Low thyroid: What to do?

8. February 2009 William Davis (25)
I've gotten a number of requests for solutions on how to solve the low thyroid issue if either 1) your doctor refuses to discuss the issue or denies it is present, or 2) there are government mandates against thyroid correction unless certain (outdated) targets are met.

Oh, boy.

While I'm not encouraging anyone to break the laws or regulations of their country (and it's impossible to generalize, with readers of this blog originating from over 30 countries), here are some simple steps to consider that might help you in your quest to correct hypothyroidism:

--Measure your body temperature--First thing in the morning either while lying in bed or go to the bathroom and measure your oral temp. Record it and, if it is consistently lower than 97.0 degrees (Fahrenheit), show it to your doctor. This may help persuade him/her.(You can still be hypothyroid with higher temperatures, but if low temperatures are present, it is simply more persuasive evidence in favor of treatment).

--Supplement with iodine 150 mcg per day to be sure you are not iodine deficient. This is becoming more common in the U.S. as people avoid iodized salt. It is quite common outside the U.S. An easy, inexpensive preparation is kelp tablets.

--Show your doctor a recent crucial study: The HUNT Study that suggests that cardiovascular mortality begins to increase at a TSH of only 1.5 or greater, not the 5.5 mIU usually used by laboratories and doctors.

--Ask people around you whether they are aware of a health practitioner who might be willing to work with you, or at least have an open mind (sadly, an uncommon commodity).

Also, see thyroid advocate and prolific author, Mary Shomon's advice on how to find a doctor willing to work with you. Yes, they are out there, but you may have to ask a lot of friends and acquaintances, or meet and fire a lot of docs. It shouldn't be this way, but it is. It will change through public pressure and education, but not by next week.

Another helpful discussion from Mary Shomon: The TSH Normal Range: Why is there still controversy? You will read that even the endocrinologists (a peculiarly contentious group) seethingly debate what constitutes normal vs. low thyroid function.

Also, you might remind a resistant health practitioner that guidelines are guidelines--they are not laws that restrain anyone. They are simply meant to represent broad population guidelines that do not take your personal health situation into consideration.

Which statin drug is best?

8. February 2009 William Davis (7)
I re-post a Heart Scan Blog post from one year ago, answering the question: Which statin drug is best?

I still get this question from patients in the office and online, nearly always prompted by a TV commercial. So let me re-express my thoughts from a year ago, which have not changed on this issue.


The statin drugs can indeed play a role in a program of coronary plaque control and regression.

However, thanks to the overwhelming marketing (and lobbying and legislative) clout of the drug manufacturing industry, they play an undeserved, oversized role. I get reminded of this whenever I'm pressed to answer the question: "Which statin drug is best?"

In trying to answer this question, we encounter several difficulties:

1) The data nearly all use statins drugs by themselves, as so-called monotherapy. Other than the standard diet--you know, the American Heart Association diet, the one that causes heart disease--it is a statin drug alone that has been studied in the dozens of major trials "validating" statin drug use. The repeated failure of statin drugs to eliminate heart disease and associated events like heart attack keeps being answered by the "lower is better" argument, i.e., if 70% of heart attacks destined to occur still take place, then reduce LDL even further. This is an absurd argument that inevitably encounters a wall of limited effects.

2) The great bulk of clinical data examining both the incidence of cardiovascular events as well as plaque progression or regression have all been sponsored by the drug's manufacturer. It has been well-documnted that, when a drug manufacturer sponsors a trial, the outcome is highly likely to be in favor of that drug. Imagine Ford sponsors a $30 million study to prove that their cars are more reliable and safer. What is the likelihood that the outcome will be in favor of the competition? Very unlikely. Such is human nature.

If we were to accept the clinical trial data at face value and ignore the above issues, then I would come to the conclusion that we should be using Crestor at a dose of 40 mg per day, since that was the regimen used in the ASTEROID Trial that achieved modest reversal of coronary atherosclerotic plaque by intravascular ultrasound.

But I do not advocate such an ASTEROID-like approach for several reasons:

1) In my experience, nobody can tolerate 40 mg of Crestor for more than few weeks, a few months at most. Show me someone who can survive and tolerate Crestor 40 mg per day and I'll show you somebody who survived a 40 foot fall off his roof--sure, it happens, but it's a fluke.

2) The notion that only one drug is necessary to regress this disease is, in my view, absurd. It ignores issues like hypertension, metabolic syndrome, inflammatory phenomena, lipoprotein(a), post-prandial (after-eating) phenomena, LDL particle size, triglycerides, etc. You mean that Crestor 40 mg per day, or other high-intensity statin monotherapy should be enough to overcome all of these patterns and provide maximal potential for coronary plaque reversal? No way.

3) Plaque reversal can occur without a statin agent. While statin drugs may provide some advantage in the reduction of LDL, much of the benefit ends there. All of the other dozens of causes of coronary atherosclerotic plaque need to be addressed.

So which statin is best? This question is evidence of the brainwashing that has seized the public and my colleagues. The question is not which statin is best. The question should be: What steps do I take to maximize my chances of reversing coronary atherosclerotic plaque?

The answer may or may not involve a statin drug, regardless of the subtle differences among them.

Dr. Nancy Sniderman, heart scans on Today Show

5. February 2009 William Davis (6)
While shaving this morning, I caught the report by NBC medical expert, Dr. Nancy Sniderman, about her coronary plaque and CT coronary angiogram.

Visit msnbc.com for Breaking News, World News, and News about the Economy




Those of you in the Track Your Plaque program or who follow The Heart Scan Blog know that we should tell Dr. Sniderman and her doctor that:

She has done virtually nothing that will stop an increasing heart scan score! In fact, Dr. Sniderman is now following the "prevention program" that is eerily reminiscent of Tim Russert's program! We all know how that turned out.

