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Boosting Energy with Hypothyroidism | Wellness Clinic

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Functional Medicine

The cornerstone of treating hypothyroidism and reducing its symptom involves following the proper treatment. People with hypothyroidism receive the maximum relief from exhaustion when they balance their thyroid-stimulating hormone (TSH) levels, often to below 2.5 milliunits per liter (mU/L), based on study published in the Kansas Journal of Medicine.

“Most experts agree that after hypothyroidism is diagnosed, 1 mU/L into 3 mU/L has been an appropriate TSH range,” explains Victor Bernet, MD, an endocrinologist and assistant professor of medicine at the Mayo Clinic in Jacksonville, Fla.. However, it may take time to achieve that goal, and your symptoms, such as energy, could persist for awhile. Managing fatigue as you wait is an issue of making healthy lifestyle choices and getting enough sleep.

Take the Recommended Treatment

The good news about hypothyroidism treatment is that thyroid medication is successful for most people, especially when taken as prescribed. This means that you should follow your physician’s instructions. The most severe cases of hypothyroidism see symptoms improve with treatment within six months, states Jan Hoffman, MD, an endocrinologist and leader of the section of endocrinology at the Via Christi Clinic in Wichita, Kan.. But some individuals may continue to feel tiredness. For these individuals, Dr. Hoffman suggests medication adjustments to comprise both the T3 and T4 hormones. This is not yet a mainstream treatment, if you haven’t been getting good results from your present drug 35, about trying it, but you might talk to your primary care doctor or endocrinologist.

Balance Your Diet

Eating a nutritious diet rich in fruits and vegetables, whole grains, and proteins can help give you. Cut back on added sugars, which can increase the fatigue you are feeling out of migraines. “There is certainly an advantage to maintaining a wholesome, well-balanced diet with regular exercise to improve health generally,” Hoffman says. Because sleep quality can be reduced by this, additionally you may need to avoid eating large meals within a few hours of bedtime. Instead, opt for a dinner and a snack before bed.

Try Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a style of therapy that helps you to change negative thought patterns and replace them with more positive ones. In studies looking at physical action, CBT, and fatigue, researchers have observed that this kind of therapy appears to help people feel like they’re more active or capable of being active, and so less fatigued, even if they aren’t really increasing their physical activity levels. This is in part as counter the belief that you’re simply tired from the consequences of hypothyroidism to do anything and one tactic of CBT is to assist you.

Limit Alcohol and Caffeine

If you’re fighting fatigue from hypothyroidism, it’s easy to slip into a cycle of drinking lots of drinks during the day and then using a nightcap to bring you back down. It will not tackle fatigue although caffeine can occasionally give you a elevator, such as feeling perkier in the morning. What’s worse, this cycle of caffeine and alcohol to wind down could be sapping your energy over and beyond the fatigue. Both caffeine and alcohol interfere with your body’s ability to achieve sleep. Cut back on carbonated beverages, adhering before noon, and have one alcoholic beverage if any, in the day.

Engage in Physical Activity

You may believe eczema has left you but physical activity, even a little at a time, can help counter fatigue, enhance your energy levels also improve your sleep quality. Try for the national recommendations for physical activity that is healthy: being active for at least 30 minutes. Exercising in the evening can make it difficult to get to sleep later try to schedule your workouts for earlier in the day.

Take Steps to Sleep More Soundly

Obtaining enough high-quality sleep people need seven can help fight fatigue. Deep sleep requires the appropriate “stage”: A slightly cool, dark, sound-free site. To get your body to the sleep rhythm, set a regular time to go to wake up and to sleepon weekends and holidays. If you’ve taken these measures to boost your sleep however are still lacking energy during the day and suspect you are not sleeping well, think about a sleep evaluation to determine if you have some sleeping disorders, such as sleep apnea, that may be robbing you of a good night’s sleep.

Stop Smoking

Nicotine is a stimulant. So even though smoking can feel as a relaxing routine, it’s interfering with your sleep quality and, in turn, adding to fatigue. Individuals who stop smoking find that once they’ve made it during the withdrawal period, they’ve sleep and more energy. Smoking is known to contribute to autoimmune disease, which might be challenging your hypothyroidism treatment plan’s development. Take note that hypothyroidism can be also complicated by smoking cessation, so be certain you quit smoking under the supervision of your doctor.

Get Routine Medical Tests

Dr. Bernet contrasts thyroid function into a well-functioning vehicle. “If your car is acting up and your oil is low or you have not changed it in awhile, you need oil,” he says. This is the equivalent of taking medication to get your thyroid hormone levels back to normal. This, too, applies to sleeplessness therapy. If your thyroid screening indicates you are at normal levels after treatment but you are still feeling exhausted, ask for further evaluation. About one in five people experience fatigue, but hypothyroidism is simply one cause of exhaustion that is ongoing.

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�

By Dr. Alex Jimenez

Additional Topics: Wellness

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

TRENDING TOPIC: EXTRA EXTRA: About Chiropractic

About Thyroid Disease and Fatigue | Wellness Clinic

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Functional Medicine

Are you tired of being tired? Whatever you call it, exhaustion, fatigue, lethargy, or feeling run down, overtired, or just plainly pooped out, fatigue is a frequent symptom associated with thyroid disease.

How does thyroid disease cause fatigue?

We’re not talking about regular fatigue after a late night. This is a debilitating fatigue. You might find yourself needing a rest in the afternoon to endure until dinnertime. Or you wake up tired and still sleep ten to twelve hours a night. Or you’re less able to work out, and your endurance is reduced because you are weak and lethargic. Or brain-fogged and exhausted out may just walk around about exactly the quantity of sleep that used to make you feeling refreshed.

There are a number of important things to know about the connections between thyroid disease and fatigue, and ten of the most significant things to know about boosting your energy and battling fatigue are mentioned below.

Fatigue and Hypothyroidism

Fatigue is a really common symptom of hypothyroidism, an underactive or reduced thyroid function, in many individuals. Many patients report that their fatigue is diminished or even completely solved after the treatment for hypothyroidism is optimized. Various treatment approaches, including functional medicine can help improve hypothyroidism.

Fatigue and Hyperthyroidism

Fatigue is also a symptom of hyperthyroidism, an overactive or increased thyroid function, in some patients. Exhaustion is present even when you have gotten an adequate quantity of sleep. In other scenarios, exhaustion or fatigue associated with hyperthyroidism may result from insomnia, anxiety, or disrupted sleep patterns. Typically, treatment for hyperthyroidism can help resolve the patient’s overall symptoms.

Autoimmune Thyroid Disease and Fatigue

Even when thyroid function tests demonstrate that the thyroid gland is “normal” and hormone levels fall within the benchmark range, the existence of elevated thyroid antibodies, which may indicate autoimmune Hashimoto’s disease or Graves’ disease, may lead to fatigue as a symptom in some patients.

Dietary Changes

Some thyroid patients, including individuals who don’t have celiac disease or gluten intolerance, have reported a decrease in fatigue when they switch into a gluten-free diet plan. A gluten-free diet is a nutrition plan free of wheat and gluten products. Others have reported similar effects by removing sugar, dairy, or other foods in the diet.

Unrefreshing Sleep

Some people experience fatigue due to what is called unrefreshing sleep. This indicates that you’ve had enough sleep seven or more hours, but you wake up and feel tired, because the sleep has been of poor quality, interrupted, or did not reach levels that are restorative. Unrefreshing sleep could be associated with dysfunction, in addition to chronic fatigue syndrome and fibromyalgia in most cases.

Iron

Some thyroid patients suffering from fatigue may be reduced in iron, in particular, the saved form of iron known as ferritin. It is worth having ferritin levels assessed by your healthcare professional, and if they are not optimal (in the upper end of the reference range), talk with your doctor about supplementing with iron, or even incorporating more iron to your diet through foods. An excess of iron, in particular, a hereditary condition called hemochromatosis, may also be related to fatigue. There is a link between thyroid conditions and an increased probability of hemochromatosis.

Chronic Fatigue Syndrome and Fibromyalgia

In case you have long-term, debilitating fatigue, and the tiredness is accompanied by other symptoms like enlarged lymph nodes, a chronic sore throat, and/or body/muscle aches pains, you may have other conditions such as chronic fatigue syndrome and/or fibromyalgia. These conditions are common in thyroid patients than in the general populace.

