Wednesday, July 21, 2010

Thyroid Yoga

You've heard the analogy that your thyroid acts as your body's "gas pedal" by releasing energy hormones that modulate the metabolism of your organs and cells. Your thyroid determines how fast your engine runs.

In previous posts, I've commented on the interdependence of your thyroid with other key glands, particularly your adrenals and ovaries. The adrenals act, as we continue the car analogy, like a steering wheel. Your sex hormones (estrogen, progesterone, testosterone), on the other hand, serve as the ignition -- sparking the life of your engine. I think of the engine as your liver: our livers govern how we metabolize hormones, and the liver in turn is significantly controlled by leptin and insulin.

How complicated. 

Where can we simplify and just find a little relief? What can I offer when your gas pedal is sluggish or sticky or slammed to the metal of the car floor? When your slow progress toward euthyroidism (normal thyroid labs AND normalized symptoms) is frustrating you endlessly, Yoga comes to mind. Not just because I’ve found yoga to be the best system I’ve encountered for extraordinary living, but because yoga has helped my thyroid provide a smooth ride for 35+ years (I started practicing yoga as a kid, seriously) as well as those of my patients.

We know that yoga provides balance. It is a middle path, and for many of us with lazy thyroids, this is welcome news. We know that most of us seek yoga to manage stress, and that yoga is incredibly effective at balancing stress hormones such as cortisol. It lowers cortisol when it’s high and giving you that tired-wired feeling, and it raises cortisol when it’s low and giving you that “I-need-to-lie-down,-immediately” vibe (provided you don’t have the severest form, called Addison’s Disease).

In the yoga tradition of the past 2500 years, the thyroid is related to the vishuddhi chakra, which is the psychic center that purifies the toxins of the body and turns them into nectar of immortality. Good health of the entire neuroendocrine system is understood to be vital to our higher awareness.

OK, OK, Get Me to the Practical Stuff….

Here’s a Yoga Class, featuring the yoga practices that best balance your thyroid.

Shoulder Stand

If you’ve ever practiced yoga, you probably know that shoulder stand is the mama of all poses (asanas) for healing your thyroid. When you properly come into shoulder stand, you place robust pressure on your thyroid, squeeze out much of the huge blood flow of our little butterfly organ with the chin against your trachea (windpipe), and when released, new and fresh blood infuses your little gland. Old secretions and hormones get washed away, circulation improves, and the nerves are stimulated, reminding the gland to wake up and assume more tasks. In the yoga tradition, you send awareness and prana to your thyroid in shoulder stand, and prana or life force is the vehicle of healing.

Shoulder stand also places robust pressure, in fact the weight of most of your body, onto your little cervical vertebrae in the back of your neck. Make sure you do the pose properly, with an experienced teacher watching your every move until you are safe and skillful at it.

After shoulder stand, we traditionally perform matsyasana or fish pose, to allow all that delicious prana to move into the thyroid.

If daunted, move on first to some of the other asanas described below which are less risky.

Ujjayi Pranayama (“Victory Breath”)

This breathing exercise acts also directs prana to the throat area and stimulates some of the reflex pathways of the through associated with breathing and swallowing. Many call it the “Ocean-Sounding Breath” or more colloquially, “Are you trying to breathe like Darth Vadar?” Learn this from a teacher – it is the basic breathing practice of Ashtanga and many vinyasa classes.

Viparita Karani (“Legs Up the Wall Pose”)

This is a really simple exercise that nearly all of us can do with little experience. Lie on the floor next to a wall. Create an L-shape with your legs up the wall, at a 90-degree angle to your torso, which is on the floor. Lie here for 10 minutes with your eyes closed and allow the pressure to weigh down on your thyroid and breath like Darth Vadar, constricting your glottis as you inhale for 5 seconds and exhale for 5 seconds.

There are many other scrumptious practices for the thyroid such as Nadi Shodhana (another breathing exercise that balances your hormones), Surya Namaskara, Supta Vajrasana, and Jalandara bandha, but that’s all I have time for today.