It is pure folly to believe that a combination of Lipitor, exercise, and a "healthy diet" (usually meaning a low-fat diet--yes, the diet that promotes heart disease) will stop the otherwise relentless increase in heart scan score.

Dr. Sniderman, please consider:

1) Having the real causes of your coronary plaque identified. (It is highly unlikely to be just LDL cholesterol, though the drug industry is thrilled that you believe this.)

2) Ask yourself (or, if your doctor knew what she was doing, ask her): Why do I have heart disease? LDL cholesterol is insufficient reason--virtually nobody I know has high LDL cholesterol as the sole cause. LDL cholesterol is, at most, one reason among many others, but is insufficient as a sole cause.

3) What is your vitamin D status? Crucial!

4) What is your thyroid status?

5) Fish oil--a must!

6) Do you have lipoprotein(a)? Small LDL?

Just addressing the items on the above checklist would put you on a far more confident path to stop your heart scan score from increasing.

If you were to repeat your heart scan score, my prediction: Your score will be higher by 18-24% per year.

My personal experience with low thyroid

3. February 2009 William Davis (31)
Something happened to me around October-November of last year.

I usually feel great. Ordinarily, my struggles are sleeping and relaxing. As with most people, I have too many projects on my schedule, though I find my activities stimulating and fascinating.

I blasted through a very demanding November, trying to meet the needs of a book publisher. This involved sleeping only a few hours a night for several days on end, all after a full day of office practice and hospital duties.

But it was getting tougher. My concentration was becoming more fragmented. Getting things done was proving an elusive goal. Exercise became a real chore.

Although I usually force myself to go to sleep, I was starting to fall asleep before my usual bedtime, and I was sleeping longer than usual.

It's been a tough winter in Wisconsin. Let's face it: It's Wisconsin. But it's been tough even for this region, with weeks of temperatures consistently below 10 degrees. Even so, I was having a heck of a time keeping warm. Extra shirts, socks, soaking my hands in hot water--none of it worked and I was freezing.

So I had my thyroid values checked:

Free T3: 2.6 pg/ml (Ref 2.3-4.2)
Free T4: 1.20 ng/dl (Ref 0.89-1.76)
TSH: 1.528 uUI/ml (Ref 0.350-5.500)

Normal by virtually all standards. I measured my first morning oral temperature: 96.1, 96.3, 95.9. Hmmmm.

My experience coincided with the Track Your Plaque and Heart Scan Blog conversations about low thyroid being enormously underappreciated, with the newest data on thyroid disease suggesting that a TSH for ideal health is probably 1.5 mIU or less. (More about that: Is normal TSH too high? and Thyroid perspective update .

Could this simply be a case of medical student-oma in which every beginning medical student believes he has every disease he learns about?

Despite the apparently "normal" thyroid blood tests, I took the leap and started taking Armour thyroid, beginning at 1/2 grain (30 mg), increasing to 1 grain (60 mg) after the first week.

Within 10 days, I experienced:

--Dramatic restoration of the ability to concentrate
--A boost in mood. (In fact, the last few blog posts before I replaced thyroid reflect my deepening crabbiness.)
--Large increase in energy, now restored to old levels
--Need for less sleep
--I'm warm again! (It's still <20 degrees, but I get easily stay warm while indoors.)

I am absolutely, positively convinced of the power of thyroid. I am further convinced from the clinical data, patient experiences, and now my own personal experience, that low levels of hypothyroidism are being dramatically underappreciated and underdiagnosed.

I shudder to think of what my life would have been like 6 months or a year from now without correction of thyroid hormone.

Now, the tough question: Why the heck is this happening to so many people?

Speaking availability

3. February 2009 William Davis (5)
Just a quick announcement:

If you would like to hear more about the concepts articulated in The Heart Scan Blog or in the Track Your Plaque program, I am available to speak to your group.

Among the possible topics:

Return to the Wild: Natural Nutritional Supplements That Supercharge Health
Why this apparent "need" for fish oil and other heart-healthy supplements? I discuss why some nutritional supplements make perfect sense when we are viewed in the context of primitive humans living modern lives, while other supplements do little.


Shrink Your Tummy . . .or, Why Your Dietitian is Fat!
Weight loss doesn't have to involve calorie counting, deprivation, or hunger pangs. But the conventional "rules" for weight loss and health have to be broken.

The Politically Incorrect Guide to Extraordinary Heart Health
Heart health is something that you can seize control over, something identifiable, correctable, and . . . reversible. Much of this can be achieved with little or no medication, nor procedures. I detail all the enormously empowering lessons learned through the Track Your Plaque program.


I can also present in-depth yet entertaining discussions on the power of vitamin D, natural cholesterol control, screening for heart disease, and similar topics covered in the blog.

To learn more, just e-mail us at contact@trackyourplaque, or call my office at 414-456-1123.

Learn how to eat from Survivorman

31. January 2009 William Davis (22)

Look no farther than Discovery Channel to learn how humans were meant to eat.

The Survivorman show documents the (self-filmed) 7-day adventures of Les Stroud, who is dropped into various remote corners of the world to survive on little but ingenuity and will to live. Starting without food or water, the Survivorman scrapes and scrambles in the wilderness for essentials to survive in habitats as far ranging as the Ecuadorian rainforest to sub-arctic Labrador.

What does Survivorman have to do with your nutrition habits?

Everything. The lessons we can learn by watching this TV show are plenty.

