Thyroid disease is a common problem that can cause symptoms because of over- or under-function of the thyroid gland. The thyroid gland is located in the front of the neck below the Adam’s apple. The thyroid gland is an essential organ for producing thyroid hormones, which maintain are body metabolism.
Contents
Do I have a thyroid disease?
This is the common question many individuals ask, seeking for an answer from a healthcare professional. Grave’s disease, a sort of thyroid autoimmunity disease, has been illustrated to be caused by the following factors. Please note not all of these factors are treatable. From those, the factors that are treatable and most important are:
Selenium deficiencies
Infections
Stress
Gluten
Vitamin Deficiencies
Vitamin D, omega-3, folate
Gut Microflora
Leaky gut
Infections
Many different viruses and bacteria have been associated with autoimmunity. Some of the very researched are:
Bacteria:
Yersinia enterocolitis
Helicobacter pylori
Viruses:
Epstein Barr
Cytomegalovirus
Herpes Simplex Virus
This has caused researchers to recognize those infections as one of the contributors to developing autoimmunity. A number of studies have even shown as disease activity increases, so does the severity of the autoimmune process.
A meta analysis examining the association of H. Pylori infections and thyroid autoimmunity concluded, “Overall, H. pylori infection was associated with autoimmune thyroid disease; the association was significant for Graves’ disease. These findings indicate that H. pylori infection potentially plays a part in the progression of ATDs.” ATD signifies autoimmune thyroid disease (Hashimoto’s thyroid disease and Graves’ disease being the most common forms).
Three case studies were published showing that all three women with Graves’ had concurrent Epstein Barr virus reactivation. Note severe Epstein Barr is also known as mononucleosis.
“Though the etiology of Graves’ disease is still not clear, it is generally implied that environmental factors such as infections contribute to the growth of Graves’ disease. We report here three cases of Graves’ disease which presented simultaneously with infectious mononucleosis due to primary EBV infection.”
Some researchers’re theorizing the reason why Epstein Barr virus might lead to autoimmunity is essentially because the virus really gets inside the thyroid gland thus stimulating your immune cells to attack the gland.
While there are great studies demonstrating the correlation between infections and autoimmunity; and there is a suggested causal connection, researchers are still lacking further information. Released studies demonstrating a decrease of activity are impressive although sparse.
A study was conducted in Italy that exemplified how effective treatment of infections can be in halting the autoimmune procedure. Ten patients that had Hashimoto’s thyroid disease and also had an H. Pylori infection were chosen. Five failed treatment procedures and five responded well to the treatment procedures.
Again, the patients all had thyroid disorder and a H. Pylori bacterial disease. All of the patients’ levels were elevated to begin with, however. Treating a disease helped to stop the autoimmune process that damages the thyroid gland.
How important are the anti-body amounts?
A large study, known as meta-analyses, revealed that high antibodies levels are predictive of Graves’ relapse; so whatever we can do to lower these antibodies will be a good idea.
While there may not yet be some substantial scale randomized control trials looking at this, there are various clinicians in the area, that report that screening for and treating such infections seems to contribute greatly to halting the autoimmune procedure. It is a very simple inference to draw that removing a pathogenic bacteria overgrowth like Helicobacter Pylori, can be beneficial. Remember Graves and Hashimoto’s’ are immune disorders, infections trigger activation of the immune system allows the immune system to relax.
The H. Pylori Infection was shown to cause stomach burning, inflammation and nausea. Luckily, H. Pylori and many of these other infections can be safely eradicated with a class of antibiotic herbs. So there is great reason to screen for and treat those infections especially when we know for certain they have a strong connection. Most every infection will cause fatigue and treating an infection will help with sufferers energy levels.
Leaky Gut
The topic of infections ties in with that of gut health. Why is this? Well, a number of these infections can dwell therefore that they act not only as an infection which stimulated the immune systems but also damages your gut. H. Pylori and Yersinia are just two examples of these.
Why is gut health connected to my thyroid gland? Some researchers have stated that it is not even possible to develop autoimmunity unless the gut is first damaged. But why exactly is that?
This is because the gut is the barrier between you and the outside world. Remember ‘stuff’ from the external world increases entry therefore we need to have plenty of border patrol bronchial cells. When you have ‘leaky gut’ that the intestine or boarder barrier is compromised and also much ‘stuff’ is permitted in. This stuff may be viruses, bacteria, fungus, food particles, chemicals, etc.. Therefore, if you’ve got an underlying predisposition to autoimmunity and you then create leaky gut, the point may be set for you to develop autoimmunity, or specifically Graves’.
Gut Microflora
Here is a very simplified overview of a very exciting and complex subject. Good bacteria and fungus live in your intestines, more so on your colon. They are essential to help crowd out the bad bacteria, fungus and other infections. They are needed to prevent gut issues. Additionally they help increase nutrient absorption and breakdown nutrients. As though this isn’t sufficient, the microflora has been shown to have a direct effect on particular types of autoimmunity.
At a 2012 review published in the International Journal of Immunopathology and Pharmacology the authors remarked, “Alterations in both the structure and function of intestinal microbiota could be one of the typical causative triggers of esophageal or autoinflammatory disorders.”
Dr. David Brady, ND, DC recorded a very well referenced lecture going into great detail about the gut microflora-autoimmune connection. Brady does a great job covering the way the medical literature shows a strong association between autoimmunity and gut flora. This is mentioned in practice.
Stress
Stress in known to provocate almost any health complication. The consequences of stress are far reaching, but stress can impact Graves’ via two mechanisms. Stress can weaken your immune system, which can cause an illness you already have to become much more debatable or may make you more susceptible to acquiring an infection. Second, we also understand that stress modulates what’s called the balance in the immune system. Among the theories of autoimmunity indicates that a change in this balance is a predisposing factor to growing.
Gluten
Gluten intolerance might be connected to pancreatic gland, and especially Graves’ disease by way of a gene or genes. There is known as the CLTA-4 gene, a gene known to be related to Graves’.
A study printed in 2012 revealed that 60 percent of those with AIT (autoimmune thyroid) disorder had this gene, while just 25 percent of healthy controls had this gene. How can this link to gluten intolerance? In 2013 that a meta-analysis was published showing a link between the CTLA-4 receptor as well as celiac disease, celiac disease being the maximum level of gluten intolerance one can have. These finding are confirmed in other reviews too.
Other studies, in Hashimoto’s patients, have shown that a gluten free diet can decrease the need for drugs and interrupts the gastrointestinal attack. Irrespective of the specific gene or genes involvement, observational data is fairly clear that people who have celiac disease have a higher prevalence of autoimmune thyroid disease (Graves’ and Hashimoto’s). Now it is important to mention that there’s an increasing subset of our population that doesn’t have full blown celiac disease but does have what is known as ‘gluten intolerance’. Current clinical studies support the idea that those with ‘gluten intolerance’ may also derive health benefit from a gluten free diet.
Vitamin Deficiencies
Vitamin D
It’s becoming increasingly more agreed upon that vitamin D helps fight autoimmunity to a lesser or greater degree. Lets look at a few information. A 2012 study published in the journal Endocrine revealed that individuals who relapse after Graves’ therapy have lower vitamin D levels, while those who do not snore have high levels of vitamin D.
Interestingly other studies are suggesting that autoimmunity may be because of defects in the vitamin D receptor consequently producing the vitamin D in your body less powerful. A 2013 study performed in Turkey showed that a specific flaw in the vitamin D receptor left patients at greater risk for Hashimoto’s thyroid autoimmunity. Along these very same lines, certain viral diseases might actually block the vitamin D receptor, which might be another mechanism whereby chronic infections lead to autoimmunity.
Omega 3’s
Omega 3 fatty acids have become a significant dietary and supplemental factors since they’ve become deficient in the diet in industrialized nations. Omega 3’s serve numerous functions, regarding the function they confer is their impact on inflammation.
Every cell of your body has a coating around it know as a cell membrane. The cell membrane is comprised of fatty acids. If the cell membrane is composed of a lot of omega 6 and not enough omega 3 fats, then the cell is prone in inflammation. Increasing consumption of omega 3s can help make you susceptible to autoimmunity and inflammation and also restore balance to your cell membranes. But how can inflammation tie in with autoimmunity? Remember among the hallmarks of autoimmunity is to overzealous immune reaction. Your entire body mounts an immune response by sending out white blood cells which shoot inflammation at ‘guys’ to destroy them. This is great when it is controlled, but out of control the procedure rages also in people with autoimmunity. Restoring levels of omega 3s is like taking bullets from your systems guns preventing your system. Please remember its all about balance and over consumption of omega 3s may cause difficulties like a intake.
There’s a wealth of data available on the health benefits of omega 3s. Merely to quote 1 study regarding omega 3s effect on autoimmunity, the available evidence reveal that increased daily consumption of dietary n-3 FA reduces the severity of autoimmune disorders.”
Folate/MTHFR
Some individuals have a gene mutation referred to as the MTHFR mutation. Basically this mutation reduces one’s ability to break down acid. Folic acid is a synthetic form of the vitamin. Because food processing hurts folate, the synthetic form (folic acid), is added back to our meals. Patients with this gene mutation cannot absorb folic acid plus they become deficient in this vitamin.
Data on this subject is sparse and I wonder if treating this particular gene mutation will have any significant impact on thyroid autoimmunity. Some studies show an association for this mutation and autoimmune thyroid; one study showed that 30 percent of autoimmune thyroid patients had the MTHFR gene mutation.
Yet other studies show no correlation for this particular gene mutation and thyroid autoimmunity. Curing this gene polymorphism is safe and inexpensive as the treatment is through vitamin and diet treatment. If your functional medicine practitioner is up to date on this subject, even though this might not be the first item it may be worthwhile to explore this with your health care provider to achieve overall health and wellness.
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.
Nutrition�Abstract: A number of factors contribute to success in sport, and diet is a key component. An athlete�s dietary requirements depend on several aspects, including the sport, the athlete�s goals, the environment, and practical issues. The importance of individualized dietary advice has been increasingly recognized, including day-to-day dietary advice and specific advice before, during, and after training and/or competition. Athletes use a range of dietary strategies to improve performance, with maximizing glycogen stores a key strategy for many. Carbohydrate intake during exercise maintains high levels of carbohydrate oxidation, prevents hypoglycemia, and has a positive effect on the central nervous system. Recent research has focused on athletes training with low carbohydrate availability to enhance metabolic adaptations, but whether this leads to an improvement in performance is unclear. The benefits of protein intake throughout the day following exercise are now well recognized. Athletes should aim to maintain adequate levels of hydration, and they should minimize fluid losses during exercise to no more than 2% of their body weight. Supplement use is widespread in athletes, with recent interest in the beneficial effects of nitrate, beta-alanine, and vitamin D on performance. However, an unregulated supplement industry and inadvertent contamination of supplements with banned substances increases the risk of a positive doping result. Although the availability of nutrition information for athletes varies, athletes will bene t from the advice of a registered dietician or nutritionist.
