Undoctored Health

Human hormones for human women

2009-05-13T21:35:00.005-05:00

Is there any reason for a human woman to use non-human hormones?

Premarin is the prototypical example, a mixture of around 30 different compounds, some of which resemble human estrogens (estradiol, estrone, estriol), many of which do not.

What conceivable reasons could there be to use a non-human form of a hormone over the human form? There are several theoretical reasons:

--The non-human form has been shown to be superior in some way

--The non-human form is cheaper to produce, reducing the cost

--Human women prefer the non-human form

Have any of these potential reasons ever played out in real life? NO, absolutely not.

There's one reason why non-human forms of hormones may be preferred over human forms that I've not listed: Non-human forms are more profitable and/or possess greater patent protection.

Well, that might explain it all.

The battle over progesterone

2009-05-13T21:07:00.002-05:00

I was talking with a hospital nurse recently who told me about her lack of energy, blue moods, and other assorted complaints. At age 49, she was exasperated. So I suggested that she ask her gynecologist about progesterone cream.

The gynecologist advised her, "You don't have a uterus. You don't need progesterone." He went on to explain that the only reason to take progesterone was to prevent uterine cancer caused by estrogen.

What about progesterone's weight loss benefits? It's effects on increased energy, improved mood, deeper sleep? These benefits, of course, have nothing to do with the uterus.

I've witnessed these benefits in women many times, both in the peri-menopausal period (which starts around your late 30's) and menopause.

I tracked down vocal progesterone advocate, Dr. Nisha Jackson. Dr. Jackson is a proponent of “bio-identical” hormone replacement, replacement of estrogen, progesterone, and other human hormones using natural human forms of replacement.

Dr. Jackson has several books available, including "The Hormone Survival Guide to Perimenopause."

I asked Dr. Jackson for her thoughts on several questions:

Q: What are the advantages of bio-identical hormone replacement as compared to synthetic hormones?

Dr. Jackson: If you have been prescribed drugs containing synthetic hormones, even if you use the medications as directed, chances are the results haven't been what you had hoped. Your hot flashes may be gone, your periods may return to regularity, but you’re also likely to experience a spectrum of negative side effects, including irregular bleeding, bloating, sore breasts—and weight gain.

Like millions of American women, you have been prescribed powerful hormone medications by healthcare practitioners who have no way of knowing your hormone levels! You are getting a one-size-fits-all treatment that does not address the list of maladies that can accompany hormonal imbalances.

This long list includes depression, weight gain, exhaustion, acne, insomnia, facial hair, food cravings, fuzzy thinking, bloating, joint pain, and loss of sex drive. Although some peri-menopausal women tolerate synthetic hormones, others experience mild to severe side effects that can be more annoying or debilitating than the symptoms they are meant to relieve.

Instead, if your provider ordered a complete hormone panel, it will often reveal that a woman's hormone levels are either low or out of balance. Knowing a woman's estrogen, progesterone, testosterone, DHEA (dehydroepiandrosterone), and thyroid levels would not only allow for a customized treatment plan to relieve symptoms, but also provide a baseline to observe changes as she moves through peri-menopause to menopause. Testing allows an accurate prescription for safe, quick relief of symptoms. Without testing it's a guessing game at the patient's expense.

Q: What is the basic blood panel you recommend at the start of a hormonal assessment?

Dr. Jackson: The basic blood levels that we recommend for women considering hormone replacement are: estrodiol, estriol, estrone (fractionated estrogen levels); progesterone; free testosterone; DHEA-S; TSH, free T4, and free T3 (thyroid hormones). These should be obtained in the last half of your menstrual cycle, or about 18–21 days after the first day of your period. For women without menses, these levels can be drawn any time.

Q: Why aren’t bio-identical hormones used more frequently? Shouldn’t they be the standard of practice for hormone replacement?

Dr. Jackson: The reasons why hormone testing and prescribing natural hormones are not standard of care has more to do with patent law and the pharmaceutical industry than anything else. There is also the fact that most medical schools have, until recently, ignored natural hormones as an option for treating women's hormonal imbalances. We therefore have a medical establishment out of tune with bio-identical hormone replacement.

But let's go back to the drug companies. Natural hormones cannot be patented and marketed as exclusive products. Even though safe, bio-identical natural progesterone and estrogen are readily available, pharmaceutical companies rarely use them. Instead they use lab-formulated synthetic progestins and estrogens to make their hormone-replacement therapies. These preparations are patentable and profits can therefore be protected. (Ironically, the recent discrediting of synthetic hormones is beginning to propel the drug companies in the direction of using bio-identical hormones).

Personally, having witnessed many women who have been transformed with using natural human progesterone, I have become totally convinced that it is a huge boon to health for women, far greater than estrogen.

CardioChek home cholesterol device

2009-05-13T20:51:00.002-05:00

Say you want to monitor your own cholesterol values. Say, for instance, you make a specific change in diet or lifestyle and would like to know if it has exerted any effect on cholesterol values like HDL, LDL, or triglycerides. Can you assess the effect without involving your doctor?

It has become increasingly easy with home cholesterol testing. The only hand-held at-home device that I'm aware of is the CardioChek.

The CardioChek is a hand-held device that measures total cholesterol, HDL cholesterol, and triglycerides that you can purchase for home use. It requires a finger prick to obtain a drop of blood for testing.

This is a really neat concept: a device that can be used by just about anybody that yields immediate results. Nothing needs to be mailed to a laboratory, no wait for results. It also yields more than just a total cholesterol. All other home test kits I could find tested only total cholesterol and the sample had to be mailed to the laboratory.

However, having used the device several times, some comments:

1) The company is not very good about telling you that each test--total cholesterol, HDL, and triglycerides--require a separate fingerstick and a separate test strip. It means that, for every panel of total cholesterol, HDL, and triglycerides, 3 fingersticks have to be performed and 3 test strips used.

2) The first couple of tests will be cumbersome. Even my nurses had a bit of difficulty following the instructions, though they were quite clear and concise. (They do provide a helpful online video.)

