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Natural Ways to Boost Your Immune System

​With the current coronavirus pandemic, the public is more afraid for their health and wellbeing than I have ever seen.

It is all over the news and social media.  It seems impossible to get away from it.

Why do these pandemics keep occurring?  What is wrong?

While we really can’t stop this virus or future organisms from spreading across the world, we CAN do more to get and keep our own immune system as healthy as possible.

I will discuss how to do this below…

​Germ Theory vs Terrain Theory

In order to understand our immune system and how it works, we need to discuss some topics.

​Most of us were taught the germ theory in school, so this should sound familiar.

In the late 1800s, Louis Pasteur described a microscopic world of organisms that cause disease.  He developed the pasteurization of milk, which involves heating milk to very high temperatures which kills the germs and bacteria inside the milk and thus prevents infections.

The core concept of the germ theory of disease is this:   Microorganisms (germs) are the cause of infectious disease.  They invade humans, other animals, and other living hosts.  Their growth and reproduction can lead to disease.

This has become the foundational belief for much of modern medicine.  Antibiotics, vaccines, and other antimicrobial treatments are based on this concept.

The bugs are bad.  If we want to get and stay healthy, we need to kill the bugs and do whatever we can to avoid contact with the bugs.

That is what we were all taught.  That is what we are doing in the world now, right?

​What about the terrain theory?

Antoine Bechamp, who​ was a contemporary scientist of Louis Pasteur, believed that the focus should be on the health of the person, NOT on the bug.  He famously said, “treat the patient, not the disease.”

Bechamp noted that the germs that terrified Pasteur were opportunistic in nature.  They were everywhere and even existed normally in humans.  Only when the tissue of the host became damaged or compromised did those germs manifest as a symptom of disease.  He believe they were a result of the disease, not the cause.

His thinking went something like this:  The severity of the infection will correlate with the health status of the patient.  In other words, the unhealthier the person, the more out of balance a body is, the more susceptible they will be to disease.  Also, the disease will be much more severe in that person compared to a person who is in balance and healthy.

To prevent illness, Bechamp advocated not the killing of germs but the cultivation of health through diet, hygiene and healthy living.

When treating a patient with an active infection, he was less concerned with killing the organism and focused more on restoring the health of the patient’s body through lifestyle choices.  As the person’s health was restored through diet, hygiene and detoxification, the infection would go away on its own.  There was no need to directly kill the bug.

The 2 scientists had a long and often bitter rivalry regarding which of them were right.  Ultimately, society accepted the germ theory and the terrain theory was mostly forgotten.

The irony of the story is that at the end of his life, Pasteur renounced his germ theory.  His last words were “the microbe is nothing, the terrain is everything.”

So, which theory do you endorse?  Does it have to be one or the other, or is there some truth in both?​

​The Onslaught of Microbes

​Have you noticed that every few years the latest “killer bug” arrives on the scene, threatening to destroy humanity?  Here are just a few of the big ones from the last 20 years:

  • 2003 – SARS
  • 2009 – Swine Flu
  • 2013 – Bird Flu
  • ​2014 – Ebola
  • 2016 – Zika
  • ​2019 – COVID-19

​Why does it seem like these are hitting us in waves?  What is going on?

​Are We Too Clean?

​That may seem like a really weird question to ask, but it deserves discussing.

My mother told me countless stories about her childhood in the 1930s and 1940s.  She and her siblings rarely wore shoes, they ate a bunch of dirt, only bathed every few days, and played in the cattle stable which was full of cow manure.

She said she barely remembered any of them ever getting sick.

I have always been amazed that our dogs or cattle could drink some of the dirtiest, nastiest water I had ever seen, yet it didn’t make them sick.  Why not?

The answer, at least in large part, is because of our microbiome.

​The Microbiome

​Over the past several years, the medical system has finally begun to acknowledge the importance of the microbiome.

Inside and out, our bodies are covered with microbes – bacteria, fungi, protozoa and viruses.

