Toxins Muckin' with My Thyroid

A kind gesture from my dentist today - she graciously offers plastic bottles of water in her waiting room - turns out to be a disaster for your thyroid. My daughter eagerly grabbed a bottle and started drinking. I love my dentist, but those bottle contain bis-phenol A (BPA) and they slow down our thyroid receptors. My TSH may not reveal the injury, but my weight does, as does my sluggish morning energy.

You’ve heard the dire news on environmental pollution. I used to pitch it into the file of “things I can’t worry about right now,” but then I realized that I too was affected. Turns out my lazy thyroid was rooted in mercury toxicity and too much BPA. What I thought 5 years ago was a healthy lunch once/week of brown rice/tuna sushi rolls from Whole Foods was slowly poisoning my system as mercury mounted and shut down my thyroid hormone production. My hair fell out, I gained weight despite an aggressive exercise campaign and I was tired most of the time.

Second-hand smoke has also been shown to impair your thyroid, particularly in younger kids and infants.

If your bod can’t keep up with the steady diet of toxins that we encounter, your liver metabolism takes a hit. Leptin rises. You become cranky, irritable and tired. You develop dark circles under your eyes. The main organ tasked with detoxification is your liver, and toxic backlog is a common diagnosis in my integrative medical practice. This is well-summarized by integrative nutritionist Byron Richards:

“It is like pouring sand into the gas tank of a car, It does not matter whether the car is old or new, when the engine gets clogged, it will not run correctly. The liver must be clear all such chemicals.”

There is a definite correlation between the severity of hypothyroid symptoms and toxic exposure. Being overweight is especially complex, because toxins are stored in fat. Toxic folks have tremendous difficulty losing weight, and here’s the worst part: when you manage to lose a few pounds of fat, you get re-exposed to the toxins stored in the fat you’re burning. So unfair!

What’s a thyroidista to do?

1.    Reduce exposure – you know that it’s best to drink from glass or stainless steel containers. Use them exclusively. Read Time Magazine’s recent review of what toxins do to your endocrine system and how to limit your risk. Recent data also shows that probiotics limit your absorption of BPA. Cracks in your metal dental fillings are another source of mercury – if you have metal amalgams, consider replacement with your dentist. http://tinyurl.com/GCtoxins

2.    Cleanse your liver – I recommend to my patients a 30-day cleanse every 6 months. Check out our website for more information. http://gottfriedcenter.com/

3.    See if you have mercury toxicity – there are many tests available commercially. I recommend a provoked test with a chelator such as DMPS. Testing is available for $79-100. Contact my staff for more info and to order your test at 510.893.3907.

For more info, check out the NRDC's excellent article on BPA-free water containers.

 Reposted from DearThyroid.org

Are You Mercury Toxic?

Great post by Mark Hyman, MD, on mercury toxicity, in the Huffington Post. Read it right here. Then read Part 2.

Important stuff especially if you have kids or have symptoms of high mercury (fatigue, difficulty with weight loss, low libido, headaches, hair loss, etc).

Weight Gain in PeriMenopause & PostMenopause

Good post on how estrogens, when they are reduced by perimenopause and menopause, lower your metabolic rate. Unfortunately, this can start at early as age 35-40. Welcome to Perimenopause, My Friends! But there are things we can do about it. Read on....

Question: Does exercise attenuate or prevent the weight gain that occurs during peri- and post-menopause?

Commentary from:
Wendy M. Kohrt, PhD
Professor of Medicine
University of Colorado, Denver
in Menopause E-consult by the North American Menopause Society

The short answer is, yes, exercise can attenuate
or prevent weight gain during peri- and
postmenopause. The prevention of weight gain
at any age requires only that energy intake not
exceed energy expenditure. Thus, it is possible
to maintain body weight by modifying exercise
and/or eating habits. However, although simple
in theory, there are physiologic changes that
make it particularly challenging for middle-aged
women to maintain energy balance (ie, intake =
expenditure). Because the menopause transition
occurs over a number of years, it is difficult to
determine whether the increased propensity for
weight gain at midlife is primarily a
consequence of the menopause transition or of
advancing age. Both involve factors that make
weight maintenance a challenge.

