodies.73,74 An August 2010 paper suggests that treatment with T4 improves the itching associated with urticaria, but did not advise treatment with T4 unless the patient was hypothyroid. 75

Additional testing: Sometimes biopsy or enzymatic studies are required to establish a definite diagnosis for thyroid dysfunction. Major abnormalities of the thyroid gland detected in physical exam can be further assessed by ultrasound or a procedure known as scintigraphy.

Hypothalamic pituitary axis (HPA): There is an intimate relationship between the thyroid, the adrenal glands and the sex hormones.76 If hypothyroidism is suspected, an evaluation of the adrenal glands as well as the sex hormones is suggested.
Hypothyroidism: What you need to know

* Thyroid diseases occur about five times more frequently in women than in men. As many as 20% of women over 60 years old have subclinical hypothyroidism.77
* If untreated, chronic hypothyroidism can result in myxedema coma, a rare, life-threatening condition. Mental dysfunction, stupor, cardiovascular collapse, and coma can develop after the worsening of chronic hypothyroidism as well.78
* An autoimmune disease called Hashimoto’s thyroiditis is the most common cause of low thyroid function in the US. The body’s immune system mistakenly attacks the thyroid tissue impairing the ability to make hormones.79 Hypothyroidism caused by Hashimoto’s disease is treated with thyroid hormone replacement agents.
* Hashimoto’s disease usually causes hypothyroidism, but may also trigger hyperthyroid symptoms.80
* Hyperthyroidism is usually caused by Graves’ disease, in which antibodies are produced that bind to TSH receptors in the thyroid gland, stimulating excess thyroid hormone production.20
* The distinction between Hashimoto’s thyroiditis and Graves’ disease may not be as important as once thought. In 2009 researchers wrote that, “Hashimoto’s and Graves’ disease are different expressions of a basically similar autoimmune process, and the clinical appearance reflects the spectrum of the immune response in a particular patient.”81 The two diseases can overlap causing both thyroid gland stimulation and destruction simultaneously or in sequence.82 Some clinicians consider the two conditions different presentations of the same disease.83 About 4% of patients with Graves’ disease displayed some symptoms of Hashimoto’s thyroiditis during childhood.84
* Pregnant women are especially at risk for hypothyroidism. During pregnancy, the thyroid gland produces more thyroid hormone than when a woman is not pregnant,85 and the gland may increase in size slightly.
* Uncontrolled thyroid dysfunction during pregnancy can lead to preterm birth, mental retardation, and hemorrhage in the postpartum period. 86 It is important to work closely with a physician to monitor thyroid function during pregnancy.
* Tests to diagnose and monitor hypothyroidism include: Thyroid Stimulating Hormone (TSH), Total T4, Total T3, Free T4 (fT4), Free T3 (fT3), Reverse T3 (rT3), Thyroid peroxidase antibody (TPOAb), Thyroglobulin antibody (TgAb)

Thyroid Panel (TSH, T4, Free T4, Free T3)

Item Catalog Number: LC304131

This panel is used to evaluate thyroid function. Low thyroid function may result in fatigue, dry skin, and excessive weight gain. The test includes the following:

  • Thyroid-Stimulating Hormone (TSH)
    Evaluates overall thyroid function.
  • Total Thyroxine (T4)
    Evaluates the total amount of T4 produced by the thyroid gland.
  • Free Thyroxine (T4)
    Evaluates the amount of T4 available to the cells and tissues.
  • Free Tri-iodothyronine (T3)
    Measures the amount of T3 (the active form of the hormone) available to the cells and tissues.

This test does not require fasting. Take your medications as prescribed. However, do not take your supplements on the day of the test.

$100.00 Call to order 800-316-3932

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