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Unwanted side effects of (bioidentical) hormone replacement therapy

Posted in common conditions, remedies, tagged , , on February 3, 2010| 402 Comments »

The use of bioidentical hormones got a lot of press after Suzanne Somers (Three’s Company cast member and promoter of the ThighMaster™) began touting them as an alternative to synthetic hormone replacement. I wholeheartedly agree that bioidentical hormones are preferable to synthetic hormone replacement therapy (HRT). Recall the large experiment on the female population known as the “Women’s Health Initiative Postmenopausal Hormone Therapy Trials”. If you aren’t familiar with the results of that study, here is a summary provided by the National Institutes of Health:

Compared with the placebo, estrogen plus progestin resulted in:

•Increased risk of heart attack
•Increased risk of stroke
•Increased risk of blood clots
•Increased risk of breast cancer
•Reduced risk of colorectal cancer
•Fewer fractures
•No protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)

Compared with the placebo, estrogen alone resulted in:

•No difference in risk for heart attack
•Increased risk of stroke
•Increased risk of blood clots
•Uncertain effect for breast cancer
•No difference in risk for colorectal cancer
•Reduced risk of fracture
(Findings about memory and cognitive function are not yet available.)

Just because synthetic hormones come with proven risk, it seems that people have decided bioidentical hormones are totally fine to take. Bioidentical hormones are crafted to be the exact molecular structure of the hormone(s) your body produces. Synthetic hormones, on the other hand are not. Synthetic hormones are typically a bit different from the exact structure that your body makes because that way it can be patented by the manufacturer.

The purpose of this article is not necessarily to compare and contrast synthetic from bioidentical HRT; but to alert you as to how the body responds when bioidentical (and synthetic) hormones are taken. Well, really to alert you on the downside consequences of taking ANY hormones. The physiology is simple and logical. It can be more in depth, but I’ll focus on the basics. By the way, I’m referring to the pathways of the most commonly replaced hormones, steroid (e.g.: estrogen, testosterone, progesterone, cortisol, DHEA, etc.) and thyroid hormones.

Most hormones work in the body via a negative feedback loop. This means that as the level of a hormone rises, a signal is mediated that ceases that hormone’s production and release; in order to prevent the production of the hormone from getting out of control. Let’s begin with an example using thyroid hormone.

The three main glands involved in thyroid hormone production are the hypothalamus, pituitary and thyroid. The hypothalamus releases “thyroid releasing hormone” (TRH), which stimulates the pituitary gland to release “thyroid stimulating hormone” (TSH), which in turn stimulates the thyroid gland to manufacture and release thyroid hormones (thyroxine or T4 and triiodothyronine or T3). Once the thyroid hormone begins to do its job throughout the body, production begins to decline, so as not to produce too many hormones. So, as the level of thyroid hormone increases, the levels of TRH and TSH decrease. It’s called a negative feedback loop because the rise in hormone levels results in a decreased production; as opposed to a positive feedback loop where a rise in hormone levels would produce an even greater rise in the level of that same hormone. The only example of a hormone that works on a positive feedback loop that I can think of is oxytocin.

Because these hormones work this way, you may be able to guess what happens when you are exposed to (i.e.: ingest) exogenous hormones. Exogenous (as opposed to endogenous) refers to those taken in from outside the body, and can be any type of hormone. So, if you take a hormone, you can be sure that those negative feedback loops will still function as usual. The result…your body stops (or significantly slows) its own production of these hormones. What’s wrong with that? Eventually, you’ll be dependent on these hormones as your glands have “gone to sleep”, because “someone” else is doing their job. It’s simply not necessary for the glands to have to do anything.

So if you stop taking them, it may be extremely difficult to get your body’s own production back up to par. Now, considering people often take hormones because they’re not producing enough on their own in the first place, you can imagine how difficult it would be to begin the production process after taking exogenous hormones and suppressing your hormone production even further. Therefore, people usually become completely dependent on hormones, bioidentical or not. In general, as long as you’re okay with taking a hormone for the rest of your life, there is no need to worry. However, most (if not all) of my patients shun that idea.

The next issue is that of hormone receptor insensitivity. Generally speaking, each hormone docks into a receptor on it’s target cell. It’s as if the receptor is the lock and the hormone is the key. Once the cell “door” opens, the hormone goes on to carry out it’s function (usually turning on or off genes). The problem with bombarding the cells with large doses of a hormone is that eventually it’s as if the cell decides to change the lock on the door. The result is that it is harder and harder for the hormone to open the cell door, and therefore more and more of the hormone is needed each successive time you want to make an effect on the cell/genes. It’s almost as if you need enough hormone to knock the cell door down, because it doesn’t want to open. This is especially prevalent with the use of hormone creams (usu. progesterone). However, if you make no lifestyle changes it typically happens with any hormone. That’s why people on thyroid hormone often have to continue increasing the dose to get the same effect; the same goes for those who take insulin. Have you ever known of diabetic or person with hypothyroidism (except for autoimmune thyroid disease/Hashimoto’s) that had to decrease their dose, without making lifestyle changes? So, taking a hormone for the rest of your life may not even do the trick, especially insulin. You may be familiar with how well diabetics fare without changing their lifestyle, and continually increasing their doses of insulin. By the way, hormone receptor sites often “run out” of the vitamin and minerals that are necessary to allow them to function properly, due to the constant bombardment of hormones they are subject to in these cases.