Friday, July 16, 2010

Thyroid Goddessness

When I was 38, I discovered that my thyroid was a laggard. After having trouble losing weight post-partum from my second baby, and had a vague feeling that Kaiser's version of what constituted a normal thyroid test was different from my version. I decided to test my T3, and low and behold, the sucker was low. Soon I started a small dose of Armour Thyroid, and all was good in the world again: my body responded to exercise by losing fat, I didn't have to be as fastidious about what I ate, and my energy was vastly improved.

 As with many issues in integrative medicine, there's a gigantic gap between what conventional medicine has to say about what is normal thyroid function and what integrative or functional medicine offers. Daily I discover that my patients have a low free and/or total T3, the active version of thyroid hormone that makes you leap out of bed in the morning.  Or I find that they have autoimmune thyroiditis, and even thought their Thyroid Stimulating Hormone (TSH) is normal, they are making antibodies to their thyroid and heading toward a crash.

Many symptoms characterize an underactive thyroid but the top two are: weight gain and fatigue. Here are some other common symptoms: constipation (which I define as less than two bowel movements per day), cold hands and feet, depression, hair loss, joint achiness, poor memory and executive functioning, and increased cholesterol. The list is long and I have a questionnaire for you on the blog right here. Take the quiz to see if you should test, and consider performing a thyroid panel home test via Canary Club for free T3, TSH, free T4 and thyroid peroxidase antibodies. I am also a big fan of following your reverse T3 but I don't know where you can order that as a home test.

When you have thyroid issues, your diet requires your rapt attention. Got goitrogens in the food you're eating? I’ve never heard a conventional doc talk to patients about foods (called goitrogens) that lower your thyroid function. Tell me your stories of docs who are sharing this info! Yet, as with most things, the info is easy to find online. Raw foods are lightly goitrogenic (cooking inactivates the goitrogenic compounds). Short version: strawberries, pears, peanuts, pine nuts, cassava (yucca), Brassica veggies such as broccoli, bok choy and brussel sprouts. I know, I know – they help your estrogen metabolism but recall the see-saw analogy.

For more info on thyroid, I highly recommend Mary Shomon's excellent books as well as Thyroid Power by Dr. Richard Shames, MD. I challenge you to have goddess-like thyroid function, which is, after all, your birthright.

Thursday, July 15, 2010

Imma Be Queen of Leptin

Many of us are waking up to the rather unwelcome slow-down of our metabolism now that we've hit 35 or 45 or 55 years. What helps? Becoming a master of the forces that shape your metabolism and how they interact with your other hormonal systems. Leptin is a major driver, and a lesser-know hormonal cousin to insulin, so I thought I'd repost my guest blog from Dear Thyroid on the leptin scoop - how it controls metabolism, how it relates to your sluggish thyroid and the muffin around your middle.

Ever wonder why you still feel hypothyroid yet your TSH is normal? Or why the weight you gained while hypothyroid hasn’t fallen away? A key intermediary hormone that many of us are unacquainted with is leptin, a regulator of both body weight and your thyroid control. Let leptin become your new BFF by getting to know her intimately and learning how she rocks your thyroid and weight.

If you haven’t heard of leptin, that’s because it was discovered relatively recently in 1994. It’s similar to insulin in its job description. Leptin acts as an important control system that makes telephone calls to other organs about the state of your fat balance and whether to go or stay in low-metabolism survival mode. It’s made in your fat cells, and more fat cells = higher leptin levels. The high leptin normally tells your hypothalamus that you don’t need to eat as much, so metabolism slows (you make more TRH, and this raises TSH) and the TSH tells your thyroid to crank out more thyroid hormone. This is when your leptin is communicating clearly and functionally, and your hypothalamus is responding appropriately.

Optimal Leptin

Ideally, leptin should be between 4-6. If your leptin is 4-6, your hypothalamus is getting the correct phone calls from leptin. If your level is above 10, your leptin receptors are fatigued, and the phone calls are no longer getting to or from the hypothalamus. Result? Metabolism slows inappropriately because the hypothalamus is interpreting the messages inappropriately.