Introduction To The Importance & Influence Of Nutrition On Exercise
Nutrition is increasingly recognized as a key component of optimal sporting performance, with both the science and practice of sports nutrition developing rapidly.1 Recent studies have found that a planned scientific nutritional strategy (consisting of fluid, carbohydrate, sodium, and caffeine) compared with a self-chosen nutritional strategy helped non-elite runners complete a marathon run faster2 and trained cyclists complete a time trial faster.3 Whereas training has the greatest potential to increase performance, it has been estimated that consumption of a carbohydrate�electrolyte drink or relatively low doses of caffeine may improve a 40 km cycling time trial performance by 32�42 and 55�84 seconds, respectively.4
Evidence supports a range of dietary strategies in enhancing sports performance. It is likely that combining several strategies will be of greater bene t than one strategy in isolation.5 Dietary strategies to enhance performance include optimizing intakes of macronutrients, micronutrients, and fluids, including their composition and spacing throughout the day. The importance of individualized or personalized dietary advice�is becoming increasingly recognized,6 with dietary strategies varying according to the individual athlete�s sport, personal goals, and practicalities (eg, food preferences). �Athlete� includes individuals competing in a range of sport types, such as strength and power (eg, weight-lifting), team (eg, football), and endurance (eg, marathon running). The use of dietary supplements can enhance performance, provided these are used appropriately. This manuscript provides an overview of dietary strategies used by athletes, the efficacy of these strategies, availability of nutrition information to athletes, and risks associated with dietary supplement intake.
Review Of Diet Strategies Employed By Athletes
Maximizing Muscle Glycogen Stores Prior To Exercise
Carbohydrate loading aims to maximize an athlete�s muscle glycogen stores prior to endurance exercise lasting longer than 90 minutes. Benefits include delayed onset of fatigue (approximately 20%) and improvement in performance of 2%�3%.7 Initial protocols involved a depletion phase (3 days of intense training and low carbohydrate intake) followed by a loading phase (3 days of reduced training and high carbo- hydrate intake).8,9 Further research showed muscle glycogen concentrations could be enhanced to a similar level without the glycogen-depletion phase,10 and more recently, that 24 hours may be sufficient to maximize glycogen stores.11,12 Current recommendations suggest that for sustained or intermittent exercise longer than 90 minutes, athletes should consume 10�12 g of carbohydrate per kg of body mass (BM) per day in the 36�48 hours prior to exercise.13
There appears to be no advantage to increasing pre- exercise muscle glycogen content for moderate-intensity cycling or running of 60�90 minutes, as signi cant levels of glycogen remain in the muscle following exercise.7 For exercise shorter than 90 minutes, 7�12 g of carbohydrate/kg of BM should be consumed during the 24 hours preceding.13 Some14,15 but not all16 studies have shown enhanced performance of intermittent high-intensity exercise of 60�90 minutes with carbohydrate loading.
Carbohydrate eaten in the hours prior to exercise (com- pared with an overnight fast) has been shown to increase muscle glycogen stores and carbohydrate oxidation,17 extend cycle time to exhaustion,5 and improve exercise performance.5,18 Specific recommendations for exercise of longer than 60 minutes include 1�4 g of carbohydrate/kg of BM in the 1�4 hours prior.13 Most studies have not found improvements in performance from consuming low glycemic�index (GI) foods prior to exercise.19 Any metabolic or performance effects from low GI foods appear to be attenuated when carbohydrate is consumed during exercise.20,21
Carbohydrate Intake During The Event
Carbohydrate ingestion has been shown to improve performance in events lasting approximately 1 hour.6 A growing body of evidence also demonstrates beneficial effects of a carbohydrate mouth rinse on performance.22 It is thought that receptors in the oral cavity signal to the central nervous system to positively modify motor output.23
In longer events, carbohydrate improves performance primarily by preventing hypoglycemia and maintaining high levels of carbohydrate oxidation.6 The rate of exogenous carbohydrate oxidation is limited by the small intestine�s ability to absorb carbohydrate.6 Glucose is absorbed by the sodium- dependent transporter (SGLT1), which becomes saturated with an intake of approximately 1 g/minute. The simultaneous ingestion of fructose (absorbed via glucose transporter 5�[GLUT5]), enables oxidation rates of approximately 1.3 g/minute,24 with performance benefits apparent in the third hour of exercise.6 Recommendations reflect this, with 90 g of carbohydrate from multiple sources recommended for events longer than 2.5 hours, and 60 g of carbohydrate from either single or multiple sources recommended for exercise of 2�3 hours� duration (Table 1). For slower athletes exercising at a lower intensity,�carbohydrate requirements will be less due to lower carbohydrate oxidation.6 Daily training with high carbohydrate availability has been shown to increase exogenous carbohydrate oxidation rates.25
The �Train-Low, Compete-High� Approach
The �train-low, compete-high� concept is training with low carbohydrate availability to promote adaptations such as�enhanced activation of cell-signaling pathways, increased mitochondrial enzyme content and activity, enhanced lipid oxidation rates, and hence improved exercise capacity.26 However, there is no clear evidence that performance is improved with this approach.27 For example, when highly trained cyclists were separated into once-daily (train-high) or twice-daily (train-low) training sessions, increases in resting muscle glycogen content were seen in the low-carbohydrate- availability group, along with other selected training adaptations.28 However, performance in a 1-hour time trial after 3 weeks of training was no different between groups. Other research has produced similar results.29 Different strategies have been suggested (eg, training after an overnight fast, training twice per day, restricting carbohydrate during recovery),26 but further research is needed to establish optimal dietary periodization plans.27
Fat As A Fuel During Endurance Exercise
There has been a recent resurgence of interest in fat as a fuel, particularly for ultra endurance exercise. A high-carbohydrate strategy inhibits fat utilization during exercise,30 which may not be beneficial due to the abundance of energy stored in the body as fat. Creating an environment that optimizes fat oxidation potentially occurs when dietary carbohydrate is reduced to a level that promotes ketosis.31 However, this strategy may impair performance of high-intensity activity, by contributing to a reduction in pyruvate dehydrogenase activity and glycogenolysis. 32 The lack of performance benefits seen in studies investigating �high-fat� diets may be attributed to inadequate carbohydrate restriction and time for adaptation.31 Research into the performance effects of high fat diets continues.
Nutrition: Protein
While protein consumption prior to and during endurance and resistance exercise has been shown to enhance rates of muscle protein synthesis (MPS), a recent review found protein ingestion alongside carbohydrate during exercise does not improve time�trial performance when compared with the ingestion of adequate amounts of carbohydrate alone.33
Fluid And Electrolytes
The purpose of fluid consumption during exercise is primarily to maintain hydration and thermoregulation, thereby benefiting performance. Evidence is emerging on increased risk of oxidative stress with dehydration.34 Fluid consumption prior to exercise is recommended to ensure that the athlete is well-hydrated prior to commencing exercise.35 In addition,�carefully planned hyperhydration ( fluid overloading) prior to an event may reset fluid balance and increase fluid retention, and consequently improve heat tolerance.36 However, fluid overloading may increase the risk of hyponatremia 37 and impact negatively on performance due to feelings of fullness and the need to urinate.
Hydration requirements are closely linked to sweat loss, which is highly variable (0.5�2.0 L/hour) and dependent on type and duration of exercise, ambient temperature, and athletes� individual characteristics.35 Sodium losses linked to high temperature can be substantial, and in events of long duration or in hot temperatures, sodium must be replaced along with fluid to reduce risk of hyponatremia. 35
It has long been suggested that fluid losses greater than 2% of BM can impair performance,35 but there is controversy over the recommendation that athletes maintain BM by fluid ingestion throughout an event.37 Well-trained athletes who �drink to thirst� have been found to lose as much as 3.1% of BM with no impairment of performance in ultra-endurance events.38 Ambient temperature is important, and a review illustrated that exercise performance was preserved if loss was restricted to 1.8% and 3.2% of BM in hot and temperate conditions, respectively.39
Dietary Supplementation: Nitrates, Beta-Alanine & Vitamin D
Performance supplements shown to enhance performance include caffeine, beetroot juice, beta-alanine (BA), creatine, and bicarbonate.40 Comprehensive reviews on other supplements including caffeine, creatine, and bicarbonate can be found elsewhere.41 In recent years, research has focused on the role of nitrate, BA, and vitamin D and performance. Nitrate is most commonly provided as sodium nitrate or beetroot juice.42 Dietary nitrates are reduced (in mouth and stomach) to nitrites, and then to nitric oxide. During exercise, nitric oxide potentially influences skeletal muscle function through regulation of blood ow and glucose homeostasis, as well as mitochondrial respiration.43 During endurance exercise, nitrate supplementation has been shown to increase exercise efficiency (4%�5% reduction in VO at a steady attenuate oxidative stress.42 Similarly, a 4.2% improvement in performance was shown in a test designed to simulate a football game.44
BA is a precursor of carnosine, which is thought to have a number of performance-enhancing functions including the reduction of acidosis, regulation of calcium, and antioxidant properties.45 Supplementation with BA has been shown to�2�state; 0.9% improvement in time trials), reduce fatigue, and�augment intracellular carnosine concentration.45 A systematic review concluded that BA may increase power output and working capacity and decrease feelings of fatigue, but that there are still questions about safety. The authors suggest caution in the use of BA as an ergogenic aid.46
Vitamin D is essential for the maintenance of bone health and control of calcium homeostasis, but is also important for muscle strength,47,48 regulation of the immune system,49 and cardiovascular health.50 Thus inadequate vitamin D status has potential implications for the overall health of athletes and performance. A recent review found that the vitamin D status of most athletes reflects that of the population in their locality, with lower levels in winter, and athletes who train predominantly indoors are at greater risk of deficiency.51 There are no dietary vitamin D recommendations for athletes; however, for muscle function, bone health, and avoidance of respiratory infections, current evidence supports maintenance of serum 25-hydroxy vitamin D (circulating form) concentrations of 80�100 nmol/L.51
Diets Specific For Post Exercise
Recovery from a bout of exercise is integral to the athlete�s training regimen. Without adequate recovery of carbohydrate, protein, fluids, and electrolytes, beneficial adaptations and performance may be hampered.