3) LDL will need to be calculated, just as your laboratory does. (LDL = total cholesterol - HDL - triglycerides/5).

How about costs? The device can be obtained for as little as $79 at Walmart and Amazon.com. The tests strips come in separate boxes, purchased separately. A set of 3 total cholesterol test strips costs between $12 and $15; similar prices for HDL and triglycerides. Thus, each run of total cholesterol, HDL, and triglycerides will cost you about $12-15 (3 test strips), provided there are no fumbles (which are somewhat common, particularly at first.)

Availability is a bit of a difficulty. The CardioChek website lists CVS, Walgreen's, and Walmart as retailers, along with several online distributors that I've never heard of. I bought a device at CVS for $99, test strips for $14.95 each for HDL and total cholesterol. However, after stopping at 5 different CVS locations, 3 Walgreen's, and one Walmart, none carried triglyceride test strips, which therefore have to be purchased online. Also, none of the Walgreen's or Walmart even carried the device itself, despite the website's claims.

Despite the hurdles, the CardioChek device is a useful and practical tool if you are interested in monitoring your own cholesterol values. With a bit of practice, you can get quite facile at performing this on your own with an accuracy close to that of your doctor's office or laboratory.

DHEA for osteoporosis

2009-05-12T13:13:00.013-05:00

One fairly clear-cut benefit of supplementation of the adrenal gland hormone, DHEA, is increased bone density.

Here's one study showing very persuasive effects of DHEA supplementation, 50 mg per day for 12 months, on bone density: Effects of Dehydroepiandrosterone Replacement Therapy on Bone Mineral Density in Older Adults: A Randomized, Controlled Trial

70 men and 70 women were given DHEA 50 mg per day vs. placebo with pre- and post- measures of bone density made.

From Jankowski CM et al. J Clin Endocrinol Metab 2006 Aug;91(8):2986-93.

As you can see, the women responded more vigorously than the men.

From Jankowski CM et al. J Clin Endocrinol Metab 2006 Aug;91(8):2986-93.

To achieve these results, women increased DHEA blood levels to 225-300 mcg/dl, while men increased DHEA blood levels to 300-400 mcg/dl.

This study corroborates findings made by a Washington University group and that of a University of California group that also showed increased bone with DHEA supplementation.

Perfect cholesterol values without statins

2009-05-12T05:26:00.003-05:00

Who is better off?

John takes Crestor, 40 mg per day:

LDL cholesterol 60 mg/dl
HDL cholesterol 60 mg/dl
Triglycerides 60 mg/dl
Total cholesterol 132 mg/dl

Or Sam:

LDL cholesterol 60 mg/dl
HDL cholesterol 60 mg/dl
Triglycerides 60 mg/dl
Total cholesterol 132 mg/dl

who obtained these values through vitamin D normalization (to increase HDL); wheat elimination (to reduce triglycerides and LDL); and omega-3 fatty acids (to reduce triglycerides).

Believe the drug industry motto--If some statin is good, more statin is better--then John is clearly better off: He has obtained all the "benefits" of statin drugs. They refer to the "pleiotropic" effects of statin drugs, the presumed benefits that extend outside of cholesterol reduction. The most recent example are the JUPITER data that demonstrated 55% reduction in cardiovascular events in people with increased c-reactive protein (CRP). Media reports now unashamedly gush at the benefits of Crestor to reduce inflammation.

However, on Sam's program, elimination of wheat and vitamin D both exert anti-inflammatory effects on CRP, typically yielding drops of 70-90%--consistently, rapidly, and durably.

So which approach is really better?

In my experience, there is no comparison: Sam is far better off. While John will reduce his cardiovascular risk with a statin drug, he fails to obtain all the other benefits of Sam's broader, more natural program. John will not enjoy the same cancer protection, osteoporosis and arthritis protection, relief from depression and winter "blues," and increased mental and physical performance that Sam will.

If our goal is dramatic correction of cholesterol patterns and reduction of cardiovascular risk, for many, many people statin drugs are simply not necessary. In fact, they may be inferior to what is achievable without them applying effective nutritional strategies.

Go wheat-free to reduce LDL cholesterol

2009-05-11T22:15:00.004-05:00

TV ads, media conversations, magazine articles, even advice from the American Heart Association and USDA (a la Food Pyramid) all agree: eat more whole grains, get more fiber.

What happens when you follow this advice?

Look around you: People gain weight, they become pre-diabetic and diabetic. Abnormal lipids and lipoprotein patterns emerge: increased triglycerides and VLDL, reduced HDL, increased (small) LDL. Blood sugar goes up, inflammatory responses are ignited. You feel crumby, cancer risk is increased.

"Official" agencies have urged us to eat more grains, get more fiber and most Americans have complied. We now have a nationwide health disaster that will eventually lead to more people with coronary plaque, more heart disease, more heart attack, more heart procedures.

This is why I've been urging patients to go wheat-free. It has proven an extraordinarily and surprisingly effective strategy for:

1) rapid and profound weight loss
2) raising HDL and reducing triglycerides, VLDL, and LDL (small)
3) reducing blood sugars, pre-diabetes and diabetes

Yes, as crazy as it may sound, elimination of wheat products reduces LDL cholesterol--dramatically. And it reduces the small type of LDL specifically, the type that is most likely to cause heart disease.

Here's a sampling of the comments I've received on another blog of mine, the Heart Scan Blog, regarding elimination of wheat to reduce LDL cholesterol and obtain other health effects:

Barbara W said:

It's true! We've done it. My husband and I stopped eating all grains and sugar in February. At this point, we really don't miss them any more. It was a huge change, but it's worth the effort. I've lost over 20 pounds (10 to go)and my husband has lost 45 pounds (20 to go). On top of it, our body shapes have changed drastically. It is really amazing. I've got my waist back (and a whole wardrobe of clothes) - I'm thrilled.