This is not to say that no one should be on HRT, bioidentical or synthetic. There is a time and place for everything. And when these hormones are necessary, they can be miraculous. The big question is: When are they necessary? That’s a debatable issue and can certainly vary between individuals. So I am not absolutely against HRT, though I definitely prefer bioidentical over synthetic when possible.

The point I’m trying to get across is that I wouldn’t recommend anyone start with HRT, unless they are in a very unmanageable state. In these instances, one option may be to start with HRT to “prime the pump” and then eventually wean off them. Unfortunately, with all the books written about HRT and the attention it gets these days, many people (and doctors) go straight for hormones (with or without lab tests). Don’t get me wrong, chances are you’ll feel like a million bucks if you take hormones that you are deficient in, or insensitive to. But don’t forget to ask the million dollar question just because you feel like a million bucks: How long does that last? Well, there is no single answer to that question because everybody’s condition and lifestyle is a bit different. But, from what I’ve seen, it lasts about six months at best, before they have to adjust the dose upward. You may eventually find yourself always having to increase the dose to get the same effect. And finally, your cells just may not respond adequately, despite the dose. That’s not say there is no hope though.

I’m currently working with a patient who had low testosterone and used testosterone replacement therapy for over a year. Sure enough, he had to continually increase the dose, until it eventually stopped giving him the results he needed (i.e.: absence of musculoskeletal pain, strength, libido, and an erection). In this case (and others), I determine if the hypothalamus, pituitary, gonads (when it comes to testosterone), and/or cell receptors need support. Fortunately, in the above mentioned case, the patient got immediate results that according to him, showed via the number of plates he kept adding on the machines at the gym.

In some cases, it may not be easy to get everything back up and running like new. But with the proper nutritional support and lifestyle improvements, it certainly is an attainable goal. The willingness of the patient to change their lifestyle and the length of time the person has been on hormones are two very important factors that will help to determine the outcome. Fortunately, I haven’t seen a “lost cause” yet; but I sure have seen people feeling miserable after the hormones stop giving the desired effect. Remember, there’s no such thing as a free lunch!

Not to go into politics…but I’m a big advocate of being able to buy supplements over-the-counter. Although I truly believe that hormones should only be dispensed through licensed health care practitioners who know how to use them.

PS: There are more problems associated with HRT (bioidentical or not) than what I mentioned above. For example, many men who take testosterone can eventually wind up converting it into estrogen (just about the opposite effect they are looking for)…that’s enough on that for now.

PSS: I’m not saying that bioidentical hormones are never necessary. They certainly can be in some instances…just consider the potential side-effects and work with a licensed, competent, qualified health care professional who knows how to use them appropriately. They can be very useful to “prime the pump” when other lifestyle changes are implemented.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Natural treatment for urinary tract infections

Posted in common conditions, remedies, tagged on January 5, 2010| Leave a Comment »

Urinary tract infections (UTIs) are fairly common and most prevalent in females. The reason they are more common in females is basically because of the difference in anatomy between males and females. A bacterial organism is the most common culprit in UTIs; and a majority of the time the bacteria gets transferred from the lower bowel and into the opening of the urethra (this happens easier in females due to the proximity between the two). The bacteria then typically travels up the urethra and into the bladder. In severe cases, the bacteria can migrate up into the kidney(s) and cause an infection there as well. Some other common causes include: sexual intercourse and yeast infections. There are other factors that increase the likelihood of UTIs, but they are rare (at least from what I see). These include: pregnancy, menopause, diabetes, and resisting the urge to urinate. Other factors that I have seen contributing to a UTI or even preventing it from resolving are: a urinary pH (acidity/alkalinity) that is too high or low, not drinking enough clean water, excessive sugar consumption, intestinal infections, and/or a weakened immune system.

Most women are probably familiar with the symptoms of a UTI regardless of whether they’ve had one in the past. The most obvious is painful or burning urination. Other possible symptoms include: pressure in the lower pelvis, frequent or urgent need to urinate, needing to urinate at night, and a change in the color (usually cloudy or bloody) or odor of the urine.

The treatment obviously depends on the cause. However, there are some simple ways to get rid of a UTI quickly without actually knowing the cause. Keep in mind however; if there are complicating factors like intestinal infections, a weakened immune system, etc., it may not be so simple.