T3 and Natural Thyroid

Some thyroid patients on thyroid hormone replacement have reported a rise in their exhaustion levels or fatigue when switching from a T4 only treatment (i.e., levothyroxine), to some T4/T3 treatment, for example, the inclusion of artificial T3, or use of a natural desiccated thyroid medication.

Sleep Apnea

Thyroid patients are at greater risk of sleep apnea, and at which breathing stops for short periods during sleep. Sleep apnea can contribute to fatigue, due to an improper oxygen intake when sleeping. Thyroid patients experiencing fatigue should speak with a healthcare professional about having a sleep study or evaluation completed to determine if sleep abnormalities, such as apnea, may be contributing to the fatigue.

Get Better and More Sleep

Be sure you receive optimum treatment for your thyroid illness and address any sleeping disorders, food sensitivities, and imbalances on your iron levels. Also, make sure you get adequate sleep. According to the National Sleep Foundation, many adults need a minimum of seven to eight hours each night, and a considerable proportion of us aren’t currently getting this level of sleep on a regular basis.

Here are some tips to help avoid fatigue by getting better and more sleep:

Try to maintain the same sleep schedule weekdays and weekends
Keep your bedroom cool
Don’t watch television or work in your bedroom
Avoid alcohol and caffeine in the day, and before bedtime
Don’t take naps
Don’t exercise after dinner period
Have a hot shower or bath before bedtime
Use a sound conditioner or earplugs to block noise
Avoid large meals before bedtime
Boost light exposure during the day
Minimize lighting into your bedroom by using blinds or blackout curtains, turn off tv and computer at night, prevent illuminated clocks, and don’t read from or look at backlit devices or smart phones at nighttime
Listen to relaxation or guided imagery audios to help fall asleep.
Do not drink too much liquid in the evening
Restrict changes in your job shifts
Drink a natural or relaxation tea at bedtime
Have a bedtime snack with protein

By Dr. Alex Jimenez

Additional Topics: Wellness

TRENDING TOPIC: EXTRA EXTRA: About Chiropractic

Three Metabolic Energy Systems

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Basal Metabolic Index (BMI), Fitness, Metabolic Syndrome, Power & Strength, PUSH-as-Rx

Personal Training 101

How You Get Energy & How You Use It

We usually talk of energy in general terms, as in �I don�t have a lot of energy today� or �You can feel the energy in the room.� But what really is energy? Where do we get the energy to move? How do we use it? How do we get more of it? Ultimately, what controls our movements? The three metabolic energy pathways are the�phosphagen system, glycolysis�and the�aerobic system.�How do they work, and what is their effect?

Albert Einstein, in his infinite wisdom, discovered that the total energy of an object is equal to the mass of the object multiplied by the square of the speed of light. His formula for atomic energy, E = mc², has become the most recognized mathematical formula in the world. According to his equation, any change in the energy of an object causes a change in the mass of that object. The change in energy can come in many forms, including mechanical, thermal, electromagnetic, chemical, electrical or nuclear. Energy is all around us. The lights in your home, a microwave, a telephone, the sun; all transmit energy. Even though the solar energy that heats the earth is quite different from the energy used to run up a hill, energy, as the first law of thermodynamics tells us, can be neither created nor destroyed. It is simply changed from one form to another.

ATP Re-Synthesis

The energy for all physical activity comes from the conversion of high-energy phosphates (adenosine�triphosphate�ATP) to lower-energy phosphates (adenosine�diphosphate�ADP; adenosine�monophosphate�AMP; and inorganic phosphate, P_i). During this breakdown (hydrolysis) of ATP, which is a water-requiring process, a proton, energy and heat are produced: ATP + H₂O �^��ADP + P_i�+ H⁺�+ energy + heat. Since our muscles don�t store much ATP, we must constantly resynthesize it. The hydrolysis and resynthesis of ATP is thus a circular process�ATP is hydrolyzed into ADP and P_i, and then ADP and P_i�combine to resynthesize ATP. Alternatively, two ADP molecules can combine to produce ATP and AMP: ADP + ADP �^��ATP + AMP.

Like many other animals, humans produce ATP through three metabolic pathways that consist of many enzyme-catalyzed chemical reactions: the phosphagen system, glycolysis and the aerobic system. Which pathway your clients use for the primary production of ATP depends on how quickly they need it and how much of it they need. Lifting heavy weights, for instance, requires energy much more quickly than jogging on the treadmill, necessitating the reliance on different energy systems. However, the production of ATP is never achieved by the exclusive use of one energy system, but rather by the coordinated response of all energy systems contributing to different degrees.

1. Phosphagen System

During short-term, intense activities, a large amount of power needs to be produced by the muscles, creating a high demand for ATP. The phosphagen system (also called the ATP-CP system) is the quickest way to resynthesize ATP (Robergs & Roberts 1997). Creatine phosphate (CP), which is stored in skeletal muscles, donates a phosphate to ADP to produce ATP: ADP + CP �^��ATP + C. No carbohydrate or fat is used in this process; the regeneration of ATP comes solely from stored CP. Since this process does not need oxygen to resynthesize ATP, it is anaerobic, or oxygen-independent. As the fastest way to resynthesize ATP, the phosphagen system is the predominant energy system used for all-out exercise lasting up to about 10 seconds. However, since there is a limited amount of stored CP and ATP in skeletal muscles, fatigue occurs rapidly.

2. Glycolysis

Glycolysis is the predominant energy system used for all-out exercise lasting from 30 seconds to about 2 minutes and is the second-fastest way to resynthesize ATP. During glycolysis, carbohydrate�in the form of either blood glucose (sugar) or muscle glycogen (the stored form of glucose)�is broken down through a series of chemical reactions to form pyruvate (glycogen is first broken down into glucose through a process called�glycogenolysis). For every molecule of glucose broken down to pyruvate through glycolysis, two molecules of usable ATP are produced (Brooks et al. 2000). Thus, very little energy is produced through this pathway, but the trade-off is that you get the energy quickly. Once pyruvate is formed, it has two fates: conversion to lactate or conversion to a metabolic intermediary molecule called acetyl coenzyme A (acetyl-CoA), which enters the mitochondria for oxidation and the production of more ATP (Robergs & Roberts 1997). Conversion to lactate occurs when the demand for oxygen is greater than the supply (i.e., during anaerobic exercise). Conversely, when there is enough oxygen available to meet the muscles� needs (i.e., during aerobic exercise), pyruvate (via acetyl-CoA) enters the mitochondria and goes through aerobic metabolism.

When oxygen is not supplied fast enough to meet the muscles� needs (anaerobic glycolysis), there is an increase in hydrogen ions (which causes the muscle pH to decrease; a condition called acidosis) and other metabolites (ADP, P_i�and potassium ions). Acidosis and the accumulation of these other metabolites cause a number of problems inside the muscles, including inhibition of specific enzymes involved in metabolism and muscle contraction, inhibition of the release of calcium (the trigger for muscle contraction) from its storage site in muscles, and interference with the muscles� electrical charges (Enoka & Stuart 1992; Glaister 2005; McLester 1997). As a result of these changes, muscles lose their ability to contract effectively, and muscle force production and exercise intensity ultimately decrease.

3. Aerobic System

Since humans evolved for aerobic activities (Hochachka, Gunga & Kirsch 1998; Hochachka & Monge 2000), it�s not surprising that the aerobic system, which is dependent on oxygen, is the most complex of the three energy systems. The metabolic reactions that take place in the presence of oxygen are responsible for most of the cellular energy produced by the body. However, aerobic metabolism is the slowest way to resynthesize ATP. Oxygen, as the patriarch of metabolism, knows that it is worth the wait, as it controls the fate of endurance and is the sustenance of life. �I�m oxygen,� it says to the muscle, with more than a hint of superiority. �I can give you a lot of ATP, but you will have to wait for it.�

The aerobic system�which includes the�Krebs cycle�(also called the�citric acid cycle or TCA cycle) and the�electron transport chain�uses blood glucose, glycogen and fat as fuels to resynthesize ATP in the mitochondria of muscle cells (see the sidebar �Energy System Characteristics�). Given its location, the aerobic system is also called�mitochondrial respiration.�When using carbohydrate, glucose and glycogen are first metabolized through glycolysis, with the resulting pyruvate used to form acetyl-CoA, which enters the Krebs cycle. The electrons produced in the Krebs cycle are then transported through the electron transport chain, where ATP and water are produced (a process called�oxidative phosphorylation) (Robergs & Roberts 1997). Complete oxidation of glucose via glycolysis, the Krebs cycle and the electron transport chain produces 36 molecules of ATP for every molecule of glucose broken down (Robergs & Roberts 1997). Thus, the aerobic system produces 18 times more ATP than does anaerobic glycolysis from each glucose molecule.