Muscle Glycogen Synthesis
Consuming carbohydrates immediately post exercise to coincide with the initial rapid phase of glycogen synthesis has been used as a strategy to maximize rates of muscle glycogen synthesis. An early study found delaying feeding by 2 hours after glycogen-depleting cycling exercise reduced glycogen synthesis rates.52 However the importance of this early enhanced rate of glycogen synthesis has been questioned in the context of extended recovery periods with sufficient carbohydrate consumption. Enhancing the rate of glycogen synthesis with immediate carbohydrate consumption after exercise appears most relevant when the next exercise session is within 8 hours of the first.53,54 Feeding frequency is also irrelevant with extended recovery; by 24 hours post exercise, consumption of carbohydrate as four large meals or 16 small snacks had comparable effects on muscle glycogen storage.55
With less than 8 hours between exercise sessions, it is recommended that for maximal glycogen synthesis, 1.0�1.2 g/kg/hour is consumed for the first 4 hours, followed by resumption of daily carbohydrate requirements.13 Additional protein has been shown to enhance glycogen�synthesis rates when carbohydrate intake is suboptimal.56 The consumption of moderate to high GI foods post exercise is recommended;13 however, when either a high-GI or low-GI meal was consumed after glycogen-depleting exercise, no performance differences were seen in a 5 km cycling time trial 3 hours later.57
Muscle Protein Synthesis
An acute bout of intense endurance or resistance exercise can induce a transient increase in protein turnover, and, until feeding, protein balance remains negative. Protein consumption after exercise enhances MPS and net protein balance,58 predominantly by increasing mitochondrial protein fraction with endurance training, and myofibrillar protein fraction with resistance training.59
Only a few studies have investigated the effect of timing of protein intake post exercise. No significant difference in MPS was observed over 4 hours post exercise when a mixture of essential amino acids and sucrose was fed 1 hour versus 3 hours after resistance exercise.60 Conversely, when a protein and carbohydrate supplement was provided immediately versus 3 hours after cycling exercise, leg protein synthesis increased threefold over 3 hours.61 A meta-analysis found timed post exercise protein intake becomes less important with longer recovery periods and adequate protein intake,62 at least for resistance training.
Dose�response studies suggest approximately 20 g of high-quality protein is sufficient to maximize MPS at rest,63 following resistance,63,64 and after high-intensity aerobic exercise.65 Rate of MPS has been found to approximately triple 45�90 minutes after protein consumption at rest, and then return to baseline levels, even with continued availability of circulating essential amino acids (termed the �muscle full� effect).66 Since exercise-induced protein synthesis is elevated for 24�48 hours following resistance exercise67and 24�28 hours following high-intensity aerobic exercise,68 and feeding protein post exercise has an additive effect,58,64 then multiple feedings over the day post exercise might maximize muscle growth. In fact, feeding 20 g of whey protein every 3 hours was subsequently found to maximally stimulate muscle myofibrillar protein synthesis following resistance exercise.69,70
In resistance training, where post exercise intake of protein was balanced by protein intake later in the day, increased adaptation of muscle hypertrophy resulted in equivocal strength performance effects.71,72 Most studies have not found a subsequent bene t to aerobic performance with post exercise protein consumption.73,74 However, in two�well controlled studies in which post exercise protein intake was balanced by protein intake later in the day, improvements were seen in cycling time to exhaustion75 and in cycling sprint performance.76
Fluids And Electrolyte Balance
Fluid and electrolyte replacement after exercise can be achieved through resuming normal hydration practices. However, when euhydration is needed within 24 hours or substantial body weight has been lost (.5% of BM), a more structured response may be warranted to replace fluids and electrolytes.77
Availability Of Nutritional Information To Athletes At Varying Levels
The availability of nutrition information for athletes varies. Younger or recreational athletes are more likely to receive generalized nutritional information of poorer quality from individuals such as coaches.78 Elite athletes are more likely to have access to specialized sports-nutrition input from qualified professionals. A range of sports science and medicine support systems are in place in different countries to assist elite athletes,1 and nutrition is a key component of these services. Some countries have nutrition programs embedded within sports institutes (eg, Australia) or alternatively have National Olympic Committees that support nutrition programs (eg, United States of America).1 However, not all athletes at the elite level have access to sports-nutrition services. This may be due to financial constraints of the sport, geographical issues, and a lack of recognition of the value of a sports-nutrition service.78
Athletes eat several times per day, with snacks contributing to energy requirements.79 Dietary intake differs across sports, with endurance athletes more likely to achieve energy and carbohydrate requirements compared to athletes in weight-conscious sports.79 A review found daily intakes of carbohydrate were 7.6 g/kg and 5.7 g/kg of BM for male and female endurance athletes, respectively.80 Ten elite Kenyan runners met macronutrient recommendations but not guide- lines for fluid intake.81 A review of fluid strategies showed a wide variability of intake across sports, with several factors influencing intake, many outside the athlete�s control.82
Nutrition information may be delivered to athletes by a range of people (dietitians, nutritionists, medical practitioners, sports scientists, coaches, trainers) and from a variety of sources (nutrition education programs, sporting magazines, the media and Internet).83 Of concern is the provision of�nutrition advice from outside various professional�s scope of practice. For example, in Australia 88% of registered exercise professionals provided nutrition advice, despite many not having adequate nutrition training.84 A study of Canadian high-performance athletes from 34 sports found physicians ranked eighth and dietitians, 16th as choice of source of dietary supplement information.85
Risks Of Contravening The Doping Regulations
Supplement use is widespread in athletes.86,87 For example, 87.5% of elite athletes in Australia used dietary supplements88 and 87% of Canadian high-performance athletes took dietary supplements within the past 6 months85 (Table 2). It is difficult to compare studies due to differences in the criteria used to define dietary supplements, variations in assessing supplement intake, and disparities in the populations studied.85
Athletes take supplements for many reasons, including for proposed performance benefits, for prevention or treatment of a nutrient deficiency, for convenience, or due to fear of �missing out� by not taking a particular supplement.41
The potential benefits (eg, improved performance) of taking a dietary supplement must outweigh the risks.86,87 There are few permitted dietary supplements available that have an ergogenic effect.87,89 Dietary supplementation cannot compensate for poor food choices.87 Other concerns include lack of efficacy, safety issues (toxicity, medical concerns), negative nutrient interactions, unpleasant side effects, ethical issues, financial expense, and lack of quality control.41,86,87 Of major concern, is the consumption of prohibited substances by the World Anti-Doping Agency (WADA).
Inadequate regulation in the supplement industry (com- pounded by widespread Internet sales) makes it difficult for athletes to choose supplements wisely.41,86,87 In 2000�2001, a study of 634 different supplements from 13 countries found that 94 (14.8%) contained undeclared steroids, banned by WADA.90 Many contaminated supplements were routinely used by athletes (eg, vitamin and mineral supplements).86 Several studies have confirmed these findings. 41,86,89
A positive drug test in an athlete can occur with even a minute quantity of a banned substance.41,87 WADA maintains a �strict liability� policy, whereby every athlete is responsible for any substance found in their body regardless of how it got there.41,86,87,89 The World Anti-Doping Code (January 1, 2015) does recognize the issue of contaminated supplements.91 Whereas the code upholds the principle of strict liability, athletes may receive a lesser ban if they can��show �no significant fault� to demonstrate they did not intend to cheat. The updated code imposes longer bans on those who cheat intentionally, includes athlete support personnel (eg, coaches, medical staff), and has an increased focus on anti-doping education.91,99
In an effort to educate athletes about sports-supplement use, the Australian Institute of Sport�s sports-supplement program categorizes supplements according to evidence�of efficacy in performance and risk of doping outcome.40 Category A supplements have sound evidence for use and include sports foods, medical supplements, and performance supplements. Category D supplements should not be used by athletes, as they are banned or are at high risk for contamination. These include stimulants, pro-hormones and hormone boosters, growth hormone releasers, peptides, glycerol, and colostrum.40
Conclusion
Athletes are always looking for an edge to improve their performance, and there are a range of dietary strategies available. Nonetheless, dietary recommendations should be individualized for each athlete and their sport and provided by an appropriately qualified professional to ensure optimal performance. Dietary supplements should be used with caution and as part of an overall nutrition and performance plan.
Disclosure
The authors report no conflicts of interest in this work.
Kathryn L Beck1 Jasmine S Thomson2 Richard J Swift1 Pamela R von Hurst1
1School of Food and Nutrition, Massey institute of Food Science and Technology, College of Health, Massey University Albany, Auckland, 2School of Food and Nutrition, Massey institute of Food Science and Technology, College of Health, Massey University Manawatu, Palmerston North, New Zealand
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Thyroid disease affects the thyroid gland, a butterfly-shaped gland found in the front of the neck. The thyroid has important roles to regulate numerous metabolic processes throughout the body. Different types of thyroid disorders affect either its structure or function. Hyperthyroidism, is one of the most common thyroid diseases, which causes the overproduction of the thyroid hormones in the human body.
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What natural treatments can help hyperthyroidism?
While there are many treatment methods available to help ease the symptoms of and treat the condition, most individuals may prefer a natural treatment approach to treating their hyperthyroidism. Natural treatments for hyperthyroidism include the regulation of these hormones through the use of various compounds.
The best and most studied compounds proven to curb hyperthyroidism are:
L-carnitine
Selenium
Bugleweed and Lemon Balm
Iodine
L-Carnitine
A randomized, double-blind, placebo-controlled clinical trial (using a crossover arm) was conducted in a group of 50 girls. In this research scientists induced hyperthyroidism from the study participants. For various lengths of time which makes it excellent in assessing the effects of, this study utilized different doses of L-carnitine. This study demonstrated:
The authors of this study concluded, “L-carnitine is successful in both preventing and reversing symptoms of hyperthyroidism.” The authors also comment that L-carnitine can be utilized in pregnant women with Graves’ disease, a thyroid disease which attacks the thyroid gland itself. They also comment that L-carnitine may be used to prevent and cure the most acute kind of hyperthyroidism called thyroid storm. L-carnitine has no known toxicity, contraindications or interactions with other medications or side effect that is significant.
How long until L-carnitine will start working?
Its been observed that patients begin feeling a difference within days of starting L-carnitine, even though the most benefit may take weeks to months to realize based on some studies.
Selenium
The most research regarding selenium and thyroid has examined selenium’s effect on Hashimoto’s thyroid disease, an autoimmune disorder. That being said there have also been some promising findings regarding Alzheimer’s effect on Graves’ disease. While the data do not appear to be 100 percent conclusive, evidence suggests the following:
Selenium has the ability to lower the antibodies associated with Hashimoto’s
Selenium has the ability to lower the antibodies associated with Grave’s
Selenium can be used by pregnant women with thyroid disease to help avoid regression of thyroid health postpartum, and has no effect on the embryo and perhaps a small advantage
Selenium can diminish the eye complications associated with Grave’s
Selenium can lower the eye problems associated with Grave’s radioactive iodine treatment
Greater blood glucose levels correlate with a lower relapse rate of Grave’s
Patients with Grave’s tend to have lower selenium levels
Selenium seems to lower the symptoms related to Graves’
Patients given selenium along with radioactive iodine or anti-thyroid drugs (Methimizole) achieve regular thyroid position quicker than people not receiving selenium.
