Thyroid and Thyroid metabolism: follow the science or follow opinion?

 

“The best advice I ever got was that knowledge is power and to keep reading”.Knowledge

-David Bailey

 

What does this quote have to do with Thyroid metabolism and Thyroid metabolites?  Directly, not a lot.  Indirectly—a whole lot.  I believe this quote points to an often unrecognized problem that permeates under the surface of medicine today–an ever prevalent problem, but a never visually evident problem.  The average physician lacks a current, working knowledge of scientific evidence due to a lack of reading.  How can this be?  We physicians get caught into a trap.  We spend the better part of 12+ years in higher education (when you count college, medical school, and medical residency).  Once completed, there is a sense of accomplishment that cripples most physicians.  The volume of knowledge learned leads to the conclusion that there is little left to be learned.  This thinking permeates the medical community and it breeds complacency.  This complacency leads to a no-growth curve in the average physician’s knowledge.   Without daily reading, new discoveries and new knowledge will quickly bypass the average physician leaving the average physician practicing far behind the current science.

 

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The unlikely Origins of the Hot Flash

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September is Menopause Awareness Month.

 

In support of Menopause Awareness Month, and women struggling with Hot Flashes everywhere, I want to highlight 5 unlikely causes of Hot Flashes.  Sure low Estrogen can cause Hot Flashes, but is that all there is to a Hot Flash?

 

For so many, Menopause or Peri-menopause for women means Hot Flashes.  Hot flashes are the #1 identified menopausal symptom.   Whether they be day or night, they are still Hot Flashes.  Some women struggle with severe Hot Flashes, other women battle almost no Hot Flashes.  Why the difference?  Simply stated, Hot Flashes are complex.  If Hot Flashes were simply the result of a decline in Estrogen during the Menopause transition, as most marketing implies, then all women would struggle with Hot Flashes in the Menopause transition.  But obviously, Hot Flashes (and Menopause for that matter) is so much more than declining Estrogen levels.  The following 5 unrecognized causes of Hot Flashes will reveal the complexity of the dreaded Hot Flash.

 

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Man Boobs to Metabolic Syndrome

Does Testosterone therapy increase Cardiovascular disease in men?  Does low Testosterone increase Cardiovascular disease in men?  Is low Testosterone even a problem in men, or is it simply a marketing fallacy?  Is there a timeline of low Testosterone to the development of disease in men to follow?  Are men simply Testosterone fueled erections as marketing implies or is Testosterone simply one piece of the puzzle in men’s health?   Is Testosterone the effect, the cause, or both?

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As it relates to Testosterone, that is all we get today–questions.  Is Testosterone safe?  Is Testosterone dangerous?  How about some answers?  This new video post will  review the scientific evidence and the timeline of Low Testosterone to Cardiovascular disease in men.  No opinions here, just let the science highlight the metabolic dysfunction that is the result of low Testosterone.  The result is Metabolic Syndrome that is the door way to disease for men.  Dr Goodyear will answer these questions and more as he moves beyond Man Boob Nation to “Man Boobs to Metabolic Syndrome”.

 

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The more we know, the more we realize we don’t know

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The more we know, the more we realize we don’t know…if we are honest with ourselves.

 

 

Know your number?  Know you numbers?  That is how the marketing goes for Testosterone.  As if the Testosterone number is all there is to know.   The same could be applied to women.  Instead of the low T marketing campaigns, we could all be bombarded with low P commercials instead.  The same logic would apply— women struggle with “low P” the same time men start to struggle with “low T”.  So why no “low P” campaigns?  We learned years ago that focusing on the “low P” loses the forest for the trees.  With men, medicine is repeating the same mistakes that it made with women decades ago.  

 

The more appropriate question is— is the individual healthy?  Instead of the question what is your number, the better questions would be— what is your hormone balance, what are your hormone receptors, and what is your hormone metabolism.  Know what your body is doing with the hormones that are produced endogenously or given as replacement exogenously.  The key moment for evaluation would be prior to the initiation of hormone therapy.  The same questions could and should be applied to all hormones. I have previously applied these questions to Testosterone metabolism and Cortisol metabolism.  This post, I will apply the questions to Progesterone and Progesterone metabolism.