We are all familiar with cranberry juice as the touted cure-all for UTIs. Personally, I am not a fan of drinking large quantities of cranberry juice to help this condition. The reason is simply because of the amount of sugar in the juice. Although it may be natural fruit sugar (fructose), excessive amounts (usually necessary with a UTI) will compromise the bacterial balance in the intestinal tract and possibly weaken the immune as a result. Also, this compromise will allow for more pathogenic bacteria to grow in the gut, while the “good” bacteria (acidophilus, bifidus, etc.) diminish. Getting a cranberry juice concentrate and adding water is better although it may pose the same problem. Cranberry capsules or tablets are usually fine, because they don’t contain the fructose.

The active ingredient in cranberry juice that helps abate or eliminate UTIs is a simple sugar known as D-mannose. Although D-Mannose is a sugar, is does not act like the fructose in cranberry juice. D-mannose acts to essentially line the bladder and urethra, not allowing the bacteria to adhere to lining. As a result, the bacteria cannot gain a foothold and they are voided during urination.

Other natural treatments that may be necessary include specific botanicals that help combat bacterial (or other) infections, immune system boosters, probiotics, and substances that help raise or lower the pH of the urine. Also consider nutrients to help fortify the integrity of the epithelial cells that line urinary tract; such as vitamins A and C and nutrients required for collagen formation.

Generally speaking, UTIs can be overcome fairly easily. But if you get recurrent UTIs, you should probably look into the cause because you are most likely missing something critical. Lastly, if you get recurrent UTIs due to intercourse and treatments seem to fail, it may be prudent to have your partner checked.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Nutrients for healthy bones

Posted in common conditions, remedies, tagged , on December 15, 2009| 2 Comments »

Bone is living, growing tissue that is constantly remodeling. It is continuously breaking down and rebuilding, essentially replacing itself as most tissues in the body. In order to properly rebuild bone, certain nutrients are necessary. From a macro perspective, the composition of bone is made up of minerals (~70%) and protein (~30%). Without minerals, bone would bend and be malleable like a piece of clay. And without protein (or collagen) bone would shatter like a piece of glass hitting hard pavement. Now I’ll get more specific.

• Calcium – This is the most abundant mineral in the body. We all know calcium is a necessary component of bone, and about ninety-nine percent of the body’s calcium is found in bone. Some good forms of calcium include calcium citrate, calcium lactate, calcium citrate-malate, and calcium hydroxyapatite.

• Phosphorus – This is the second most abundant mineral in the body, and about eighty-five percent of the body’s phosphorus is in bone. Despite its essential nature, it is rarely something that needs to be supplemented, and excessive amounts of phosphorus may actually be detrimental to bone. However, it is generally accepted that a ratio of 10:4, calcium to phosphorus, should be maintained for healthy bone density.

• Magnesium – This mineral is not as abundant as calcium or phosphorus in bone. However it is still considered important due to its role in calcium and bone metabolism.

• Iron – Iron is important more as a co-factor in building collagen, the main protein makes up bone.

• Zinc – Like iron, zinc plays an important role as a co-factor (in several enzymes) necessary for bone formation. The first enzyme is alkaline phosphatase which is necessary for bone mineralization to take place. Zinc is also a co-factor in reactions involving the enzyme collagenase, essential for the protein-containing portion of bone. Another one of zinc’s crucial roles (for the entire body) is in allowing for the proper formation of DNA. This is because zinc is necessary for the enzyme DNA polymerase which is involved in the replication and repair of DNA (the cellular blueprint); thus cellular growth.

• Copper – This mineral acts as a co-factor in the enzyme lysyl oxidase. This enzyme works to ensure that amino acids involved in the production of collagen are properly (cross)-linked, which contributes to the mechanical strength of collagen.

• Vitamin D – As you may know, scores of people are deficient in this vitamin. The main reason it is helpful for healthy bone formation is because it allows for the absorption of calcium through the intestinal wall. Although it also increases the activity of the bone-building cells (osteoblasts).

• Vitamin F (essential fatty acids) – These fats (specifically omega 3’s and omega 6’s) are considered “essential” because we must obtain them from diet, as our body cannot synthesize them from other fats. They are important for bone strength because of their ability to drive calcium into the tissues (i.e.: bone) from the blood. Without essential fatty acids calcium would not be metabolized properly for its use in bone (and other tissues).

• Vitamin K – This fat-soluble vitamin is a co-factor for an enzyme that ultimately enhances calcium’s ability to be incorporated into bone. Additionally, it allows for the optimal form/function of osteocalcin (a “non-collagen” protein) which is incorporated in bone, during bone formation. The exact function of osteocalcin remains unclear. However, during periods of bone resorption (or breakdown), osteocalcin is released into circulation. A deficiency in vitamin K may result in an analogue of osteocalcin that has been found in the blood of osteoporotic patients.

• Vitamin C – Kept simply, vitamin C is necessary for collagen production, the major component of the protein portion of bone. Do remember that vitamin C cannot be synthesized in the body and must be obtained from food. And ascorbic acid is technically only one portion of the vitamin C complex, so it’s best obtained from food sources or a “whole food” supplement.