Survivorman plays out the life we are supposed to be living: slaughtering wild game with simple handmade tools and his bare hands, identifying plants and berries that are safe to eat, trapping fish, scavenging the kill of other predators. He's even resorted to eating bugs and caterpillars, particularly following several days of unsuccessful hunting and scavenging.

What is notable from the Survivorman experience is what is absent: In the steppe, desert, tundra, or jungle, you will not find bread, fruit drinks, or Cheerios. You won't find farm-fattened, corn-fed livestock with meat marbled with fat.

Imagine the result of such an experience for us, drawn out over 6 months. Even an obese, diabetic, gluttonous, XXX dress size 350-lb woman would return a lean 105 lbs, size 0, non-diabetic, fully able to run miles in the wild tracking game.

Survivorman's quiet desperation of living in the wild, preoccupied with worries over where his next meal might be found, is a stark contrast to the bloated, shelves stacked floor-to-ceiling supermarkets, and our modern society's all-you-can-eat several times per day lifestyle.

Am I advocating selling the car and house and chucking modern society for the "safety" of the jungles of Borneo?

No, of course not. I am advocating taking a lesson from the clever experiment conducted by Mr. Stroud, a return-to-the-wild experience that should teach us something about how perverse our modern nutritional lives have become.

CIS: Carbohydrate intolerance syndrome

28. January 2009 William Davis (28)
Carbohydrate intolerance comes in many shades and colors, shapes and sizes.

I call all of its varieties the Carbohydrate Intolerance Syndrome, or CIS. (Not to be confused with CSI, or Crime Scene Investigation . . . though, come to think of it, perhaps there are some interesting parallels!)

At its extreme, it is called type II diabetes, in which any carbohydrate generates an extravant increase in blood sugar, followed by the domino effect of increased triglycerides, reduction in HDL, creation of small LDL, heightened inflammation, etc. and eventually to kidney disease, coronary atherosclerosis, neuropathies, etc.

An intermediate form of carbohydrate intolerance is called metabolic syndrome, or pre-diabetes. These people, for the most part, look and act like diabetics, though their reaction to carbohydrate intake is not as bad. Blood sugar, for instance, might be 125 mg/dl fasting, 160 mg/dl after eating. The semi-arbitrary definition of metabolic syndrome includes at least three of the following: HDL <40 mg/dl in men, <50 mg/dl in women; triglycerides 150 mg/dl or greater; BP 135/80 or greater; waist circumference >40 inches in men, >35 inches in women; fasting glucose >100 mg/dl.

This is where the conventional definitions stop: Either you are diabetic or have metabolic syndrome, or you have nothing at all.

Unfortunately, this means that the millions of people with patterns not severe enough to match the standard definition of metabolic syndrome are often neglected.

How about Kevin?

Kevin, a 56 year old financial planner, is 5 ft 7 inches, 180 lbs (BMI 28.2). His basic measures:

HDL 36 mg/dl
Triglycerides 333 mg/dl
BP 132/78
Waist circumference 34 inches
Blood sugar 98 mg/dl

Kevin meets the criteria for metabolic syndrome on only two of the five criteria and therefore does not "qualify" for the diagnosis.

Kevin's basic lipids showed LDL 170 mg/dl, HDL 36 mg/dl, triglycerides 333 mg/dl.

But take a look at his underlying lipoprotein patterns (NMR):

LDL particle number 2231 nmol/L (equivalent to a "true" LDL of 223 mg/dl)
Small LDL 1811 nmol/l
Large HDL 0.0 mg/dl


In other words, small LDL constitutes 81% of all LDL particles (1811/2231), a severe pattern. Large HDL is the healthy, protective fraction and Kevin has none. These are high-risk patterns for heart disease. These, too, are patterns of carbohydrate intolerance.

Foods that trigger small LDL and reduction in healthy, large HDL include sugars, wheat, and cornstarch. Kevin is carbohydrate-intolerant, although he lacks the (fasting) blood sugar aspect of carbohydrate intolerance. But he shows all the underlying lipoprotein and other metabolic phenomena associated with carbohydrate intolerance.

We could also cast all three conditions under the umbrella of "insulin resistance." But I prefer Carbohydrate Intolerance Syndrome, or CIS, since it immediately suggests the basic underlying cause: eating carbohydrates, especially those that trigger rapid and substantial surges in blood sugar.

CIS is the Disease of the Century, judging by the figures (both numbers and humans) we are seeing. It will dominate healthcare in its various forms for many years to come.

The first treatment for the Carbohydrate Intolerance Syndrome? Some would say the TZD class of drugs like Avandia. Others would say a DASH or TLC (American Heart Association) diet. How about liposuction, twice-daily Byetta injections, or even the emerging class of drugs to manipulate leptin and adiponectin? How do "heart healthy" foods like Cheerios and Cocoa Puffs fit into this? (Don't believe me? The American Heart Association says they're heart healthy!)

The first treatment for the Carbohydrate Intolerance Syndrome is elimination of carbohydrates, except those that come from raw nuts and seeds, vegetables, occasional real fruit (not those green fake grapes), wine, and dark chocolates.

Making sense out of lipid changes

27. January 2009 William Davis (9)
Maggie had been doing well on her program, enjoying favorable lipids near our 60-60-60 targets (HDL 60 mg/dl or greater, LDL 60 mg/dl or less, triglycerides 60 mg/dl or less). Last fall, her last set of values were:

Total cholesterol: 149 mg/dl
LDL cholesterol: 67 mg/dl
HDL cholesterol: 73 mg/dl
Triglycerides: 43 mg/dl

The holidays, as with most people, involved a frenzy of indulgent eating: Christmas cookies, cakes, pies, stuffing, potatoes, candies, etc.