I'm also very happy to be eating foods that I always loved like eggs, avocados, and meats - without feeling guilty that they're not good for me.

With the extremely hot weather this week in our area, we thought we'd "treat" ourselves to small ice cream cones. To our surprise, it wasn't that much of a treat. Didn't even taste as good as we'd anticipated. I know I would have been much more satisfied with a snack of smoked salmon with fresh dill, capers, chopped onion and drizzled with lemon juice.

Aside from weight changes, we both feel so much better in general - feel much more alert and move around with much greater flexibility, sleep well, never have any indigestion. We're really enjoying this. It's like feeling younger.

It's not a diet for us. This will be the way we eat from now on. Actually, we think our food has become more interesting and varied since giving up all the "white stuff". I guess we felt compelled to get a little more creative.

Eating out (or at other peoples' places) has probably been the hardest part of this adjustment. But now we're getting pretty comfortable saying what we won't eat. I'm starting to enjoy the reactions it produces.

Weight loss, increased energy, less abdominal bloating, better sleep--I've seen it many times, as well.

Dotslady said:

I was a victim of the '80s lowfat diet craze - doc told me I was obese, gave me the Standard American Diet and said to watch my fat (I'm not a big meat eater, didn't like mayo ... couldn't figure out where my fat was coming from! maybe the fries - I will admit I liked fries). I looked to the USDA food pyramid and to increase my fiber for the constipation I was experiencing. Bread with 3 grams of fiber wasn't good enough; I turned to Kashi cereals for 11 years. My constipation turned to steattorrhea and a celiac disease diagnosis! *No gut pains!* My PCP sent me to the gastroenterologist for a colonscopy because my ferritin was a 5 (20 is low range). Good thing I googled around and asked him to do an endoscopy or I'd be a zombie by now.

My symptoms were depression & anxiety, eczema, GERD, hypothyroidism, mild dizziness, tripping, Alzheimer's-like memory problems, insomnia, heart palpitations, fibromyalgia, worsening eyesight, mild cardiomyopathy, to name a few.

After six months gluten-free, I asked my gastroenterologist about feeling full early ... he said he didn't know what I was talking about! *shrug*

But *I* knew -- it was the gluten/starches! My satiety level has totally changed, and for the first time in my life I feel NORMAL!

Feeling satisfied with less is a prominent effect in my experience, too. You need to eat less, you're driven to snack less, less likely to give in to those evil little bedtime or middle-of-the-night impulses that make you feel ashamed and guilty.

An anonymous (female) commenter said:

My life changed when I cut not only all wheat, but all grains from my diet.

For the first time in my life, I was no longer hungry -no hunger pangs between meals; no overwhelming desire to snack. Now I eat at mealtimes without even thinking about food in between.

I've dropped 70 pounds, effortlessly, come off high blood pressure meds and control my blood sugar without medication.

I don't know whether it was just the elimination of grain, especially wheat, or whether it was a combination of grain elimnation along with a number of other changes, but I do know that mere reduction of grain consumption still left me hungry. It wasn't until I elimnated it that the overwhelming redution in appetite kicked in.

As a former wheat-addicted vegetarian, who thought she was eating healthily according to all the expert advice out there at the time, I can only shake my head at how mistaken I was.

That may be a record for me: 70 lbs!!

Stan said:

It's worth it and you won't look back!

Many things will improve, not just weight reduction: you will think clearer, your reflexes will improve, your breathing rate will go down, your blood pressure will normalize. You will never or rarely have a fever or viral infections like cold or flu. You will become more resistant to cold temperature and you will rarely feel tired, ever!

Ortcloud said:

Whenever I go out to breakfast I look around and I am in shock at what people eat for breakfast. Big stack of pancakes, fruit, fruit juice syrup, just like you said. This is not breakfast, this is dessert ! It has the same sugar and nutrition as a birthday cake, would anyone think cake is ok for breakfast ? No, but that is exactly the equivalent of what they are eating. Somehow we have been duped to think this is ok. For me, I typically eat an omelette when I go out, low carb and no sugar. I dont eat wheat but invariably it comes with the meal and I try to tell the waitress no thanks, they are stunned. They try to push some other type of wheat or sugar product on me instead, finally I have to tell them I dont eat wheat and they are doubly stunned. They cant comprehend it. We have a long way to go in terms of re-education.

Yes. Don't be surprised at the incomprehension, the rolled eyes, even the anger that can sometimes result. Imagine that told you that the food you've come to rely on and love is killing you!

Anne said:

I was overweight by only about 15lbs and I was having pitting edema in my legs and shortness of breath. My cardiologist and I were discussing the possible need of an angiogram. I was three years out from heart bypass surgery.

Before we could schedule the procedure, I tested positive for gluten sensitivity through www.enterolab.com. I eliminated not only wheat but also barley and rye and oats(very contaminated with wheat) from my diet. Within a few weeks my edema was gone, my energy was up and I was no longer short of breath. I lost about 10 lbs. The main reason I gave up gluten was to see if I could stop the progression of my peripheral neuropathy. Getting off wheat and other gluten grains has given me back my life. I have been gluten free for 4 years and feel younger than I have in many years.

There are many gluten free processed foods, but I have found I feel my best when I stick with whole foods.

Ann has a different reason (gluten enteropathy, or celiac disease) for wanting to be wheat-free. But I've seen similar improvements that go beyond just relief of the symptoms attributable to the inflammatory intestinal effects of gluten elimination.

Wccaguy said:

I have relatively successfully cut carbs and grains from my diet thus far.

Because I've got some weight to lose, I have tried to keep the carb count low and I've lost 15 pounds since then.

I have also been very surprised at the significant reduction in my appetite. I've read about the experience of others with regard to appetite reduction and couldn't really imagine that it could happen for me too. But it has.

A few weeks ago, I attended a party catered by one of my favorite italian restaurants and got myself offtrack for two days. Then it took me a couple of days to get back on track because my appetite returned.