In fact, there are over 100 trillion of them!  Microbes outnumber our human cells by 10 to 1. That results in about 5 pounds of material.

The microbiome is the genetic material contained in all of those microbes.  There is 200 times more genetic material in those microbes than the number of human genes our body contains.

​These organisms help us digest our food, regulate our immune system, protect against diseases, produce neurotransmitters, produce hormones, and even produce many of the vitamins that are essential for our health.

If this complex colony of organisms gets out of balance in any way, our health will be affected.

An analogy would be to look at your lawn.  As long as your grass is healthy and thick, weeds and other invaders will not be able to spread.  If it gets some bare patches or other issues, very quickly some opportunistic weeds will start to take over.

Autoimmune diseases are another example.  Autoimmunity is associated with a dysfunction of the microbiome.  The wrong kinds and amounts of microbes accumulate on or in the body over time, which changes the gene activity and metabolic processes.  This results in the immune system attacking parts of the body instead of foreign invaders.

Autoimmune diseases seem to run in families.  It is now believed that it occurs not by inheriting defective DNA, but instead by inheriting a family’s unhealthy microbiome.

Our microbiome is critical to our health.  It is also not a stagnant, unchanging group of microbes. Rather, it changes almost by the minute.

For example, if you touch the ground outside, some microbes from your skin will transfer to the ground while some from the ground will transfer to your skin.  In this way, your body is in constant communication with the environment.  Your body assesses these new microbes and uses them to further fortify your immune defenses.

The same thing happens with our diet.  We we eat foods that are full of beneficial bacteria, our body adds those microbes to the flora in our colon.

If we eat things such as a high sugar or processed food diet, our gut flora is actually damaged and some of the good bacteria are killed.

On a side note, some bacteria in the gut promote a leaner body while others promote the body to gain weight.  Sugar in the diet has been shown to promote an increase in the bacteria that cause weight gain.  So, weight gain is not just a matter of someone eating too many calories.

​Medications and the Gut Microbiome

​Many prescription and over the counter medications have been shown to have a severe impact on the bacterial balance in our gut.  These include:

  • Proton Pump Inhibitors – These include meds such as Prilosec and Nexium
  • Metformin – The most commonly used medication for diabetes
  • Antibiotics – These kills both the good and the bad bacteria
  •  Laxatives – Used to treat constipation
  • NSAIDS – Anti-inflammatory meds such as aspirin, Aleve, and ibuprofen

A lab in Germany tested the effect of 835 different non-antibiotic medications on 40 of the most common gut bacteria.  About 25% of the medications restrained the growth of at least one bacteria, while about 5% affected the growth of at least 10 of the 40 bacteria.

Medications are not without risks.

​The rates of allergies and asthma in westernized countries are skyrocketing.  You have most likely even noticed this in your own family.  This is felt to be due to things such as improved hygiene, decreased physical activity, and poor diet.  All of those things affect our microbiome which affects our immune function.

So are we too clean?  Possibly.  Are we being exposed enough to the good microbes in our environment.  Probably not.

Liberally using hand sanitizers can also alter the good bacteria in our microbiome.

During the current pandemic, we are being told to stay inside, wear a mask, wash our hands often, and use hand sanitizers.

We had to protect the at-risk population from a dangerous new virus.  But we can’t and shouldn’t do these things long-term if we all want to have a strong, resilient immune system.

​How To Boost Your Immune System

​Okay, so in light of everything we have discussed, what can you do to boost your immune system?

1. Optimize Your Diet

– Reduce sugar and processed carbs –

Sugar increases inflammation which impairs our immune system.

– Eat more vegetables and fruit –

The fiber in plant foods feeds your gut bacteria which boosts your immunity.  They also contain flavonoids which reduce inflammation and augment the antiviral properties of zinc.

– Increase your good fat intake –

Healthy fats such as those found in olive oil and salmon boost the body’s immune response by decreasing inflammation.