Fat, which is stored as triglyceride in adipose tissue underneath the skin and within skeletal muscles (called�intramuscular triglyceride), is the other major fuel for the aerobic system, and is the largest store of energy in the body. When using fat, triglycerides are first broken down into free fatty acids and glycerol (a process called�lipolysis). The free fatty acids, which are composed of a long chain of carbon atoms, are transported to the muscle mitochondria, where the carbon atoms are used to produce acetyl-CoA (a process called�beta-oxidation).

Following acetyl-CoA formation, fat metabolism is identical to carbohydrate metabolism, with acetyl-CoA entering the Krebs cycle and the electrons being transported to the electron transport chain to form ATP and water. The oxidation of free fatty acids yields many more ATP molecules than the oxidation of glucose or glycogen. For example, the oxidation of the fatty acid palmitate produces 129 molecules of ATP (Brooks et al. 2000). No wonder clients can sustain an aerobic activity longer than an anaerobic one!

Understanding how energy is produced for physical activity is important when it comes to programming exercise at the proper intensity and duration for your clients. So the next time your clients get done with a workout and think, �I have a lot of energy,� you�ll know exactly where they got it.

Energy System Characteristics

Energy System Workouts

Have clients warm up and cool down before and after each workout.

Phosphagen System

An effective workout for this system is short, very fast sprints on the treadmill or bike lasting 5�15 seconds with 3�5 minutes of rest between each. The long rest periods allow for complete replenishment of creatine phosphate in the muscles so it can be reused for the next interval.

2 sets of 8 x 5 seconds at close to top speed with 3:00 passive rest and 5:00 rest between sets
5 x 10 seconds at close to top speed with 3:00�4:00 passive rest

Glycolysis

This system can be trained using fast intervals lasting 30 seconds to 2 minutes with an active-recovery period twice as long as the work period (1:2 work-to-rest ratio).

8�10 x 30 seconds fast with 1:00 active recovery
4 x 1:30 fast with 3:00 active recovery

Aerobic System

While the phosphagen system and glycolysis are best trained with intervals, because those metabolic systems are emphasized only during high-intensity activities, the aerobic system can be trained with both continuous exercise and intervals.

60 minutes at 70%�75% maximum heart rate
15- to 20-minute tempo workout at lactate threshold intensity (about 80%�85% maximum heart rate)
5 x 3:00 at 95%�100% maximum heart rate with 3:00 active recovery

by�Jason Karp, PhD

References:

Brooks, G.A., et al. 2000.�Exercise Physiology: Human Bioenergetics and Its Applications.Mountain View, CA: Mayfield.

Enoka, R.M., & Stuart, D.G. 1992. Neurobiology of muscle fatigue.�Journal of Applied Physiology, 72�(5), 1631�48.

Glaister, M. 2005. Multiple sprint work: Physiological responses, mechanisms of fatigue and the influence of aerobic fitness.�Sports Medicine, 35�(9), 757�77.

Hochachka, P.W., Gunga, H.C., & Kirsch, K. 1998. Our ancestral physiological phenotype: An adaptation for hypoxia tolerance and for endurance performance?�Proceedings of the National Academy of Sciences, 95,�1915�20.

Hochachka, P.W., & Monge, C. 2000. Evolution of human hypoxia tolerance physiology.�Advances in Experimental and Medical Biology, 475,�25�43.

McLester, J.R. 1997. Muscle contraction and fatigue: The role of adenosine 5′-diphosphate and inorganic phosphate.�Sports Medicine, 23�(5), 287�305.

Robergs, R.A. & Roberts, S.O. 1997.�Exercise Physiology: Exercise, Performance, and Clinical Applications.�Boston: William C. Brown.

Dietary Strategies: Treatment Of Metabolic Syndrome

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Basal Metabolic Index (BMI), Functional Medicine, Metabolic Syndrome, Nutrition, Wellness

Dietary Strategies:

Abstract: Metabolic syndrome (MetS) is established as the combination of central obesity and different metabolic disturbances, such as insulin resistance, hypertension and dyslipidemia. This cluster of factors affects approximately 10%�50% of adults worldwide and the prevalence has been increasing in epidemic proportions over the last years. Thus, dietary strategies to treat this heterogenic disease are under continuous study. In this sense, diets based on negative-energy-balance, the Mediterranean dietary pattern, n-3 fatty acids, total antioxidant capacity and meal frequency have been suggested as effective approaches to treat MetS. Furthermore, the type and percentage of carbohydrates, the glycemic index or glycemic load, and dietary fiber content are some of the most relevant aspects related to insulin resistance and impaired glucose tolerance, which are important co-morbidities of MetS. Finally, new studies focused on the molecular action of specific nutritional bioactive compounds with positive effects on the MetS are currently an objective of scientific research worldwide. The present review summarizes some of the most relevant dietary approaches and bioactive compounds employed in the treatment of the MetS to date.

Keywords: metabolic syndrome; dietary strategies; bioactive compounds

1. Metabolic Syndrome

dietary healthy unhealthy food It was during the period between 1910 and 1920 when it was suggested for the first time that a cluster of associated metabolic disturbances tended to coexist together [1]. Since then, different health organisms have suggested diverse definitions for metabolic syndrome (MetS) but there has not yet been a well-established consensus. The most common definitions are summarized in Table 1. What is clear for all of these is that the MetS is a clinical entity of substantial heterogeneity, commonly represented by the combination of obesity (especially abdominal obesity), hyperglycemia, dyslipidemia and/or hypertension [2�6].

dietary table 1

Obesity consists of an abnormal or excessive fat accumulation, for which the main cause is a chronic imbalance between energy intake and energy expenditure [7,8]. The excess of energy consumed is primarily deposited in the adipose tissue as triglycerides (TG) [9].

Dyslipidemia encompasses elevated serum TG levels, increased low density lipoprotein- cholesterol (LDL-c) particles, and reduced levels of high density lipoprotein-cholesterol (HDL-c) [10]. It is associated with hepatic steatosis [11], dysfunction of pancreatic ?-cells [12] and elevated risk of atherosclerosis [13], among others.

Another main modifiable MetS manifestation is hypertension, which is mainly defined as a resting systolic blood pressure (SBP) ? 140 mmHg or diastolic blood pressure (DBP) ? 90 mmHg or drug prescription to lower hypertension [14]. It usually involves narrowed arteries and is identified as a major cardiovascular and renal risk factor, related to heart and vascular disease, stroke and myocardial infarction [13,15�17].

Hyperglycemia, related insulin resistance and type 2 diabetes mellitus are characterized by an impaired uptake of glucose by the cells, that lead to elevated plasma glucose levels, glycosuria and ketoacidosis [18]. It is responsible for different tissue damage that shortens the life expectancy of diabetics, involving cardiovascular diseases (CVD), atherosclerosis, hypertension [19], ?-cell dysfunction [12], kidney disease [20] or blindness [21]. Currently, diabetes is considered the leading cause of death in developed countries [22].

Moreover, oxidative stress and low grade inflammation are two important mechanisms implicated in the etiology, pathogenesis, and development of MetS [23]. Oxidative stress is defined as an imbalance between the pro-oxidants and antioxidants in the body [24]. It plays a key role in the development of atherosclerosis by different mechanisms such as the oxidation of LDL-c particles [25] or impairment of HDL-c functions [26]. Inflammation is an immune system response to injury hypothesized to be a major mechanism in the pathogenesis and progression of obesity related disorders and the link between adiposity, insulin resistance, MetS and CVD [27].

Although the prevalence of the MetS varies broadly around the word and depends on the source used for its definition, it is clear that over the last 40�50 years the number of people presenting with this syndrome has risen in epidemic proportions [28]. Moreover, the frequency of this syndrome is increased in developed countries, sedentary people, smokers, low socioeconomic status population, as well as in individuals with unhealthy dietary habits [29,30].