Check out Jimmy Moore's website for lots of ideas about variations of foods to try. The latest thing I picked up from Jimmy is the good old-fashioned hard boiled egg. Two or three eggs with some spicy hot sauce for breakfast and a handful of almonds mid-morning plus a couple glasses of water and I'm good for the morning no problem.

I find myself thinking about lunch not because I'm really hungry but out of habit.

The cool thing too now is that the more I do this, the more I'm just not tempted much to do anything but this diet.

Going wheat-free, along with a reduction in processed sugary foods like Hawaiian Punch, sodas, and candy, is the most direct path I know of to lose weight, obtain all the health benefits listed by our commenters, as well as achieve the cholesterol corrections we seek, like reduction of LDL cholesterol (small LDL particles) and increase in HDL.

Do-it-yourself osteoporosis treatment

2009-05-09T17:14:00.005-05:00

Debbie did not want to take the osteoporosis drugs prescribed by her primary care doctor for mild osteoporosis (T score -2.7) identified by a DEXA scan (x-ray densitometry).

He'd offered her the choice of Fosamax, Actonel, or Boniva. But Debbie was concerned about some of the reports of side-effects, including irreversible damage to the jaw bone requiring reconstructive surgery ("mandibular necrosis"). He'd warned her about the long-term risks of fractures, especially of the hip, if her osteoporosis progressed. So she committed to trying it on her own with an all-out effort.

At 56, Debbie was skeptical. So she put together her own osteoporosis prevention program:

Vitamin D--using a dose sufficient to raise her 25-hydroxy vitamin D blood level to 60-70 ng/nl.

Vitamin K2--Borrowing from the Japanese experience, in which vitamin K2 is used as a prescription "drug" for treatment of osteoporosis (Glakay, Eisai Pharmaceuticals), she started 1000 mcg of a mixture of K2 forms, MK-7 and MK-4.

Magnesium--Based on evidence that magnesium strengthens the bonds in bone tissue, she started magnesium glycinate, 400 mg per day (200 mg twice a day), a form that is well-absorbed and causes little or no loose stools.

Progesterone--Debbie added natural topical progesterone cream formulated for her by a compounding pharmacy, 60 mg twice a day.

The one interesting agent she did not add was strontium, despite evidence of benefit.

Debbie also added twice weeekly strength exercises for 20 minutes in addition to her walks.

14 months later, a second DEXA result: A T score of +1--complete reversal of her osteoporosis.

Getting blood tests on your own

2009-05-04T16:27:00.003-05:00

It is now possible to obtain an impressive range of blood tests performed at home without a blood draw.

Using a finger stick similar to that performed by people with diabetes to monitor blood sugar, you can test:

Lipid (cholesterol) panels--total cholesterol, LDL, triglycerides (no HDL cholesterol yet; it's in the works)
C-reactive protein (CRP)

Thyroid testing--free T3, free T4, TSH, thyroglobulin antibody

Male hormones--total testosterone, DHEA

Female hormones--estradiol, progesterone, DHEA

Cortisol

Vitamin D

The process is simple and the kit contains everything you need.

A finger is pricked using a nearly-painless spring-loaded pricking device. The small bit of blood is then used to make blots on the paper provided:

The number of blots required depends on the number of blood tests desired. Results are returned to you within about 7-10 days.

The testing methods used have been compared to conventional methods using blood draws with excellent correlation.

We are making the at-home tests available on the Track Your Plaque website.

The battle for T3

2009-05-04T15:15:00.003-05:00

Among the most important insights on what is desirable or ideal in thyroid measures comes from the provocative findings of the the HUNT Study. The text of the study can be found at:

Thyrotropin levels and risk of fatal coronary heart disease: the HUNT study.

The HUNT Study was the largest thyroid study ever performed. In this particular substudy, an incredible 25,000 people were included. The surprising conclusion: Thyroid-stimulating hormone (TSH) levels even in the "normal" range correlated with cardiovascular events such as heart attack. Risk began at TSH values as low as 1.5 mIU/ml or greater. (The higher the TSH, the poorer the thyroid function.)

Hypothyroidism, or low thyroid that is signaled by high TSH, is proving far more prevalent an issue than previously thought. While previous estimates put hypothyroidism as affecting only about 3% of younger populations, 10-20% of older populations (women more so), data like the HUNT Study suggest that, if lower and lower TSH levels (higher thyroid) are necessary for perfect heart health, then many more people stand to benefit than we used to think.

But another crucial issue in the world of hypothyroidism: Is T4 (thyroxine) enough? Or should we be supplementing T3 (triiodothyronine) along with T4?

Your friendly neighborhood primary care doctor or endocrinologist would likely argue vehemently that T4 (as Synthroid, Levoxyl, levothyroxine, and others) is adequate and not subject to the impurities and contaminants of natural thyroid extracts. They would also argue that T4 is effectively converted to T3 at the tissue level, and exogenous supplementation is unnecessary.

Others--most of all thyroid patients themselves, along with thyroid advocates like Mary Shomon and Janie Bowthorpe, along with some physicians--argue that supplementing T3 along with T4 can be very important for some people. They argue that people feel better, have more physical energy, lose weight more effectively, and more completely resolve many of the phenomena of hypothyroidism with T3 added. There are also some data that argue the same, although the data are clearly incomplete and vary in findings:

Treatment of Hypothyroidism with Combinations of Levothyroxine plus Liothyronine

Adding T3 to the mix may address the presumed poor conversion of T4 to T3 that is peculiar to some people. It may overcome the "reverse T3" phenomenon, the production of a useless look-alike T3 that occurs in some people. It may also (anecdotally) exert greater effects on some lipid/lipoprotein parameters, such as LDL cholesterol and Lp(a).

My experiences adding T3 to T4 have been strongly positive: 70% feel better, while 30% do not. Some show objective improvements, others do not.

How to assess your thyroid status

2009-05-04T10:54:00.003-05:00

Assessing thyroid status is an easy process. As with many measures, what is not so easy is defining what is truly desirable or ideal for health. (More on that in future posts.)