– Eat more fermented foods –

Foods such as yogurt, kombucha, sauerkrat, kefir and kimchi are rich in beneficial bacteria that help populate our gut microbiome.  One study in children showed that those who drank only 2.4 ounces of fermented milk daily had 20% fewer infections than the control group.

​2. Get Regular, Moderate Exercise –

​Regular, moderate exercise reduces inflammation and helps your immune cells regenerate.  Examples include brisk walking, biking, jogging, and swimming.  Your goal should be to get 150 minutes of exercise each week.

​3. Drink More Water –

​Dehydration causes headaches and worsens focus, mood, digestion and other bodily functions. All of these increase your susceptibility to illness.

​4. Get Adequate Sleep –

​Getting less than 6 hours of sleep per night significantly increases your chance of getting a cold. Getting adequate rest will increase your natural immunity.

​5. Manage Your Stress –

​Stress increases inflammation and impairs immune functions.  It is critical to manage your stress if you want to have an optimal immune system. Activities that help manage stress include meditation, exercise, yoga, and starting a hobby you enjoy.

​6. Consider Supplementation –

​You can never supplement yourself to good health, but it is often necessary to add a few good-quality supplements to your daily regimen to help ensure your immune system is operating at an optimal level.

​     Vitamin D3 –

Optimizing vitamin D levels reduces the chance of developing an autoimmune disease and improves your immune system.  T​he optimal level is 50-80 ng/mL of 25-OH-vitamin D.  In most people, this can be achieved with a supplement dose of 2000-5000IU per day.  Sometimes it may require a higher dose for a short period of time.

​     Vitamin C –

One study showed that taking 1000-2000mg of vitamin C per day reduced the duration of a cold by 8% in adults and 14% in children.

​     Zinc –

One review showed that supplementing with 75mg of zinc per day in patients with a cold resulted in a 33% reduction in the duration of the cold.  Zinc works by helping prevent viruses from entering the cells of the body.  A typical daily dose is 30-60mg but more can be taken during an acute infection.

​     Elderberry –

A meta-analysis showed that elderberry significantly reduced the symptoms during an upper respiratory infection.  Typical doses are 1 TBSP 3-4 times per day of syrup or one 175mg lozenge twice daily.

​     Garlic –

This study showed that supplementing with garlic reduced the incidence of the common cold by about 30%.

​     Probiotics –

Probiotic supplements boost our immune response and reduce the amount of viral shedding.

     Melatonin –

Not only does melatonin play a role in our sleep and circadian rhythm, it helps to regulate our immune system and has antioxidant functions.  A typical dose is 1-5mg taken an hour before bedtime.

​     Fish Oil –

Omega 3 fatty acids boost our immune system in several ways.  A typical dose is 1000-2000mg daily.

​7. Talk to Your Doctor About Your Medications

​If you are taking several prescription or over the counter medications, talk to your medical provider to see if it is possible to reduce or eliminate as many of them as you can. Each could potentially be affecting your microbiome as we discussed earlier.

​8. Just For Fun

​If you want to have a laugh with a friend or family member, refer them to this article!

Keto Diet Pros and Cons

​Chances are you have heard about the Keto Diet ​​a lot from friends, coworkers, or family members.  It is also all over the news and social media.

​The popularity of the Keto Diet has soared over the past few years via marketing campaigns and word-of-mouth.

So what is the Keto Diet?  Is it safe?  Does it work?  What foods do you eat ​and what do you avoid?  What are the ​keto diet pros and cons?  What does the research show about it?  When should you consider using it?

I will answer these questions and many more in this article…​

​History of the Keto Diet

​Versions of the ketogenic (Keto) diet have been around for over 100 years.  It was used in the 1800s to help control blood sugar levels in patients with diabetes.  It was introduced as a treatment for epilepsy in children in the 1920s.  It has since been used as a treatment for various conditions, including cancer, dementia, and other neurological disorders.

Over the past 30 to 40 years, its popularity as a weight loss diet has skyrocketed.  It began with the Adkins Diet, which promoted a mostly protein (meat) based diet with moderate fat intake and low carbohydrates.  ​Other diets ​have since been developed such as the South Beach Diet, Whole 30, Paleo, and many others.  