 

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Dr Goodyear Speaks at AFMA

DSC06088Dr. Goodyear was proud to be a part of the inaugural AFMA (American Functional Medicine Association) meeting in Atlanta.  This biannual meeting brought functional medicine physicians from all over the US and Puerto Rico.  Dr. Goodyear presented the evidence from his newly published book “Man Boob Nation, an Integrative model to Low T”.

 

Dr. Goodyear discussed the causes of low Testosterone.  Due to the massive marketing campaign, many (doctors included) think that low T is the problem.  However, low T is the effect not the cause.  Dr. Goodyear discussed the causes of low T as found in the scientific literature.

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How do I Detoxify? Detoxification Part 3

DrGoodyear1First of all, take a few minutes to read through my two previous posts: Detoxification Part 1 and  Detoxification Part 2. Part 3 of our detoxification series begins with a little chemistry lesson. Are you ready? Here we go. Let’s get down to the nuts and bolts of detoxification in the liver. By learning how the detoxification process works, we can learn the steps we need to take to detoxify.

As I mentioned in my earlier post, there are two basic parts to liver detoxification: Phase I and Phase II (this reminds me of Thing 1 and Thing II from the Dr. Seuss book I read to my kids).

Phase I Detoxification.

Phase 1 detoxification involves the cytochrome P450 system. Phase I detoxification involves oxidation, reduction, and hydrolysis. Phase I detoxification is always active and is very redundant.  What do I mean by redundant? There are a handful of enzymes in the CYP450 family that are utilized by over 200,000 substrates for oxidation, reduction and hydrolysis. In other words, many different chemicals or substrates will use the same CYP450 enzyme. A great picture of the redundancy is seen by clicking here.

CYP1A2, an important part of Phase 1 detoxification.

Of note is the the CYP1A2 enzyme. This particular enzyme is responsible for metabolism of 40-50% of the drugs that we take. Do you remember the statistic from my earlier post? A leading cause of death is drug-to-drug interactions. Approximately 100,000 Americans die each year from adverse reactions to medications. If we are taking too many medications, then there is not enough CYP1A2 enzyme to adequately metabolize the drugs in the system leading to drug-to-drug interactions.

Let me give you some perspective. Drug interactions cause twice as many deaths as car accidents. And furthermore, hospital costs due to drug interactions have been estimated at between $1 and $4 billion annually. One of the big topics in the healthcare debate is controlling health care costs. Reducing deaths due to drug interactions looks like a good place to start, doesn’t it?

It doesn’t stop there. Phase I detoxification requires many cofactors: niacin, magnesium, copper, zinc, vitamin C, vitamins B2, B3, B6, B12, folic acid, and flavonoids. As you can see, vitamins are extremely important in the detox process. Without them, our bodies don’t work well. One more tidbit on vitamins — many causes of vitamin deficiencies today are the prescription medications we take — a double whammy!

Phase II Detoxification.

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Fast food can result in a malnourished body.

Phase II detoxification leads to further modification of the products of Phase I detoxification.  Large water-soluble molecules are added to the toxins through several different processes: glutathione conjugation, amino acid conjugation, methylation, sulfation, acetylation, and glucoronidation. In layman’s terms, after phase II modification, the body is able to eliminate the inactivated toxins via the bowels and/or bladder.

In summary, Phase I and Phase II enzymes are the power houses that detoxify our bodies of our daily toxin load. They are very dependent on vitamins, minerals, and energy. The many prescriptions we take lead to major drug interactions and vitamin depletions which interfere with our body’s ability to detoxify. Thus, if we are malnourished (typical American diet of fast food) and lack key vitamins and nutrients, then our body cannot adequately detoxify.  If we cannot detoxify, then we become inflamed. If we become inflamed, we develop disease.