Maggie returned to the office 6 pounds heavier with these values:

Total cholesterol: 210 mg/dl
LDL cholesterol: 124 mg/dl
HDL cholesterol: 57 mg/dl
Triglycerides: 144 mg/dl

In other words, holiday indulgences caused an increase in LDL cholesterol, a reduction in HDL, an increase in triglycerides, an increase in total cholesterol.

What happened?

At first glance, many of my colleagues would interpret this as fat indulgence and/or a "need" for statin drug therapy.

Having done thousands of lipoprotein panels, I can tell you that, beneath the surface, the following has occurred:

--Overindulgence in carbohydrates from the goodies triggered triglyceride (actually VLDL) formation in the liver, released into the blood.
--Increased triglycerides and VLDL triggered a boom in conversion of large LDL to small LDL (since triglycerides are required to form small LDL particles) via cholesteryl-ester transfer protein (CETP) activity.
--Increased triglycerides and VLDL interacted with HDL particles, causing "remodeling" of HDL particles to the less desirable, less protective small particles, which do not persist as long in the blood, resulting in a reduction of HDL.

The critical factor is carbohydrate intake. This triggered a domino effect that is often misintepreted as excessive fat intake or a genetic predisposition. It is nothing of the kind.

I discussed this phenomenon with Maggie. She now knows to not overindulge in the holiday snacks in future and will revert promptly back to her 60-60-60 values.

How to Give Yourself Hashimoto's Thyroiditis: 101

25. January 2009 William Davis (18)
I borrowed this from the enormously clever Dr. BG at The Animal Pharm Blog.


How to Give Yourself Hashimoto's Thyroiditis: 101

--lack of sunlight/vitamin D/indoor habitation
--mental stress
--more mental stress
--sleep deprivation... (excessive mochas/lattes at Berkeley cafes)
--excessive 'social' calendar
--inherent family history of autoimmune disorders (who doesn't??)
--wheat, wheat, and more wheat ingestion ('comfort foods' craved in times of high cortisol/stress, right? how did I know the carbs were killing me?)
--lack of nutritious food containing EPA DHA, vitamin A, sat fats, minerals, iodine, etc
--lack of play, exercise, movement (or ?overtraining perhaps for Oprah's case)
--weight gain -- which begins an endless self-perpetuating vicous cycle of all the above (Is it stressful to balloon out for no apparent reason? YES)


If you haven't done so already, take a look at Animal Pharm you will get a real kick out of Dr. BG's quick-witted take on things.


We are systematically looking for low thyroid (hypothyroidism) in everyone and findings oodles of it, far more than I ever expected.

Much of the low thyroid phenomena is due to active or previous Hashimoto's thyroiditis, the inflammatory process that exerts destructive effects on the delicate thyroid gland. It is presently unclear how much is due to iodine deficiency in this area, though iodine supplementation by itself (i.e., without thyroid hormone replacement) has not been yielding improved thyroid measures.

I find this bothersome: Is low thyroid function the consequence of direct thyroid toxins (flame retardants like polybrominated diphenyl ethers, pesticide residues in vegetables and fruits, bisphenol A from polycarbonate plastics) or indirect toxins such as wheat via an autoimmune process (similar to that seen in celiac disease)?

I don't know, but we've got to deal with the thyroid-destructive aftermath: Look for thyroid dysfunction, even in those without symptoms, and correct it. This has become a basic tenet of the Track Your Plaque approach for intensive reduction of coronary risk.

Framing

24. January 2009 William Davis (0)
Heart health without a 12" incision



Heart health for less than $44,483 (Cost of a coronary stent according to the American Heart Association 2008 Update)



Track Your Plaque: A drug-free zone



Lead to Gold: The alchemy of transforming nutritional-supplement-to-medication

Lead to Gold: The alchemy of transforming nutritional-supplement-to-medication

9. January 2009 William Davis (25)
Here's a recipe to make hundreds of millions of dollars. Others have done it and you can do it, too!

1) Identify a nutritional supplement that works.

Find some agent deemed to fall within the broad allowances of the 1994 Dietary Supplement Health and Education Act . However, because this agent is already in the public domain and is essential non-patent-protectable, you may need to develop some patent protectable aspect of its production, application, or encapsulation. This patent-protected aspect may or may not provide genuine advantage, but that's not your concern. Your concern is protecting your investment and providing the appearance of exclusivity.


2) Identify a medical indication for your product.

Choose a disease or condition that is likely to yield unquestioned efficacy, e.g., omega-3 fatty acids to reduce high triglycerides in people with familial hypertriglyceridemia (triglycerides >500 mg/dl). While this will restrict your ability to make market claims, it will not restrain your ability to sell or allow use of your agent for "off-label" applications. In fact, there are methods to surreptitiously promote the use of your product for off-label use, such as hiring experts to discuss the science behind your product with doctors who can prescribe your product. Ideally, your product's primary indication will provide a substantial market on its own to justify your investment. However, the eventual off-label sales can be substantial, even outstripping the sales generated through your primary indication.


3) Obtain at least $230 million to pay for the clinical trials required to obtain FDA approval.

You will also have to raise the capital to build the business to manufacture, distribute, and sell your product.


4) After FDA approval is obtained, your business is up and running, and distribution begins, start bashing the non-FDA-approved nutritional products that stand to compete in your market.

You could point out that only your product has actually passed through the rigorous FDA process. You could make claims regarding purity, potency, "approved by your doctor," etc., whether or not there is any truth behind the claim.


5) Buy that second vacation home in Aspen and the corporate jet you've been dreaming about! After all the risks you've taken, you deserve it!