The primary progression of these diets has been in the percentage of fat that is recommended.

​What is the Keto Diet?

​While Adkins, South Beach and other diets ​have a high amount of protein, the Keto Diet gets the majority of its calories from fats.  Protein levels are moderate, while carbs are extremely low (~5% on the traditional Keto).

The concept of the keto diet is to make your body burn fat for fuel instead of glucose.

The preferred fuel for our cells is glucose (sugar).  Glucose is derived from eating foods that contain sugar and carbohydrates.  That glucose is either used immediately for fuel or stored in the liver or muscles as glycogen.

With the keto diet, the body is deprived of the majority of food sources of sugar and carbs.  After 3-4 days, all stores of glucose in the body are used up.  The liver will then begin burning fat for fuel.  A bi-product of this process is the production of ketones (thus the name ketosis).

​Keto Diet vs Low Fat Diet

​Many of the major health organizations (AHA, ADA, etc) still hold the position that too much fat in the diet is a major cause of health issues.  In fact, most still recommend keeping fat intake to no more than 30% of the total calories.

However, many studies over the past decade have called this into question.  Many experts now recommend reducing the carbohydrate intake rather than fat.

So which is better a helping with weight loss?  Low car or low fat?

One study showed no weight loss difference between a low fat and a low carb diet.

Several other studies, however, show that low carb diets result in more weight loss than low fat diets, especially early.  Click here, here, here and here for examples.

​A big problem with most low fat diets is participants tend to replace the fat content in the diet with simple or processed carbs, which is much worse than eating fat.

​Benefits of the Keto Diet

​Potential Negatives of the Keto Diet

  • The keto diet can be hard for some people to follow.
  • The first 5-14 days on the keto diet may cause flu-like symptoms as your body converts to burning fat for fuel.  This is sometime called the “keto flu.”  The best way to manage this is to increase fluid intake.
  • Keto may cause low blood sugar, especially initially.  Be especially careful if you are diabetic and taking a medication that lower glucose levels (such as sulfonylureas).
  • It may cause in increased risk for kidney stones.  This is typically more common in the high protein diets like Adkins.
  • Staying on the keto diet for a prolonged period of time can possibly lower bone density.  Another study, however, showed no significant change.
  • It may increase uric acid which can trigger a gout attack.  This is the highest risk within the first few days of starting the diet.  Reducing inflammation in the body will eventually lower the risk for gout.
  • The source of fat and protein in a keto diet is very important.  One study showed an increased death risk from people eating a keto diet that was using animal sources for the fat and protein vs plant-based fat and protein.
  • The keto diet is not recommended during time of rapid growth – pregnancy and breast-feeding.  Children must be closely monitored if on it.
  • It may cause constipation.  Push the vegetables.
  • After stopping the keto diet, ghrelin levels may rise which can increase the appetite temporarily.
  • ​It could potentially lower free thyroid hormone levels.  Monitor your thyroid levels regularly while on the diet, especially if you have know thyroid issues.

​How Long Should You Stay on the Keto Diet?

​The short answer is, it depends.  Some people feel great on the keto diet, while other people can feel fatigued or moody while on it.

Some experts feel that the true benefit of the keto diet would be to go in and out of ketosis, not necessarily stay in ketosis indefinitely.

I typically recommend giving the diet a good 4-6 weeks.  At that time, assess how you feel and monitor your labwork – blood sugar, insulin, thyroid, kidney function, and liver function.

If you feel good, you can continue on it for longer.  If you feel bad, consider slowly adding back some good whole food carbs (fruit, veggies, legumes) until you feel better.

Another option to consider is eating a strict keto diet for about 1 month every 3-4 months, then going back to a whole food, organic diet with more carbs during the other months.

Every body and every system is unique.  You may have to do trial and error until you find what eating plan best fits you.

​​How Do You Get Off of the Keto Diet?