So what next?  A shoe isn’t one-size-fits-all. And neither is detoxification. Assessment of your individual detoxification system and the build-up of toxins within your body will allow us to develop a customized detoxification process to fit your individual needs. Not only will we live healthier, disease-free lives through detoxification, but we will also save money! It all starts with a call. Make an appointment at Seasons join us on the path to wellness. Renew yourself.

From The Doctor’s Desk: Who Needs To Detoxify? Detoxification Part 2

Ever wonder if you need to detoxify? My first recommendation is look at and listen to your body.  The body will tell you if it is in trouble or imbalanced.  How? Physical signs or symptoms are our bodies’ message that all is not right. Here’s how to know if your DrGoodyear1signs and symptoms are saying that you might be suffering from toxic build up. Here are some symptoms of toxin buildup.

  • Headaches
  • Muscle aches and pains
  • Fatigue
  • Asthma
  • Allergies
  • Skin disorders
  • Chronic infections
  • Altered mood
  • Altered cognition
  • Weight gain
  • Altered stress tolerance
  • Altered libido
  • Infertility

Where do toxins in our bodies come from? Remember the quote from last week’s post? “For the first time in the history of the world, every human being is now subjected to contact with dangerous chemicals, from the moment of conception until death.  In the less than two decades of their use, the synthetic pesticides have been so thoroughly distributed throughout the animate and inanimate world that they occur virtually everywhere.”  — Rachel Carson from her book Silent Spring, published 1962.

Toxins are everywhere. The sources can range from toxins like Dioxins to prescription medication.  Adverse reactions to prescription drugs have been ranked as the 4th to 6th leading cause of death in the US according to the Journal of American Medical Association. This amounts to over 100,000 deaths per year.  The cause of adverse drug reactions is an overloaded pathway in Phase I of detoxification (CYP3A4), the pathway that detoxifies over 50% of all drugs in your system. The costs associated with adverse drug reactions has been estimated at up to $4 billion. With the rising costs of health care, treating the cause of these adverse drug reactions in addition to decreasing prescription drugs are two excellent ways to prevent complications and lower costs.

The most dangerous sources of toxins are environmental. Organochlorine pesticides, industrial chemicals, and unintended chemical byproducts surround us everyday and expose us to unwanted toxins. Widespread production of  pesticides began less than 80 years ago. Recently, the EPA estimated that more than 4 billion pounds of chemicals were released into the grounds natural water sources in the year 2000. In addition to pesticides and chemicals, the average American eats, unknowingly I might add, 124 pounds of additives per year. Frightening to think of it, isn’t it? And over 2.5 billion pounds of pesticides are used on crop lands, forests, lawns, and fields. The unfortunate fact is this: we live in a toxic world.

How can you decrease your daily exposure to toxins? Here are some great ways.

  1. Avoid processed foods
  2. Avoid fats
  3. Avoid tap water — use filtered water
  4. Avoid excess caffeine
  5. Avoid excess alcohol
  6. NO tobacco
  7. Limit chronic medicine, if possible
  8. Daily exercise
  9. Avoid exposure in your workplace
  10. Avoid living near industrial plants
  11. Avoid liver dysfunction
  12. Avoid kidney problems
  13. Avoid intestinal dysfunction

The first ten suggestions are steps you and I can take every day to decrease our toxin exposure. But the last three require a bigger step: detoxification. By detoxifying your body, the liver, kidney, and intestines can operate more efficiently and effectively.

So, the question is not who needs detoxification, but who does NOT need detoxification?  The answer? EVERYONE will benefit from a periodic detoxification program.

From the Doctor’s Desk: The Sludge Pool of Toxins–Detoxification Part 1

“For the first time in the history of the world, every human being is now subjected to DrGoodyear1contact with dangerous chemicals, from the moment of conception until death.  In the less than two decades of their use, the synthetic pesticides have been so thoroughly distributed throughout the animate and inanimate world that they occur virtually everywhere.”

While this quote sounds like a line from a recent news report, it is actually an excerpt from Rachel Carson’s book Silent Spring published in 1962.