Problem with Chronic Dieting

Chronic dieting and/or major stress are a common cause leptin resistance. As a result, leptin no longer has a clear line of communication with your hypothalamus and thereby your metabolism. Leptin resistance makes the hypothalamus believe that you are in starvation mode, and you make more fat, and slow down thyroid hormone production. TSH goes down, you don’t convert as much T3 (active thyroid hormone) from T4 (inactive), reverse T3 goes up, appetite increases (crazy unfair, sorry about that), and often you become insulin resistant, and slow down lipolysis (fat breakdown). More fat accumulates, you’re hungrier and you age prematurely. Not good!

Over time, you get fatter, especially at the mid-section, and it becomes increasingly difficult to lose the weight and fat. In fact, it takes herculean efforts.

High Leptin Renders TSH Unreliable

As if herculean efforts weren’t enough, If your leptin is high, TSH less reliably reflects your tissue level of thyroid hormones. For example, in diabetics who are almost universally leptin-resistant, T4-to-T3 conversion is cut in half without a change in TSH. While you may not be diabetic, you may still experience a significant reduction in your conversion before your TSH picks it up. This is where, yet again, measuring your free T3 (fT3) and reverse T3 (rT3) can help elucidate the issues.

More Bad News: Leptin & Thyroid Cancer

When your leptin rises in the blood, it increases (upregulates) leptin receptors on thyroid cancer cells causing them to become more aggressive. Does it help transform normal thyroid cells into malignant cells? We don’t know. But we do know that overzealous leptin receptors were found in 80% of thyroid cancers in one series published in 2009. Leptin has been shown to stimulate growth of thyroid cancers and reduce cell death.

How About PCOS?

Short version: leptin problems cause PCOS, both in lean and obese women. The science is quite complex, and involves loss of the timing of certain hormonal rhythms of both growth hormone and luteinizing hormone. From your comments to the last post, I’d like to offer a future blog post on all things PCOS, so please comment your questions and concerns.

OK, OK… Tell Me What to Do

Measure your leptin level. If it’s above 10, use nutrition as a first strategy to reset your level. I find that 70-80% of my patients are successful just by making the nutritonal changes that are recommended for reversing leptin resistance, such as Dr. Ron Rosedale’s program ( or Byron Richards 5-step plan. Dr. Rosedale presents a food program in his book that includes elimination of fruit except avocadoes and olives for three weeks and limited starchy foods. There is far more detail in his book. I find the food changes are the primary way to lower leptin; nutraceutical supplements are another approach that may augment your success with leptin-sensitizing foods.

Here again (similar to what we reviewed in my blog post last week), we want to normalize both the thyroid and the leptin levels simultaneously for the best results. What works in those who are not successful with the nutritional program to lower leptin is to add prescription therapies. I don’t like the prescription approach – I favor using natural therapies but they require deep commitment to change old eating patterns. HCG treatment has also been successful, but that’s a hugely controversial approach that merits it’s own blog post!

While leptin resistant, make sure your free T3 and reverse T3 are being managed properly. I like to see the free T3 mid-range for your lab, and the fT3/rT3 >1.8 (when fT3 is in units of ng/dl).

As leptin lowers, your TSH will more accurately reflect your tissue levels, assuming you are also limiting stress and exposure to endocrine disruptors such as bis-phenol A (BPA) and other lovelies that mess with your thyroid receptors. One side note: probiotics have been shown to reduce BPA absorption, but that’s a big topic for another post too!

If I’m making this sound as if we have the whole leptin scene figured out, let me also mention that there’s a lot we don’t know. How insulin resistance interacts with, or causes leptin resistance, for instance, is still not completely clear.

Personally, I’ve found that optimizing leptin makes my thyroid care and weight management much more successful. I’ve reversed my leptin from 11 to 4 in 6 months. As the Black Eyed Peas might put it: “Imma be Queen of my leptin, getting it down lower than 6, Imma be the flyest chick….”

Monday, July 12, 2010

Mystic Mondays in My Manolos: Let's Feminize Mysticism

After the past 6 weeks hangin' with the goddesses, I've decided to broaden Goddess Mondays into Mystic Mondays. Still the same theme song: transform an otherwise dreaded day-of-the-week into a luxurious exploration of divine potential and archetypes. Today I studied, invoked and got a mani/pedi with both two Hindu goddesses -- Radha, goddess of love, and Kali, the fierce goddess of battle, carrying a sword dripping in blood of the severed ego.