  • Go slow.  Don’t just go back to the way you used to eat.
  • Slowly increase complex carbs (fruit, veggies, beans) one meal per day.  If you are tolerating it, you can gradually add them to other meals.  Watch for bloating or gas and slow down adding them if it occurs.
  • Avoid simple carbs and sugars.  Remember, that’s probably what got you to the point of needing to start the keto diet in the first place!
  • You might feel more hungry at first and might even have some blood sugar variations.  Watch your blood sugar and avoid the munchies.

Will You Gain Weight After Stopping the Keto Diet?

​The answer is maybe.  If you go right back to your previous poor eating habits, you will likely gain most if not all of the weight that you lost on the diet.

That is why it is so important to transition off of the keto diet slowly and carefully, preferably to a primarily whole food, organic diet.  Continue to avoid sugar and processed carbs (pasta, bread, doughnuts, etc).

If you do this right, your weight will most likely maintain at your goal weight that your worked so hard to achieve while on the keto diet.

​My Guidelines for Using the Keto Diet

  • The keto diet is a great choice for patients with seizure disorder or other neurological or cognitive conditions.
  • Great choice for patients with insulin resistance/type 2 diabetes.  If on diabetes medication, closely monitor your glucose levels and consult with your medical provider before starting the diet.  The medications may need to be reduced rapidly or even stopped.
  • ​Be careful of the sources of fats and proteins.  Plant sources are better than animal sources.
  • Eat plenty of whole, green vegetables.  You need the fiber and it is a healthier source of protein and fat.
  • Hydrate, hydrate, hydrate!  Most of us are dehydrated which will worsen potential side effects of the diet.
  • Consider doing keto for a limited time several times per year.  Eat a whole food, organic, primarily plant-based diet the other times.

​Summary

​The keto diet is an extremely popular diet that works by reducing the amount of sugar and carbs consumed.  The majority of calories come from healthy fats, while protein intake is moderate.

After a few days, the lack of sugar in the diet forces the body to burn fat for fuel.  This results in the production of ketones.

The keto diet can cause significant weight loss and help reduce appetite.  It has been shown to help treat neurological and cognitive disorders.  It can also help reduce insulin resistance and lower cholesterol levels.

The keto diet can cause significant side effects early in its use.  It may also increase uric acid, worsen constipation, and may have an effect on thyroid levels.

It is important to eat from good sources of fat and protein, especially plants.

Make sure you hydrate well while on the keto diet.

​Now it’s your turn…

Have you tried the keto diet?  What results did you have?

Di you have any side effects or other problems?

Leave any comments or questions in the comments section below.

SHBG Test – How to Interpret Your Results and What to do With Them

​SHBG is short for Sex Hormone Binding Globulin​.

This test is rarely ordered, which is unfortunate because it can give you a lot of information about the hormones in your body.

​High levels can ​lead to symptoms of excess estrogen, excess thyroid, and low testosterone.

Low levels can lead to symptoms of low thyroid, low estrogen, and excess testosterone.

​In this article, I will ​discuss how to interpret your SHBG test results, and ​list some common causes of elevated levels and low levels.  

I will show how SHBG can be used to monitor your thyroid function if you are on thyroid medication.

​I will also discuss some things that you can do to help you get your SHBG level back into the optimal range​ whether it is high or low…

More…

​What is SHBG?

​SHBG is an acronym for sex hormone binding globulin.

It does what it sounds like it does – it binds up sex hormones.

Why is that important?

In order to understand this better we need to discuss how hormones work in general.

​The vast majority of hormones in your body are bound to proteins in the bloodstream.  This helps to stabilize the hormone so it can get to the targeted cells all over the body.

While it is bound, however, it is inactive and not available for the cells to use.

​In order for the hormone to be active, it must break away from the protein.  This makes it a “free” hormone and it can then enter the cells and turn on the cellular function it is designed to do.

This is called the Free Hormone Hypothesis.

The “free” hormones are therefore the “active” hormones.

