Thyroid Health

Hypothyroidism, Hyperthyroidism and the Prevalence of Autoimmune Thyroiditis


An autoimmune disorder is characterized as a malfunction of the immune system where the body produces antibodies that attack the body’s own cells and tissues – the thyroid gland being the most commonly affected organ. Although the reasons for this dysfunction are complex, we understand that many environmental and endogenous factors are associated with autoimmunity of the thyroid.


Hashimoto’s vs Graves’ disease:
Both Graves’ disease and Hashimoto’s thyroiditis are autoimmune disorders of the thyroid. They are both conditions where the immune system (immune T and B cells specifically), infiltrate the thyroid gland and produce autoantibodies leading to abnormal function – underfunction or overstimulation of the thyroid gland in Hashimoto’s and Graves’ respectively.


Testing for these conditions involves looking at the presence of anti-TPO and anti-Tg antibodies in the blood. Usually easy to detect, these antibodies may precede diagnosis of clinical symptoms by 2-7 years. Usually the presence of anti-TG antibodies is not enough to make a definite diagnosis – as these antibodies can also be elevated in other conditions, including arthritis and type 1 diabetes. However, most patients with Hashimotos will have elevated anti-TG antibodies which is very characteristic of this disorder.


Possible risk factors/ contributors
It is now believed that an interaction between genetic and environmental factors can lead to an autoimmune thyroiditis condition. Some risk factors include: recent or past infections, gender (females being more affected) and iodine intake. Environmental factors that can contribute to the development of these conditions include over-exposure to pesticides, heavy metals, halogens, polyhalogenated biphenols and various nutrient deficiencies or excesses. For example, although iodine is recognized as essential for thyroid functions, overconsumption can increase the risk of thyroid dysfunction in susceptible individuals, therefore levels should be monitored in at-risk and diagnosed individuals.


Treatment:
Once testing has confirmed a diagnosis of Hashimotos or Graves’, there are several options for treatment. First and foremost, thyroid replacement hormone (Levothyroxine) may be prescribed for Hashimoto’s (hypothyroidism). For Graves’ (Hyperthyroidism) – anti-thyroid medications, radioactive iodine or surgical removal (partial or full) of the thyroid gland may be needed.


There are effective treatments which may be used to help treat autoimmune thyroid disorders. Addressing specific deficiencies such as vitamin D deficiency can help address some of the problem – with adequate levels having an immunomodulatory effect. In addition, botanical anti-inflammatory agents such a blue flag, selenium and rosmarinic acid which can target the thyroid – preventing an auto-immune reaction are used in specific doses. Knowing when to use the right botanical and at what dose is key to reducing damage to the thyroid gland, returning balance to the immune system and eliminating symptoms.


Conclusion:
There are several compounds with varied mechanisms of action which can support thyroid function and prevent auto-immune damage. Some mechanisms involve T cell modulation and cytokine response. In addition to these therapies, it’s also important to consider stress reduction options, improving digestion, and absorption through adequate nutrition and avoidance of triggering foods known to interfere with proper thyroid function. Finally, incorporating exercise helps induce 5′-deiodinase – an enzyme that helps stimulate production of thyroid hormones (T3 and T4). When treated multi-factorially, patients usually experience the best outcomes and can often significantly improve their thyroid health.

Sources:
Hutfless S, Matos P, Talor MV, et al. Significance of prediagnostic thyroid antibodies in women with autoimmune thyroid disease. J Clin Endocrinol Metab. 2011;96:E1466-E1471.
Gallagher CM, Meliker JR. Mercury and thyroid autoantibodies in U.S. women, NHANES 2007-2008. Environ Int. 2012;40:39-43.
McLeod DS, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012;42:252-265.
Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull 2011;99:39-51.

Trust Your Gut!

The Gut microbiome includes all the microorganisms that inhabit our digestive tract –that’s about 100 trillion bacteria! New research continues to demonstrate the powerful role of the microbiome within the digestive tract lining. We now understand that the digestive trat is actually the unifying or centre point of the nervous, immune and hormonal systems. It is also, in large part, responsible for the balance of neurotransmitters that control emotion and mood regulation. Many people associate a healthy microbiome as a key factor to healthy digestion and weight management but it can confer other benefits such as healthy hormone balance, kidney function, psychological health and more.


The microbiome acts much like a sophisticated phone operator -sending bi-directional communication between the digestive system and the brain. Since the enteric nervous system, neuroendocrine system and immune system all meet in the gut – a healthy and well functioning microbiome allows for smooth communication between all of these systems. It also enables the brain to generate healthy levels of GABA (a calming amino acid – known to slow down and calm areas of the brain responsible for anxiety and panic and even anxious depression.