That's it, plain and simple. It is a tried-and-true formula that has been applied many times.

It is a formula like this that brought Lovaza-brand omega-3 fatty acids to market, Niaspan brand of niacin, ergocalciferol form of vitamin D, Folbee (prescription combination B vitamins), with a slightly different spin for Synthroid (since the Armour Thyroid it is meant to replace is not a nutritional supplement, but a low-cost, generic thyroid replacement).

Whatever you do, don't EVER run a head-to-head comparative trial of your agent versus the nutritional supplement competition. For instance, NEVER compare Lovaza to supplemental fish oil capsules, matched milligram-for-milligram for EPA and DHA content. NEVER compare Niaspan to over-the-counter Sloniacin. NEVER compare Armour Thyroid to Synthroid. You never know what you might find. (Psssssttt! They might be equivalent!)

The formula is not a foolproof road paved with riches, however. There have been market failures, as well. Folbee, for instance, is hardly a household name. So there's risk involved, no question about it. But, should it all work out, the payoff can be big, VERY big, as it has been for Niaspan and Lovaza.

So, start thinking about how you might follow this formula for:

1) Cholecalciferol (vitamin D3)--e.g., for osteopenia, low HDL, or high c-reactive protein
2) Vitamin K2--also for osteopenia
3) Magnesium--for suppression of ventricular arrhythmias (especially Torsade de Pointes)
4) Iodine--for goiter and iodine deficiency
5) Vitamin C--for uric acid reduction

Who said you can't turn lead into gold?
Tags :

Comments (25) -

  • Dr. B G

    1/9/2009 3:01:00 PM |

    Dr.D...

    What curious insights...

    Don't forget the lobbyists who get the 'Gold' onto the Medicare and Medi-Cal/Medicaid formularies (approved drug lists) though cheap, OTC or generic alternatives exist.

    Guess who pays for these indirectly?

    BTW, this does not occur at the VA MC system level which has been awesomely managed and deliver I believe good healthcare and effective drug care.

    -G

  • Dr. B G

    1/9/2009 3:01:00 PM |

    Dr.D...

    What curious insights...

    Don't forget the lobbyists who get the 'Gold' onto the Medicare and Medi-Cal/Medicaid formularies (approved drug lists) though cheap, OTC or generic alternatives exist.

    Guess who pays for these indirectly?

    BTW, this does not occur at the VA MC system level which has been awesomely managed and deliver I believe good healthcare and effective drug care.

    -G

  • Jan Jones, M.A.in Education, B.S. in Education

    1/9/2009 4:09:00 PM |

    Dr. D,

    I was taking Armour Thyroid for several years(90mg)and levels were checked and remained 'normal'. Recently, having no rx insurance I found that the AT is considerably more expensive than synthroid, so my dr recommended I switch to the correct converted dosage to get the cheaper price.  I have been concerned that the synthroid is not as good, as effective, as the AT I was taking.  By your final comment on the post are you saying those meds are pretty equivalent in effectiveness, in your opinion? It would really help me to know if I have made a good decision to follow the price and not sacrifice effectiveness.

    Thanks,
    Jan

  • Anne

    1/9/2009 5:46:00 PM |

    I live in the UK where strontium in the form of patented Strontium Ranelate (Protelos) is prescribed for the treatment of osteoporosis. I am prescribed it. It works ! I've been having it 18 months and my bone density has increased and it doesn't have the side effects of the bisphosphonates. The 'supplemental' form strontium (strontium citrate for example) however is not available in health food shops in the UK. In the US the supplemental form of strontium is available in health food stores but Strontium Ranleate has not been approved by the FDA - strange !

    Still, I'm happy as the medication only costs me the flat rate prescription charge of £7 for three months supply....so there can sometimes be a benefit depending on where you live. It currently costs me just over £25 a month to buy omega-3 fish oil from my local health food shop so next time I see my cardiologist I'm going to ask him to prescribe me Omacor as it will save me tons of money if I can get it on prescription....don't know if he'll oblige though.

  • Jessica

    1/9/2009 10:23:00 PM |

    Gee, thanks for stealing my golden parachute, Doc.

    With my 401(k) having turned into a 104(k) this year, I planned on enacting my Vit D analogue project in 2009 with hopes of making it big.

    You've foiled my plan!

    (P.S. I was also going to ask Sally Fields to be the spokeswoman for my D analogue and in the commercial, she would say something like, "I thought taking Vitamin D and Calcium would help stop my bone loss, but turns out, it didn't." Then she should plug my FDA-approved drug. Oh wait, doesn't that commercial already exist?).

    Smile

  • Grandma S.

    1/10/2009 12:12:00 AM |

    Does anyone know a good Vit K2 to take, so many choices.  Thank you!

  • Lynn M.

    1/10/2009 6:25:00 AM |

    Jan Jones,
    Normally you can buy a generic Armour for much less than what Armour costs.  However, since this summer there has been a supply problem with the dessicated thyroid products, which has made some of the generic forms unavailable and may have driven up the Armour price.

    Cost aside, from someone who has been totally dependent on thyroid supplementation for 59 years because of a congenital disorder, Synthroid is not equivalent to a dessicated thyroid such as Armour.  Synthroid only has T4, whereas Armour has T4, T3, T2, T1, and calcitonin, which are all naturally produced by the human thyroid.  For an in-depth perspective of the superiority of Armour from a patient's point of view, see www.stopthethyroidmadness.com.
    Lynn

  • Jan Jones, M.A.in Education, B.S. in Education

    1/10/2009 3:25:00 PM |

    Lynn,

    Thanks for your perspective.  Since I switched about 3 months ago, I have thought I didn't feel quite the same on the synthroid but I was attributing some of that to the change.  Next week I will have my levels checked to see if it has remained in the "normal" range on the generic synthroid.  Even if it is ok, I am leaning towards asking the dr to go back to AT.  I am still wondering if Dr.D is categorizing it in the same group as the quasi-drug/vitamins he mentions, meaning it's not really any better. My dr seems to think they are equivalent.
    I have read the info on AT, which is why I started on it over 6 years ago and at the time I had rx coverage. Dr.D is correct in his assertion that one way or another it's all about $$.