Detoxification seems to be a buzz word these days. Just google detoxification. You will find everything from water detoxification to colon cleanses.

So what is detoxification? The official definition of detoxification is this: the chemical changes of a xenobiotic, a phytochemical or an endogenous (one your own body makes) compound that renders it less toxic and ready to be excreted.  In layman’s terms, detoxification is the way our body protects us from things that we take in that could damage our body.

The ideal situation is toxins in and toxins out, right? If the body is working as designed, then it should be toxins in and toxins out. And how does the body get toxins out? There are many organs that detoxify.  The skin (through sweating), kidneys (through urination), but the liver is the most important detox organ.  The liver detoxification mechanism involves 2 main processes: Phase I and Phase II detoxification.

Phase I detoxification involves the cytochrome P-450 system in the liver. This is the first line of defense against all toxins.  Toxins are tagged and altered for further detoxification, which then occurs in Phase II.  Any break down in this process will result in increased toxin load on the body.  We will talk more in-depth about the detoxification process in my next two posts.

We are what we eat, drink, breath, and touch. But did you ever think that we are what we don’t eliminate? Without elimination of the toxic chemicals we take in and produce every day, our bodies swim in a sludge pool of toxins.

This increased toxic load on the body leads to  inflammation, the balance between pro-inflammatory and anti-inflammatory substances. The balance between Omega 6, a pro-inflammatory subtance, and Omega 3, an anti-inflammatory substance, is the perfect example.

It is the chronic imbalance of  pro-inflammatory substances that then leads to disease.

Shouldn’t the aim of all health care be to prevent inflammation and, therefore, disease? It is in fact, one of the main focuses of the Seasons approach to health and wellness.

In my next two posts, I will cover what detoxification is, who needs detoxification, and how one detoxifies.

Don’t be duped to dope.

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Don’t be duped to dope.

 

Most are aware of the recent doping scandals in sports.  There was the recent Lance Armstrong admission of doping in cycling.  The current Biogenesis clinic doping scandal in south Florida is  making its way through Major League Baseball   There was the complete waste of time by Congress investigating Roger Clemens.  And of course the olympics, with the most stringent anti-doping rules in sports, is littered with doping scandals–the most recent involving Asafa Powell, Sherone Simpson, and Tyson Gay.

 

However, there is one doping scandal that occurs everyday.  The press reports it everyday.  We all hear it everyday.   But, this doping scandal goes essentially unnoticed everyday.

 

The evidence?

 

    •   enlarged and painful breasts
    •   lower sperm count
    •   blood clots
    •   increased risk of prostate cancer
    •   don’t use if you have a history of breast cancer
    •   talk to your doctor if you have heart problems
    •   may cause problems with breathing

 

The latest doping scandal is not in sports, but in you.

 

No more is doping just confined to athletic events.  Doping occurs almost everyday when men and women present to their medical provider(s) for hormone therapy.  This doping problem is especially evident with Testosterone therapy in men.

 

The symptoms listed above are the common side effects listed in the “low T” commercials one hears almost daily on the radio and/or TV.  They are not “side effects” of Testosterone.  If they were the side effects of Testosterone, then every man would have these symptoms.  They are merely the result of Testosterone overdosage–Testosterone doping.

 

Let me explain.

 

The peak Testosterone production in a young man occurs around the age of 20.  This peak Testosterone dosage is approximately 5-10 mg per day.  Contrast this with the average 30-60 mg starting dosage of most testosterone therapies employed today and you have Testosterone overdosing.  If we men didn’t need 30-60 mg/day when we were chasing everything with a skirt, we sure don’t need it beyond 40.