Both animal and human double blind, placebo controlled studies corroborate these findings and show how a health microbiome can confer psychological benefit. For example, one study divided participants into 2 groups. Subjects were fed either a probiotic-containing milk drink or placebo for 3 weeks, and mood and cognition were assessed before treatment and after 10 and 20 days of consumption. Subjects who initially scored in the lowest third for depressed mood showed significant improvement in symptoms after probiotic treatment. Another study where participants with chronic fatigue syndrome (who very often have abnormal gut microflora) – were given Lactobacillus casei for 2 months. Using the Beck Anxiety Inventory as a tool to identify changes, patients in the probiotic group reported far fewer anxiety symptoms compared to the placebo group.


So how can one create a healthy microflora in their digestive tract?


1) Minimize/decrease sugary foods – especially refined sugars – as these may cause a build up of yeast such as candida that may displace beneficial bacteria and may cause various symptoms.

2) Relaxation/meditation – to allow the body the ability to maintain a rest/digest mode or parasympathetic state, instead of the stress of sympathetic state. When you’re more relaxed, there is improvement in the circulation to the gut which not only helps in digestion but also improves a healthy microflora.

3) Quality sleep – key to repair of the intestinal lining.

4) Foods high in fiber: dietary fiber sources include vegetables, fruits, psyllium, inulin, flax and more. These help keep you regular and also feed the good bacteria by acting as prebiotics.

5) Consume probiotic foods – before reaching for supplements it is always best to start with a diet rich in probiotics. Some of my favourites include kim chi, sauerkraut, natto and miso, homemade pickles (non vinegar) are also great for some.

6) Consider probiotic supplements if you cannot stomach probiotic-rich foods or if you’ve just received a bout of antibiotics it sometimes makes sense to take a supplement. There are many strains available so knowing which ones are right for you is important!

Sources:
Foster JA, McVey Neufeld KA. Gut-brain axis: how the microbiome influences anxiety and depression.Trends Neurosci. 2013;36(5):305-312.
Benton D, Williams C, Brown A. Impact of consuming a milk drink containing a probiotic on mood and cognition. Eur J Clin Nutr. 2007;61(3):355-361.
Rao AV, Bested AC, Beaulne TM, et al. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog. 2009;1(1):6.

Migraines!

Migraines – New Treatments, Old Disease

Migraines have been around for a long, LONG time. In the 2nd Century CE – Aretaseus of Cappadocia coined the term “heterocrania” describing it as “an illness by no means mild..” Those who suffer from migraines dont need Aretaseus to know just how debilitating and painful the attacks can get though, right?

The WHAT
The way migraines occur is rather complicated and every person can experience them differently. Generally speaking however, they are described as a unilateral headache with a throbbing quality. They tend to last from 4 to 72 hours, be classified as classic migraines (with aura) or common migraine (without aura) or with with a mild and transient sensory/visual symptoms that occur right before the pain comes on.

The WHY
Studies have found that migraines with aura can result from – cortical spreading depression – a neuronal depolarization wave followed by inhibition of bioelectrical brain activity. A mouthful sentence, I know. But what this means is that migraines with aura are linked to changes in brain electrical signaling. This pattern, however, does not apply to migraines without aura and need to be approached differently. And one last layer, I promise – still other patients can experience some migraines with aura and some without and this can change throughout the individuals life.
A genetic component also exists for migraines with aura but not for migraines without aura. And some research is now finding links to methylenetetrahydrofolate reductase (MTHFR) mutations.

What about the vascular theory?
The vascular theory proposes that migraine pain is due to the vasodilation of intracranial blood vessels – this dilation then activates nociceptors (receptors for painful stimuli) causing the sensation of pain. This theory is substantianted by the fact that medications like triptans which cause vasoconstriction can be quite effective at dealing with migraine symptoms. However, new research is beggining to show that the vascular theory is only a piece of the puzzle and that there might be other secondary mechanisms at work. – That is a mechanism related to neuroinflammation. Some studies found no correlation between blood flow during migraines with aura – but instead found increased inflammatory markers present in the body.

