When I became an endocrinologist in 1981 I was truly excited about the field. At that time it seemed that the science of endocrinology was expanding rapidly and new discoveries were on the horizon particularly in regards to the way hormones effect the brain, mood and the immune system. Was I ever wrong! Itâ€™s thirty years later and none of those expectations were realized. In fact, I find that the field of endocrinology has barely budged since then and in some areas has actually lost ground.
Bringing on this round of pessimism on my part, is a recent â€œdevelopmentâ€ in the area of treatment for hyperthyroidism (over active thyroid). Ever since I was in training there have been two medicines, propylthiouracil (PTU) and methimazole (Tapazole), which are the mainstays of medical treatment for hyperthyroidism. Both medicines have been available since the 1940â€™s and show excellent efficacy and tolerability (and they are cheap!). Almost all endocrinologists I have met use these two drugs interchangeably although in pregnancy propylthyiouracil is favored due to rare birth defects in fetuses exposed to methimazole.
The â€œdevelopmentâ€ which I find so discouraging is the recent action by the FDA to place a very strict (black box) warning on the use of PTU due to the possible occurrence of a rare form of liver injury attributed to the drug. After almost 70 years of exemplary use, this has given rise to extensive debate in the endocrinology literature about how to restrict PTU use.
While it is true that methimazole is equally as effective as PTU to treat hyperthyroidism, I have personally seen numerous cases of fairly severe allergic reactions to methimazole. Fortunately it has been easy to continue medical treatment by simply switching to PTU. If we canâ€™t use PTU freely then the only other options are surgical removal of the thyroid or eradication of the thyroid using radioactive iodine, neither of which is free of potentially adverse outcomes.
I have never encountered severe liver injury with PTU nor has any of the colleagues I have polled. It has to be very, very rare. This is obvious because it has taken 70 years to get around to recognizing it formally. Can we really call it progress that we now have one less simple option for treating hyperthyroidism, a common and relatively benign disease? Let me take my cynicism to the next level. I wonâ€™t be surprised if a major pharmaceutical company soon announces the development of a new drug for treating hyperthyroidism. If Iâ€™m right the new drug will add nothing of real value that wasnâ€™t previously available but is many times more expensive then the drug it replaces.
So goes endocrinology into the new century, the stogy old lady of medicine.
Large Neck Size Equals Big Metabolic Problems:
A bulging stomach is widely accepted as a sign of poor metabolic health. A recent study published in the August Clinical Endocrinology and Metabolism (95:3701, 2010), finds a chubby neck is likely to hold even a worse prognosis for metabolic health.
The research team evaluated the relationship between waist circumference and neck circumference with levels of blood sugar, good cholesterol (HDL), bad cholesterol (LDL), triglycerides, and insulin resistance, as well as blood pressure. What was found was that neck circumference was a better predictor than waist circumference of elevated blood pressure, LDL, triglycerides and insulin resistance, with lower levels of HDL. All this amounts to a greater risk of cardiovascular disease as neck size increases. As an example, an increase in neck circumference of about one inch is expected to result in a 2.5 point rise in blood pressure.
The authors point out that the neck circumference was a more accurate predictor of cardiovascular risk in women than men. The average neck size for men in this study was about 16 inches (40.5 cm) and about 13.7 inches for women (34 cm).
Alfred Hitchcock, the famous director of suspense movies, made a trademark of his corpulent silhouette with bulging chin and abdomen. Thanks to this research we know his silhouette can signify more than a movie that will thrill you but also a metabolism that will kill you.
Gary Pepper, M.D.
One of our members notes loss of sex drive, strength, motivation. He is concerned that this could be due to low testosterone levels;
Here is his comment;
Iâ€™m 64 years old. Excellent health. 6 ft tall, 177 pounds, work out three times a weekâ€¦â€¦.finding my self depressed, losing strengthâ€¦..havenâ€™t had any sexual desire in last 3 yearsâ€¦â€¦..I use the VA for all my health issues. My doctor said he tested my levels and they were normal, but he wouldnâ€™t let see the results. Based on my info could someone tell me what my level should be at. Also, I noted someone said they got tested freeâ€¦how is that ?? My only option without paying is to use the VA, and Iâ€™ve already noted that experience. Thank You.