 

A common overdosage problem I see in men, is a problem called polycythemia.  Polycythemia occurs when the blood levels, hemoglobin and hematocrit levels, are above normal.  This creates “thick” blood and increases the risk of stroke.  This is the result of excessive testosterone dosing or as I call it–doping.  If we men don’t need to donate blood at peak testosterone production, then we shouldn’t have to with Testosterone therapy.  How many 20 year old men do you see running around having to donate blood due to their own Testosterone production?  None, of course.  This is listed as a side effect.  That is an incorrect assessment.  This is a result of overdosing and doping of Testosterone.  One study proves this point well.  This study looked at men > 65 with mobility limitations on Testosterone therapy.  The study was halted early due to a significant spike in cardiovascular events in the men in this study.  Their conclusion?  Testosterone in men with prior cardiovascular disease is contraindicated.  Their conclusion was seriously flawed.  The source of their flaw was their dosing.  Their starting dosage was 10 grams!  This dosage was even increased to 15 grams in some of the men in the study.  That is > 1000 fold excess than peak production in men in their early 20s.  They didn’t realize it, but their study was a published case of the physiologic effects of massive testosterone doping–not in athletes, but in regular men.

 

In women, the same problem persists.  If peak libido occurs in women without concern for facial hair, hair loss, and increase in acne, then it shouldn’t occur with therapy for libido.  A women shouldn’t have to weigh libido versus hair loss, facial shaving, and acne.  And of course, they don’t.  These are all regular problems found in women being legally “doped” with excessive Testosterone therapy.

 

I have seen numerous cases of Testosterone doping.  Of course, they all feel europhic.  But, ask a body builder that is cycling with steroids and he/she will be EUROPHIC as well.  Neither person is in a place that they were meant to be physiologically.  That is why one sees the “side effects”.

 

How should hormone therapy be managed?  Hormones should be balanced.  Hormone balance is the key.  There are 6 key points to hormone therapy:

 

    •   Proper evaluation of hormones
    •   Are hormones in the reference range of normal?
    •   Are the hormones balanced?
    •   How are the hormones metabolized?
    •   What is the balance of the hormone receptors?
    •   What are the micronutrient levels that support hormone balance?

 

All points are required to provide proper, physiologic hormone support,  Side effects due to hormone doping need not apply.

To your Health!

From the Doctor’s Desk: Salivary Hormone Testing Backed by Science

Saliva testing for hormones first appeared in the medical research literature in the early 1980′s. Salivary testing is becoming the testing method of choice for many reasons including: saliva testing seasons

  1. Saliva testing evaluates the “free” (active) hormone levels. A hormone has to be unbound to elicit a physiologic action. Saliva testing looks at the active hormone inside the cell, at the site of action. Saliva testing has been validated as a testing method for measuring the hormones cortisolestradiolprogesteroneDHEA, and testosterone to name a few.
  2. Saliva testing requires no needles.
  3. Saliva testing has been shown to be well validated and superior than blood, with sensitivities and specificities exceeding 100% and 97.4% respectively.  Other than perfection, you can’t get much better than that.
  4. According to the National Institute for Health, saliva testing is useful in “detecting various cancers, heart disease, diabetes, periodontal disease…”
  5. Saliva testing is also useful in disease evaluation. Saliva testing of cortisol has been recommended as the first-line test for Cushing’s syndrome due to “high diagnostic accuracy.”

Testing hormones through saliva is backed by science. But don’t take my word for it. In fact, it’s well supported in medical literature and is the right thing to do. Below are links to several abstracts regarding salivary hormone testing. Read them for yourself and learn about the science behind this form of hormone testing.

These articles are published in well-respected journals; and if you notice, they are not recent. Salivary testing of hormones has been well published in the medical literature for some time now.

Here are a few quotes from these studies:

  • “…salivary cortisol may be used as an alternative parameter in dynamic endocrine tests.”
  • “…assessment of ovarian function…can be performed precisely with the saliva estradiol assay.”
  • “…saliva collection has provided the medical and research community with an excellent medium for the monitoring of plasma steroid levels.”

Nowhere else in medicine do we blindly treat people without assessing a baseline and post treatment level(s). Balance is the key; not one individual hormone. Unfortunately, the medical field is very slow to learn and change.

For more information about salivary testing, read Evaluating Hormones Requires More Than Just a Blood Test.

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