Is that it?
Nope! More recently research is showing that calcitonin-related peptide (CGRP) – a potent vasodilator has been implicated in the role of migraine headaches. The studies showed that patients who suffered from migraines had elevated levels of CGRP and certain treatments that inhibit the release of CGRP reduced the symptoms as well.
Hormones may also play a role in cyclical headaches. The connection is believed to be related to the hormone estrogen. When estrogen levels drop – before menstruation, women have an increased likelihood to develop migraine headaches. The degree of fluctuation in the hormone, rather than the level itself, is thought to be the main instigator. Interestingly during pregnanacy – most women will stop experiencing migraines due to a stable rise in estrogen lebels. After pregnancy, however, the abrupt drop in estrogen levels may trigger headaches again. Since estrogen levels drop during perimenopause and menopause – migraines tend to occur more frequently due to the eneven rise/fall of hormones during this period.

The French (DIET) Connection –
Tyramine has long been linked with migraine symptom exacerbation – in individuals prone to migraines of course. This non-essential amino acid can be found in highest concentration in foods like ages cheeses, wine and cured meats. Tyramine foods can increase the sympathetic nervous system and this can lead to excessive cerebral dilation, thus triggering vasocongestion and migraine.

The Naturopathic Treatment:
From a naturopathic perspective – finding out the cause of the migraine is obviously key. From a digestive perspective specifically – going through a simple elimination diet, particularly – avoiding foods containing tyramine, nitrites, MSG, and aspartame can go a long way on its own. However this is often not enough especially since migraines may have multiple causes.
In order to tackle migraines that result from inflammtory states – certain “blood movers” can be prescribed. Some examples include Zingiber, Allium, Curcuma, and Cinnamomum as these may reduce platelet aggregation and activation.
Angelica Sp. – a herb often used in Chinese medicine has been found to reduce plasma calcitonin, nitric oxide and dopamine. Scutellaria baicalensis is often used in tandem with Angelica and both produce a synergistic antiinflammatory effect which can be effective at eliminating the some of the root causes of migraines.
Tanacetum parthenium is showing promise by inhibiting the release of seratonin – a neurotransmitter often elevated in individuals suffering from migraines, and reducing the symptoms of migraine. Tanacetum must be taken for several weeks of months on a daily basis before effects are noticable however and will not work if taken acutely to stave off current migraine attacks.
Several other botanicals can be prescribed, including topical treatments that are usually used in conjunction with more systemic therapies. Acupucture has also been well studied to help with migraine prophylaxis and probably deserves a whole article on its own. In sum, however, it’s important to know that there are effective treatments for migraines – once the pathophysiology is discovered is becomes that much easier to treat this prevalent condition.

Sources:
Jayarajah CN, Skelley AM, Fortner AD, Mathies RA. Analysis of neuroactive amines in fermented beverages using a portable microchip capillary electrophoresis system. Anal Chem. 2007;79(21):8162-8169.
Lea RA, Ovcaric M, Sundholm J, et al. The methylenetetrahydrofolate reductase gene variant C677T influences susceptibility to migraine with aura. BMC Med. 2004;2:3.
Raddant AC, Russo AF. Calcitonin gene-related peptide in migraine: intersection of peripheral inflammation and central modulation. Expert Rev Mol Med. 2011;13:36.
Wang YH, Liang S, Xu DS, et al. Effect and mechanism of senkyunolide I as an anti-migraine compound from Liguisticum chuanxiong. J Pharm Pharmacol. 2011;63(2):261-266.
Weir GA, Cader MZ. New directions in migraine. BMC Med. 2011;9:116.

GERD

GERD or gastro-esophageal reflux disorder is a very common disorder affecting up to 10% of Canadians on a daily basis. Although more common in adults over 40 -it can occur at any age, and given the endless commercials for antacids on TV – it’s likely that most people are aware that the condition exists.


Typically symptoms include heartburn and regurgitation of stomach contents but can also include difficulty swallowing, hoarseness, sore throat, sinus issues, ear infections and more. In fact sometimes people don’t even experience heartburn – know as silent GERD, but they experience one or more of these symptoms – making diagnosis that much more difficult to make.


Why do people get GERD?
The pathophysiological reason people can develop GERD is due to a problem with the lower esophageal sphincter (or the “hatch” that opens and closes between your esophagus and stomach. When the sphincter loses its patency, its ability to tightly close – stomach contents can shoot up and cause heartburn (pain, irritation and cellular damage to more sensitive esophageal cells – if left untreated this cellular damage can cause much more pathological issues down the road – which is why eliminating GERD can be that much more important.