Bugleweed & Lemon Balm
Bugleweed and lemon balm, also known as Lycopus europaeus and Melissa officinalis respectively, are utilized for a long time in the management of moderate hyperthyroidism. Despite their history that is favorable, there aren’t many studies. This being said, however, Bugleweed and lemon balm appear to be safe and have a positive impact in hyperthyroidism that is handling. Here are a few highlights in what we know about these herbs:
Bugleweed and Lemon Balm may really work to obstruct TSH and cause a lowering of T4 and T3
Short term animal studies have demonstrated an ability to reduce TSH, T4 and T3
Decreased heart rate with no side effects in prospective human studies
Bugleweed was shown to reduce the higher heart rate and blood pressure associated with Grave’s. It was found to be as effective as the pharmaceutical beta block, Atenolol, in an animal study
Iodine
Iodine shouldn’t be used as a primary therapy, although it does seem to have utility as a brief term addition to help manage hyperthyroidism. One study showed that 150mg per day of potassium iodide resulted in reversal of hyperthyroidism. The effects, however, were short lived; just lasting for 21 times in certain but around 6 months in others. Due to this it appears Iodide is employed as a temporary add on to help dampen up a flare .
In short, many healthcare professionals who specialize in natural treatment, such as functional medicine practitioners, have utilized these four natural compounds as treatment alternatives for managing the hyperthyroidism associated with Graves’ disease, Hashimoto’s thyroid disease, as well as other thyroid issues. Its been found that these compounds are effective for most individuals and they have caused no side effects, with the exception to L-carnitine which can cause loose stools in large doses. When decreasing the dose, this issue resolves.
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.
Often times, when patients are diagnosed with a thyroid disease, they are scared are become pressured to make a quick decision regarding the treatment they should follow. These choices are often not well informed, leaving the patient regretting the surgical or radioactive procedure once they have had time to think and get a different view.
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What are the my treatment options for Graves’ disease?
In case you have Graves’ disease and are reading this, take a deep breath. Allow yourself the time to read this guide and receive another opinion. In this article, we will describe what Graves’ disease is, what causes it, the dangers related to Graves’ and conventional and functional medicine treatment options.
What is Graves’ Disease?
Graves� disease is a form of thyroid autoimmunity that causes hyperthyroidism. It is a process in which immune cells are made by the body and attack they thyroid, causing the overproduction of thyroid hormones, or hyperthyroidism. Hyperthyroid means too much thyroid hormone. What are the symptoms of hyperthyroidism or Graves’ disease?
Thick, reddish skin usually on the shins or tops of their feet (Graves’ dermopathy)
What are the Risks of Graves’ Disease?
In case the hyperthyroidism brought on by Graves’ disease isn’t managed, it can cause significant damage. It can cause problems with changes in the structure and function of the heart, such as changes in heart rhythm and even heart failure because the signs of Grave’s includes increased heart speed. If a pregnant woman has Graves’ disease, it may cause complications like poor growth, problems with the child’s thyroid, premature birth or preeclampsia.
Thyroid storm is a life threatening complication of Graves’ in which one becomes hyperthyroid. It can cause profuse perspiration, fever, delirium, confusion, fatigue, tremors, highly irregular heartbeat, very low blood pressure and coma. This is considered a medical emergency. Brittle bones are also connected with untreated Grave’s disease.
People who have celiac disease are at increased risk to develop another autoimmune disease. Some common autoimmune disorders are; eczema/psoriasis, rheumatoid arthritis, type I diabetes, celiac disease, Crohn’s disease and multiple sclerosis. Actually, autoimmune disease are now more common than cancer.
Conventional Treatment for Graves’ Disease
In conventional medicine, thyroid controlling drugs and beta blockers are normally the initial treatment. Drugs interfere with your thyroid’s ability to use iodine; so thyroid hormone levels will be lowered by blocking iodine, iodine is required to make thyroid hormones. An example is Tapazone (Methimazole). Additionally, thyroid hormone levels do not affect thyroid hormone levels, instead, they obstruct the effects of thyroid hormone on the heart. Examples include Propranolol (Inderal), Atenolol (Tenormin), Metoprolol, Nadolol (Corgard). What are the side effects of anti-thyroid drugs?
The Mayo clinic lists the “most common” side effects of Methimazole as:
Black, tarry stools
Chest pain
Chills
Cough
Fever
Painful or difficult urination
Shortness of breath
Sore throat
Sores, ulcers, or white spots on the lips or in the mouth
Swollen glands
Unusual bleeding or bruising
Unusual tiredness or weakness
What are the Side Effects of Beta Blockers?
The Mayo clinic lists the “most common” side effects of Beta Blockers as:
Infection
Cold hands
Headache
Upset stomach
Constipation
Diarrhea
Dizziness
Targeting the Thyroid Gland
For more than 50 percent of individuals, these therapies will not work, prompting either surgical removal of the thyroid gland or even destruction of the gland using iodine. Radioactive iodine gets consumed by the thyroid gland and causes harm and destruction of the gland. Unfortunately, since the thyroid gland is either eliminated or destroyed, patients usually become hypothyroid, this is truly the goal of either surgery or radioactive iodine. These patients will then require thyroid hormone replacement for the rest of their lives. What are the dangers of surgery or radioactive iodine?
One of the drawbacks to radioactive iodine treatment is the simple fact that eye complications associated with Grave’s disease can be worsened by it. There are also dangers associated with the surgery such as damage to your glands and your vocal cords. Unfortunately, most who undergo surgery or radioactive iodine will require thyroid hormone replacement medication. Fortunately there are a few alternative treatment options for Graves’ disease.
Functional Medicine Treatment for Graves’ Disease
There are two main goals of functional medicine management of Graves’ disease. Functional medicine practitioners have to curb the hyperthyroidism. The goal here would be to provide immediate relief where: no damage occurs; and you as a patient may unwind, think clearly and not feel like today, you need to make a treatment choice.
Secondly, functional medicine practitioners must research the cause of the Graves’ disease. After they diagnose and determine the proper way to treat your thyroid issue, the thyroid gland has been described to return to normal and no unnecessary ongoing treatment may be required.
What if I have had my thyroid gland removed or irradiated?
It is still a good idea to read this guide and pursue what resulted in the Graves’ disease to begin with. Irradiating or eliminating the thyroid gland doesn’t take care of some of the symptoms. Healing and investigating the cause will assist in preventing any other forms of autoimmune disease from developing in the future and may significantly increase your overall health and wellness. A functional medicine practitioner can help determine the next steps to take.
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.
About 20 million Americans are affected by thyroid diseases, where one in eight women will undergo thyroid dysfunction sometime during their lifetime. Among the most common thyroid disorders is hypothyroidism. Approximately 90 percent of low thyroid function or all hypothyroidism is an autoimmune condition. With Hashimoto’s thyroid disease, however, your body’s immune system is attacking and destroying your own thyroid gland.
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What triggers Hashimoto’s thyroid disease?
The exact cause(s) of Hashimoto’s thyroid disease and all other autoimmune diseases like lupus, rheumatoid arthritis, MS, type 1 diabetes and Sjogrens syndrome, among others are unknown, nevertheless what we do know is that a range of factors can contribute to the development of immune system dysfunction and finally autoimmune disorder.
These include a mix of several factors like stress (adrenal gland malfunction), viral, parasitic and bacterial infections, estrogen changes (birth control pills, hormone replacement therapy, pregnancy, peri-menopause), insulin resistance, polycystic ovary disease, ecological toxicity, vitamin D deficiency, leaky gut, chronic inflammation, and gluten intolerance and celiac disease in addition to a genetic predisposition or susceptibility.
How to Know if you Have Hashimoto’s Disease
Before we discuss this, we need to record some of the symptoms of the two hypothyroid and hyperthyroid so we are better able to comprehend thyroid issues. A number of the better known symptoms include tiredness, weight gain, cold hands and feet, thinning hair and hair loss, depression, absence of motivation and constipation. Symptoms of hyperthyroidism (Graves Disease) are heart palpitations, increased heartbeat, insomnia, anxiety, night sweats, nervousness and difficulty gaining weight.
Most people with Hashimoto’s thyroid disease will have a blend of hypo and hyper thyroid ailments. For instance, an individual might suffer from baldness, cold hands and feet and fatigue, but when their immune system attacks the thyroid gland, thyroid cells have been discharged and released into the blood flow together with thyroid hormones. Some of the hormones such as T3 might cause heart palpitations, night sweats and nervousness when they are released and are stimulatory of other symptoms.
If you’ve already been diagnosed with hypothyroidism and are on thyroid medication, and you continue to have hypothyroid symptoms or your medical doctor is always changing your thyroid medication dose as your thyroid “just can not be modulated” or your thyroid drug dose is always being increased, then you should be analyzed for Hashimoto’s.
How Can I Be Tested For Hashimoto’s?
Most doctors do not go far enough when analyzing the thyroid for potential dysfunction. A thyroid gland including TPO antibodies and TGA antibodies should be carried out through laboratory blood testing. Even a TSH (thyroid stimulating hormone) blood test can never determine whether a patient has Hashimoto’s. Bear in mind, Hashimoto’s is an autoimmune disease. Thus, the most precious test measures autoimmune antibodies TPO (thyroid peroxidase antibodies) and TGA (thyroglobulin antibodies) which show the autoimmune attack on the thyroid gland itself.
Remedies for Hashimoto’s Thyroid Disease
Considering that Hashimoto’s thyroid disease is not a disease of the thyroid gland, but rather an autoimmune disorder, therapy must center on the immune system rather than the thyroid gland itself. This is why prescribing thyroid drugs does nothing to help your gastrointestinal condition. Your thyroid will continue to get attacked without controlling your immune system and you will continue to undergo thyroid symptoms in addition to a worsening autoimmune disorder.
Consequently, Hashimoto’s must be treated as an autoimmune disorder and not a thyroid disorder. This means your immune system function has to be monitored via blood tests. Essential lab panels quantify inflammatory cytokines for TH1/TH2 dominance and the ratio of T-Helper cells into T-Suppressor cells (CD4/CD8 ratio). Vitamin D levels are quantified. Testing for leaky gut is also critical in autoimmune disease. When the results are in, an application is implemented to regulate the immune response and stop the destruction of the thyroid gland along with restoring adrenal gland health as well as the resistant barrier of the intestine lining. Since gluten is believed to be a frequent cause behind Hashimoto’s thyroid disease, a gluten free diet is a must for patients with the condition.
Why Hashimoto’s is Commonly Misdiagnosed
Hashimoto’s often goes misdiagnosed and usually mismanaged by traditional medicine. Autoimmune attack are also not addressed by conventional medicine. With time, increasingly more of the thyroid gland is ruined since a patient’s autoimmune reaction is ignored and their illness progresses. Also, when a patient presents with one autoimmune disease such as Hashimoto’s, if the immune system remains untreated, this individual is more prone to creating additional autoimmune diseases such as pernicious anemia (inability to absorb vitamin B12) and Type 1 diabetes.