The ​amount of “free” hormones is much smaller than the amount of “bound” hormones.

This protein binding is one of the ways that the body uses to regulate the hormone ​levels.

So what about SHBG?

SHBG levels naturally ​increase as we age.  Since ​most hormone levels naturally decline as well, this makes a deficiency of those hormones (especially testosterone) even more pronounced.

​Sex Hormone Binding Globulin binds to several different hormones.  The body uses SHBG to ​inactivate these hormones in the bloodstream.

Too much of it can be bad because it can bind so much of the hormone that we can have symptoms caused by a ​lack of that hormone.

Too little can also be bad because it can cause an excess of certain hormones which ​also causes symptoms.

Even small changes in SHBG can cause substantial symptoms and problems.

SHBG has a stronger affinity for some hormones that others.

It will preferentially bind to sex hormones in this ​order (from highest affinity to lowest):

  • Dihydrotestosterone (DHT)
  • Testosterone
  • Androstenediol
  • Estradiol
  • Estrone

​As you can see, SHBG has a greater affinity for androgens than estrogens.

​You can therefore predict the symptoms you may have by knowing the effect that the SHBG level has on your androgen levels.

For example, if you have an elevated SHBG, it will bind DHT and testosterone which will cause symptoms of low testosterone (weight gain, depression, increased belly fat, loss of muscle, etc.).

With low levels of SHBG, you will have more unbound or free testosterone which will cause symptoms of high testosterone (acne, facial hair growth, PCOS, etc).

Hopefully you can see why it’s important to check your SHBG level if you are having any symptoms of hormonal imbalance to help you and your doctor determine what issues are going on in your body.

The optimal range for SHBG is 60-80 nmol/L.  Any level below or above this range should be investigated.

​​Elevated SHBG Test

There are several things that I will list below that can elevate SHBG levels.

​Most of these occur because they affect​ one of these 2 hormones in the body​ – Estrogen and thyroid​ hormone.

An increase in either or both of these hormones will stimulate the liver to increase SHBG production.

A SHBG level > 80 nmol/L is considered too high.

​​Common Causes of ​Elevated SHBG

​Another hormone to keep in mind that is closely linked to SHBG is cortisol.

Cortisol is our stress hormone.  In times of increased stress (physical or mental), our adrenal glands increase cortisol production.  

​An elevated cortisol level stimulates the liver to increase SHBG production.

​Symptoms of Elevated SHBG

​Please realize that an elevated level of SHBG does not in itself cause any symptoms.

The symptoms are caused by the effect that the high SHBG level has on hormones in the body.

Most of the symptoms will be due to either excess estrogen and/or low testosterone:

  • Menstrual Irregularities
  • searchWeight Gain (pear shape type)
  • searchMood Swings
  • searchBreast Tenderness
  • searchLoss of Muscle Mass
  • searchFatigue
  • Fluid Retention

If the elevated SHBG is caused by the situation of a high thyroid level (hyperthyroidism or excessive oral thyroid medication), you can also have symptoms related to the elevated thyroid such as tremor, palpitations and weight loss.

​How to Treat an Elevated SHBG

​Treating an elevated SHBG has more to do with finding the cause of the elevation rather than treating the elevated SHBG itself.

There are several things you should consider doing:

1.  Check your Estrogen and Progesterone Levels –

​The ratio of these 2 hormones is more important than the numbers themselves.

Check the levels in the middle of your cycle (2 weeks after your last period) for the best results.

If the ratio of estrogen:progesterone is >10:1, you have estrogen dominance that needs to be addressed.

​2. Check Your Thyroid Levels –

If your estrogen level is normal, then it is highly likely that your thyroid is the culprit of your elevated SHBG.

Check a complete thyroid panel, especially free T3 and free T4.

If these are elevated and you are on thyroid medication, you may need to lower your dose or even change your thyroid medication.

If you aren’t on thyroid medication, you need to have more testing done ASAP to find the cause of your elevated thyroid (most likely Grave’s Disease).