Problem is, I was deterred from Mystic Mondays for a while by Caroline Myss' comments about the "Mystic" archetype in her book, Sacred Contracts. I find her comments too male and patriarchal. See what you think.

Perhaps no archetype is more coveted by my students or more misunderstood than the Mystic. Many want to believe that they have mystical inclinations, yet underestimate how arduous the genuine mystical path is. When they find out, they're usually happy to let someone else have this role. The lives of the world's great mystics have often included extraordinary states of consciousness, such as prolonged ecstatic trances, and preternatural abilities of prerecognition or bilocution. Yet they also contained sometimes great physical as well as spiritual suffering, hard work, and mundane activities that made up much of their days. If you truly want to name this archetype as part of your sacred consortium, ask yourself if you are ready to pay the price in blood, sweat and tears. If mystical consciousness is something you engage in once a day during meditation, or on a weekend retreat or a yoga workshop, you may be a spiritual seeker, but not a Mystic. The single-minded dedication of the Mystic carries over to the Renunciate, who relinquishes material desires and ambitions to pursue spiritual practices; the Anchorite, who withdraws from the world almost entirely to follow a similar path; and the Hermit, who withdraws from others to pursue a solitary life, although not always for spiritual purposes.

I was very blessed a few weeks ago to be gifted a book by a beloved patient, The Unknown She by Hilary Hart, which contains the voices of many modern mystics from around the world. The first mystic interview, with Angela Fischer, fascinated me: Angela described mysticism and sacred feminine consciousness as being a path that one defines within the swirl of husbands, kids and other loved ones, not separate from them. She helps women come into contact with their deeper essence, and offers a path that is grounded in our "householder" lives and ordinary, rounded, seamed bodies - which is very different than the Hero's Journey described for men.

Men's journeys are of course toward themselves, but at the same time they seem to journey away from themselves, leaving their bodies behind. They master... ascetic trials like fasting, physical endurance, and controlling sexuality. And we consider these as general spiritual practices, not recognizing that they might be inappropriate for women. Women often don't need these practices, because they stay where they are; their connections within life, within the created world, provide the ground for their transformation. Our bodies can be included because they do not need to be purified as men's do; they are already pure.

All righty, then. Sounds like I can still aspire to mysticism or at least spiritual seeker status and try to carve a more uniquely female path, a broader more inclusive path than Caroline had in mind. In her defense, she wrote Sacred Contracts in 2001.

Meanwhile, I'm having a blast on Mondays, getting to know the goddesses, shamans and other mystics I am drawn toward, seeking qualities I need to develop myself and those that are under hormonal influence, from love to bonding to sacred destruction. Let me know if you have a fave mystic that I should be looking into. Did I mention that I wear MBTs, not Manolos Blahniks? Just didn't have the same ring to it....

Friday, July 2, 2010

Memo to Your Thyroid: Role of Adrenals & Estrogen/Progesterone, etc

Somehow I made it through med school, residency and years of medical practice before I figured out a key epiphany: interdependence of the glandular systems of thyroid, adrenals and sex hormones (estrogen, progesterone, testosterone). Turns out I needed to teach it to myself - it's not in the medical textbooks or even conventional medical discourse. Once I got "it," meaning how all these crazy thryoid, adrenal and sex hormones fit together, much of my thryoid chaos fell away, for myself and more importantly, for my patients.

Here's the memo I never got.