    Jan

  • Sam

    1/10/2009 4:22:00 PM |

    Grandma S., I take Thorne Research MK-4 K2.

    It's a little pricey, but at dietary supplementation dosage of less than 1mg/day, a $60 bottle should last about 18 months. (1mg/day is one drop.)

    Search with google for vendors with the best price.

  • David

    1/10/2009 6:45:00 PM |

    Grandma S.,

    I can't speak for everyone, but I like Life Extension's K2 supplement. It's not terribly expensive, and has more K2 than a lot of the other brands. 100 mcg of MK-7, and 1,000 mcg of MK-4. It's not the only one that's good, of course, but I like it.

    Here's the link at LEF: http://www.lef.org/Vitamins-Supplements/Item01224/Super-K-with-Advanced-K2-Complex.html

    Also look for LEF's K2 for a cheaper price (w/ free shipping) at healthmegamall.com.

    Hope this helps!

  • Dr. William Davis

    1/11/2009 2:12:00 PM |

    Jan-

    Sorry for the imprecision.

    I believe that Armour thyroid is superior to T4-only preparations. While there are some published data to support this, real life makes it patently clear as day. People feel better, lose weight more effectively, have better cholesterol values, including Lp(a).

  • Lynn M.

    1/12/2009 7:59:00 AM |

    Jan Jones,
    The way you feel is a much better measure of thyroid sufficiency than any blood test.  Blood tests don't measure what is happening at the cellular level. Factors such as adrenal insufficiency and thyroid antibodies can leave a person with good thyroid levels in the blood but not enough hormone in the cells.

    I'm curious as to what levels you will be having checked.  The best blood tests for determining thyroid sufficiency are the Free T3 and Free T4, which measure thyroid hormone levels.  The TSH is a useless test for anyone already on supplemental thyroid. It is only an indirect measure of thyroid sufficiency and actually measures the pituitary hormone produced as part of a feedback loop. If you're supplementing, you've disturbed the normal feedback loop. I don't understand why doctors settle for the myriad of problems associated with TSH tests when they can directly measure thyroid levels with a Free T3 and Free T4 test.  But nonetheless the TSH test is considered the gold standard.  

    Even when I have been on too low a dose of generic Armour, as measured by hypo symptoms and low-in-range FT3 and FT4 readings, my TSH level was only .011 (ref range 0.35-5.50).  After years of supplementing, I guess my brain has learned that producing thyroid stimulating hormone (TSH) is useless.  Just one example of why the TSH test shouldn't be relied on.

  • mike V

    1/13/2009 5:18:00 AM |

    Lynn M
    I positively endorse your comments based on experience of >30 years of T4->T4+T3->Armour Thyroid->generic (Armour)
    The latter is actually shipped free of charge under Humana Medicare part D.(RightSourceRX)
    (An excellent price! Smile)
    MikeV

    PS:In earlier posts/comments re: thyroid,there was a suggestion that vitamin D3 supplements could significantly impact TSH readings. I would like to hear if this has been observed by others.
    M

  • Anna

    1/13/2009 7:25:00 PM |

    Having taken Levoxyl T4 in combination with a small dose of compounded, timed-release natural thyroid hormone when I was seeing a fantastic out-of-network endo (unfortunately, he was also out-of-state and the distance made it hard to use his services last year).

    Now my new (HMO network) endo prescribed  Levoxyl (T4) only, and I can say that T4 only wasn't right for me, though my labs were great (TSH about 1.0 and FreeT4 just fine).  I just didn't feel quite right on T4 alone.  

    I was able to convince the endo last spring to add Cytomel (T3) with the T4, which is much better than T4 alone, but not nearly as good as the combination of T4 and T3 in the natural thyroid extract in a ratio that mimics human thyroid physiology (98%-2%, Armour is a porcine ratio of 80%-20%).  

    So I think I'm going to continue looking for a new local doc who has the expertise to use compounded natural thyroid extract in the way that worked best for me, even if it means paying more out-of-pocket.  

    Like processed industrial food that will fill you up but won't nourish your body, some cheaper things just aren't worth the savings.

  • Dr. B G

    1/14/2009 6:01:00 AM |

    Mike V,

    I've noticed my own TSH improve from 1.3-1.9 to 1.0 on vitamin D supplementation to 25(OH)D 70 ng/ml. I stopped vitamin D this summer and noticed the TSH trended back up to 1.3.

    I've seen this trend for patients as well -- though the more wheat-damaged/addicted -- the less the improvement seen with vitamin D repletion. Guess that is to be expected.

    Yes -- there is limited science but there is a significant observation between lower TSH and summer months. I wonder WHY?? Smile

    Thank you for your info and all your insightful comments here!

    -G

  • Dr. B G

    1/14/2009 6:01:00 AM |

    Mike V,

    I've noticed my own TSH improve from 1.3-1.9 to 1.0 on vitamin D supplementation to 25(OH)D 70 ng/ml. I stopped vitamin D this summer and noticed the TSH trended back up to 1.3.

    I've seen this trend for patients as well -- though the more wheat-damaged/addicted -- the less the improvement seen with vitamin D repletion. Guess that is to be expected.