The ingredients of a thyroid assessment include:

Ensuring adequate iodine intake

Neglect of iodine is a common reason to develop marginally low thyroid function. In my experience, about 20% of people are deficient. Ironically, the most health-conscious are most likely to be deficient, since they are more likely to avoid iodized salt, processed foods that contain iodine, and may even follow an "eat local" philosophy in iodine-deficient regions of the country.

Iodine is not optional--it is an essential trace mineral. Without it, health is impossible, thyroid and otherwise. While the Recommended Daily Allowance (RDA) for iodine is 150 mcg per day, this may not be the ideal quantity for health. Until we have clarification on the ideal quantity, I generally recommend obtaining 500 mcg iodine per day from kelp tablets, an inexpensive form that is widely available.

Assess thermoregulatory status

It simply means taking your temperature.

I prefer oral temperatures, since they best track the circadian variation of internal temperatures, unlike surface temperature (e.g., axillary, forehead). Temperatures are best assessed using a digital thermometer immediately upon arising, aiming for a normal temperature in the vicinity of 97.3 degrees F. Temperatures consistently below 97.3 are suggestive of hypothyroidism (low thyroid).

Thyroid Stimulating Hormone (TSH)

TSH is actually a pituitary hormone responsible for regulating thyroid function: the higher the TSH, the poorer the thyroid function.

Most laboratories continue to quote a Reference Range (often mistakenly called "normal range") of 0.5-5.5 mIU/ml, even though several major studies suggest that cardiovascular events and even mortality are increased with TSH as low as 1.5 mIU/ml or greater.

I therefore aim to achieve TSH of 1.0 mIU or less.

Free T3

T3 is the principal thyroid hormone. (The "3" refers to the number of iodine molecules present per T3 molecule.) Low T3 represents low thyroid status. We aim for the the upper half of the "normal" T3 range.

Free T4

T4 serves as a respository for T3 and persists longer in the blood than T3. Low T4 signifies low thyroid. We aim for the upper half of the T4 range.

Iodine intake and temperature assessment can both be self-assessed easily.

Thyroid hormones can also be self-assessed with at-home blood tests, such as this offered through Track Your Plaque.

Even monkeys do it

2009-05-04T10:06:00.003-05:00

“Chausiku goes directly to and sits down in front of a shrub and pulls down several new growth branches about the diameter of my little finger. She places them all on her lap and removes the bark and leaves of the first branch to expose the succulent inner pith. She then bites off small portions and chews on each for several seconds at a time. By doing this, she makes a conspicuous sucking sound as she extracts and swallows the juice, spitting out most of the remaining fiber. This continues for 17 minutes, with short breaks as she consumes the pith of each branch in the same manner.”

Michael A. Huffman, PhD, a primatologist at the Primate Research Institute, Kyoto University, observing the chimpanzee, Chausiku, medicating herself in the jungles of Tanzania.

Dr. Michael Huffman’s description of Chausiku documents an extraordinary example of animal self-medication, unaided by human direction. In this instance, the chimpanzee, weak, clutching her back in pain, and listless, was ingesting the leaves of the plant, Vernonia amygdalina, to purge an intestinal parasite. She recovered by the next morning.

Vernonia leaves have since been found to contain over a dozen potential anti-parasitic compounds.

Perhaps if chimps can do it, we can, too.

On the news, you hear about a new study that showed reduction in heart attack in people who eat fish or take fish oil. Intrigued, you go to the health food store and purchase a bottle of fish oil capsules.

Believe it or not, you have just participated in the new exploding phenomenon that I call self-directed health, taking part in your own health based on an information exchange that does not involve your doctor¾undoctored.

It certainly doesn’t end at taking fish oil to reduce heart attack risk. There is a revolution underway that will help identify health conditions before they require a doctor, locate treatments that stop or reverse the condition without medication, share experiences with others with similar concerns, help people become far more healthy than ever believed possible¾certainly healthier than the hands off, call-me-when-you-hurt approach of conventional medicine. In fact, incredible health is achievable for most of us free of medication, managed under self-direction.

Even 10 years ago, the prospect of self-directing aspects of health would have been difficult. In 10 short years, the resources available to us have exploded. And they will continue to increase at an exponential rate.

What is self-directed health?

2009-05-02T08:48:00.002-05:00

The Undoctored Health Blog is all about self-directed health.

Let me explain.

I’m going to make a bold proposal, one you may find farfetched, even irresponsible.

I propose that much of human health can be managed without a doctor or hospital, but by individuals, on their own.

Sure, you could remove a wart using the cider vinegar recipe your grandmother gave you⎯big deal. But I’m referring to something much more substantial. And I don’t mean removing your own appendix, or self-splinting a leg fracture in your garage.

What I mean is that many health conditions can be safely, effectively, and inexpensively managed by an individual without a doctor’s guidance, without a doctor’s diagnosis, and without need for prescription medication.

It’s already happening. And it’s already happening on an incredible scale, not just by the eccentric doctor-phobe bearing acupuncture needles along meridian lines. It is a philosophy already embraced by tens of millions of people, although they may have done so unknowingly.

I call this phenomenon self-directed health: health practices and disease treatment that are self-managed.

You might already recognize a rudimentary form of self-directed health in its predecessor, “wellness,” the healthy-eating, exercise-break, check-your-blood-pressure and know-your-cholesterol practices followed at workplaces to reduce healthcare costs. But the concept is evolving rapidly from this humble start. And it’s going to grow much bigger.

To view evidence of self-directed health at work on a large scale, look no farther than nutritional supplements, the wildly popular $21 billion confirmation that people desire self-managed health solutions. Though we may dispute the wisdom and effectiveness of some of it, there is no doubt that options in nutritional supplements have exploded over the past two decades⎯and the public has embraced them enthusiastically. Lax regulation imposed by the 1994 Dietary Supplement Health and Education Act has allowed the definition of “nutritional supplement” to be stretched to the limit and includes obviously non-nutritional (though still potentially interesting) products like the hormones pregnenolone, dehydroepiandrosterone (DHEA), and melatonin to be sold on the same shelf as vitamin C, “nutritional supplements” that fill the growing public appetite for self-directed health.