1.   Got estrogen? Got too much estrogen? Estrogen dominance is common with hypothyroidism. Symptoms are: moodiness, cysts (ovarian, breast), weight gain, night sweats/hot flashes, irregular cycles. Too much estrogen raises thyroid-binding globulin, and this in turn can bind your free thyroid hormones, even if they are present in the right amounts. Think see-saw: if estrogen is high, free thyroid hormone is low. And vice-versa.
2.   Conversely, hypothyroidism causes sex-hormone binding globulin (SHBG) to decrease – this raises both free testosterone and estrogen. Note the significant overlap between estrogen dominance and hypothyroid symptoms – there is both redundancy in this system and crossover. Best fix: balance both systems simulataneously or sequentially. Most conventional docs will look at you like you’re nuts if you mention estrogen dominance – find an integrative doc here or test yourself.
3.   Adrenals operating properly? Adrenal function and thyroid function have a relationship also like a see-saw: when one is up, the other is down. Get both systems balanced so the see-saw is even.
4.   More on cortisol: correct amount of cortisol (not too much, not too little) helps the conversion from T4 (inactive thyroid hormone with 4 iodine atoms) to T3 (active form – 3-4 times more potent than T4, 3 iodines). You can check a questionnaire to assess for this, or even better, get it tested right here. Another benefit of balanced adrenal hormones is less thyroid inflammation.
5.   Polycystic ovaries? Another key aspect of interdependence is the dance between PCOS, your adrenals and your thyroid.  While the cause isn’t well-delineated, I believe most of PCOS begins with the stress cascade of overtaxed adrenals and too much cortisol in the fight-flight-collapse response, and leading to insulin resistance (typically defined as fasting insulin > 7), which is toxic to the ovary and makes progesterone levels drop. This leads to irregular cycles and imbalanced hormones (high androgens, high estrogens). One treatment is more progesterone, preferably the natural flavor as Chastetree Vitex, progesterone cream or prometrium. But that’s another blogpost for another day. Key point is that high cortisol when stressed can block your progesterone receptors, keeping the progesterone you make from doing its job. Another cause of high cortisol? HYPOTHYROIDISM! Oy, interdependence is a vicious cycle until you understand it. But know this: women with PCOS are four times more likely to have hypothyroidism due to autoimmune thyroiditis
6.   Speaking of inflamed thyroids, have you been tested for thyroid antibodies? Know your titers? Crucial, my friend. More often than not, your under-active or over-active thyroid is a result of autoimmune thyroiditis. What makes autoimmune thyroiditis worse? You guessed it, adrenal dysregulation and estrogen dominance. Oh, and digestive inflammation.
7.     Iodine, as the differentiator between thyroid hormones, is essential to the right balance of thyroid. I find most of my patients are deficient in the Bay Area of California, but too much can cause problems too. Best plan of action is to perform a iodine challenge test, available through Meridian Valley Labs in Washington among other places.
8.     Nutrition – what does that have to do with hormones? A ton. Just going gluten-free reduces estradiol (the key estrogen of our reproductive years and bioidentical hormone therapy in women 40+) by 30-40%. Big help if you’re estrogen-dominance.
9.     Got goitrogens? I’ve never heard a conventional doc talk to patients about foods (called goitrogens) that lower your thyroid function. Tell me your stories of docs who are sharing this info! Yet, as with most things, the info is easy to find online. Raw foods are lightly goitrogenic (cooking inactivates the goitrogenic compounds). Short version: strawberries, pears, peanuts, pine nuts, cassava (yucca), Brassica veggies such as broccoli, bok choy and brussel sprouts. I know, I know – they help your estrogen metabolism but recall the see-saw analogy.
10.  Polyendocrinopathy? Long word, key concept – refers to more than one endocrine gland malfunctioning at a time. Sometimes the thyroid is the first to manifest (or perhaps more commonly, the only one to be tested and/or recognized by your doc), yet one or more endocrine glands is on the wane. This can cause a more complex array of symptoms that are harder to treat. This is where a root cause analysis and step-wise or multi-system hormone treatments can be helpful.
You maybe wondering with all this complexity and interdependence, which is the chicken and which is the egg? Often we don’t know. That’s where balancing all three systems either simultaneously makes the most sense.
For more info, visit my website and like my Facebook page, all available right here.
Originally posted on the fantastic site for thyroidistas, Dear Thyroid.

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I'm an organic gynecologist, yoga teacher + writer. I earn a living partnering with women to get them vital and self-realized again. We're born that way, but often fall off the path. Let's take your lousy mood and fatigue, and transform it into something sacred and useful.