Menopause-related factors that promote weight
gain. Studies of laboratory animals provide
compelling evidence that estrogen plays an
important role in the regulation of body weight.
Oophorectomy has consistently been found to
cause excess weight gain, and this is prevented
by estrogen replacement.1 There appear to be
multiple mechanisms by which estrogen
deficiency leads to weight gain in animals,
including increased food intake, decreased
spontaneous physical activity, and a suppression
of metabolic rate. If such effects of estrogen
deficiency also occur in humans, this would
suggest that there is a “biological drive” around
the time of menopause toward weight gain.

In fact, there is evidence that estrogen regulates
body weight in women. A number of large,
randomized, placebo-controlled, and open-label
trials of estrogen-based hormone therapy (HT)
have provided strong evidence that weight gain
and, more specifically, fat gain, is attenuated in
women on HT when compared to women on
placebo or no HT.2 Suppressing sex hormone
levels in premenopausal women with
gonadotropin-releasing hormone (GnRH)
agonist therapy also causes fat gain. For
example, women treated for 16 weeks with a
GnRH agonist gained 1.0 kg of fat, which
equates to an energy excess of about 80 kcal per
day.3 Because it is difficult to accurately
measure changes in energy intake and
expenditure of this magnitude in humans, it is
not clear whether the suppression of sex 2
hormones influences eating and/or exercise
habits. However, short-term hormone
suppression has been found to cause a decrease
in resting metabolic rate of 40 to 70 kcal per
day.4 This reduction in metabolic rate would be
expected to cause weight gain if not
accompanied by a compensatory decrease in
energy intake or increase in physical activity.

Aging-related factors that promote weight gain.
Even if the menopause transition does not alter
bioenergetics in a way that promotes weight
gain, there are unavoidable factors related to
aging that do so. Two important factors are the
loss of muscle mass and the decline in maximal
aerobic power. Lean body mass is an important
determinant of resting metabolic rate. As lean
mass declines with aging, there is a decrease in
metabolic rate and, therefore, daily energy
expenditure. The decline in metabolic rate will
result in weight gain unless appropriate
behavioral changes are adopted (ie, decrease in
energy intake or increase in physical activity).

Maximal aerobic power, also referred to as
aerobic capacity or VO2 max, is a direct index of
the rate at which an individual can expend
energy during exercise. For example, a healthy
young woman with an average VO2 max for her
age can easily increase her energy expenditure
by 8 to 10 kcal per minute during exercise.
However, there is a decline in VO2 max with
aging that cannot be avoided, due in part to the
inevitable decrease in maximal heart rate (ie,
maximal heart rate = 220 minus age).
Accordingly, with advancing age there is a
decline in the rate at which energy can be
expended during exercise, even in people who
maintain a vigorous level of physical activity.5
Rather than being able to increase energy
expenditure by 8 to 10 kcal per minute during
exercise, middle-aged women may be able to
burn only 6 to 8 kcal per minute. This has an
important impact on how women can use
exercise to maintain body weight as they age.
Because the rate at which energy can be
expended decreases gradually with aging,
maintaining the same level of total exercise
energy expenditure may require an increase in
the amount of exercise time.
Do physically active women gain less weight
than sedentary women during peri- and
postmenopause? Exercise can prevent weight
gain in peri- and postmenopausal women, but
factors related to menopause and aging make
weight maintenance a challenge. Even though
regular exercise does not come with a guarantee
against weight gain, prospective studies of
perimenopausal women indicate that the most
active women gain the least weight.6,7 Most
important, women should not abandon their
exercise habits if they become discouraged by
what they perceive as a lack of effectiveness of
exercise to prevent weight gain. Exercise has
numerous health benefits that are independent of
its effects on body weight regulation.8

Disclosure: Dr. Kohrt reports: Research support—
National Institutes of Health.