Last, but certainly not least, since the human brain is loaded with thyroid hormone receptors, as soon as a person hypothyroid, brain function and chemistry are compromised. Because brain neurotransmitters such as GABA, serotonin, dopamine and acetylcholine are jeopardized, patients suffering from hypothyroid conditions experience poor memory, diminished ability to learn, increased states of depression, anger, feelings of hopelessness, inability to handle stress and lack of enthusiasm for life, not to mention brain degeneration and Alzheimer’s! Hypothyroidism can increase your chances of Parkinson’s Disease deficiency.
Thus, if you are currently suffering from Hashimoto’s disease it is best to have a proper diagnosis and follow up with the proper treatment. Rather than losing their health into autoimmune disease when a patient is examined, diagnosed and treated in such a way to restore proper function, they could lead a healthier life. Functional medicine has become increasingly popular for treating thyroid issues. A functional medicine practitioner uses natural treatments to alter an individual’s lifestyle and promote a sense of overall health and wellness.
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.
Allostasis: The process of achieving stability, or homeostasis, through physiological or behavioral change. This can be carried out by means of alteration in HPATG axis hormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term. It is essential in order to maintain internal viability amid changing conditions.
Antecedents: Factors that predispose to acute or chronic illness. For a person who is ill, antecedents form the illness diathesis. From the perspective of prevention, they are risk factors. Examples of genetic antecedents include the breast cancer risk genes BRCA1 and BRCA2.
Apoptosis: Programmed cell death. As a normal part of growth and development, cells that are superfluous or that become damaged activate a cascade of intracellular processes leading to their own demise. In cancer cells, DNA damage may inactivate the apoptosis cascade, allowing mutated cells to survive and proliferate.
Biochemical individuality: Each individual has a unique physiological and biochemical composition, based upon the interactions of his or her individual genetic make-up with lifestyle and environment�i.e., the continuous exposure to inputs (diet, experiences, nutrients, beliefs, activity, toxins, medications, etc.) that influence our genes. It is this combination of factors that accounts for the endless variety of phenotypic responses seen every day by clinicians. The unique makeup of each individual requires personalized levels of nutrition and a lifestyle adapted to that individual�s needs in order to achieve optimal health. The consequences of not meeting the specific needs of the individual are expressed, over time, as degenerative disease.�
Bioidentical Hormone Therapy: Giving exogenous hormones that are identical in structure to the endogenous hormones.�
Biomarker: A substance used as an indicator of a biological state. Such characteristics are objectively measured and evaluated as indicators of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. Cancer biomarkers include prostate specific antigen (PSA) and carcinoembryonic antigen (CEA).
Biotransformation: The chemical modification(s) of a compound made by an organism. Compounds modified in the body include, but are not limited to, nutrients, amino acids, toxins, heavy metals, and drugs. Biotransformation also renders nonpolar compounds polar so that they are excreted, not reabsorbed in renal tubules.
Cancer: A group of diseases characterized by uncontrolled growth and spread of abnormal cells, which, if not controlled, can result in death. Cancer is caused by both external factors (tobacco, infectious organisms, chemicals, and radiation) and internal factors (inherited mutations, hormones, immune conditions, and mutations that occur from metabolism), two or more of which may act together or in sequence to initiate or promote carcinogenesis. Ten or more years often pass between exposure to external factors and detectable cancer.
Chronic Care Model: Developed by Wagner and colleagues, the primary focus of this model is to include the essential elements of a healthcare system that encourage high-quality chronic disease care. Such elements include the community, the health system, self-management support, delivery system design, decision support and clinical information systems. It is a response to powerful evidence that patients with chronic conditions often do not obtain the care they need, and that the healthcare system is not currently structured to facilitate such care.�
Complementary and Alternative Medicine (CAM): A group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional, mainstream medicine. The list of what is considered to be CAM changes frequently, as therapies demonstrated to be safe and effective are adopted by conventional practitioners, and as new approaches to health care emerge. Complementary medicine is used with conventional medicine, not as a substitute for it. Alternative medicine is used in place of conventional medicine. Functional medicine is neither complementary nor alternative medicine; it is an approach to medicine that focuses on identifying and ameliorating the underlying causes of disease; it can be used by all practitioners with a Western medical science background and is compatible with both conventional and CAM methods.�
Cytochromes P450 (CYP 450): A large and diverse group of enzymes, most of which function to catalyze the oxidation of organic substances. They are located either in the inner membrane of mitochondria or in the endoplasmic reticulum of cells ans play a critical role in the detoxification of endogenous and exogenous toxins. The substrates of CYP enzymes include metabolic intermediates such as lipids, steroidal hormones, and xenobiotic substances such as drugs.
DIGIN: A heuristic mnemonic for assessment of gastrointestinal dysfunction. Thorough assessment of the GI tract should include investigation of the following:
Digestion/Absorption � Problems with the digestive process including ingestion, chemical digestion, mechanical digestion, absorption, and/or assimilation
Intestinal Permeability � Permeability of the intestinal barrier: is the epithelium allowing in larger particles in a paracellular manner, making the gut barrier �leaky�?
Gut Microbiota/Dysbiosis � Changes in composition of the gut flora including balance and interaction of commensal species (See: Dysbiosis)
Inflammation/Immune � Inflammation and immune activity in the GI tract
Nervous System � Enteric nervous system function, which controls motility, blood flow, uptake of nutrients, secretion, and immunological and inflammatory processes in the gut.
Dysbiosis: A condition that occurs when the normal symbiosis between gut flora and the host is disturbed and organisms of low intrinsic virulence, which normally coexist peacefully with the host, may promote illness. It is distinct from gastrointestinal infection, in which a highly virulent organism gains access to the gastrointestinal tract and infects the host.�
Functional Medicine: A systems-based, science-driven approach to individualized medicine that addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It reflects a personalized lifestyle medicine approach and utilizes the Functional Medicine Matrix to organize the patient�s story and determine appropriate interventions for the prevention and treatment of chronic diseases.
Functional Medicine Matrix: The graphic representation of the functional medicine approach, displaying the seven organizing physiological systems, the patient�s known antecedents, triggers, and mediators, and the personalized lifestyle factors that promote health. Practitioners can use the matrix to help organize their thoughts and observations about the patient�s health and decide how to focus therapeutic and preventive strategies.
Cytokines: Immunoregulatory proteins (such as interleukin, tumor necrosis factor, and interferon). They may act locally or systemically and tend to have both immunomodulatory and other effects on cellular processes in the body. Cytokines have been used in the treatment of certain cancers.�
Genomics: The study of the whole genome of organisms, including interactions between loci and alleles within the genome. Research on single genes does not fall into the definition of genomics unless the aim of this functional information analysis is to elucidate the gene�s effect on the entire genome network. Genomics may also be defined as the study of all the genes of a cell, or tissue, at the DNA (genotype), mRNA (transcriptome), or protein (proteome) levels.�
GO-TO-IT: A heuristic mnemonic for the processes involved in the clinical practice of functional medicine:
Gather oneself and be mindful in preparing to see each patient; gather information through intake forms, questionnaires, the initial consultation, physical exam, and objective data. A detailed functional medicine history that is appropriate to age, gender, and nature of presenting problems is taken.
Organize the subjective and objective details from the patient�s story within the functional medicine paradigm. Position the patient�s presenting signs and symptoms, along with the details of the case history, on the timeline and Functional Medicine Matrix.
Tell the story back to the patient in your own words to ensure accuracy and understanding. The re-telling of the patient�s story is a dialogue about the case highlights�including the antecedents, triggers, and mediators identified in the history and correlating them to the timeline and matrix. The patient is asked to correct and amplify the story, engendering a context of true partnership.
Order and then prioritize the patient�s information:
Acknowledge patient�s goals
Address modifiable lifestyle factors
Sidney Baker�s too much/not enough model: what are the insufficiencies/excesses?
Identify clinical imbalances or disruptions in the organizing physiological systems of the matrix
Initiate further functional assessment and intervention based upon the above work:
Perform further assessment
Referral to adjunctive care:
Nutritional professionals
Lifestyle educators
Other healthcare providers
Specialists
Initiate therapy
Track assessments, note the effectiveness of the therapeutic approach, and identify clinical outcomes at each visit�in partnership with the patient.
Heuristic: A strategy used for problem solving, learning, and discovery that is experience-based, not algorithmic. When an exhaustive search is impractical, heuristic methods may be used to speed up the process of finding a satisfactory solution. A heuristic is sometimes referred to as a rule of thumb.
Homeostasis and Homeodynamics: The former term describes the tendency of living things to maintain physiological parameters within a narrow range usually considered normal in order to maintain optimal function. Under this definition, disease can be defined as a departure from the homeostatic state. The latter term describes the tendency of homeostatic set points to change throughout an organism�s lifespan, and thus describes how departures from a homeostatic norm can be adaptive (e.g., fever) or pathological, depending on the context.
Integrative Medicine: Medicine that combines treatments from conventional medicine and those from Complementary and Alternative Medicine (CAM) for which there is some high-quality evidence of safety and effectiveness. In a broader sense, it is healing-oriented medicine that takes into account the whole person (body, mind, and spirit), including all aspects of lifestyle, and makes use of all appropriate therapies, both conventional and alternative. The field is more than 10 years old and it is the only one of the emerging models to explicitly encompass the integration of therapeutics that, until recently, were the sole purview of complementary and alternative medicine. Note: functional medicine is different from integrative medicine because functional medicine emphasizes the evaluation of underlying causes of health and dysfunction and organizes assessment and treatment using the Functional Medicine Matrix, the timeline, and GOTOIT.
Lifestyle Medicine: The use of lifestyle interventions such as nutrition, physical activity, stress reduction, and rest to lower the risk for the approximately 70% of modern health problems that are lifestyle-related chronic diseases (such as obesity and type 2 diabetes), or for the treatment and management of disease if such conditions are already present. It is an essential component of the treatment of most chronic diseases and has been incorporated in many national disease management guidelines.