    Yes -- there is limited science but there is a significant observation between lower TSH and summer months. I wonder WHY?? Smile

    Thank you for your info and all your insightful comments here!

    -G

  • Anna

    1/14/2009 3:42:00 PM |

    Dr B G mentioned the seasonal aspect of thyroid function.  I definitely think there's something to that.  

    When I was first treated for hypothroidism by Dr. Kenneth Blanchard, who is located near Boston MA, he mentioned that many, if not most of his patients need a very slight dose-up tweak in the fall-winter months.   But I live in mild San Diego, so he wasn't sure if I'd experience that effect.  I saw him in early July that first time.  In hindsight, summer has always been my least hypothyroid-feeling time of year.

    But sure enough,  that fall I was dragging my knuckles.  The addition of an extra 50 mcg tablet of Levoxyl for a days, followed by just one more 50 mcg tablet of Levoxyl *a week* helped a lot throughout the winter.  Periodic lab draws were used in addition to my symptoms (or lack of them).  By the time I saw him again in June (with labs drawn and reviewed in the interim) I was back to the original dose.  

    This seasonal cycle has been my experience for three years since beginning thyroid hormone supplementation, and feels quite pronounced to me every Fall, but the dose adjustment needed is very minor.  I seem to have settled on a fall-winter cycle of 2 x 50 mcg Levoxyl 5 days a week, 1 x 50 mcg 2 days a week; and a late spring-summer cycle of 2 x 50 mcg 4 days a week, 1 x 50 mcg 3 days a week.

    And I don't think this cycle is temperature or weather-induced, but rather by less daylight, as the San Diego area usually has some of its warmest temps in the Fall (the winds shift from the onshore breezes to dry, warm winds from the desert).  The second time I called the endo to say I had some symptoms return or increase, he mentioned that my file indicated  that I called the same week the previous year.  So it's not that I was tuned into the calendar, either, it had to be pointed out to me, though now I am aware of it, of course.

  • mike V

    1/15/2009 7:42:00 AM |

    Dr B G, and Anna:
    Thanks for the interesting feedback.
    Vitamin D seems to be regarded as a hormone, or at least a prohormone, and I have seen it suggested that it may increase thyroid sensitivity in the tissues. If so I would expect the control feedback loop to lower the thyroid stimulating hormone (TSH) which of course calls for less to be secreted.


    My interest relates to the following.
    I have a 'night time only' wake up phenomenon, that is a sort of "adrenoline rush" with heart racing.
    This was rare at first but increased a month or two after a Fall vitamin D3 increase about two years ago.

    Now it prefers the half hour after falling asleep, or prior to normal AM awakening.
    My heart "plumbing and electrical" are in excellent order, and sleep apnea has been eliminated.
       Anna, did you have specific symptoms from the extra T3 fraction of porcine thyroid, or is it perhaps just a matter of preference, or of not feeling your 'best'?
    I have been using it for some years, and although aware, have not questioned it till now.
      
    I guess it could be a factor in my sleeping, even with the shorter half-life. My age (72) could also be a factor.
    My next step will be FT3, FT4 and 25(OH) testing.
    Thank you again for the respones.
    Mike V

    I would be interested to know if Dr D or anyone else believes that the higher porcine T3/T4 ratio has caused specific symptoms?

  • Anna

    1/15/2009 6:22:00 PM |

    Mike V,

    Vit D3 is indeed a hormone precursor.  The vitamin in its name is sort of misleading.  

    I've never taken Armour, so I can't comment on it.  I've always either taken straight T4 (Levoxyl); Levoxyl with a small dose of compounded natural [porcine] thyroid extract in a timed-release preparation; or Levoxyl (T4) with Cytomel (T3).  The later is what I am currently taking, prescribed by the endo in my HMO network.

    The Levoxyl with the added compounded thyroid extract was prescribed by Dr. Kenneth Blanchard (author of What Your Doctor May Not Tell You About Hypothyroidism).  He feels that the 80/20% ratio of T4/T3 in Armour is not the best ratio for humans; he says they do well initially, but over time, the T3 content is too high for humans.  He's an endocrinologist MD and has a PhD in biochemistry, and he's hypothyroid himself.  He prefers to Rx in a T4/T3 ratio of about 98/2% and uses 50 mcg tablets of Levoxyl because they have no dyes that can cause issues for some people, and the compounded thyroid dose (for the T3), using a formula to come up with the 98/2% amounts.  

    Dr. Blanchard is the one who came up with way I take the Levoxyl, 2 tablets some days and only 1 tablet some others, because the T4 has such a long half life in the body.  Averaging the dose like on a weekly basis seems to be fine, so I have continued to do that with my current local endo, but it does drive my current endo a bit batty, but he can find little to argue with it.  If my TSH is a bit too low I adjust how many days I take only 1 tablet up or down.

    I really needed that bit of extra T3 and noticed it in mental processing and daily productivity, though I don't think it was reflected in my labs at all.  So my HMO endo added a small dose of Cytomel, but it gives me about 6% T3 now, and my TSH was .06 last time instead of hovering arounf 1.0.  So I dropped 1 tablet of 50mcg Levoxyl one day a week. I'm about to get labs done again so we'll see.  

    If I had to chose my own ratio, I think I'd do best on just a bit more T3 than Dr. Blanchard allows, and just a bit less than I get in the daily 1 tablet of Cytomel, perhaps around 4-5%.  I also liked the timed release compounded version better than Cytomel, which wears off too soon due to its short half life in the body (and it's too small a capsule to divide, but I take the smallest dose).  