3.  Stop Smoking!
4.  If you are on oral birth control pills, consider using another form of birth control –
​5.  Work on Stress Management –

I discuss several techniques to better manage your stress in my article on Adrenal Fatigue.

​Low SHBG Test

​Low SHBG is more difficult to detect and often harder to treat.

As a result, it is often ignored much more than an elevated SHBG.

Common Causes of Low SHBG

​A low SHBG typically occurs in menopausal women or patients with hypothyroidism (low thyroid).

​So if your SHBG is ​< 60 nmol/L, you should look at estrogen and thyroid as the probable causes if you are menopausal.

If you are still menstruating, then hypothyroidism is the likely cause.

If one or both of those hormones is low, SHBG levels will drop which will increase free testosterone, paving the way for conditions such as PCOS.

This series of hormone imbalances also ​appears to set up a person to develop insulin resistance.

In fact, a low SHBG level has been shown to be a strong predictor for type 2 diabetes in both men and women.

​Symptoms of Low SHBG

​The symptoms associated with a low SHBG are typically caused by low thyroid hormone, low estrogen, and elevated testosterone.  The include:

  • Weight Gain
  • search​Menstrual Irregularities
  • searchFatigue
  • searchHot flashes
  • searchAcne
  • searchFacial Hair Growth
  • searchHair loss
  • searchDepression

​Keep in mind that your individual symptoms will depend on which hormones are out of balance and to what extent.

​Treatment of Low SHBG

​If you have a low SHBG, you should consider the following things:

​1.  Check a complete thyroid panel –
  • TSH
  • free T4
  • free T3
  • reverse T3
  • TPO antibodies
  • thyroglobulin antibodies

​Compare these tests with their optimal levels to determine if you have a thyroid issue.

If your thyroid function is low, it is probably affecting your SHBG level and you will need to consider taking a thyroid medication and doing other things to help boost your thyroid function.

​2.  Check your estrogen/progesterone ratio if you are menopausal- 

After menopause, your estrogen levels will drop which can drop your SHBG level.

If that is the case in your situation, you might need to consider bioidentical hormone replacement therapy.

​3.  Check your free testosterone level – 

If your SHBG level is low, there will be less of it to bind to testosterone, so it may cause your free testosterone level to rise.

This can usually be alleviated by maximizing your thyroid medication which will raise your SHBG level.

​How the SHBG Test Can Be Used to Monitor Thyroid Function

​One final benefit of checking your SHBG level is it a good indicator of the thyroid function in your body.

In states of low thyroid function, the SHBG level drops.

In states of high thyroid function, the SHBG level rises.

This allows the SHBG to be used as a marker to assess the thyroid hormone absorption and cellular function.

If you have low SHBG and hypothyroidism, you should test your SHBG level at the beginning of treatment to assess if you are on the right type of thyroid hormone and the right amount.

If you are taking a T4 only thyroid medication and your SHBG level does not increase, you may have a problem with peripheral conversion of T4 into active T3.

You therefore may need to change to a natural dessicated thyroid (NDT) or add T3 to your current regimen.

On the flip side, if after starting your thyroid medication your SHBG level rises > 80 nmol/L, that is an indication that your dose is too high and it should be reduced.

​Summary

​The sex hormone binding globulin level gives us important information on the status of several hormones in the body.

​A high level is typically caused by estrogen excess and excess cortisol.

​A low level is typically caused by low thyroid.  It also is an indicator that you may be having issues with insulin resistance.

The key to treating an abnormal SHBG level is to identify what is causing the abnormality and correct it.

Doing this will help return the SHBG level to the optimal range and reduce symptoms.

​Now it’s your turn…

Do you have an abnormal SHBG level?

Have you identified the cause or causes?

Please leave your comments below.

Treatment of Low Ferritin Levels

​Ferritin is an indicator of how much iron is stored in your body.

Low ferritin levels can cause symptoms such as fatigue, shortness of breath, hair loss, and difficulty exercising.