References:
1. Shi H, Clegg DJ. Sex differences in the regulation of
body weight. Physiol Behav 2009 Feb 27. [Epub ahead of
print]
2. Lobo RA. Metabolic syndrome after menopause and
the role of hormones. Maturitas 2008;60:10-18.
3. Yamasaki H, Douchi T, Yamamoto S, Oki T,
Kuwahata R, Nagata Y. Body fat distribution and body
composition during GnRH agonist therapy. Obstet
Gynecol 2001;97:338-342.
4. Day DS, Gozansky WS, Van Pelt RE, Schwartz RS,
Kohrt WM. Sex hormone suppression reduces resting
energy expenditure and beta-adrenergic support of resting
energy expenditure. J Clin Endocrinol Metab 2005;90:
3312-3317.
5. Hawkins SA, Marcell TJ, Victoria JS, Wiswell RA.
A longitudinal assessment of change in VO2 max and
maximal heart rate in master athletes. Med Sci Sports
Exerc 2001;33:1744-1750.
6. Sternfeld B, Wang H, Quesenberry CP Jr, et al.
Physical activity and changes in weight and waist
circumference in midlife women: findings from the Study
of Women’s Health Across the Nation. Am J Epidemiol
2004;160:912-922.
7. Macdonald HM, New SA, Campbell MK, Reid DM.
Longitudinal changes in weight in perimenopausal and
early postmenopausal women: effects of dietary energy
intake, energy expenditure, dietary calcium intake and
hormone replacement therapy. Int J Obes Relat Metab
Disord 2003;27:669-676.
8. Haskell WL, Lee IM, Pate RR, et al. Physical activity
and public health: updated recommendation for adults
from the American College of Sports Medicine and the
American Heart Association. Circulation 2007;116:1081-
1093.

Higher TSH Associated with Weight Gain

Here is a good review of a study showing that higher thyroid stimulating hormone (TSH, the most sensitive indicator of thyroid function) is associated with weight gain, and the increase is linear. Optimum TSH is < 2.5.

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD

March 25, 2008 — Modest increases of thyroid-stimulating hormone (TSH) within the reference range may be associated with weight gain, according to the results of a large, community-based study reported in the March 24 issue of the Archives of Internal Medicine.

"Overt hypothyroidism and hyperthyroidism may be associated with weight gain and loss," write Caroline S. Fox, MD, MPH, from the National Heart, Lung, and Blood Institute's Framingham Heart Study in Framingham, Massachusetts, and colleagues. "We assessed whether variations in thyroid function within the reference (physiologic) range are associated with body weight."

This study included 2407 participants in the Framingham Offspring Study who attended 2 consecutive routine examinations, were not receiving thyroid hormone therapy, and had baseline serum thyrotropin (TSH) concentrations of 0.5 to 5.0 mIU/L and follow-up concentrations of 0.5 to 10.0 mIU/L. During 3.5 years of follow-up, the relationship of baseline TSH concentrations with body weight and body weight change was determined.

From the lowest to highest TSH concentration quartiles at baseline, adjusted mean weight increased progressively from 64.5 to 70.2 kg in women (P < .001 for trend) and from 82.8 (lowest quartile) to 85.6 kg (highest quartile) in men (P = .007 for trend). Mean body weight increased by 1.5 ± 5.6 kg in women and 1.0 ± 5.0 kg in men during 3.5 years of follow-up.

Although baseline TSH concentrations were not associated with weight change during follow-up, an increase in TSH concentration at follow-up was positively associated with weight gain in women
(0.5 - 2.3 kg across increasing quartiles of TSH concentration change; P < .001 for trend) and men (0.4 - 1.3 kg across quartiles of TSH concentration change; P = .007 for trend).

"Thyroid function (as assessed by serum TSH concentration) within the reference range is associated with body weight in both sexes," the study authors write. "Our findings raise the possibility that modest increases in serum TSH concentrations within the reference range may be associated with weight gain."