Long Latency Disease: Disease that becomes manifest at a time remote from the initial exposure to disease triggers, or that requires continued exposure to triggers and mediators over an extended period of time to manifest frank pathology. Examples include heart disease, cancer, and osteoporosis.�
Mediators: Intermediaries that contribute to the continued manifestations of disease. Mediators do not cause disease; instead, they underlie the host response to triggers. Examples include biochemical factors (e.g., cytokines and leukotrienes) as well as psychosocial ones (e.g., reinforcement for staying ill).�
Metabolomics (or metabonomics): �The study of metabolic responses to drugs, environmental changes and diseases. Metabonomics is an extension of genomics (concerned with DNA) and proteomics (concerned with proteins). Following on the heels of genomics and proteomics, metabonomics may lead to more efficient drug discovery and individualized patient treatment with drugs, among other things.� (From MedicineNet.com)�
Nutrigenomics (or nutritional genomics): The study of how different foods may interact with specific genes to increase the risk of common chronic diseases such as type 2 diabetes, obesity, heart disease, stroke, and certain cancers. It can also be described as the study of the influence of genetic variation on nutrition by correlating gene expression or single-nucleotide polymorphisms with a nutrient’s absorption, metabolism, elimination, or biological effects. Nutrigenomics also seeks to provide a molecular understanding of how common chemicals in the diet affect health by altering the expression of genes and the structure of an individual’s genome. The ultimate aim of nutrigenomics is to develop rational means to optimize nutrition for the patient�s genotype.�
Organ Reserve: The difference between the maximal function of a vital organ and the level of function required to maintain an individual�s daily life. In other words, it is the �reserve power� of a particular organ, above and beyond what is required in a healthy individual. It can also be thought of as the degrees of freedom available in the body organs to perform their functions and maintain health. Decline in the organ reserve occurs under stress, during sickness, and as we age.�
Organ System Diagnosis: In the allopathic medical model, it is common to give a collection of symptoms a name based on dysfunction in an organ system, then to cite the named disease as the cause of the symptoms the patient is experiencing. This bit of circular logic avoids any discussion of the systemic or underlying causes of dysfunction and also treats all people with �disease X� the same, despite the fact that two people with the same collection of symptoms may have completely different underlying physiological causes for the symptoms they display.�
Organizing Physiological Systems: To assist clinicians in understanding and applying the complexity of functional medicine, IFM has organized and adapted a set of seven interrelated biological systems that underlie all physiology. Imbalances in these systems or core clinical imbalances are the underlying cause of disease and dysfunction.
Defense and Repair (e.g., Immune, Inflammation, Infection/Microbiota)
Energy (e.g., Energy Regulation, Mitochondrial Function)
Biotransformation and Elimination (e.g., Toxicity, Detoxification)
Transport (e.g., Circulation, Lymphatic Flow)
Communication (e.g., Endocrine, Neurotransmitters, Immune messengers)
Structural Integrity (e.g., from Subcellular Membranes to Musculoskeletal Structure)�
Using this construct, it becomes much clearer that one disease/condition may have multiple causes (i.e., multiple clinical imbalances), just as one fundamental imbalance may be at the root of many seemingly disparate conditions.�
Oxidation-Reduction (also called Redox): Paired chemical reactions that occur in balance with each other within the body of a healthy individual. These reactions involve the transfer of electrons (or the distribution of electron sharing) and thus require both a donor and acceptor. When this physiological parameter is out of balance, a net accumulation of donors or acceptors can lead to deleterious cellular oxidation phenomena (lipid peroxidation, free radical formation).�
Oxidative Stress: Oxidative stress occurs when there is an imbalance between the production of damaging reactive oxygen species and an individual�s antioxidant capacity to detoxify the reactive intermediates or to repair the resulting damage. Disturbances in the normal redox state of tissues can cause toxic effects through the production of peroxides and free radicals that damage all components of the cell, including proteins, lipids, and DNA. Oxidative stress is implicated in the etiology of several chronic diseases including atherosclerosis, Parkinson’s disease, Alzheimer’s disease, and chronic fatigue syndrome.�
Personalized Lifestyle Factors: The modifiable lifestyle factors that appear along the bottom of the Functional Medicine Matrix. Clinicians and their patients can partner to develop an individualized plan for addressing these issues. Health-promoting lifestyle factors include:
Sleep and Relaxation � Getting adequate sleep and meaningful relaxation time in one�s life
Exercise and Movement � Participating in physical activity that is appropriate for age and health
Nutrition and Hydration � Eating a diet that is appropriate for age, genetic background, and environment, as well as maintaining adequate hydration
Stress and Resilience � Reducing stress levels and managing existing stress
Relationships and Networks � Developing and maintaining healthy relationships and social networks while reducing the impact of noxious relationships
Personalized (Individualized) Medicine: Personalized medicine can be described as the effort to define and strengthen the art of individualizing health care by integrating the interpretation of patient data (medical history, family history, signs, and symptoms) with emerging ��omic� technologies�nutritional genomics, pharmacogenomics, proteomics, and metabolomics. It is also defined as medicine that treats each patient as a unique individual and takes into account the totality of personal history, family history, environment and lifestyle, physical presentation, genetic background, and mind/body/spirit. Interventions are tailored to each patient and adjusted based on the patient�s individualized response.�
Precipitating Event: Similar to a trigger�a trigger, however, only provokes illness as long as the person is exposed to it (or for a short while afterward), while a precipitating event initiates a change in health status that persists long after the exposure ends
Prospective Medicine (aka: 4-P Medicine): A relatively new concept introduced in 2003, prospective medicine is a descriptive rather than a prescriptive term, encompassing �personalized, predictive, preventive, and participatory medicine.� Snyderman argues persuasively that a comprehensive system of care would address not only new technologies (e.g., identification of biomarkers, use of electronic and personalized health records), but also delivery systems, reimbursement mechanisms, and the needs of a variety of stakeholders (government, consumers, employers, insurers, and academic medicine). Prospective medicine does not claim to stake out new scientific or clinical territory; instead, it focuses on creating an innovative synthesis of technologies and models�particularly personalized medicine (the �-omics�) and systems biology�in order to �determine the risk for individuals to develop specific diseases, detect the disease�s earliest onset, and prevent or intervene early enough to provide maximum benefit.�
Proteomics: The large-scale study of proteins, particularly their structures and functions, how they’re modified, when and where they’re expressed, how they’re involved in metabolic pathways, and how they interact with one another. The proteome is the entire complement of proteins, including the modifications made to a particular set of proteins, produced by an organism or system. This will vary with time and distinct requirements, or stresses, that a cell or organism undergoes. As a result, proteomics is much more complicated than genomics: an organism’s genome is more or less constant, while the proteome differs from cell to cell and from time to time.�
PURE: A heuristic mnemonic for assessment and treatment of toxicity-related disorders. Steps to consider when assessing and treating patients with toxic exposures include:
Pattern Recognition � Recognize common patterns of toxicity signs and symptoms, including those associated with neurodevelopmental toxicity, immunotoxicity, mitochondrial toxicity, and endocrine toxicity
Undersupported/Overexposed � Examine the patient�s environment and lifestyle to determine what might be lacking and what there might be too much of
Reduce Toxin Exposure � Design a strategy for the patient to avoid continued toxin exposure
Ensure a Safe Detox � Support the patient during detoxification by ensuring adequate nutrients to aid in the detoxification and biotransformation process and by recommending lifestyle changes that increase the safety and efficacy of detox programs.�
PTSD: A heuristic for general treatment of hormone-related disorders. Factors to be considered include:
Production � Production/synthesis and secretion of the hormone
What are the building blocks of thyroid hormone and cortisol?
Transport � Transport/conversion/distribution/ interaction with other hormones
Do the levels of insulin impact the levels of E or T?
Does a hormone�s transport from its gland of origin to the target gland impact its effectiveness or toxicity?
Can we influence the level of free hormone?
Is the hormone transformed (T4 to T3 or RT3) and can we modulate that?
Sensitivity � Cellular sensitivity to the hormone signal
Are there nutritional or dietary factors that influence the cellular response to insulin, thyroid hormones, estrogens, etc.?
Detoxification � Detoxification/excretion of the hormone. For example:
How is estradiol metabolized in the process of biotransformation?
Can we alter it?
What can we do to affect the binding to and excretion of estrogens?
Single Nucleotide Polymorphism or SNP (pronounced �snip�) is a DNA sequence variation occurring when a single nucleotide�A, T, C, or G�in the genome differs between members of a species or between paired chromosomes in an individual. Almost all common SNPs have only two alleles. These genetic variations underlie differences in our susceptibility to, or protection from, several diseases. Variations in the DNA sequences of humans can affect how humans develop diseases. For example, a single base difference in the genes coding for apolipoprotein E is associated with a higher risk for Alzheimer’s disease. SNPs are also manifestations of genetic variations in the severity of illness, the way our body responds to treatments, and the individual response to pathogens, chemicals, drugs, vaccines, and other agents. They are thought to be key factors in applying the concept of personalized medicine.
Relative Risk: A measure of the strength of the relationship between risk factors and a condition. For example, one could compare the risk of developing cancer in persons with a certain exposure or trait to the risk in persons who do not have this characteristic. Male smokers are about 23 times more likely to develop lung cancer than nonsmokers, so their relative risk is 23. Most relative risks are not this large. For example, women who have a first-degree relative (mother, sister, or daughter) with a history of breast cancer have about twice the risk of developing breast cancer compared to women who do not have this family history.�
Systems Biology: Although there is not yet a universally recognized definition of systems biology, the National Institute of General Medical Services (NIGMS) at NIH provides the following explanation: �A field that seeks to study the relationships and interactions between various parts of a biological system (metabolic pathways, organelles, cells, and organisms) and to integrate this information to understand how biological systems function.�
The 5Rs: A heuristic mnemonic for the five-step process used to normalize gastrointestinal function that is a core element of functional medicine:
Remove � Removing the source of the imbalance (e.g., pathogens, allergic foods) is the critical first step.
Replace � Next replace any factors that are missing (e.g., HCL, digestive enzymes)
Reinoculate � Repopulate the gut with symbiotic bacteria (e.g., lactobacilli, bifidobacteria)
Repair � Heal damaged gut membranes using, for example, glutamine, fiber, and butyrate
Rebalance � Modify attitude, diet, and lifestyle of the patient to promote a healthier way of living
Three Legs of the Stool: A framework for practicing functional medicine that includes three parts:
Retelling the patient�s story with ATMs (antecedents, triggers, and mediators): The clinician collects information from the patient through extensive interaction, then reflects the problem back to the patient in terms of antecedents, triggers, and mediators
Organizing the clinical imbalances: The clinician organizes the clinical imbalances in the organizing physiological systems and lists them on the Functional Medicine Matrix.
Personalized lifestyle factors: The clinician assesses each patient�s environment and lifestyle, and partners with patients to help them develop, adopt, and maintain appropriate personalized health-promoting behaviors.�
Timeline: A tool that allows clinicians to visualize a patient�s story chronologically by organizing important life events and health issues from pre-conception to the present.
Triage Theory: Linus Pauling Award winner Bruce Ames� theory that DNA damage and late onset disease are consequences of a �triage allocation mechanism� developed during evolution to cope with periods of micronutrient shortage. When micronutrients (vitamins and minerals) are scarce, they are consumed for short-term survival at the expense of long-term survival. In 2009, Children�s Hospital and Research Center Oakland concluded that triage theory explains how diseases associated with aging like cancer, heart disease, and dementia (and the pace of aging itself) may be unintended consequences of mechanisms developed during evolution to protect against episodic vitamin/mineral shortages.
Triggers: Triggers are discrete entities or events that provoke disease or its symptoms (e.g., microbes). Triggers are usually insufficient in and of themselves for disease formation, however, because the health of the host and the vigor of its response to a trigger are essential elements.