• Vitamin A – Again, to keep it simple, vitamin A is necessary for both the bone-building cells (osteoblasts) and bone-breakdown cells (osteoblasts). Therefore, too much or too little little vitamin A can be a complication. However, it remains necessary.

• Protein – Protein can be likened to a chain, while amino acids can be considered the individual links in the chain. In general, protein is necessary to form the collagen portion (~30%) of bone. Specifically, the amino acids proline, lysine, and glycine are necessary to form collagen. Ingesting (and properly digesting) adequate amounts of protein through diet should take care of this requirement.

Lastly, hormone balance is extremely important for the maintenance of healthy bones. So taking all the bone-building nutrients possible may be futile if you don’t have proper hormone balance. That topic is beyond the scope of this article and will be addressed in the future. Also, don’t forget weight-bearing exercise for building strong bones.

I cannot say this list is 100% conclusive as other minerals such as boron, manganese, and strontium (and probably others by now) have also been found to be helpful for bones. Also, other nutrients that help hormones to function optimally should be considered; in addition to nutrients that allow for the optimal formation and function/strength of collagen.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

source: Seminar material: Principles of Nutrition for bone and joint health – Dr. Micheal Dobbins

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Gallbladder symptoms

Posted in common conditions, tagged , , , , on December 8, 2009| Leave a Comment »

Gallbladder dysfunction is a fairly common clinical condition. According to the U.S. Department of Health and Human Services, cholecystectomy (or gallbadder removal) was the seventh most common ambulatory (or out-patient) surgery in the U.S. in 2003. This is rather unfortunate considering how important the gallbladder is in overall body function; in addition to the fact that there are many successful, non-invasive natural methods in order to help it function properly.

The gallbladder is located on the right side of your body, behind the lower edge of the ribcage underneath the liver; in line with the center of the clavicle (or collarbone). Its purpose is to store bile that is manufactured by the liver, and then release the bile into the small intestine. From a digestive standpoint, bile’s purpose is to emulsify (or break down) fats in the small intestine, which allows them to be absorbed efficiently. Additionally, this allows for the proper absorption of the fat-soluble vitamins A, D, E, and K. Another role bile plays is to carry cholesterol and toxins into the intestines in order to rid them from the body. The toxins include anything ranging from pesticides, estrogens, toxic metals, and any other fat-soluble toxins. As you can see, a sluggish gallbladder (or worse, cholecystectomy) can cause a wide variety of complications.

The most common symptoms of gallbladder dysfunction include nausea, constipation, indigestion (especially after eating fatty meals), bloating (especially about half-an-hour to an hour after eating), gas, pain in the area where the gallbladder is located, pain in the right shoulder, a bitter taste in the mouth, clay or light-colored stools, and stools that float (except if you’ve consumed large amounts of fiber).

The gallbladder constricts and releases its bile via the action of a hormone called cholecystokinin (CCK). Cholecystokinin secretion is stimulated by the presence of fat- and protein-rich food that enters into the small intestine. As a result, avoiding fat completely may not be the best way to avoid gallbladder complications; because the mere presence of fat is helpful in releasing the bile that resides in the gallbladder in the first place.

The most common problem you’ve probably heard of related to the gallbladder is gallstone formation. And the most common type of stone is known as a cholesterol stone. It is not fully understood why cholesterol gallstones form, but it is generally accepted that they stem from any of the following: too much cholesterol, too much bilirubin (a breakdown product of old red blood cells), insufficient bile salts, a lack of emptying of the gallbladder, or the gallbladder not emptying enough. Cholesterol and bilirubin are normal components of bile. It is when they increase in concentration that they may become a problem. The other less common stone is known as a pigment stone.

I spoke about what causes the gallbladder to constrict (i.e.:CCK). In addition to a possible inhibition of the constriction of the gallbladder, the bile can also become thick and lose its ability to flow freely; regardless of the amount of CCK release. When this occurs, it is called cholestasis, or a suppression of the flow of bile. There are several possibilities as to why this may occur. First, realize that the largest component of bile is water. Therefore, being sufficiently hydrated is of prime importance to keep the viscosity down. Next, you must have an adequate supply of essential fatty acids, particularly omega 3’s. These fatty acids help to thin the bile to keep it flowing freely. Additionally, certain nutrients can be helpful in aiding fat metabolism and bile flow. In particular, inositol, choline, taurine, and betaine (not betaine-HCl, though it is possible that betaine-HCl may be helpful through improving overall digestion and stimulating the release of CCK). The gallbladder (and liver) can also be helped by botanicals such as milk thistle, dandelion root, and ginger. By the way, beet leaves are high in betaine, and juicing them would be best.