For all of this, there is currently a wide concern to find effective strategies to detect, treat and control the comorbidities associated with MetS. This is a complex challenge as MetS is a clinical entity of substantial heterogeneity and therefore, the different cornerstones implicated in its development should be addressed. In this review we compiled and examined different dietary patterns and bioactive compounds that have pointed out to be effective in MetS treatment.

2. Dietary Patterns

dietary Several dietary strategies and their potential positive effects on the prevention and treatment of the different metabolic complications associated to the MetS, are described below and summarized in Table 2.

2.1. Energy-Restricted Diet Strategies

dietary

Energy restricted diets are probably the most commonly used and studied dietary strategies for combating excess weight and related comorbidities. They consist in personalized regimes that supply less calories than the total energy expended by a specific individual [31].

A hypocaloric diet results in a negative energy balance and subsequently, in body weight reduction [31]. Weight loss is achieved via fat mobilization from different body compartments as a consequence of the lipolysis process necessary to provide energy substrate [32,33]. In people who are overweight or suffering from obesity, as is the case of most people with MetS, weight loss is important as it is associated with improvement of related disorders such as abdominal obesity (visceral adipose tissue), type 2 diabetes, CVD or inflammation [32�36].

Moreover, as described above, low grade inflammation is associated with MetS and obesity. Therefore, of particular importance is the fact that in obese individuals following a hypocaloric diet, a depletion of plasma inflammatory markers such as interleukin (IL)-6 has been observed [34]. Thus, caloric restriction in obese people suffering MetS may improve the whole-body pro-inflammatory state.

At the same time, body weight reduction is associated with improvements in cellular insulin signal transduction, increments in peripheral insulin sensitivity and higher robustness in insulin secretory responses [32,36]. People with excess body weight who are at risk of developing type 2 diabetes, may benefit from a hypocaloric regime by improving plasma glucose levels and insulin resistance.

In addition, different intervention trials have reported a relationship between energy restricted diets and lower risk of developing CVD. In this sense, in studies with obese people following a hypocaloric diet, improvements in lipid profile variables such as reductions of LDL-c and plasma�TG levels, as well as improvements in hypertension via depletion of SBP and DBP levels have been observed [35,37].

Among the different nutritional intervention trials, a reduction of 500�600 kcal a day of the energy requirements is a well-established hypocaloric dietary strategy, which has demonstrated to be effective in weight reduction [38,39]. However, the challenge lies in maintaining the weight loss over time, as many subjects can follow a prescribed diet for a few months, but most people have difficulty in maintaining the acquired habits over the long term [40,41].

2.2. Diets Rich in Omega-3 Fatty Acids

dietary foods omega 3 infographic The very long-chain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are essential omega-3 polyunsaturated fatty acids (n-3 PUFAs) for human physiology. Their main dietary sources are fish and algal oils and fatty fish, but they can also be synthesized by humans from ?-linolenic acid [40].

There is a moderate body of evidence suggesting that n-3 PUFAs, mainly EPA and DHA, have a positive role in the prevention and treatment of the pathologies associated to MetS [42].

In this context, it has been described that EPA and DHA have the ability to reduce the risk of developing CVD and cardiometabolic abnormalities as well as CVD-related mortality [42]. These beneficial effects are thought to be mainly due to the ability of these essential fatty acids to reduce plasma TG levels [43].

Moreover, different studies have shown that people following an increased n-3 PUFA diet have reduced plasma levels of the pro-inflammatory cytokines IL-6 and tumor necrosis factor-alpha (TNF?), as well as plasma C-reactive protein (CRP) [44]. These effects are probably mediated by resolvins, maresins and protectins, which are EPA and DHA metabolic products with anti-inflammatory properties [44].

There are some studies that have observed an association between n-3 ingestion and improvements or prevention of type 2 diabetes development. However, other studies found opposite results [44]. Thus, it cannot be made any specific affirmation in this respect.

The European Food Safety Authority recommends and intake of 250 mg EPA + DHA a day, in the general healthy population as a primary prevention of CVD [45]. These amounts can be achieved with an ingestion of 1�2 fatty fish meals per week [45].

2.3. Diets Based on Low Glycemic Index/Load

dietary salad unconstructed Over the last ten years, the concern about the quality of the carbohydrates (CHO) consumed has risen [46]. In this context, the glycemic index (GI) is used as a CHO quality measure. It consists in a ranking on a scale from 0 to 100 that classifies carbohydrate-containing foods according to the postprandial glucose response [47]. The higher the index, the more promptly the postprandial serum glucose rises and the more rapid the insulin response. A quick insulin response leads to rapid hypoglycemia, which is suggested to be associated with an increment of the feeling of hunger and to a subsequent higher caloric intake [47]. The glycemic load (GL) is equal to the GI multiplied by the number of grams of CHO in a serving [48].

There is a theory which states that MetS is a consequence of an elevated intake of high GI foods over time, among others unhealthy dietary habits [49]. In this sense, following a diet rich in high GI CHO has been associated with hyperglycemia, insulin resistance, type 2 diabetes, hypertriglyceridemia, CVD, and obesity [47,50,51], abnormalities directly related to MetS.

On the contrary, a low GI diet has been associated with slower absorption of the CHO and subsequently smaller blood glucose fluctuations, which indicate better glycemic control [46]. In patients with type 2 diabetes, diets based on low GI are associated with reductions in glycated hemoglobin (HbA1c) and fructosamine blood levels, two biomarkers used as key monitoring factors in diabetes management [52,53].

For all of this, it is common to find the limitation of CHO at high GI among the advice for MetS treatment [28], in particular with respect to �ready-to-eat processed foods� including sweetened beverages, soft drinks, cookies, cakes, candy, juice drinks, and other foods which contain high amounts of added sugars [54].

2.4. Diets with High Total Antioxidant Capacity

dietary antioxidant foods Dietary total antioxidant capacity (TAC) is an indicator of diet quality defined as the sum of antioxidant activities of the pool of antioxidants present in a food [55]. These antioxidants have the capacity to act as scavengers of free radicals and other reactive species produced in the organisms [56]. Taking into account that oxidative stress is one of the remarkable unfortunate physiological states of MetS, dietary antioxidants are of main interest in the prevention and treatment of this multifactorial disorder [57]. Accordingly, it is well-accepted that diets with a high content of spices, herbs, fruits, vegetables, nuts and chocolate, are associated with a decreased risk of oxidative stress-related diseases development [58�60]. Moreover, several studies have analyzed the effects of dietary TAC in individuals suffering from MetS or related diseases [61,62]. In the Tehran Lipid and Glucose Study it was demonstrated that a high TAC has beneficial effects on metabolic disorders and especially prevents weight and abdominal fat gain [61]. In the same line, research conducted in our institutions also evidenced that beneficial effects on body weight, oxidative stress biomarkers and other MetS features were positively related with higher TAC consumption in patients suffering from MetS [63�65].

In this sense, the World Health Organization (WHO) recommendation for fruit and vegetables consumption (high TAC foods) for the general population is a minimum of 400 g a day [66]. Moreover, cooking with spices is recommended in order to increase the TAC dietary intake and, at the same time, maintain flavor while reducing salt [67].

2.5. Moderate-High Protein Diets

dietary Protein rich Foods The macronutrient distribution set in a weight loss dietary plan has commonly been 50%�55% total caloric value from CHO, 15% from proteins and 30% from lipids [57,68]. However, as most people have difficulty in maintaining weight loss achievements over time [69,70], research on increment of protein intake (>20%) at the expense of CHO was carried out [71�77].

Two mechanisms have been proposed to explain the potential beneficial effects of high-moderate protein diets: the increment of diet-induced thermogenesis [73] and the increase of satiety [78]. The increment of the thermogenesis is explained by the synthesis of peptide bonds, production of urea and gluconeogenesis, which are processes with a higher energy requirement than the metabolism of lipids or CHO [75]. An increment of different appetite-control hormones such as insulin, cholecystokinin or glucagon-like peptide 1, may clarify the satiety effect [79].