Xenobiotics: Chemicals found in an organism that are not normally produced by or expected to be present in that organism. This may also include substances present in much higher concentrations than usual. The term xenobiotics is often applied to pollutants such as dioxins and polychlorinated biphenyls, because xenobiotics are understood as substances foreign to an entire biological system, i.e. artificial substances that did not exist in nature before their synthesis by humans. Exposure to several types of xenobiotics has been implicated in cancer risk.
Hypothyroidism, or low thyroid function, is among the most frequent chronic hormonal problem on the planet. With approximately 20 million instances in America alone and 200 million people affected globally, hypothyroidism is a silent epidemic. What’s worse is that about half of those struggling with this health issue are undiagnosed.
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How can people know they have a thyroid disease?
Living with weight gain, fatigue, hair loss, brain fog, depression, nervousness or gastrointestinal problems can cause pain and discomfort, often making the individual feel hopeless. If your thyroid is not functioning well, nothing within your body works properly. Many people will visit their healthcare specialists to have lab tests. In case your thyroid-stimulating hormone, or TSH, is out of this lab range, you are given Synthroid, or even levothyroxine. If the labs are “normal,” you’re typically shipped home, without any choices left for a traditional medicine approach.
“Normal” Lab Ranges for Thyroid Issues
Should you still have low thyroid symptoms and your TSH is “normal”, something is not being addressed. How can we get the “normal” lab range anyhow? The reference array is based on a statistical average of the lab’s populace. That is, other than vitamin D and cholesterol levels, laboratory reference ranges will change depending upon the lab.
The people who normally have work done on labs are mathematically not the weakest segment of the population. So if the laboratory results are “normal” despite them having symptoms, what your healthcare professional is essentially saying is that you’re the same as a lot of other ill people. In functional medicine, practitioners look at a more narrow range wherever your body functions optimally and you feel great.
Functional Medicine Guide To Recognizing Thyroid Labs
A functional medicine approach at your thyroid is more in depth than a T4 plus and TSH. Here are a few of the labs functional medicine practitioners perform on their patients and what they mean:
TSH
Thyroid-stimulating hormone is released from your pituitary gland to communicate with your thyroid gland. It’s sort of like your brain shouting in your thyroid, if your TSH is elevated. Research has linked a lab “normal” TSH of 2.5-3.5 mIU/mL with a 69 percent risk of dying from a heart attack or stroke. Now you can see why the optimal “functional” range is so important for your health, not just on the lookout for labs from the larger reference array.
Laboratory Range: .45-5.5 mIU/L
Optimal Range: 1.8-2.5 mIU/L
Total T4
T4 is mostly inactive from the human body and has to be converted to be usable. This lab gives you a total of bound and unbound forms of T4. Hormones have to be unbound to be utilized by your entire body. Due to this, this lab doesn’t provide the action of T4 to us when quantified alone. T4 is measured together with a T3 uptake.
Laboratory Range: 4.5-12 mg/DL
Maximum Range: 6.0-12.0 mg/DL
T3 Uptake
This lab does not look at T3, but is very helpful at indirectly looking at hormones like testosterone or estrogen and their relation with the binding of thyroid hormones.
Reference Range: 22-35%
Optimal Range: 28%-38%
Total T3
This laboratory shows us the amount of the active thyroid hormone. It permits a healthcare professional to verify your body’s ability also to rule out an overactive thyroid gland and to convert T4 to T3.
Lab Range: 80-200 ng/DL
Maximum Range: 100-180 ng/DL
Free T4
This will let you know the degrees of free or active form of T4. This will be reduced in cases of hypothyroidism but may be normal in early stages of thyroid disorder.
Laboratory Range: 0.8-1.8 ng/DL
Optimal Range: 1.0-1.5 ng/DL
Free T3
This is your thyroid hormone’s more energetic form. Low T3 syndromes are a common dysfunction seen in practice, and also a low level of the hormone is strongly linked to a greater risk of coronary attack. The issue with this if you’re taking a T4 medicine is that the hormone isn’t being converted by your body into T3, though there are other reasons why thyroid medications may not be working properly.
Laboratory Range: 2.3-4.2 pg/mL
Maximum Range: 3.0-4.0 pg/mL
Reverse T3
Stress and cortisol may increase levels of reverse T3, which is an form of the thyroid gland.
Reference Range: 8-25 ng/DL
Maximum Range: 9.2-24.1 ng/DL
Thyroid Antibodies
Elevated levels of thyroid antibodies reveals an attack against the thyroid gland. The majority of low thyroid cases are around the spectrum, the most typical Hashimoto’s disease.
Thyroid Peroxidase (TPO) Ab Optimal Range: 0-15 IU/mL
Thyroglobulin Ab Optimal Range: 0-0.9 IU/mL
Labs to address the health of your immune system, your microbiome, along with hormones should be considered. Every one of these labs are going to be a first step into finding out which thyroid pattern which you have, and keep in mind there are thyroid dysfunctions that don’t appear on labs.
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.
El Paso, TX. Chiropractor, Dr. Alex Jimenez welcomes all to the new clinic location grand opening!
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Grand Opening: Injury Medical Chiropractic Clinic
El Paso, TX, INJURY MEDICAL & CHIROPRACTIC CLINIC announces its newest east side location at 11860 Vista Del Sol, Suite 128 will officially open. The clinic is located in TheMission Business Center near Walgreens.
Injury Medical & Chiropractic Clinic offers an innovative, patient-friendly experience that allows patients access to affordable, quality chiropractic care. Appointments are not necessary, however in order to avoid waiting time appointments are recommended.
Based in El Paso, TX Injury Medical & Chiropractic Clinic is reinventing chiropractic by making quality care convenient and affordable for patients seeking pain relief and ongoing wellness. Extended hours and three convenient locations make care more accessible. Injury Medical & Chiropractic Clinic is an emerging company and key leader in the chiropractic profession. For more information, visit www.dralexjimenez.com, follow us on�Twitter @dralexjimenez�and find us on�Facebook, and�LinkedIn.
I thank you and have a special and respectful message� God loves motion.�God has created a fantastic design in all of us. His love of joints and articulations is obvious. Simply put, as an observer, our creator would have not given us so many joints with so many functions. So again, I repeat, God loves motion. Therefore, it is not just a choice to take care of them,�it is our obligation. I will help everybody I meet and treat to move better while�freeing themselves of any joint limitation preventing the full expression of life.
With a bit of work, we can achieve optimal health together. I look forward in doing my absolute best and helping those in need. It is what my mentors taught me, it is what I teach and it is what I will do passionately until�my last breath.
Functional medicine is a natural, medical practice which has been becoming more popular. What is functional medicine, how is it different from traditional, medical practices, and why is it important to know about when managing Hashimoto’s hypothyroidism and high TSH (thyroid stimulating hormone)? Functional medicine addresses thyroid disease by looking at the root causes instead of masking symptoms with surgery or medication, as with conventional treatments.
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What are the benefits of FM on hypothyroidism?
With functional medicine treatment approaches, healthcare practitioners can take a look at the root causes behind the patient’s Hashimoto’s hypothyroidism and TSH, improving your sleep, energy, vitality, and libido. This is the reason why seeing a functional medicine practitioner for Hashimoto’s hypothyroidism, as well as for TSH and other thyroid issues, can improve hormone balance, gut problems, and brain function. Everything within the body functions together.
Thyroid Disease: Addressing the Root Causes
In the event the motor light of your vehicle is based on, do you find a way to turn off the engine light, or do you research beneath the hood? That analogy works for functional medicine when managing Hashimoto’s hypothyroidism and TSH.
Functional medicine is not about providing you a medication for a symptom, but instead investigating why you have that symptom and functioning on this instead. By way of example, assume 10 different people have the same complaint, whether it is depression, fatigue, digestive problems, or persistent skin rashes. Each of these 10 individuals can have the same symptom, but also for 10 very different reasons. An overgrowth of gut bacteria might be causing depression in one individual, while it’s a gluten intolerance in a different. With Hashimoto’s hypothyroidism and high TSH, it is helpful to look at the underlying causes that led to the development of the autoimmune thyroid disorder and address people.
Understanding the Reason for Thyroid Disease
Until you realize why you are experiencing Hashimoto’s hypothyroidism and higher TSH, following drugs or therapies may keep landing you in dead ends. Functional medicine relies on published, peer-reviewed science to help us understand how the body functions and where breakdowns happen. Lab tests, questionnaires, in-office exams, and a discussion about your case history help the functional medicine practitioner learn where the root cause of your Hashimoto’s hypothyroidism and high TSH lies.
Five Common Functional Medicine Root Causes
Although different people can have the exact same symptom for different reasons, practical medicine often finds ordinary root causes. Some of them are:
Autoimmunity (when the immune system attacks and destroys body tissue). In most people, hypothyroidism is brought on by thyroid autoimmunity, which causes TSH.
Food intolerances, particularly to gluten and dairy
Low Blood Glucose
High blood sugar (insulin resistance, or pre-diabetes)
Intestinal yeast, bacterial overgrowths, and leaky gut
Addressing one or all of these variables, based on the individual, can help you better handle your Hashimoto’s, reduce your TSH, also relieve not only your thyroid symptoms, but a number of other symptoms as well.
There are No Specialties in the Human Body
The body is an extremely complex web where all systems and parts are related. The body does not have specialties in the way medicine does. The digestive tract — or any other system in your system, doesn’t operate independently of the rest of the human body.
For example, if autoimmune disease is destroying the thyroid gland causing high TSH, it is not just the thyroid you tackle, but also the immune system. Addressing a gluten intolerance if the stomach is behaving and chronic inflammation can prevent gallbladder surgery. For instance, with Hashimoto’s and high TSH, it’s not merely the thyroid you address, but also the immune system.
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.
Chronic Back Pain: Living with chronic pain can be exhausting and frustrating. But you can limit the severity of your pain�and the effect it has on you�with the following 3 strategies:
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1. Become An Expert At Chronic Back Pain Management
No one pain management technique works for everyone; it helps to be open to trying all sorts of methods and techniques to diminish and manage your pain.
Keeping your pain at the lowest level possible will help keep you active, which in turn will minimize your chronic pain and keep it from getting worse. It will also help decrease the stress that is often associated with chronic pain. Common pain management techniques include:
Cold / heat therapy
Over-the-counter or prescription pain medications
A healthy exercise regimenAside from those above, which can be done on your own, some people find alternative treatments quite helpful, such as chiropractic care, acupuncture, or massage therapy.With patience, find what combination of treatments works best for you.
2. Find A Support Network
Chronic back pain can be an isolating experience. You may not be able to be as active as you once were, saying �No� to social gatherings, and limiting participation in some of your favorite activities.
As you become more isolated, your experience of chronic pain may increase because of less stimuli to distract you. You also increase the risk for developing mental health issues, such as depression.
It is encouraged you find a network of social support to limit the isolation effects of chronic pain. The key to a support network is not only finding people who are empathetic and supportive, but also finding a health distraction from the pain.
3. Practice Imagery Control Techniques
When treating your chronic back pain, it is important to remember the role your mind can play in reducing your perception of chronic pain.