Other factors that can affect bile flow need to be considered as well. In particular, estrogen dominance can be a problem. Estrogen dominance refers to either: 1) too much estrogen in relation to progesterone, 2) too little progesterone, or 3) too much estrogen with normal progesterone levels. The reasons for estrogen dominance are beyond the scope of this article. Essentially, excessive estrogen can result in lithogenic (or calculi/stone forming) bile according to this article from the Annals of Surgery. Additionally, eMedicine cites a study which “postulated that estrogens cause increased cholesterol secretion and progesterone promotes biliary stasis”, thus possibly leading to gallstones or bile stasis. Low thyroid function (which can result from estrogen dominance, but certainly not always) can also cause the gallbladder to become sluggish and congested.

Women tend to be more likely to suffer from gallstones and gallbladder complications, which may further point to excess estrogen levels as being a major problem. There is a profile of a person likely to get gallbladder problems coined the “4F’s”: 1) female; 2) (let’s just say overweight); 3) forties (age); and 4) fertile (implying high levels of hormones).

Otherwise, I’ve quoted the following characteristics that put people at risk for gallbladder complications from the National Digestive Diseases Information Clearinghouse:

  • women—especially women who are pregnant, use hormone replacement therapy, or take birth control pills
  • people over age 60
  • Native Americans
  • Mexican Americans
  • overweight or obese men and women
  • people who fast or lose a lot of weight quickly
  • people with a family history of gallstones
  • people with diabetes
  • people who take cholesterol-lowering drugs

However, don’t rule out a gallbladder problem if you don’t fit into any of the categories above. I commonly see gallbladder problems in all types of individuals. The most common related complaints I see are sharp, piercing pain at the right fourth rib (where it connects to the fourth thoracic vertebrae) sometimes extending upward into the neck and resulting in neck pain as well; knee pain; and digestive disturbances. If you suspect a gallbladder problem, please seek a licensed, qualified healthcare practitioner that can help you before the worst case scenario (cholecystectomy). It can be a very simple problem to manage through diet and lifestyle changes.

One last thing! For those who have had their gallbladders removed, it may be a good idea to take bile salts (in supplement form) with every meal, as there is a good chance that fat digestion will be impaired without them.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Potential causes of hypothyroidism

Posted in Applied Kinesiology, common conditions, tagged , , , , , , , on September 15, 2009| 3 Comments »

The previous article titled “Hypothyroidism” was written to allow for an understanding of the function of the thyroid gland; the symptoms of hypothyroidism; and the medical approach to treatment. In this article I will focus on what I see as the potential causes of hypothyroidism in the first place based on my experience. Remember, many people have the same “diagnosis” but for different reasons. That is why I focus on treating patients and not their diagnosis or blood tests. By the way, I have yet to see the cause as a deficiency of taking drugs.

OK, in the first article I mentioned 7 different possible reasons for clinical or sub-clinical hypothyroidism. Let’s begin.

1) Structural imbalances in the cranium or TMJ (possibly affecting the pituitary)
The pituitary is nestled in the brain and sits in a little “saddle” that’s part of the sphenoid bone. This bone happens to be the center of cranial bone motion. If there are muscular imbalances in the muscles of the neck and TMJ, you can be sure that undue stress will be placed on the pituitary. Remember, structure determines function, not the other way around. There is even a particular cranial fault, which is corrected via the “pituitary drive technique” in applied kinesiology. It targets sphenoid bone motion specifically. But you must correct the muscle(s) involved as well, as muscles move bones; the “heart” of applied kinesiology principles. Just like adjustments to the spine and extremities; if the muscles haven’t been balanced, you can be sure the joint problem will come right back. I unfortunately don’t have research on this topic, as I wouldn’t be surprised if the government or drug companies are NOT handing out grants to people interested in researching structural stress on the pituitary. I could be wrong though.

2) Weakened/stressed out adrenal glands
The adrenal glands are the “stress” glands. They produce the hormone cortisol (and others) and neurotransmitters adrenaline and noradrenaline. One quick mention about thyroid hormone first. T3 is a much more (perhaps 90-95%) metabolically active hormone than T4. T3 is “made” by a conversion of T4 into T3, by removing one of the iodine molecules on the T4 (hence 3 molecules instead of 4). This is enormously important for the thyroid hormone to ultimately do its job appropriately. High or low levels of cortisol can however inhibit that conversion of T4 to T3. As a result, the circulating thyroid hormone will not work very effectively, and often cause the symptoms of hypothyroidism. One more thing – high or low cortisol can cause the body to convert T4 into “reverse T3”. This is when the iodine is pulled off the wrong part of the T4 molecule. This will result in a metabolically inactive hormone, that may even get tallied into the total T3 reading on blood tests. So it may look like there is plenty, but much of it may be inactive “reverse T3”. Reverse T3 can be ordered on blood tests, but I’ve never seen it, unless I instructed the patient about it and they asked for it to be ordered. There are ranges of normal on the test results for reverse T3, but there is usually a clause saying it’s not been studied enough to determine it’s accuracy. I would still look to get it in normal ranges if this is the suspected cause (you’ll see how soon). By the way, the reasons for imbalances in cortisol levels are too plentiful to mention here; but poor blood sugar metabolism is of prime importance (this does not mean you need to be diagnosed with diabetes or hypoglycemia). Most people have faulty have blood sugar metabolism (and stressed adrenal glands) to some degree.