Other beneficial effects attributed to moderate-high protein diets in the literature are the improvement of glucose homeostasis [80], the possibility of lower blood lipids [81], the reduction of blood pressure [82], the preservation of lean body mass [83] or the lower of cardiometabolic disease risk [84,85]. However, there are other studies that have not found benefits associated to a moderate-high protein diet [76]. This fact may be explained by the different type of proteins and their amino acid composition [80], as well as by the different type of populations included in each study [85]. Therefore, more research in the field is needed in order to make these results consistent.

In any case, when a hypocaloric diet is implemented, it is necessary to slightly increase the amount of proteins. Otherwise it would be difficult to reach the protein energy requirements, established as 0.83 g/kg/day for isocaloric diets and which should probably be at least 1 g/kg/day for energy-restricted diets [86].

2.6. High Meal Frequency Pattern

dietary eating time

The pattern of increasing meal frequency in weight loss and weight control interventions has currently become popular among professionals [87,88]. The idea is to distribute the total daily energy�intake into more frequently and smaller meals. However, there is no strong evidence about the efficacy of this habit yet [89]. While some investigations have found an inverse association between the increment of meals per day and body weight, body mass index (BMI), fat mass percentage or metabolic diseases such as coronary heart disease or type 2 diabetes [71,88,90�92], others have found no association [93�95].

Different mechanisms by which high meal frequency can have a positive effect on weight and metabolism management have been proposed. An increment of energy expenditure was hypothesized; however, the studies carried out in this line have concluded that total energy expenditure does not differ among different meal frequencies [96,97]. Another postulated hypothesis is that the greater the number of meals a day, the higher the fat oxidation, but again no consensus has been achieved [89,98]. An additional suggested mechanism is that increasing meal frequency leads to plasma glucose levels with lower oscillations and reduced insulin secretion which is thought to contribute to a better appetite control. However, these associations have been found in population with overweight or high glucose levels but in normal-weight or normoglycaemic individuals the results are still inconsistent [93,99�101].

2.7. The Mediterranean Diet

dietary Mediterranean Diet The concept of the Mediterranean Diet (MedDiet) was for the first time defined by the scientific Ancel Keys who observed that those countries around the Mediterranean Sea, which had a characteristic diet, had less risk of suffering coronary heart diseases [102,103].

The traditional MedDiet is characterized by a high intake of extra-virgin olive oil and plant foods (fruits, vegetables, cereals, whole grains, legumes, tree nuts, seeds and olives), low intakes of sweets and red meat and moderate consumption of dairy products, fish and red wine [104].

There is a lot of literature supporting the general health benefits of the MedDiet. In this sense, it has been reported that a high adherence to this dietary pattern protects against mortality and morbidity from several causes [105]. Thus, different studies suggested the MedDiet as a successful tool for the prevention and treatment of MetS and related comorbidities [106�108]. Moreover, recent meta-analysis concluded that the MedDiet is associated with less risk of developing type 2 diabetes and with a better glycemic control in people with this metabolic disorder [107,109,110]. Other studies have found a positive correlation between the adherence to a MedDiet pattern and reduced risk of developing CVD [111�114]. In fact, many studies have found a positive association between following a MedDiet and improvements in lipid profile by reduction of total cholesterol, LDL-c and TG, and an increase in HDL-c [111�115]. Finally, different studies also suggest that the MedDiet pattern may be a good strategy for obesity treatment as it has been associated with significant reductions in body weight and waist circumference [108,116,117].

The high amount of fiber which, among other beneficial effects, helps to weight control providing satiety; and the high antioxidants and anti-inflammatory nutrients such as n-3 fatty acids, oleic acid or phenolic compounds, are thought to be the main contributors to the positive effects attributed to the MedDiet [118].

For all these reasons, efforts to maintain the MedDiet pattern in Mediterranean countries and to implement this dietary habits in westernized countries with unhealthy nutritional patterns should be made.

3. Dietary: Single Nutrients and Bioactive Compounds

dietary Nutrition single nutrient New studies focused on the molecular action of nutritional bioactive compounds with positive effects on MetS are currently an objective of scientific research worldwide with the aim of designing more personalized strategies in the framework of molecular nutrition. Among them, flavonoids and antioxidant vitamins are some of the most studied compounds with different potential benefits such as antioxidant, vasodilatory, anti-atherogenic, antithrombotic, and anti-inflammatory effects [119]. Table 3 summarizes different nutritional bioactive compounds with potential positive effects on MetS, including the possible molecular mechanism of action involved.

dietary table 3

3.1. Ascorbate

dietary Ascorbate Vitamin C, ascorbic acid or ascorbate is an essential nutrient as human beings cannot synthesize it. It is a water-soluble antioxidant mainly found in fruits, especially citrus (lemon, orange), and vegetables (pepper, kale) [120]. Several beneficial effects have been associated to this vitamin such as antioxidant and anti-inflammatory properties and prevention or treatment of CVD and type 2 diabetes [121�123].

This dietary component produces its antioxidant effect primarily by quenching damaging free radicals and other reactive oxygen and nitrogen species and therefore preventing molecules such as LDL-c from oxidation [122]. It can also regenerate other oxidized antioxidants like tocopherol [124].

Moreover, it has been described that ascorbic acid may reduce inflammation as it is associated with depletion of CRP levels [125]. This is an important outcome to take in consideration in the treatment of MetS sufferers, as they usually present low grade inflammation [27].

Supplementation with vitamin C have also been associated with prevention of CVD by improving the endothelial function [126] and probably by lowering blood pressure [121]. These effects are thought to be exerted by the ability of vitamin C to enhance the endothelial nitric oxide synthase enzyme (eNOS) activity and to reduce HDL-c glycation [127].

Additionally, several studies have attributed to ascorbate supplementation an antidiabetic effect by improving whole body insulin sensitivity and glucose control in people with type 2 diabetes [123]. These antidiabetic properties are thought to be mediated by optimization of the insulin secretory function of the pancreatic islet cells by increasing muscle sodium-dependent vitamin C transporters (SVCTs) [128].

Despite all of this, it should be taken into account that most people reach ascorbic acid requirements (established at 95�110 mg/day in the general population) from diet and do not need supplementation [122,129]. Besides, it should be considered that an excess of vitamin C ingestion leads to the opposite effect and oxidative particles are formed [130,131].

3.2. Hydroxytyrosol

dietary Hydroxytyrosol Hydroxytyrosol (3,4-dihydroxyphenylethanol) is a phenolic compound mainly found in olives [132].

It is considered the strongest antioxidant of olive oil and one of the main antioxidants in nature [133]. It acts as a powerful scavenger of free radicals, as a radical chain breaker and as metal chelator [134]. It has the ability of inhibiting LDL-c oxidation by macrophages [132]. In this sense, it is the only phenol recognized by the European Food Safety Authority (EFSA) as a protector of blood lipids from oxidative damage [135].

Hydroxytyrosol has also been reported to have anti-inflammatory effects, probably by suppressing cyclooxygenase activity and inducing eNOS expression [136]. Thus, enhancement of olives/olive oil intakes or hydroxytyroxol supplementation in people suffering from MetS may be a good strategy in order to improve inflammatory status.

Another beneficial effect attributed to this phenolic compound is its cardiovascular protective effect. It presents anti-atherogenic properties by decreasing the expression of vascular cell adhesion protein 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1) [132,137], which are probably the result of an inactivation of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF?B), activator protein 1 (AP-1), GATA transcription factor and nicotinamide adenine dinucleotide phosphate (NAD(P)H) oxidase [138,139]. Hydroxytyrosol also provides antidyslipidemic effects by lowering plasma levels of LDL-c, total cholesterol and TG, and by rising HDL-c [138].

Despite the beneficial effects attributed to hydfroxytyrosol as an antioxidant, for its antiinflamatory properties and as cardiovascular protector, it should be taken into account that most studies focused on this compound have been performed with mixtures of olive phenols, thus a synergic effect cannot be excluded [140].

3.3. Quercetin

dietary Quercetin is a predominant flavanol naturally present in vegetables, fruits, green tea or red wine. It is commonly found as glycoside forms, where rutin is the most common and important structure found in nature [141].

Many beneficial effects that can contribute to MetS improvement have been attributed to quercetin. Among them, its antioxidant capacity should be highlighted, as it has been reported to inhibit lipid peroxidation and increase antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) or glutathione peroxidase (GPX) [142].