Though still in its infancy, direct-to-consumer access to medical imaging is yet another facet of the phenomenon of self-directed health. Today, it is possible to diagnose your own coronary disease (CT heart scan), measure bone density for osteoporosis (DEXA, ultrasound, or bone densitometry), or quantify the severity of carotid atherosclerosis (ultrasound) with tests available to the consumer⎯directly, without a doctor’s involvement. A number of market forces in healthcare (including increasing exposure to large insurance deductibles) are converging to make direct-to-consumer medical imaging an appealing option.

Direct-to-consumer laboratory testing, a silent but substantial phenomenon, has emerged only in the last few years, largely in response to physician reluctance to order tests requested by individuals eager to explore health. Cost awareness to the price of lab testing is growing as more people are being exposed to health costs through larger insurance deductibles. The competitive pricing that develops naturally in a direct-to-consumer retail service yields substantial cost savings. (50% is not uncommon.) A mind-boggling array of self-directed tests is now available, from advanced markers for heart disease, to genetic cancer markers, to hormonal assessments.

Undoctored Health is going to chart these explorations in self-directed health. I invite you to follow along.

The irresistible itch

The prospect of self-managing aspects of health is tantalizing to a lot of people.

Self-directed health conceivably means that cholesterol abnormalities can be identified and managed without a doctor; blood pressure reduced without seeing a doctor; early osteoporosis corrected using commonly available nutritional supplements and exercise; vitamin D blood levels can be self-measured and self-corrected; low thyroid underlying fatigue can be identified and corrected.

When people begin to realize just how much they are capable of in directing their own health, an amazing spark of interest ignites and they develop a deep fascination with learning more⎯a stark contrast with the conventional health interaction.

Self-directed health is a phenomenon that will stretch far and wide into human health. It will encompass preventive practices, diagnostic testing, and therapeutic strategies. Self-directed health will grow to include heart disease, cancer prevention and identification, diabetes and pre-diabetes identification and management; osteoporosis identification and correction; genetic testing; issues peculiar to men, issues peculiar to women.

Self-directed health will dramatically shift the landscape of healthcare, change the economics of payment for healthcare, and revolutionize health for millions. This is not a concept, but the start of a movement.

Critics will say this is hazardous. In our drive-thru, just-add-water-and-microwave world of instant gratification, critics will warn that potential for danger is prohibitive. They fear that people will misdiagnose, misinterpret, or fail to recognize health conditions, choose the wrong diagnostic test, institute the wrong treatment. Chaos will result, unnecessary or unwise treatments instituted.

I disagree.

Surely, increased freedom necessitates increased responsibility. Boundaries will need to be established, rules followed, guidelines provided, guidance available.

But I predict that self-directed health will, on the whole, improve health⎯enormously.

The investment industry: Model of self-directed behavior

Up until the 1980s, individual investment was managed by a stockbroker or other money manager.

Stockbrokers, analysts, and investment houses commanded the flow of investment in stocks, options, futures, commodities, bonds, and derivatives.

Individuals lacked access to the methods and knowledge that allowed them to manage their own portfolios. They had no choice but to engage the services of a professional investor.

That has all changed. Today, the process has largely converted to discount brokers and online services used by individuals trading and managing their own portfolios. Stockbrokers and investment houses continue, of course, but are competing for a shrinking piece of the individual investment market. Independent investors now have access to investment tools that were not even in existence 20 years ago. Companies that serve individual investors like E-Trade and Ameritrade now command annual revenues of approximately $2 billion each.

I believe that the same revolution that shook the investment industry in the 1980s will seize healthcare in the near future. In fact, the transition to self-directed health will dwarf its investing counterpart. It will spread more vigorously through our lives, since health is a more complicated “product,” with more complex modes of delivery, and more varied levels of need. Nonetheless, the emergence of health directed by the individual, just as the emergence of self-directed investment, will explode over the coming years.

Even monkeys do it

“Chausiku goes directly to and sits down in front of a shrub and pulls down several new growth branches about the diameter of my little finger. She places them all on her lap and removes the bark and leaves of the first branch to expose the succulent inner pith. She then bites off small portions and chews on each for several seconds at a time. By doing this, she makes a conspicuous sucking sound as she extracts and swallows the juice, spitting out most of the remaining fiber. This continues for 17 minutes, with short breaks as she consumes the pith of each branch in the same manner.”

Michael A. Huffman, PhD, a primatologist at the Primate Research Institute, Kyoto University, observing the chimpanzee, Chausiku, medicating herself in the jungles of Tanzania.

Dr. Michael Huffman’s description of Chausiku documents an extraordinary example of animal self-medication, unaided by human direction. In this instance, the chimpanzee, weak, clutching her back in pain, and listless, was ingesting the leaves of the plant, Vernonia amygdalina, to purge an intestinal parasite. She recovered by the next morning.

Vernonia leaves have since been found to contain over a dozen potential anti-parasitic compounds.

Perhaps if chimps can do it, we can, too.

On the news, you hear about a new study that showed reduction in heart attack in people who eat fish or take fish oil. Intrigued, you go to the health food store and purchase a bottle of fish oil capsules.

Believe it or not, you have just participated in the new exploding phenomenon that I call self-directed health, taking part in your own health based on an information exchange that does not involve your doctorundoctored.

It certainly doesn’t end at taking fish oil to reduce heart attack risk. There is a revolution underway that will help identify health conditions before they require a doctor, locate treatments that stop or reverse the condition without medication, share experiences with others with similar concerns, help people become far more healthy than ever believed possiblecertainly healthier than the hands off, call-me-when-you-hurt approach of conventional medicine. In fact, incredible health is achievable for most of us free of medication, managed under self-direction.