3) Heavy metal toxicity
By now you probably know that heavy (toxic) metals can cause a wide array of problems. Well, here’s one more. Just like high or low cortisol, heavy metals can cause an inhibition in the conversion of T4 to the more active T3. Especially consider mercury, cadmium, and lead; but I wouldn’t stop there. By the way I often say “toxic” metals because aluminum is not “heavy”, it is actually “light” in molecular weight – and I wouldn’t want to avoid including it, as it is certainly toxic. [aside: check those salt packets you get from the deli – you just may find an aluminum compound on the list of ingredients]

4) Imbalances in estrogen and progesterone (commonly thought of as female hormones) – however, males also produce these hormones
According to Janet Lang, DC, an imbalance in estrogen and progesterone can lead to thyroid hormone being inactive at the cellular level. I’m not sure of the exact mechanism she proposes, but I agree, as I’ve seen it in patients who have these imbalances (usually a condition known as “estrogen dominance”). Janet Lang has dedicated almost all of her research to (functional) hormone problems.

5) Vitamin, mineral, and amino acid deficiencies
First, the amino acid tyrosine and the mineral iodine are the raw material to make T4 and T3. The “T” stands for tyrosine and it is an essential (must be obtained from diet) amino acid we get from eating protein. The number “4” or “3” refers to the number of iodine atoms attached to the tyrosine. So these are obviously necessary. Next, the mineral selenium in necessary for the conversion of T4 into the more active T3. A deficiency in this mineral would not allow for that conversion. Additionally, there are a number of vitamins and minerals that are necessary for the thyroid hormone receptor (where it “docks” in to the cells) to function properly; and for the manufacturing of the hormone. These include, but are certainly not limited to: iron; zinc; potassium; manganese; vitamins A, B1, B2, and E. Don’t forget digestion and absorption of these nutrients.

6) Imbalances in the output of pituitary and/or hypothalamic hormones
I spoke about this above regarding cranial and TMJ imbalances. The hypothalamus, which “controls” the pituitary can also be a problem in hypothyroidism. In addition to cranial treatments, there are some specialized supplements that can help the function of these glands.

7) Liver toxicity or malfunction
The liver is one of the main sites where the conversion of T4 to T3 takes place. An imbalance in liver function, for any number of reasons (usually toxicity or a build up of fat) can impede this conversion. For these cases, detoxification through diet, lifestyle and targeted nutrition is usually necessary.

Notice how the list of 7 problems above, doesn’t even mention the thyroid! That’s because I’ve never encountered a problem with the thyroid directly that causes a problem. I suppose that makes sense because most problems that exist arise through lifestyle (nutrition, stress, etc.) complications. Even a liver, adrenal, nutrient deficiency or absorption, or structural problem isn’t THE problem – it is the result. There is usually a combination of the factors mentioned that contribute to thyroid problems; which of them is primary depends on the person.

By the way, there are many people taking thyroid hormone in the form of drugs, and they still exhibit the signs and symptoms of hypothyroidism. I find that this is usually a nutrient deficiency that presumably prevents the thyroid hormone receptors from working properly. Unfortunately, the conventional approach to this is usually to simply increase the dose, which may help temporarily.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Hypothyroidism

Posted in Applied Kinesiology, chiropractic, common conditions, tagged , , , , , on September 11, 2009| 4 Comments »

The thyroid is a butterfly-shaped endocrine (hormone secreting) gland located in your neck beneath the cricoid cartilage, or “Adam’s apple” (as it’s referred to in  males). Essentially its job, or the hormones it secretes, is to control your body’s metabolism. That is, it determines the rate at which your body builds, maintains, and breakdowns biochemicals (and ultimately energy). It is controlled by hormones released from the pituitary gland, which in turn is controlled by the hypothalamus. It secretes three hormones – T4(thyroxine), T3(triiodothyronine), and calcitonin. This article will focus on a common disorder known as hypo-thyroidism (decreased output of thyroid hormone), which refers to the levels of T4 and T3, as they are the two associated with metabolism. The “T” refers to the amino acid tyrosine, and “3” or “4” refers to the number of iodine atoms atttached to it. Calcitonin as its name implies helps regulate calcium metabolism.

Some of the thyroid’s main functions are to convert food into energy, help control body temperature, and basically affect the speed and efficiency of all biochemical processes. Additionally, it can have a profound effect on emotions, mood, cravings, and addictions because T3 influences brain chemistry.