“Doc, lets get rid of that stomach acid!” – Typically, and more conventionally, GERD will be treated by prescribing acid-lowering medication also know as PPIs (proton pump inhibitors). Although these work well in certain situations (to heal a peptic ulcer for example) – patients tend to stay on these medications for years and very often experience a wide array of side effects. Think about it for a second, the person taking the medication has chronically lowered stomach acid – so how likely are they to digest foods properly? I’ve seen this happen numerous times! Anyway, over time suppressed stomach acid causes decreased absorption of B12, calcium, magnesium, iron. It can cause bone fragility and fracture, decreased gallbladder function, increase your risk for food poisoning and various nasty infections like clostridium difficile.
Ironically, each patient should be analyzed for DECREASED production of stomach acid. Wait what?! Although this seems counter-intuitive at first, adequate stomach acid production is needed for that lower esophageal sphincter to receive its signal to tightly close. In cases where stomach acid production is decreased the sphincter can stay ajar causing the aforementioned symptoms.


GERD can also be caused or triggered by food allergies. Which is why I will test with a specific IgG food allergy panel if necessary. These tests can be very informative and prevent the patient from avoiding foods that they “think” may be exacerbating their symptoms but in reality have no effect.
Finally, once the cause of the problem is found, various botanicals may be prescribed to heal the lining of the stomach. Reinoculating the GI tract with good bacteria is also necessary to regenerate beneficial bacteria in the tract.
With correct diagnosis, the condition is very treatable. This means patients can once more open up their diets and enjoy foods that they’ve been avoiding.

Insomnia?

“When you have insomnia, you’re never really asleep, and you’re never really awake. With insomnia, nothing’s real. Everything is far away. Everything is a copy of a copy of a copy.” (Chuck Palahniuk, Fight Club).

Tossing and turning at night and the inability to sleep can be one of the most frustrating things experienced by an individual! In addition, disrupted sleep can affect our health in many ways – including an increase in appetite, weight gain, depressed immunity, low energy, decreased attention span and many more.

Insomnia and sleep issues should not be considered normal and ought to be addressed before they begin to negatively affect our health. Surprisingly perhaps, insomnia also occurs more frequently than most would imagine. In fact a study in the Canadian Journal of psychiatry showed that within the tested sample – over 40% of participants in a randomized survey presented with at least 1 symptom of insomnia (trouble falling asleep, staying asleep or morning awakening for a minimum of 3 nights per week in the previous month.

Generally, insomnia can be broken down into 2 categories – acute and chronic. –Acute insomnia usually lasts several days to weeks and occurs in response to an identifiable stressor. Symptoms usually resolve when the stressor is eliminated or resolved or when the individual adapts to the stressor. Occasionally, sleep problems persist and lead to chronic insomnia. The chronic stage can be more problematic and discovering the cause is sometimes more difficult.

The causes of chronic insomnia are numerous and oftentimes the case is much more complicated. From a naturopathic perspective, insomnia can be very treatable once the actual cause(s) is/are addressed. Normally, once secondary organic causes (like menopausal hormonal shifts, thyroid dysregulation etc) are eliminated or treated – the treatment focuses on identifying sleep hygiene and regulation of circadian rhythms (our sleep/wake cycle), regulating melatonin levels, stress hormones (adrenaline and cortisol) and investigating the individuals microbiome health. New research, for example, illustrates strong evidence to suggest that 80% of our serotonin (a neurotransmitter that is responsible for metabolism, mood and many other functions) is produced in the GUT by commensal (healthy) bacteria. That is why creating a healthy GUT environment is crucial for restful and uninterrupted sleep.

As already mentioned the treatment focuses on identifying the causal factors and addressing them. By creating an effective strategy to identify your specific causes of insomnia and by helping you reset your sleep/wake clock – a restful night’s sleep is definitely within your reach. If you have any questions or would like to book a free 20 minute consultation don’t hesitate to contact me or book an appointment.

Don’t forget to follow me on Instagram @drmichaelmichna for weekly health posts and tips!

Sweet Dreams!

Sources:

ncbi.nlm.nih.gov/pubmed/21959029

If you have IBS or perhaps you think that you do

If you have IBS or perhaps you think that you do – you’re definitely not alone. Prevelance rates are estimated to be around 10-15% – slightly skewing females and individuals under 50.

But what exactly is IBS?? IBS comes in different forms and can manifest with different symptoms including:

  • Pain
  • Flatulence (gas)
  • Diarrhea
  • Constipation
  • Bloating
  • And many more…

IBS is a diagnosis of exclusion, which means that other organic causes must be ruled out first. The good news is that research on potential causes and treatments of IBS continues to grow:

Alterations in GUT microbiota (imbalance of “good” bacteria), brain/GUT interaction, motility (the stretching and contracting of muscles in your gastrointestinal tract) and so on.

Basically all this means is that IBS is often quite complicated. That said, a systemic and individualistic approach for each person can lead to the best possible outcome, eventually healing the person and eliminating their symptoms.