Even 10 years ago, the prospect of self-directing aspects of health would have been difficult. In 10 short years, the resources available to us have exploded. And they will continue to increase at an exponential rate.

Why self-directed health is necessary

While seizing control over health to reach new heights of energy, well-being, and freedom from disease is wonderfully enticing, spiraling healthcare costs make self-directed health a necessity.

The self-directed health phenomenon will be catalyzed as individuals bear more healthcare costs through larger insurance deductibles, flex-spending and medical savings accounts. As control over more of the healthcare dollar is returned to that of the health consumer, they will seek to spend their dollars wisely and look for solutions that don’t involve costly conventional medical answers like medication and procedures.

Cost savings will be realized, as consumers are more likely to engage in preventive care and avoid expensive doctors, prescriptions, and hospital services.

Thyroid and thermoregulation

2009-05-02T08:28:00.001-05:00

Is there an at-home test you can do to gauge thyroid status?

Yes. Measure your temperature.

Unlike a snake, alligator, or other reptile that relies on the sun or its surroundings to regulate body temperature, you and I internally regulate temperature. The hypothalamus-pituitary-thyroid glands are the organs involved in thermoregulation, i.e., body temperature regulation. While the system can break down anywhere in the sequence, as well as in other organs (e.g., adrenal), the thyroid is the weak link in the chain.

Thus, temperature assessment can serve as a useful gauge of thyroid adequacy. Unfortunately, temperature measurement as a reflection of thyroid function has not been well explored in clinical studies. It has also been the subject of a good deal of unscientific discussions.

How should temperature be measured? The temperature you really desire is between 3 am and 6 am, while still asleep. However, this is difficult to do, since it would require your bed partner to surreptitiously insert a thermometer into some body orifice without disturbing you. A practical solution is to measure temperature first upon awakening in the morning, before drinking water, coffee, making the bed, etc.

While traditionalists (followers of Dr. Broda Barnes, who first suggested that temperature reflects thyroid function) still advocate axillary (armpit) temperatures, it is clear that axillary temperatures are unreliable. Axillary temperatures are inconsistent, vary substantially with the clothing you wear, vary from right to left armpit, ambient temperature, sweat or lack of sweat, and other factors. It also can commonly be 2-3 degrees Fahrenheit below internal ("core") temperature and does not track with internal temperatures through the circadian rhythms of the day (high temperature early evening around 7 pm, lowest temperature 3-6 am).

Rectal, urine, esophageal, tympanic membrane (ear), and forehead are other means to measure body temperature, but are either inconvenient (rectal) or require correction factors to track internal temperature (e.g., forehead and ear). For these reasons, we use oral temperatures. Oral temperatures (on either side of the underside of the tongue) are convenient, track reasonably well with internal temperatures, and are familiar to most people.

Though there are scant data on the distribution of oral temperatures correlated to thyroid function, we find that a cutoff of 97.3 degrees Fahrenheit, or 36.0 C, seems to track well with symptoms and thyroid laboratory evaluation (TSH, free T3, and free T4). In other words, oral temp <97.3 F correlates well with symptoms of fatigue, cold hands and feet, mental fogginess, along with high LDL cholesterol, all corrected or improved with thyroid replacement and return of temperature to 97.3 F.

But be careful: There are many factors that can influence oral temperature, including clothing, season, level of fitness, "morningness" (morning people) vs. "nightness" (night owls), relation to menstrual cycle, concurrent medical conditions.

Also, be sure that your thermometer can detect low temperatures. Just because it shows low temperatures of, say 94.0 degrees F, doesn't mean that it can really measure that low. If in doubt, dip your thermometer in cold water for one minute. If an improbable temperature is registered, say, 97.0 F, then you know that your device is incapable of detecting low temps. For this reason, I've had most success with digital thermometers.

Thyroid self-testing

2009-04-30T21:47:00.001-05:00

Low thyroid, or hypothyroidism, is a ubiquitous and growing health problem that now affects tens of millions of people nationwide.

Conventional thyroid treatment leaves a yawning gap that falls short of restoring perfect thyroid health, consigning millions to lives of low energy, leg edema, foggy thinking, weight gain, and long-term health struggles. Conventional practitioners neglect many aspects of thyroid health due to the drug-focused nature of conventional medical practice and the reluctance to regard fatigue and similar non-catastrophic complaints as medical conditions.

Thermoregulation

You have, literally at your fingertips, an easy, safe, reliable gauge of thyroid function.

First-a.m. oral (“basal”) temperatures can serve as a gauge of thyroid function that can be used to diagnose and track the adequacy of thyroid status.

The thyroid gland is the body's thermoregulatory center, the organ that acts like a thermostat to maintain body temperature within the normal healthy range. But, if the thermostat malfunctions for one reason or another, temperature control--thermoregulation--can be disrupted.

Body temperature normally displays a predictable cycling pattern through the day and night, or circadian rhythm. The typical temperature variation of humans shows the following pattern (rectal temperatures):

From Duffy JF et al 1998. Core (rectal) body temperatures for young and older subjects. Solid circles = Older subjects (n =43); open circles = young subjects (n = 97); solid bar, usual sleep episode of older subjects; open bar, usual sleep episode of young subjects. Data are plotted with respect to actual time of day.

Taking your first-upon-awakening oral temperature therefore provides an estimate of your body's lowest temperature.

At-home thyroid testing

Thanks to direct-to-consumer laboratory testing (performed in the comfort of your home with a finger prick), thyroid dysfunction can be identified, steps taken to correct it.

The tests you can obtain on your own are the very same tests that your doctor would perform to evaluate your thyroid status: free T3, free T4, and TSH. (More on the ABC's of thyroid testing in a future post.)

In fact, an individual’s self-management of thyroid can be superior to that provided by the majority of physicians.

One interesting facet of thyroid health is the recent resurgence of iodine deficiency, since most healthy people are now avoiding iodized salt; iodine replacement can restore normal thyroid function in some people. More on that also in a future post.