Moreover, an anti-inflammatory effect mediated via attenuation of tumor necrosis factor ? (TNF-?), NF?B and mitogen-activated protein kinases (MAPK), as well as depletion of IL-6, IL-1?, IL-8 or monocyte chemoattractant protein-1 (MCP-1) gene expression has also been attributed to this polyphenol [143].

As most people with MetS are overweight or obese, the role of quercetin in body weight reduction and obesity prevention has been of special interest. In this sense, it stands out the capacity of quercetin to inhibit adipogenesis through inducing the activation of AMP-activated protein kinase (AMPK) and decreasing the expression of CCAAT-enhancer-binding protein-? (C/EBP?), peroxisome�proliferator-activated receptor gamma (PPAR?), and sterol regulatory element-binding protein 1 (SREBP-1) [141,144].

According to the antidiabetic effects, it is proposed that quercetin may act as an agonist of peroxisome proliferator-activated receptor gamma (PPAR?), and thus improve insulin-stimulated glucose uptake in mature adipocytes [145]. Moreover, quercetin may ameliorate hyperglycemia by inhibiting glucose transporter 2 (GLUT2) and insulin dependent phosphatidylinositol-3-kinase (PI3K) and blocking tyrosine kinase (TK) [142].

Finally, different studies observed that quercetin has the ability to reduce blood pressure [146�148]. However, the mechanisms of action are not clear, since some authors have suggested that quercetin increases eNOS, contributing to inhibition of platelet aggregation and improvement of the endothelial function [146,147], but there are other studies that have not come across these results [148].

3.4. Resveratrol

dietary

Resveratrol (3,5,4?-trihidroxiestilben) is a phenolic compound mainly found in red grapes and derived products (red wine, grape juice) [149]. It has shown antioxidant and anti-inflammatory activities, and cardioprotective, anti-obesity and antidiabetic capacities [150�156].

The antioxidant effects of resveratrol have been reported to be carried out by scavenging of hydroxyl, superoxide, and metal-induced radicals as well as by antioxidant effects in cells producing reactive oxygen species (ROS) [150].

Moreover, it has been reported that the anti-inflammatory effects of resveratrol are mediated by inhibiting NF?B signaling [151]. Furthermore, this polyphenol reduces the expression of proinflammatory cytokines such as interleukin 6 (IL-6), interleukin 8 (IL-8), TNF-?, monocyte chemoattractant protein-1 (MCP-1) and eNOS [152]. In addition, resveratrol inhibits the cyclooxygenase (COX) expression and activity, a pathway involved in the synthesis of proinflammatory lipid mediators [152].

Concerning the effects of resveratrol against development of type 2 diabetes, it has been reported that treatment of diabetes patients with this polyphenol provides significant improvements in the status of multiple clinically relevant biomarkers such as fasting glucose levels, insulin concentrations or glycated hemoglobin and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) [153,154].

Additionally, cardioprotective effects have been attributed to resveratrol. In this sense, it is suggested that resveratrol improves the endothelial function by producing nitric oxide (NO) through increasing the activity and expression of eNOS. This effect is thought to be conducted through activation of nicotinamide adenine dinucleotide-dependent deacetylase sirtuin-1 (Sirt 1) and 5? AMP-activated protein kinase (AMPK) [155]. Besides, resveratrol exerts endothelial protection by stimulation of NF-E2-related factor 2 (Nrf2) [156] and decreasing the expression of adhesion proteins such as ICAM-1 and VCAM-1 [152].

Finally, it has been described that resveratrol may have a role in preventing obesity as it has been related with energy metabolism improvement, increasing lipolysis and reducing lipogenesis [157]. However, more studies are needed in order to corroborate these findings.

3.5. Tocopherol

dietary vitamin e Tocopherol Tocopherols, also known as vitamin E, are a family of eight fat-soluble phenolic compounds whose main dietary sources are vegetable oils, nuts and seeds [130,158].

For a long time, it has been suggested that vitamin E could prevent different metabolic diseases as a potent antioxidant, acting as scavenger of lipid peroxyl radicals by hydrogen donating [159]. In this sense, it was described that tocopherols inhibit peroxidation of membrane phospholipids and prevent generation of free radicals in cell membranes [160].

Moreover, it has been shown that supplementation with ?-tocopherol or ?-tocopherol, two of the different isoforms of vitamin E, could have an effect on inflammation status by reducing CRP levels [161]. Additionally, inhibition of COX and protein kinase C (PKC) and reduction of cytokines�such as IL-8 or plasminogen activator inhibitor-1 (PAI-1) are other mechanisms that may contribute to these anti-inflammatory effects [162,163].

However, the beneficial effects attributed to this vitamin previously have lately became controversial as different clinical trials have not come across such benefits, but ineffective or even harmful effects have been observed [164]. It has been recently suggested that this may be explained by the fact that vitamin E may lose most of the antioxidant capacity when ingested by human beings through different mechanisms [162].

3.6. Anthocyanins

dietary Anthocyanins

Anthocyanins are water-soluble polyphenolic compounds responsible for the red, blue and purple colors of berries, black currants, black grapes, peaches, cherries, plums, pomegranate, eggplant, black beans, red radishes, red onions, red cabbage, purple corn or purple sweet potatoes [165�167]. Actually, they are the most abundant polyphenols in fruits and vegetables [167]. Moreover, they can also be found in teas, honey, nuts, olive oil, cocoa, and cereals [168].

These compounds have high antioxidant capacity inhibiting or decreasing free radicals by donating or transferring electrons from hydrogen atoms [167].

Regarding clinical studies, it has been shown that these bioactive compounds may prevent type 2 diabetes development by improving insulin sensitivity [169]. The exact mechanisms by which anthocyanins exert their antidiabetic effect are not yet clear, but an enhancement of the glucose uptake by muscle and adipocyte cells in an insulin-independent manner has been suggested [169].

Moreover, it has been shown that anthocyanins may have the capacity to prevent CVD development by improving endothelial function via increasing brachial artery flow-mediated dilation and HDL-c, and decreasing serum VCAM-1 and LDL-c concentrations [170�173].

Finally, these polyphenolic compounds may exert anti-inflamatory effects via reducing proinflamatory molecules such as IL-8, IL-1? or CRP [172,174].

However, most studies have used anthocyanin-rich extracts instead of purified anthocyanins; thus, a synergic effect with other polyphenols cannot be discarded.

3.7. Catechins

dietary tea leaves Catechins Catechins are polyphenols that can be found in a variety of foods including fruits, vegetables, chocolate, wine, and tea [175]. The epigallocatechin 3-gallate present in tea leaves is the catechin class most studied [176].

Anti-obesity effects have been attributed to these polyphenols in different studies [176]. The mechanisms of action suggested to explain these beneficial effects on body weight are: increasing energy expenditure and fat oxidation, and reducing fat absorption [177]. It is thought that energy expenditure is enhanced by catechol-O-methyltransferase and phosphodiesterase inhibition, which stimulates the sympathetic nervous system causing an activation of the brown adipose tissue [178]. Fat oxidation is mediated by upregulation of acyl-CoA dehydrogenase and peroxisomal b-oxidation enzymes [178,179].

Moreover, catechin intake has also been associated with lower risk of CVD development by improving lipid biomarkers. Thus, it has been reported that consumption of this kind of polyphenols may increase HDL-c and decrease LDL-c and total cholesterol [180].

Finally, and antidiabetic effect has also been related to catechin comsumption, lowering fasting glucose levels [175] and improving insulin sensitivity [178].

4. Conclusions

As the prevalence of MetS reaches epidemic rates, the finding of an effective and easy-to-follow dietary strategy to combat this heterogenic disease is still a pending subject. This work recompiled different dietary nutrients and nutritional patterns with potential benefits in the prevention and�treatment of MetS and related comorbidities (Figure 1) with the aim of facilitating future clinical�studies in this area. The challenge now is to introduce precision bioactive compounds in personalized�nutritional patterns in order to gain the most benefits for prevention and treatment of this disease�through nutrition.

Conflicts of Interest: The authors declare no conflict of interest.