    I have been taking a lot more Vit D3 lately to a) get my 25 (OH)D level up and to fend off colds this winter.  It'll be interesting to see if that is also reflected on my thryoid labs.  I'll report if anything significant shows up.

    Incidentally, I also had some gluten and casein sensitivity and gene tests done by Enterolab (www dot entrolab dot com) recently, and I was positive for IgA antibodies (both gluten and casein), anti-transglutaminase IgA, and genes for gluten sensitivity (my son has similar results except he had one celiac gene and one gluten sensitivity gene - I know of  one person in my husband's extended family with celiac sprue).  I wanted to know this because gluten reactions often correlate to autoimmune hypothyroidism (I don't think I've ever had thyroid antibodies tested though).

  • mike V

    1/16/2009 2:50:00 PM |

    Anna:
    Thank you once again for your detailed response.
    I will check out Dr Blanchard for info on my query.

    MikeV

  • Dr. B G

    1/17/2009 2:04:00 AM |

    Mike V,

    Are you taking vitamin D or A in the evening?

    These stimulate people most frequently (as they are related to daytime-foods, right? and of course solar radiation exposures).

    Take these during AM or daytime hours only.

    Armour apparently has a short half-life -- consider with your MD and try taking only in the AM.

    Hope you feel better and resolve the nighttime waking!

  • Dr. B G

    1/17/2009 2:04:00 AM |

    Mike V,

    Are you taking vitamin D or A in the evening?

    These stimulate people most frequently (as they are related to daytime-foods, right? and of course solar radiation exposures).

    Take these during AM or daytime hours only.

    Armour apparently has a short half-life -- consider with your MD and try taking only in the AM.

    Hope you feel better and resolve the nighttime waking!

  • Anna

    1/17/2009 8:09:00 PM |

    Mike V,

    Another thought occurred to me.  How's your blood glucose? Is it steady from a fairly low carb diet?  Or could you be consuming too many carbs in the evening?

    Evening carbs can initiate insulin secretion at night and drive down BG.    While sleeping, the body  senses lowered BG (maybe not even too low) and prompts an adrenaline rush to quickly raise BG, because  the liver  is "dumping" some glucose into the bloodsteam.  That series of glucose regulatory events is enough to wake some with palpitations people at the times and in the manner you describe (especially early morning, about 3-6 am), and they often see morning BG ("dawn phenomenon" as the highest BG readings of the day.  

    Another thought is that if you are taking your Armour later in the day (I think many people take Armour in divided doses during the day), perhaps the last dose is too late and the relatively high T3 kicks in too strongly.  Or it could be just too much T3 for you.  In which case, a combo of T4 and Armour (to create a different ratio than 80%T4-20%T3) might be worth trying.  In my experience, though, the average endo or primary care doc doesn't want to fiddle like that, so good luck.  The ratios aren't hard to figure out (though I had to refresh my Jr High algebra memories Smile, so maybe you could ask your doc for some samples of 50 mcg Levoxyl and titrate it yourself to see how it goes.  Hopefully you have a open-minded doc.  

    BTW, I'm taking my Vit D earlier in the day now, too P (by 1 pm) because it might have been contributing to my "night owl" tendencies, too.  makes sense to not take it later than the hours of strong sun wavelengths, anyway.  

    Good luck, keep us posted.

  • mike V

    1/18/2009 8:15:00 PM |

    Dr B G & Anna:
    Thanks for your thoughts. Incidentally I think it is not insignificant that the topics of Vitamin D and and Hypothyroidism are some of the most 'commented' on Dr D's Blog. I am convinced that getting them both right is fundamental to overall western health and well being, and all is not yet fully understood.
      
    I have already pretty much eliminated the time of day, and dosing of thyroid and concluded that T should be taken in the morning, and I take nothing late at night. I have suspected for a while that T3 fraction could be a problem, but you read the Drs with T, you come across Dr John C Lowe who disagrees strongly with Ken Blanchard's position on T3. He himself has been taking solely T3 for decades without consequences!
    Many seem to agree that TSH is not a reliable indicator, and FT3 FT4 basal temperature,and 'how the heck you feel' should be relied on.
    Yet others suggest that we hypothyroids come in two types. Type 1 (low producers, and Type 2 (supposedly involving adrenal insufficiency). Maybe some of us can be both?

    Possibly vitamin D can stimulate both the tissue sensitivity to T, and/or the ability of various tissues to convert T4 to T3.
    *****************************

    The following caused my (young male, 'you MUST treat the TSH number) doctor to laugh uproariously.

    I told him that I had moderated my "wake up" problem with celery.
    However, with celery juice, you reach a point of 'diminishing returns'.
    When he asked why, I told him that celery juice is very seriously diuretic.

    http://www.herbs2000.com/herbs/herbs_celery.htm


    Excerpt:

    The essential oil found in the celery was studied in extensive clinical researches carried out in Germany and China during the 1970s and 1980s. In these studies, it was found that the oil possessed a calming effect on the functioning of the human central nervous system and could be used to alleviate nervous disorders. On further examination, some of the chemicals in the essential oil were also found to effect anti-spasmodic, sedative, and anticonvulsant actions on the human body. The effectiveness of the oil in treating high blood pressure problems have been confirmed in studies conducted on the essential oil of the celery in the Peoples Republic of China.  

    I am now trying the seed.

    MikeV

  • buy jeans

    11/3/2010 9:58:48 PM |

    It is a formula like this that brought Lovaza-brand omega-3 fatty acids to market, Niaspan brand of niacin, ergocalciferol form of vitamin D, Folbee (prescription combination B vitamins), with a slightly different spin for Synthroid (since the Armour Thyroid it is meant to replace is not a nutritional supplement, but a low-cost, generic thyroid replacement).

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