What is self-directed health? Part III

2009-04-30T21:25:00.002-05:00

The investment industry: Model of self-directed behavior

Up until the 1980s, individual investment was managed by a stockbroker or other money manager.

Stockbrokers, analysts, and investment houses commanded the flow of investment in stocks, options, futures, commodities, bonds, and derivatives.

Individuals lacked access to the methods and knowledge that allowed them to manage their own portfolios. They had no choice but to engage the services of a professional investor.

That has all changed. Today, the process has largely converted to discount brokers and online services used by individuals trading and managing their own portfolios. Stockbrokers and investment houses continue, of course, but are competing for a shrinking piece of the individual investment market. Independent investors now have access to investment tools that were not even in existence 20 years ago. Companies that serve individual investors like E-Trade and Ameritrade now command annual revenues of approximately $2 billion each.

I believe that the same revolution that shook the investment industry in the 1980s will seize healthcare in the near future. In fact, the transition to self-directed health will dwarf its investing counterpart. It will spread more vigorously through our lives, since health is a more complicated “product,” with more complex modes of delivery, and more varied levels of need. Nonetheless, the emergence of health directed by the individual, just as the emergence of self-directed investment, will explode over the coming years.

What is self-directed health? Part II

2009-04-30T21:20:00.001-05:00

The irresistible itch

The prospect of self-managing aspects of health is tantalizing to a lot of people.

Self-directed health conceivably means that cholesterol abnormalities can be identified and managed without a doctor; blood pressure reduced without seeing a doctor; early osteoporosis corrected using commonly available nutritional supplements and exercise; vitamin D blood levels can be self-measured and self-corrected; low thyroid underlying fatigue can be identified and corrected.

When people begin to realize just how much they are capable of in directing their own health, an amazing spark of interest ignites and they develop a deep fascination with learning more⎯a stark contrast with the conventional health interaction.

Self-directed health is a phenomenon that will stretch far and wide into human health. It will encompass preventive practices, diagnostic testing, and therapeutic strategies. Self-directed health will grow to include heart disease, cancer prevention and identification, diabetes and pre-diabetes identification and management; osteoporosis identification and correction; genetic testing; issues peculiar to men, issues peculiar to women.

Self-directed health will dramatically shift the landscape of healthcare, change the economics of payment for healthcare, and revolutionize health for millions. This is not a concept, but the start of a movement.

Critics will say this is hazardous. In our drive-thru, just-add-water-and-microwave world of instant gratification, critics will warn that potential for danger is prohibitive. They fear that people will misdiagnose, misinterpret, or fail to recognize health conditions, choose the wrong diagnostic test, institute the wrong treatment. Chaos will result, unnecessary or unwise treatments instituted.

I disagree.

Surely, increased freedom necessitates increased responsibility. Boundaries will need to be established, rules followed, guidelines provided, guidance available.

But I predict that self-directed health will, on the whole, improve health⎯enormously.

What is self-directed health? Part I

2009-04-30T06:26:00.001-05:00

I’m going to make a bold proposal, one you may find farfetched, even irresponsible.

I propose that much of human health can be managed without a doctor or hospital, but by individuals, on their own.

Sure, you could remove a wart using the cider vinegar recipe your grandmother gave you⎯big deal. But I’m referring to something much more substantial. And I don’t mean removing your own appendix, or self-splinting a leg fracture in your garage.

What I mean is that many health conditions can be safely, effectively, and inexpensively managed by an individual without a doctor’s guidance, without a doctor’s diagnosis, and without need for prescription medication.

It’s already happening. And it’s already happening on an incredible scale, not just by the eccentric doctor-phobe bearing acupuncture needles along meridian lines. It is a philosophy already embraced by tens of millions of people, although they may have done so unknowingly.

I call this phenomenon self-directed health: health practices and disease treatment that are self-managed.

You might already recognize a rudimentary form of self-directed health in its predecessor, “wellness,” the healthy-eating, exercise-break, check-your-blood-pressure and know-your-cholesterol practices followed at workplaces to reduce healthcare costs. But the concept is evolving rapidly from this humble start. And it’s going to grow much bigger.

To view evidence of self-directed health at work on a large scale, look no farther than nutritional supplements, the wildly popular $21 billion confirmation that people desire self-managed health solutions. Though we may dispute the wisdom and effectiveness of some of it, there is no doubt that options in nutritional supplements have exploded over the past two decades⎯and the public has embraced them enthusiastically. Lax regulation imposed by the 1994 Dietary Supplement Health and Education Act has allowed the definition of “nutritional supplement” to be stretched to the limit and includes obviously non-nutritional (though still potentially interesting) products like the hormones pregnenolone, dehydroepiandrosterone (DHEA), and melatonin to be sold on the same shelf as vitamin C, “nutritional supplements” that fill the growing public appetite for self-directed health.

Though still in its infancy, direct-to-consumer access to medical imaging is yet another facet of the phenomenon of self-directed health. Today, it is possible to diagnose your own coronary disease (CT heart scan), measure bone density for osteoporosis (DEXA, ultrasound, or bone densitometry), or quantify the severity of carotid atherosclerosis (ultrasound) with tests available to the consumer⎯directly, without a doctor’s involvement. A number of market forces in healthcare (including increasing exposure to large insurance deductibles) are converging to make direct-to-consumer medical imaging an appealing option.

Direct-to-consumer laboratory testing, a silent but substantial phenomenon, has emerged only in the last few years, largely in response to physician reluctance to order tests requested by individuals eager to explore health. Cost awareness to the price of lab testing is growing as more people are being exposed to health costs through larger insurance deductibles. The competitive pricing that develops naturally in a direct-to-consumer retail service yields substantial cost savings. (50% is not uncommon.) A mind-boggling array of self-directed tests is now available, from advanced markers for heart disease, to genetic cancer markers, to hormonal assessments.

Undoctored Health is going to chart these explorations in self-directed health. I invite you to follow along.