My first thought is to find out what the actual testosterone level is, as well as free testosterone. A doctor that refuses to share a patients lab results with them has lost credibility. Many “normal” results are subject to interpretation but the doctor may not want to be bothered explaining the finer points of diagnosis. This applies to many medical conditions but is particularly common when diagnosing low thyroid or gonadal (testicular) function. Additional testing may be necessary to make the diagnosis. If any of the pituitary hormones, prolactin, LH or FSH are abnormal then testosterone levels could be in the “normal” range and yet the patient can be suffering from significant disease. Finally, it is still possible that symptoms like those you describe are not related to testosterone deficiency and a search for other medical explanations seems appropriate.
As far as getting free testing for medical conditions I am not able to provide a clue. Perhaps one of our members knows of a way and I would welcome their comments.
Best of luck.
Dr. Gary Pepper, Editor-in-Chief, Metabolism.com
These comments are for informational purposes only and are not intended as medical advice or therapy.
Metabolism.com is pleased to share the following article provided by our guest contributor, Tom Hines.
In some ways, your body is like a machine — it works best when itâ€™s properly maintained and tuned up. Food is your fuel and when you fill your tank with lousy fuel, your engine sputters and stalls. If your bodyâ€™s engine is sluggish and needs a jumpstart, spirulina and other green superfoods can help deliver the energy necessary to keep the machine running smoothly, avoiding a breakdown.
Spirulina is a â€˜green superfood,â€™ a term used to describe various nutrient-rich natural supplements, which include Chlorella, Wheat Grass, Barley Grass, Alfalfa and Kelp. Unlike most store-bought supplements, the concentrated vitamins and minerals they provide are not synthetic. Green superfoods are whole foods harvested directly from nature and are exactly what your body needs to offset stress and to clear away toxins.
SAD is very sad indeed
S.A.D. stands for Standard American Diet â€“ there was never a more apt acronym. The majority of U.S. citizens today subsist on processed fast food laden with refined carbohydrates and saturated fats. Meats are frequently tainted with growth hormones, antibiotics and pathogens. For people who manage to work the recommended five to nine daily servings of fruit and vegetables into their diet, modern agricultural techniques have stripped crops of many vitamins and minerals.
Processed and cooked foods, which are the cornerstones of the S.A.D, and beverages such as coffee, tea, soft drinks and alcohol create an acidic blood pH, encouraging the growth of bacteria, fungus and mold. In an overly acidic environment, the body literally begins to compost. Illnesses such as heart disease and diabetes are often the result of the composting process. Green superfoods have an alkalizing effect, counteracting the acidity caused by poor diet, stress and toxic overload and setting the stage for a return to good health.
Spirulina and Chlorella, the most super of the green superfoods
Spirulina is a blue-green algae whose name comes from its spiral coil shape. High quality spirulina thrives in both salt and fresh water in tropical climates and it is known to have nourished the Aztecs, who harvested the algae from Lake Texcoco. Some of the benefits of Spirulina are:
- Contains all of the essential amino acids vital to human health
- An excellent protein source for all vegetarians, including vegans
- Balances blood sugar by boosting glycogen, which offsets insulin
- Rich in GLA (gamma linolenic acid) and other essential fatty acids Delivers an array of vitamins, including the all-important folic acid
- High in potassium and a dozen other minerals
- Improves focus and mental clarity
Chlorella is a single-celled green algae whose name is derived from Greek and Latin words that translate to â€œlittle green.â€ In the 1940â€™s and 1950â€™s, intensive research was done on little green algaeâ€™s potential role in solving world hunger, due to its high protein content and its bounty of beneficial vitamins and minerals. The natural health community, meanwhile, has always touted Chlorellaâ€™s health-imparting properties, particularly in the area of detoxification. In addition to being the very best source of chlorophyll, here are some more of Chlorella supplement benefits:
- Rids the body of toxins and stored waste
- Tones and cleanses the blood
- Reduces body odor, acting as an internal deodorant
- Improves bowel health and reduces flatulence
- Naturally freshens the breath
- Clears the skin
Cereal grasses and seaweed
Wheat grass is a popular juicing ingredient due to its superior nutrition, which it delivers without raising blood sugar. It also helps to lower blood pressure.
Barley grass alkalizes the blood and strengthens the digestive system.
Alfalfa helps reduce LDL (low-density lipoprotein) or bad cholesterol, without affecting levels of HDL (high-density lipoprotein) or good cholesterol and studies are underway to determine its effectiveness at lowering blood sugar levels and its ability to invigorate the immune system.