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Lifestyle Changes for Managing Thyroid Disease | Wellness Clinic

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Functional Medicine

A butterfly-shaped gland found at the front of the neck, the thyroid gland, may not look like much, but it can wreak havoc on your health, when it isn’t functioning properly. The thyroid gland produces thyroxin (T4) and triiodothyronine (T3), hormones which control the metabolism, respiration, temperature and other essential functions of the human body. Too much or too little of these hormones can lead to thyroid disease, such as hypothyroidism and hyperthyroidism.

What can you do to treat thyroid disorders?

To treat thyroid disorders, drugs and medications are often prescribed. The most commonly prescribed medication for treating hypothyroidism is levothyroxine, while treatment for hyperthyroidism includes anti-thyroid medicines, such as propylthiouracil or methimazole, radioactive iodine which may destroy the thyroid gland and stop the excess production of thyroid hormones, even surgery to remove the thyroid gland altogether.

A dissatisfaction with normal care, however, has resulted in an increasing interest in a more holistic approach to thyroid disease treatment, one which prefers natural, lifestyle changes, not drugs or medications. Jen Wittman, CHHC, AADP, creator of Thyroid Loving Care and a certified holistic health expert, chef and writer, is an advocate of this strategy. Wittman was diagnosed with Hashimoto’s thyroid disease, an autoimmune disorder which attacks the thyroid gland itself, but was able to undo the illness without the use of medicines.

“In my experience, changing diet, improving gut health, managing stress and maintaining overall health and wellness helps support the body so that medicine is unnecessary, or at minimum, may work more effectively,” Wittman said.

Adopting a Healthy Diet

Wittman recommends eliminating gluten, caffeine and soy, in addition to reducing sugar for all thyroid diseases, however, she says that diets are contingent on the individual.

She clarified that some folks gain from a Paleo or Autoimmune Paleo protocol, while others will need to avoid foods like nightshades such as paprika, cayenne, tomatoes, bell peppers, eggplant and potatoes or polyunsaturated fatty acids such as peppermint and vegetable oils. Others also find cutting out milk or alcohol from their diet helps.

“There is not any effective one-size fits all approach when it comes to reversing autoimmune and thyroid conditions”.

According to Charlie Seltzer, MD, owner of Lean4Life Weight Loss & Fitness Solutions, another change some healthcare professionals suggest for individuals suffering from thyroid disease is to avoid eating raw goitrogenic foods like cruciferous vegetables, such as broccoli and kale, that interfere with the function of the thyroid gland.

But comments on diet’s influence on thyroid function have a tendency to vary. Jabbour, for example, doesn’t believe that exercise and diet can cure thyroid disorder. But one thing they could all agree on though is that eating healthier can fight weight gain and reduce a few of the symptoms like fatigue and depression, especially in the first six months of hormonal therapy when a balance of hormones has not yet been attained.

To Supplement or Not?

Too much or too little of certain nutrients can greatly impact thyroid function. Stella Lucia Volpe, PhD, RD, LDN, FACSM, professor and chair of the department of nutrition sciences at Drexel University at the College of Nursing & Health Professions, clarified that some thyroid diseases could be, but not necessarily is, a consequence of iodine deficiency. Iron or Zinc deficiencies can be variables as well. For instance, the thyroid converts iodine into thyroxin (T4) and triiodothyronine (T3) so a deficiency of iodine in your diet can interfere with hormone production.

But iodine deficiency is uncommon in the USA, Jabbour cautioned. Therefore supplementation could be harmful if no authentic deficiency is present, leading to the specific opposite problem. Too much iodine in your diet can also be an issue if you’re at risk for thyroid disease. Mario Skugor, MD, advises his patients with Graves’ disease, another autoimmune thyroid disease, because their thyroid is secreting a surplus of both T4 and T3 to prevent foods.

Wittman considers that most people with thyroid disorder need supplements at least short-term, but that they often can be weaned off them. “There is just not one simple way to reverse these conditions in everybody,” Wittman said. “Rather there are several unique supplements, lifestyle changes, healing modalities and dietary alterations which can be used to reverse the conditions and eliminate symptoms.” Seltzer cautioned against supplementing on your own. See your doctor and get appropriate testing first to make sure it’s necessary in the first location.

Exercise & Your Thyroid

Opinions on exercise also differ. Seltzer does not see it playing an important role in proper thyroid function while exercise in general is good for everybody. “The best exercise routine is the one that a individual is most likely to stay with,” Seltzer said. “I enjoy resistance training supplemented with cardiovascular exercise, with a focus on interval training, but if someone hates lifting weights, then anything is better than nothing.”

Wittman advises her clients to choose exercises which don’t tax the adrenal gland like gentle yoga, walking or Tai Chi. Jabbour and Skugor say patients with hyperthyroidism must watch the intensity and duration of the workouts because exercise may exacerbate an already rapid heart rate along with other symptoms.

What is the Best Strategy?

The absence of consensus on holistic approaches will likely cause your head to spin, right? Can you choose alternative remedies or would you rather stick with normal care for treating thyroid disease? The American Thyroid Association recommends that you work with your healthcare professional about the best strategies to include alternative or complementary medicine and always keep the lines of communication open if your doctor doesn’t approve of these practices. Your well-being is the priority, and a few inappropriate options, could interfere with your treatment.

By Dr. Alex Jimenez

Additional Topics: Wellness

TRENDING TOPIC: EXTRA EXTRA: About Chiropractic

How Lifestyle Changes Can Improve Thyroid Disease | Wellness Clinic

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Functional Medicine

Any doctor can tell you that to handle thyroid disease, you need a suitable dose of thyroid hormone to replace what your body isn’t currently making on its own, or that you may need other forms of medications to control the excess. However, it may also be worthwhile to consider that making lifestyle changes can be just as significant as these.

How can lifestyle changes help with thyroid disease?

‘If you’re not feeling well, there is much to be gained from focusing on a wholesome diet, regular exercise, stress control, and more to help you feel your best with thyroid disease”, states David Borenstein, MD, an integrative medicine physician in New York City. “It is extremely important to have a lifestyle which controls stress and provides appropriate nutrition and fitness,” he added.

You might start by analyzing your daily diet to see whether any changes or swaps could be made.�More exercise is just another lifestyle change that could make a large difference in the way you feel. As with a change in your diet, ask your doctor and start exercise routines.�Yoga classes, along with tai committed or chi meditation, can decrease tension or anxiety, which can be important when you live with hypothyroidism.

If you’re not feeling well despite following your thyroid disease treatment regimen as recommended by a healthcare professional, try these lifestyle hints from experts and people living with thyroid disease.

Be Vigilant About Eating Vegetables

Vegetables are a necessary part of a healthy diet, but people with hypothyroidism, or any other thyroid disease at that, might want to avoid cruciferous vegetables, like turnips and cabbage, as they can block thyroid hormone generation.

However, Benjamin Snider, ND, a naturopathic doctor at Authentic Wellness Integrative Health Centre at Kitchener, Ontario, says that cruciferous vegetables offer you many health benefits, and you should just limit them in case you’ve got a serious iodine deficiency, as that is when they are most likely to influence thyroid function. Dr. Snider recommends steaming cruciferous vegetables, which may limit their harmful tendencies.

Eat a Clean, Balanced Diet Daily

Lorraine Williams, a volunteer for the British Thyroid Foundation and a blogger in Thyroid Hope, demands people to avoid eating any highly processed foods. “Learn to listen to your body and eat for good health,” she says. Janelle Flores, a hypothyroidism blogger in Adventures of a Thyroidless Girl, is also an advocate for “clean” eating (she’s also gluten-free). “I’ve discovered that eating healthy provides me the most energy and the best outcome,” she states.

Exercise Often but With Certain Limits

Flores emphasizes the value of daily exercise while also listening to your own body. “If I’m having a bad day, I give myself a rest,” she states. “However, I feel that I don’t have as many bad times when I focus on eating correctly.” With the appropriate dose of medication and routine exercise, my energy level is a lot higher, ” she says.

“Moderate exercise is quite good for you. Just don’t overdo it,” Borenstein illustrated. Overexertion can affect the body’s ability to convert inactive thyroid hormone (T4) to the active form (T3) by eliminating an iodine molecule,” he explains, and “when that procedure does not happen properly, it can cause thyroid disease symptoms.”

Be Careful With Supplements

“Use caution when considering nutritional supplements that claim to boost thyroid function. These nutritional supplements aren’t proven effective”, says Anne R. Cappola, MD, an associate professor at the Perelman School of Medicine at the University of Pennsylvania at Philadelphia. Some contain unregulated amounts of thyroid hormones, leading to unregulated levels of the thyroid hormones.