In particular, imagery control techniques can bring you meaningful relief in a matter of minutes. You can start by trying �the altered focus technique.� Here is how to do it:
Focus your attention on a part of your body other than your lower back.
Next, alter the sensation in that part of your body. For example, you can imagine your hands becoming cold or warm (whichever feels better).
Hold this sensation in your hands for several minutes, and your experience of pain will likely diminish.You can practice these techniques wherever, and however often, you want.If the above three strategies don�t help reduce your chronic pain, don�t despair. Instead, ask your doctor for a referral to a pain specialist to discuss other possible options for chronic back pain relief. There are a great many approaches to pain management.
Talk to Dr. Jimenez about specific questions related to your unique health situation.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
Nutrition is increasingly recognized as a key component of optimal sporting performance, with both the science and practice of sports nutrition developing rapidly.1 Recent studies have found that a planned scientific nutritional strategy (consisting of fluid, carbohydrate, sodium, and caffeine) compared with a self-chosen nutritional strategy helped non-elite runners complete a marathon run faster2 and trained cyclists complete a time trial faster.3 Whereas training has the greatest potential to increase performance, it has been estimated that consumption of a carbohydrate�electrolyte drink or relatively low doses of caffeine may improve a 40 km cycling time trial performance by 32�42 and 55�84 seconds, respectively.4
Carbohydrate ingestion has been shown to improve performance in events lasting approximately 1 hour.6 A growing body of evidence also demonstrates beneficial effects of a carbohydrate mouth rinse on performance.22 It is thought that receptors in the oral cavity signal to the central nervous system to positively modify motor output.23
The �train-low, compete-high� concept is training with low carbohydrate availability to promote adaptations such as�enhanced activation of cell-signaling pathways, increased mitochondrial enzyme content and activity, enhanced lipid oxidation rates, and hence improved exercise capacity.26 However, there is no clear evidence that performance is improved with this approach.27 For example, when highly trained cyclists were separated into once-daily (train-high) or twice-daily (train-low) training sessions, increases in resting muscle glycogen content were seen in the low-carbohydrate- availability group, along with other selected training adaptations.28 However, performance in a 1-hour time trial after 3 weeks of training was no different between groups. Other research has produced similar results.29 Different strategies have been suggested (eg, training after an overnight fast, training twice per day, restricting carbohydrate during recovery),26 but further research is needed to establish optimal dietary periodization plans.27
There has been a recent resurgence of interest in fat as a fuel, particularly for ultra endurance exercise. A high-carbohydrate strategy inhibits fat utilization during exercise,30 which may not be beneficial due to the abundance of energy stored in the body as fat. Creating an environment that optimizes fat oxidation potentially occurs when dietary carbohydrate is reduced to a level that promotes ketosis.31 However, this strategy may impair performance of high-intensity activity, by contributing to a reduction in pyruvate dehydrogenase activity and glycogenolysis. 32 The lack of performance benefits seen in studies investigating �high-fat� diets may be attributed to inadequate carbohydrate restriction and time for adaptation.31 Research into the performance effects of high fat diets continues.
While protein consumption prior to and during endurance and resistance exercise has been shown to enhance rates of muscle protein synthesis (MPS), a recent review found protein ingestion alongside carbohydrate during exercise does not improve time�trial performance when compared with the ingestion of adequate amounts of carbohydrate alone.33
The purpose of fluid consumption during exercise is primarily to maintain hydration and thermoregulation, thereby benefiting performance. Evidence is emerging on increased risk of oxidative stress with dehydration.34 Fluid consumption prior to exercise is recommended to ensure that the athlete is well-hydrated prior to commencing exercise.35 In addition,�carefully planned hyperhydration ( fluid overloading) prior to an event may reset fluid balance and increase fluid retention, and consequently improve heat tolerance.36 However, fluid overloading may increase the risk of hyponatremia 37 and impact negatively on performance due to feelings of fullness and the need to urinate.
Performance supplements shown to enhance performance include caffeine, beetroot juice, beta-alanine (BA), creatine, and bicarbonate.40 Comprehensive reviews on other supplements including caffeine, creatine, and bicarbonate can be found elsewhere.41 In recent years, research has focused on the role of nitrate, BA, and vitamin D and performance. Nitrate is most commonly provided as sodium nitrate or beetroot juice.42 Dietary nitrates are reduced (in mouth and stomach) to nitrites, and then to nitric oxide. During exercise, nitric oxide potentially influences skeletal muscle function through regulation of blood ow and glucose homeostasis, as well as mitochondrial respiration.43 During endurance exercise, nitrate supplementation has been shown to increase exercise efficiency (4%�5% reduction in VO at a steady attenuate oxidative stress.42 Similarly, a 4.2% improvement in performance was shown in a test designed to simulate a football game.44
Consuming carbohydrates immediately 
An acute bout of intense endurance or resistance exercise can induce a transient increase in protein turnover, and, until feeding, protein balance remains negative. Protein consumption after exercise enhances MPS and net protein balance,58 predominantly by increasing mitochondrial protein fraction with endurance training, and myofibrillar protein fraction with resistance training.59
Fluid and electrolyte replacement after exercise can be achieved through resuming normal hydration practices. However, when euhydration is needed within 24 hours or substantial body weight has been lost (.5% of BM), a more structured response may be warranted to replace fluids and electrolytes.77
The availability of nutrition information for athletes varies. Younger or recreational athletes are more likely to receive generalized nutritional information of poorer quality from individuals such as coaches.78 Elite athletes are more likely to have access to specialized sports-nutrition input from qualified professionals. A range of sports science and medicine support systems are in place in different countries to assist elite athletes,1 and nutrition is a key component of these services. Some countries have nutrition programs embedded within sports institutes (eg, Australia) or alternatively have National Olympic Committees that support nutrition programs (eg, United States of America).1 However, not all athletes at the elite level have access to sports-nutrition services. This may be due to financial constraints of the sport, geographical issues, and a lack of recognition of the value of a sports-nutrition service.78
Supplement use is widespread in athletes.86,87 For example, 87.5% of elite athletes in Australia used dietary supplements88 and 87% of Canadian high-performance athletes took dietary supplements within the past 6 months85 (Table 2). It is difficult to compare studies due to differences in the criteria used to define dietary supplements, variations in assessing supplement intake, and disparities in the populations studied.85
A positive drug test in an athlete can occur with even a minute quantity of a banned substance.41,87 WADA maintains a �strict liability� policy, whereby every athlete is responsible for any substance found in their body regardless of how it got there.41,86,87,89 The World Anti-Doping Code (January 1, 2015) does recognize the issue of contaminated supplements.91 Whereas the code upholds the principle of strict liability, athletes may receive a lesser ban if they can��show �no significant fault� to demonstrate they did not intend to cheat. The updated code imposes longer bans on those who cheat intentionally, includes athlete support personnel (eg, coaches, medical staff), and has an increased focus on anti-doping education.91,99
Allostasis: The process of achieving stability, or homeostasis, through physiological or behavioral change. This can be carried out by means of alteration in HPATG axis hormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term. It is essential in order to maintain internal viability amid changing conditions.
Chronic Care Model: Developed by Wagner and colleagues, the primary focus of this model is to include the essential elements of a healthcare system that encourage high-quality chronic disease care. Such elements include the community, the health system, self-management support, delivery system design, decision support and clinical information systems. It is a response to powerful evidence that patients with chronic conditions often do not obtain the care they need, and that the healthcare system is not currently structured to facilitate such care.�
Complementary and Alternative Medicine (CAM): A group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional, mainstream medicine. The list of what is considered to be CAM changes frequently, as therapies demonstrated to be safe and effective are adopted by conventional practitioners, and as new approaches to health care emerge. Complementary medicine is used with conventional medicine, not as a substitute for it. Alternative medicine is used in place of conventional medicine. 
Cytochromes P450 (CYP 450): A large and diverse group of enzymes, most of which function to catalyze the oxidation of organic substances. They are located either in the inner membrane of mitochondria or in the endoplasmic reticulum of cells ans play a critical role in the detoxification of endogenous and exogenous toxins. The substrates of CYP enzymes include metabolic intermediates such as lipids, steroidal hormones, and xenobiotic substances such as drugs.
Dysbiosis: A condition that occurs when the normal symbiosis between gut flora and the host is disturbed and organisms of low intrinsic virulence, which normally coexist peacefully with the host, may promote illness. It is distinct from gastrointestinal infection, in which a highly virulent organism gains access to the gastrointestinal tract and infects the host.�
Functional Medicine Matrix: The graphic representation of the functional medicine approach, displaying the seven organizing physiological systems, the patient�s known antecedents, triggers, and mediators, and the personalized lifestyle factors that promote health. Practitioners can use the matrix to help organize their thoughts and observations about the patient�s health and decide how to focus therapeutic and preventive strategies.
Lifestyle Medicine: The use of lifestyle interventions such as nutrition, physical activity, stress reduction, and rest to lower the risk for the approximately 70% of modern health problems that are lifestyle-related chronic diseases (such as obesity and type 2 diabetes), or for the treatment and management of disease if such conditions are already present. It is an essential component of the treatment of most chronic diseases and has been incorporated in many national disease management guidelines.
Single Nucleotide Polymorphism or SNP (pronounced �snip�) is a DNA sequence variation occurring when a single nucleotide�A, T, C, or G�in the genome differs between members of a species or between paired chromosomes in an individual. Almost all common SNPs have only two alleles. These genetic variations underlie differences in our susceptibility to, or protection from, several diseases. Variations in the DNA sequences of humans can affect how humans develop diseases. For example, a single base difference in the genes coding for apolipoprotein E is associated with a higher risk for Alzheimer’s disease. SNPs are also manifestations of genetic variations in the severity of illness, the way our body responds to treatments, and the individual response to pathogens, chemicals, drugs, vaccines, and other agents. They are thought to be key factors in applying the concept of personalized medicine.
Triage Theory: Linus Pauling Award winner Bruce Ames� theory that DNA damage and late onset disease are consequences of a �triage allocation mechanism� developed during evolution to cope with periods of micronutrient shortage. When micronutrients (vitamins and minerals) are scarce, they are consumed for short-term survival at the expense of long-term survival. In 2009, Children�s Hospital and Research Center Oakland concluded that triage theory explains how diseases associated with aging like cancer, heart disease, and dementia (and the pace of aging itself) may be unintended consequences of mechanisms developed during evolution to protect against episodic vitamin/mineral shortages.
Xenobiotics: Chemicals found in an organism that are not normally produced by or expected to be present in that organism. This may also include substances present in much higher concentrations than usual. The term xenobiotics is often applied to pollutants such as dioxins and polychlorinated biphenyls, because xenobiotics are understood as substances foreign to an entire biological system, i.e. artificial substances that did not exist in nature before their synthesis by humans. Exposure to several types of xenobiotics has been implicated in cancer risk.
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