Limitations of the study include observational design precluding determination of causality; lack of measurement of free thyroxine levels; sample nearly entirely white, with possible lack of generalizability to other ethnic groups; and inability to account for other covariates known to be associated with body weight and weight change, including diet and physical activity.

"The identification of change in thyroid function as a risk factor for weight gain might help guide research into the identification, prevention, and treatment of individuals at risk for the development of excess adiposity," the study authors write. "Confirmation of our findings in other samples is warranted, and in particular more longitudinal studies are warranted."

The National Heart, Lung, and Blood Institute's Framingham Heart Study supported this study. Two of the study authors have been supported by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. The other study authors have disclosed no relevant financial relationships.

In an accompanying editorial, Roy E. Weiss, MD, PhD, and Rebecca L. Brown, MD, from the University of Chicago Medical Center in Chicago, Illinois, address potential mechanisms linking thyroid function and obesity.

"Assuming preservation of tissue responsiveness to thyroid hormone levels, the absence of reciprocal changes in T3 and T4 levels suggests a central modification of the HPT [hypothalamic-pituitary-thyroid] axis in obesity," Drs. Weiss and Brown write. "Elucidation of the mechanisms by which obesity alters the HPT axis may give clues to the other metabolic abnormalities seen in this condition. There is no evidence at this time to advocate lowering serum TSH concentrations to treat obesity."

Drs. Weiss and Brown have disclosed no relevant financial relationships.

Arch Intern Med. 2008;168:568-569, 587-592.

Clinical Context

In the United States, the prevalence of obesity is rising. Obesity is associated with the increased risk for diabetes, vascular disease, all-cause mortality, and cancer. Known predictors of obesity and weight gain include a low level of physical activity, increased energy intake, parity, smoking cessation, inflammation, depression, and genetic factors. It has been recognized that thyroid dysfunction is a cause of weight change. Studies have suggested that variation in thyroid function within the reference range may be related to weight change.

The aim of this study was to determine whether variations in thyroid function are associated with body weight.

Study Highlights

• From the Framingham Offspring Study, participants (n = 2407) who attended 2 consecutive routine examinations, were not receiving thyroid hormone therapy, and had baseline serum TSH concentrations of 0.5 to 5.0 mIU/L and follow-up concentrations of 0.5 to 10.0 mIU/L were included in this study.
• The prevalence of obesity at baseline was 14.3%, and the mean baseline serum TSH concentration was 1.91 mIU/L in women and 1.70 mIU/L in men.
• Baseline TSH concentrations were related to body weight and change in body weight during 3.5 years of follow-up.
• Results revealed that at baseline, adjusted mean weight increased progressively from 64.5 to 70.2 kg in the lowest to the highest TSH concentration quartiles in women (P < .001 for trend) and from 82.8 (lowest quartile) to 85.6 kg (highest quartile) in men (P = .007 for trend).
• Baseline TSH concentrations were not associated with weight change during follow-up.
• During 3.5 years of follow-up, mean (SD) body weight increased by 1.5 (5.6) kg in women and 1.0 (5.0) kg in men.
• Weight increased by 1.9 kg per every 1-unit increase in log TSH concentration (P < .001) in women and by 1.0 kg per every 1-unit increase in log TSH concentration (P = .007) in men.
• An increase in TSH concentration at follow-up was positively associated with weight gain in women (0.5 - 2.3 kg across increasing quartiles of TSH concentration change; P < .001 for trend) and men (0.4 - 1.3 kg across quartiles of TSH concentration change; P = .007 for trend).
• Limitations to this study included the observational design of the study; lack of measurement of free thyroxine levels; sample nearly entirely white, with possible lack of generalizability to other ethnic groups; and inability to account for other covariates that may affect body weight, such as diet and physical activity.

Pearls for Practice

• Risk factors leading to obesity include low level of physical activity, increased energy intake, parity, smoking cessation, inflammation, depression, and genetic factors.
• Thyroid function within the reference range is associated with body weight in both sexes, suggesting that modest increases in serum TSH concentrations within the reference range may be associated with weight gain.