I won’t go into the exact mechanisms of how these hormones exert their effects on the body, but I will discuss the end results. This leads me to the main signs and symptoms of hypothyroidism. The main thing you want to think about is fatigue. Typically, the person with hypothyroidism will experience fatigue ALL day long. There is one major caveat regarding this however. These people may not completely notice how fatigued they really are. I say this because based on my experience in working with patients, they’ll tend to pack their day with things to do in order to keep going and going. Obviously they may be tired, but it won’t be as noticeable because they often stay so busy and can become preoccupied. Aside from fatigue, the next major symptom would be weight gain (or inability to lose weight); don’t be fooled by this though, as many normal or underweight individuals have (sub-clinical) hypothyroidism. Cold hands and feet is another common one; and I still have yet to see this symptom related to circulation, especially in people under 60 years-old. Dry skin, poor memory, constipation, goiter (swelling of the gland), muscles cramps (and musculoskeletal pain), high cholesterol, swelling of the extremities and face, carpal tunnel syndrome, depression and addictions, and chronic colds and flu can also be added to the list. Some cases will result in a loss of the outer-third of the eyebrows. This is not known why to my knowledge, however it’s interesting to note that the acupuncture meridian related to the thyroid ends at the outer edge of either eyebrow.

OK, so what causes hypothyroidism or a low output of thyroid hormones? According to the Mayo Clinic, the most common reported cause is Hashimoto’s thyroiditis. This is an inflammation of the thyroid due to an autoimmune reaction when the body attacks its own thyroid gland (no cause of this condition is mentioned). The next are medical treatments for hyperthyroidism (designed to slow the thyroid), radiation treatment for cancers of the head and neck, thyroid surgery (removal of some or all of the gland), or side effects of drugs for other conditions.

Great, so now what? I was expecting the medical community to at least mention iodine deficiency. But all the major medical information I found basically states the same as Mayo Clinic as the “cause” for hypothyroidism. No wonder the first thing patients are recommended is drugs that contain synthetic (or sometimes natural) thyroid hormone.

Unfortunately, sub-clinical hypothyroidism is very common. This is when the blood tests show normal levels of thyroid hormones but the patient (sometimes, not always) has “all” (or some) of the signs and symptoms of an under-functioning thyroid. The obvious problem here is if a patient accepts that there is nothing wrong with them because their thyroid hormone levels are normal (sometimes the pituitary hormone- TSH is elevated, but not always). So then what? The usual scenario is that they go back year after year (while slowly getting worse, assuming they haven’t changed anything in their lifestyle) until the tests finally pick it up – then it’s “official”; and there is something that can be done about it. Drugs of course – again, synthetic or natural thyroid hormone. OK, it’s time to stop whittling people down to numbers on a piece of paper!!! Let’s pay attention to our patient’s symptoms and concerns, and not just their blood test results. Let’s look for the causes and begin treating ASAP! Keep in mind that some doctors will immediately start the patient on drugs (usually only if the TSH is high).

Here is what I see as the major contributors to sub-clinical or clinical (shows up on blood tests) hypothyroidism; in no particular order.

1) Structural imbalances in the cranium or TMJ (possibly affecting the pituitary)
2)Weakened/stressed out adrenal glands
3) Heavy metal toxicity
4) Imbalances in estrogen and progesterone (commonly thought of as female hormones) – however, males also produce these hormones
5) Vitamin, mineral, and amino acid deficiencies
6) Imbalances in the output of pituitary and/or hypothalamic hormones
7) Liver toxicity or malfunction

In order to not make this article too lengthy, I’ll leave it there and get into those 6 specific things in the next article.

I first wanted to get you familiar with the functions of the thyroid; the signs and symptoms of hypothyroidism; and the medical approach. See you soon.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Iron-deficiency anemia

Posted in common conditions, remedies, tagged , , , , , , on August 18, 2009| 4 Comments »

It is quite common for a (female) patient to come to my office and tell me she is anemic. And very often, she has been diagnosed with it several months ago. My question is always: “Why are you still anemic if you found out about several months ago?” With the exception of some (rare) complications and rare types of anemias, there is generally no reason anyone should have iron-deficiency anemia for more than about four months.  And this type tends to be the most common, at least in my patients.  Let’s discuss why it occurs and how it can be incredibly simple to correct.  To start, anemia refers to “a condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume”.  If you are not sure, red blood cells need iron to carry and distribute oxygen around the body by way of the hemoglobin molecule.  By the way, the oxygen carrying molecule in muscles is known as myoglobin.

Iron-deficiency anemia is a “no-brainer” as to why it occurs; that is, lack of sufficient amounts of iron.  The question is always: Why?  There are three answers: a) you are not consuming enough iron, b) you are not absorbing enough, or c) you are losing blood faster than you are making it.  These can all exist together, too.

For answer “a” – this is simply not consuming enough iron-containing foods.  I almost always see this mostly in vegetarian or vegan patients.  Now, I’m not at all against being vegetarian or vegan, but I am against being deficient in vital nutrients that may come as a result of a particular diet.  Unfortunately, for vegetarians and vegans, iron is most abundant (by weight/mass) in animal foods.  Some good sources are: beef, chicken, turkey, pork, liver (beef, chicken, etc.), oysters, egg yolks and other animal foods; and kidney beans, blackstrap molasses, spinach, raisins, peas, dates, broccoli, almonds, apricots, and some other vegetarian/vegan foods.  Check the nutrition information on the foods for the exact amounts.  Here is a chart listing the recommended daily allowance (RDA) for iron according to the National Institutes of Health.