In addition, a few alternative medicine practitioners may recommend iodine nutritional supplements for thyroid disease, but the majority of people in the United States actually have adequate iodine levels (although pregnant women can be an exception). “Substantial amounts of iodine in nutritional supplements can cause a faster drop in thyroid function in people predisposed to thyroid insufficiency,” Dr. Cappola states. “These supplements should be avoided.”

Maintain a Healthy Body Weight

Carrying too many pounds may lead to insulin resistance, which affects hormone levels, according to Borenstein. Plus, people that are overweight need more thyroid gland hormones. Individuals with borderline thyroid function might observe improvements in thyroid function when they maintain a healthy weight or lose weight.

Another weight reduction benefit includes the reduced risk of thyroid cancer. According to the University of Maryland Medical Center, the most common form of hypothyroidism, Hashimoto’s thyroiditis, raises the danger of a sort of thyroid cancer called thyroid lymphoma. And a study published online at Medical Science Monitor in January 2015 found that the risk for thyroid cancer also increases among overweight and obese individuals.

Manage Stress With Yoga or Meditation

“Introducing stress management and mindfulness techniques ought to be a component of any hypothyroid application,” Snider says. “That’s because stress weakens the immune system and also can raise the resistance of thyroid gland cells”, he says. Flores exercises to be physically fit, but also to lower stress. “I especially find jogging or running curative,” she states. However, when she is not feeling good, she allows herself to relax and indulge in a day. Borenstein recommends yoga, tai chi, and meditation to help alleviate stress.

Practice Restorative Sleep Habits Every Night

“Good sleep is a no-brainer,” Borenstein says. To repair tissues you will need sleep to help your body heal. “Sleep is critical in optimizing thyroid function because it helps to modulate the stress hormone cortisol,” Snider says. Stress management and exercise can enhance sleep quality, as can a normal sleep schedule and avoiding late-day caffeine, according to the National Sleep Foundation. Additionally, it is important to achieve a wholesome sleep environment.

Learn to Listen to Signals From Your Body

Thyroid disease is different for everybody, and everyone responds differently to treatment. “I have discovered my own body well enough to understand when I am feeling like when I need a drug dose shift,” Flores says. “Overall, medication is helpful because I need it to work effectively, but for me personally, I don’t think medication alone is the answer.”

Lee Parks, MD, an endocrinologist and also the clinical director of the Vanderbilt Thyroid Center at Vanderbilt University Medical Center in Nashville, Tennessee, says suitably treated hypothyroidism and other thyroid diseases shouldn’t result in weight gain, fatigue, or other common thyroid dysfunction symptoms. But lifestyle changes are just for fundamental good health, not a replacement for treatment, Dr. Parks concludes.

By Dr. Alex Jimenez

Additional Topics: Wellness

TRENDING TOPIC: EXTRA EXTRA: About Chiropractic

Turmeric Root Side Effects

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Turmeric

Turmeric: Let us ease your mind a bit. As with any dietary supplement, there are right ways to take turmeric root that could best benefit your health. We review things to keep in mind to limit any potential side effects.�

Potential Benefits Of Turmeric Root�

The compound that gives turmeric root its signature bright yellow hue is also the compound that packs the potential health benefits punch: curcumin. Curcumin � and therefore turmeric root � is believed to provide some pretty attractive health benefits, including support of joint and muscle comfort, promotion of healthy aging of the brain, support of a healthy digestive tract, and maintenance of healthy cholesterol levels already in the normal range.

But that doesn�t mean that taking 10 turmeric root supplement capsules at once would give you 10 times the potential benefit. Quite the opposite. There are right � and wrong � ways to consume the supplement in an effort to reduce possible side effects.

Avoiding Turmeric Root Side Effects

According to�MentalHealthDaily.com, if you�re supplementing with turmeric root, especially at high doses, it is possible that you may encounter some unwanted side effects at one point or another. The two most common side effects associated are diarrhea and nausea. High on the list of possible side effects are also:

Thinning of the blood. Some research shows that curcumin may have anticoagulant effects which can slow blood clotting. If you�re already taking a blood thinner, speak to your doctor about your desire to add a turmeric root supplement, and discontinue use at least two weeks before any surgery.
Some estimates indicate that one in four turmeric root users will notice an increase in bloating and passing gas. To reduce the likelihood of experiencing this particular side effect, consider a dose less than 6 grams per day, and avoid taking your supplement on an empty stomach.
Low blood sugar. Especially in those with health concerns related to blood glucose, turmeric root supplements may yield this unwanted effect. Some experts believe that the curcumin may even act to amplify pre-existing blood sugar issues.

Less common side effects may also include facial flushing, fever, headaches, skin rash and even low testosterone.

But as with any supplement or medication, remember that the severity and number of side effects you experience is likely subject to a variety of causes and factors. Keep in mind that some individuals may not experience any side effects at all.

Recommendations And Dosages

As with all medications and supplements, we encourage you to consult with your healthcare professional before adding a turmeric root supplement to your regimen. He or she can personalize dosing recommendations for you based on your desired outcomes and other factors � like other medications and supplements you are taking. That said,�WebMD.com�offers a few general guidelines for using turmeric and avoiding possible side effects:

This root is likely safe when applied to the skin appropriately for up to eight months.
It should only be considered as a mouthwash for short-term use.
For high cholesterol levels: 1.4 grams of turmeric extract in two divided doses each day for three months has been used for those 15 years or older.

Let�s Get Technical

While there are still many studies to be done and results to be reported, BCM-95 � a highly-absorbent form of curcumin, which is the active ingredient in turmeric root � has been�clinically proven�to help temporarily relieve minor pain. When used at a dosage of 2 grams per day, volunteers participated in the study without any mild adverse reactions. To try BCM-95 out for yourself, we recommend�CuraMed�and other daily supplements from�Terry Naturally. And as always, we�re proud to provide you with free shipping anywhere in the U.S.

by�Theresa Groskopp, CN�in�Health Challenges,�Health Tips,�Nutrition Supplements

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Take the Recommended Treatment

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Try Cognitive Behavioral Therapy

Limit Alcohol and Caffeine

Engage in Physical Activity

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How does thyroid disease cause fatigue?

Fatigue and Hypothyroidism

Fatigue and Hyperthyroidism

Autoimmune Thyroid Disease and Fatigue

Dietary Changes

Unrefreshing Sleep

Iron

Chronic Fatigue Syndrome and Fibromyalgia

T3 and Natural Thyroid

Sleep Apnea

Get Better and More Sleep

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Personal Training 101

How You Get Energy & How You Use It

ATP Re-Synthesis

1. Phosphagen System

2. Glycolysis

3. Aerobic System

Energy System Characteristics

Energy System Workouts

References:

1. Metabolic Syndrome

2. Dietary Patterns

2.1. Energy-Restricted Diet Strategies

2.2. Diets Rich in Omega-3 Fatty Acids

2.3. Diets Based on Low Glycemic Index/Load

2.4. Diets with High Total Antioxidant Capacity

2.5. Moderate-High Protein Diets

2.6. High Meal Frequency Pattern

2.7. The Mediterranean Diet

3. Dietary: Single Nutrients and Bioactive Compounds

3.1. Ascorbate

3.2. Hydroxytyrosol

3.3. Quercetin

3.4. Resveratrol

3.5. Tocopherol

3.6. Anthocyanins

3.7. Catechins

4. Conclusions

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References:

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What can you do to treat thyroid disorders?

Adopting a Healthy Diet

To Supplement or Not?

Exercise & Your Thyroid

What is the Best Strategy?

Additional Topics: Wellness

How can lifestyle changes help with thyroid disease?

Be Vigilant About Eating Vegetables

Eat a Clean, Balanced Diet Daily

Exercise Often but With Certain Limits

Be Careful With Supplements

Maintain a Healthy Body Weight

Manage Stress With Yoga or Meditation

Practice Restorative Sleep Habits Every Night

Learn to Listen to Signals From Your Body

Additional Topics: Wellness

Potential Benefits Of Turmeric Root�

Avoiding Turmeric Root Side Effects

Recommendations And Dosages

Let�s Get Technical

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