Kelp is a brown-algae seaweed, which grows in abundant kelp forests in shallow oceans all around the world. Kelp is rich in iodine and therefore beneficial to overall thyroid health. Its high vitamin and mineral content promotes pituitary and adrenal gland health as well. Itâ€™s renowned for its contribution to lustrous hair and skin. Taken shortly after exposure, it can also mitigate the negative ramifications of heavy metals and irradiation.
Making the most of green superfoods
Incorporating Spirulina, Chlorella and other green superfoods into the diet is easy, since they are all available in powdered form. Simply mix the desired amount into salad dressing, or add it to soup, juice or water. The taste is fresh and green and the active enzymes of living food add a healthy dimension even to a less than healthy meal. Of course, pregnant or breastfeeding women and people taking medications should consult with their doctors before incorporating any new food into their diets.
Many people who regularly incorporate green superfoods into their daily regimen have reported increased energy, mental clarity and an overall healthy glow. When stress, toxic thoughts and an imperfect diet have left your bodyâ€™s engine sluggish, green superfoods are a quick and easy way to put yourself back on the road to health. Long may you run!
About the Author
Tom Hines, co-owner of NutritionGeeks.com (MN #1 Now Foods herbal provider), has been working in the nutrition industry since 1997, is a competitive powerlifter, lives with his wife Netti and three boys TJ, Grady and Brock on the prairie in west central Minnesota, spends his leisure time coaching youth wrestling, working with his horses and being play toy #1 for his boys.
A member of metabolism.com, Louise Infante, is a great enthusiast of the vegetarian life style. Louise submitted this blog to metabolism.com so we could help her get the word out. I found the article extremely informative and hope you do too. Thanks Louise for your effort.
Here is what Louise has to say:
Give me five minutes and Iâ€™ll give you 1 very good reason for being vegetarian.
While fish is the most important dietary way to obtain the long-chain omega-3s eicosapentaenoic acid and docosahexaenoic acid, which has been shown to be essential in supporting brain health, low intake of eicosapentaenoic acid and docosahexaenoic acid in vegetarians does not adversely affect mood, reported by a new study (Nutr J. 2010;9:26. DOI:10.1186/1475-2891-9-26).
A research team from Arizona State University conducted a cross-sectional study to compare the mood of vegetarians who never eat fish with the mood of healthy omnivorous adults.
An overall total of 138 healthy Seventh Day Adventist adults residing in Arizona and California (64 vegetarians and 79 non-vegetarians) were enrolled in the study and completed a health history questionnaire, food frequency questionnaire and 2 psychometric tests, the Depression Anxiety Stress Scale and also the Profile of Mood States..
Vegetarians had significantly lower mean intakes of eicosapentaenoic acid, docosahexaenoic acid and the omega-6 arachidonic acid; they had higher intakes of the omega-3 alpha-linolenic acid and the omega-6 linoleic acid.
“Seed oils are the richest sources of Î±-linolenic acid, notably those of rapeseed (canola), soybeans, walnuts, flaxseed (Linseed oil), clary sage seeds, perilla, chia, and hemp.”
However, the vegetarians also reported significantly less negative emotion than omnivores in both psychometric tests. Mean total psychometric scores were positively linked to the mean intakes of eicosapentaenoic acid, docosahexaenoic acid and arachidonic acid , and inversely related to alpha-linolenic acid and linolenic acid intake.
The study team noted there is also the possibility that vegetarians may make better dietary choices and could generally be healthier and happier.
If you want to give it a try, here is an example of vegetarian recipe based on Italian cuisine
Italian Spaghetti with Zucchini
* 17 oz. Spaghetti
* 24 oz. Of thin sliced zucchini
* 1 / 2 cup walnuts oil
* A few basil leaves
* 2 tablespoons of yeast flakes
* Salt and pepper
In a skillet or frying pan heat the oil and when hot, add garlic and zucchini. Raise heat and stir often to complete their cooking. They need to be golden and crispy outside and tender inside. Cook the pasta, drain and sautÃ© in pan with zucchini, basil and yeast. Serve immediately.
Zucchini contain fewer calories and possess no fat. But they are a good source of potassium, e vitamin, ascorbic acid, folate, lutein and zeaxanthin.
These types of nutrients are extremely sensitive to heat and to enjoy their benefits you should find a quick solution to cook or even eat raw in salads.
From the therapeutic perspective, zucchini have laxative, refreshing, anti-inflammatory, diuretic and detoxifying action.
About the Author – Louise Infante writes for vegetarian menu blog, her personal hobby blog centered on vegetarian cooking tips to help people live better.