Age Males
(mg/day)		 Females
(mg/day)		 Pregnancy
(mg/day)		 Lactation
(mg/day)
7 to 12 months 11 11 N/A N/A
1 to 3 years 7 7 N/A N/A
4 to 8 years 10 10 N/A N/A
9 to 13 years 8 8 N/A N/A
14 to 18 years 11 15 27 10
19 to 50 years 8 18 27 9
51+ years 8 8 N/A N/A

For answer “b” we come to the issue of iron absorption.  This can be caused by many factors.  Here are the most common ones I see.
1) Your intestinal tract can become literally be clogged up!  Iron is absorbed in the duodenum and upper jejunum of the small intestine.  There are little hair-like protrusions lining your small intestine which act to literally take up the food for absorption.  If your villi are clogged with old, undigested food from poor dietary choices, you may not be absorbing iron sufficiently (along with other nutrients as well).

2) You might not be fully breaking down the foods you are eating.  This can be due to improper chewing, or lack of hydrochloric acid and/or other digestive enzymes.  Deficiencies in minerals that stimulate the production of these digestive enzymes are one thing to consider; and possibly an enzyme supplement to help “prime the pump” while you are restoring those minerals.  By the way, iron-deficiency in a male or post-menopausal woman who is consuming enough iron in thier diet almost always results from lack of sufficient amounts of hydrochloric acid in the stomach.

3) Additionally, an outright digestive disorder like irritable bowel syndrome, Crohn’s disease, ulcerative colitis, and others may not allow for proper absorption of iron (and other nutrients).  So these conditions would need to be addressed as well.

By the way, iron from animal sources is called “heme” and from vegetable sources it’s called “non-heme”.  Please be aware that a non-heme source will be absorbed much better when combined with vitamin C in the same meal.  And phytic acid (or phytate) which is high in legumes and grains (e.g.: soy, kidney beans, wheat, rye, oats, barley, corn, and peanuts) will substantially inhibit iron (and other mineral) absorption.  However, vitamin C will also help to counteract the effect of phytic acid.

Lastly, answer “c” has to do with the issue of losing blood, faster than you are making it.

1) The most common cause that I see related to this is when women have a heavy menstrual cycle.  This is usually the result of hormone imbalances, especially a condition known as estrogen dominance.  I’ll discuss that in another article.  This is a rampant problem for females due to many reasons; and you won’t necessarily have heavy periods because of it.

2) Men and post-menopausal women (in particular) may become iron deficient due to gastrointestinal blood loss from digestive conditions like ulcers, Crohn’s disease, ulcerative colitis, irritable bowel syndrome, colon cancer and other digestive disorders.  Also, excessive intake of aspirin or other non-steroidal anti-inflammatory medications (e.g.: Advil®, Motrin®, Aleve®, etc.) can cause blood loss through the gut.  These tend to be the most common reasons for blood loss, however their certainly are others.  And these conditions can obviously occur in menstruating women as well.
Let’s hope you are not losing blood because of undetected internal bleeding!

Now for the symptoms of iron-deficiency anemia.  Some common ones are as follows: pallor (pale skin and mucous membranes – nail beds and inner membranes under the eyeball can often/not always be spotted), fatigue, irritability, brittle nails, cold hands and feet (usually hypo-thyroid though), trouble concentrating, shortness of breath, irrregular heartbeat, mild depression, muscle fatigue/lack of endurance, and perhaps more.

Another strange symptom is called pica which a craving to eat ice (probably most common), soil, paper, soap, chalk, and other things I won’t mention.  This can be especially common in children.  The jury is still out on why it relates to iron deficiency.

The best blood test to run for iron-deficiency is ferritin (the amount of stored iron in your body.  But I’d also want to see levels of actual blood iron, total iron-binding capacity (TIBC), and transferrin (the molecule that transports iron).  And of course of complete blood count, which will measure total red blood cells, hemoglobin, hematocrit, RDW (random distribution of weight) and MCV (mean corpuscular volume).  Beware however, functional/sub-clinical iron deficiency can still (and often does) exist because the reference ranges considered normal by blood labs are extremely wide – so you will be quite deficient if you fall below the lab’s “normals”.

There are several applied kinesiology functional muscle tests that can cause me to suspect iron deficiency, especially one involving muscle fatigue/endurance.  And also in-office, cross-checks to help verify.  But I definitely consider it prudent to have blood levels checked for functional ranges; as an overload of iron can be very dangerous.  Get the blood tests and have them evaluated for functional ranges, it’s simple.

Finally, it can easily be corrected through diet and/or supplements.  And will most likely take a minimum of four months to correct, because the life-span of a red blood cell is about 120 days.  Hope this helps!

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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