In this article, I will discuss ferritin, signs and symptoms of low ferritin, the common ​reasons that cause low levels, how to test for it, and the benefits of getting if back into the optimal range.

Lets get started…

​What is Ferritin?

​Ferritin is a protein that contains iron.  It is the primary form of iron that is stored in cells. 

​The level of ferritin in the blood is a reflection of how much iron storage​ is in the body.

Iron is an essential element that the body needs in order to produce red blood cells.  Red blood cells are what carry oxygen to the cells​.

Our bodies cannot produce iron, so it much absorb it from the foods or supplements that we consume.

The majority of iron that we absorb is used to make hemoglobin, the oxygen-carrying molecule in red blood cells.  Most of the remaining iron is stored as ferritin in the cells.  

​If iron levels begin dropping for whatever reason (we will discuss these shortly), the body releases ferritin into the blood in order to ​provide the iron that is​ lacking. Eventually, the ferritin levels may drop which is the first indication of iron deficiency.

If this deficiency continues, the ferritin stores will eventually be depleted, hemoglobin production will be reduced, and anemia (low blood levels) will result.

Therefore, a ferritin level is the earliest indicator we have to detect a deficiency of iron.

​Signs and Symptoms of Low Ferritin

​There are many common signs and symptoms of low ferritin or iron, but none are specific to that condition.  In other words, the symptoms could also indicate a completely different issue than low ferritin. 

The most common symptoms of low ferritin include:

  • Chronic fatigue or low energy
  • check​Inability to tolerate exercise and reduced activity level
  • checkHair loss or lack of hair growth
  • checkFrequent illnesses
  • Autoimmune condition(s)
  • GI symptoms – bloating, low stomach acid, etc.

​If you are having some of these symptoms, it is important that you see your medical provider and get a thorough history and physical as well as lab testing to help determine the potential cause(s).

​Can You Have Low Ferritin but No Anemia?

​Absolutely yes!  

​A low ferritin level is typically the first lab abnormality that ​occurs when iron levels start dropping.  It can occur for weeks or even months before the ferritin levels are depleted to the point that iron and hemoglobin levels drop.  

As a result, many patients may have symptoms of low iron, but they are not treated because it has not progressed to the point of causing anemia which would then show up on standard lab tests.

​A ferritin level is often not included in the initial labs tests of patients with the above symptoms. You may have to ​specifically request it when you see your medical provider.

Causes of Low Ferritin

​Very simplistically, low iron/ferritin is caused by one of 2 things – either you aren’t absorbing enough iron or you are losing iron somewhere.

With that in mind, the most common causes of low ferritin that I see in my practice include:

  • Heavy menstrual bleeding
  • checkChronic internal bleeding – usually from somewhere in the GI tract, such as a stomach ulcer, colon polyp, or even an undiscovered malignancy.
  • Gastrointestinal malabsorption – very important but often hard to detect.  This can be caused by SIBO, SIFO, low stomach acid, intestinal dysbiosis, leaky gut, IBS, or inflammatory bowel disease.
  • Autoimmune conditions such as celiac disease or inflammatory bowel disease.  These damage the intestines which leads to malabsorption and even chronic bleeding.

​Lab Tests for Ferritin

​When evaluating for the possibility of low iron or ferritin, I recommend getting the following tests:

  • CBC – Indicates hemoglobin and hematocrit levels, plus will show other indices that can indicate iron deficiency.
  • checkTotal Serum Iron – Most labs list the normal range to be 60-170 mcg/dL.
  • Total Iron Binding Capacity (TIBC) – Levels > 450mcg/dL typically indicate low iron levels, while < 240 mcg/dL indicate high levels of iron.
  • Ferritin – Every lab is slightly different, but the typical reference range is 15-150 ng/mL.

​Keep in mind that like with many other tests, there is a difference between the “normal” reference range of ferritin and the “optimal” range.  

Obviously, any level below 15 is “low” and should be addressed.  However, people with ferritin levels in the “low normal” range of most laboratories can still be symptomatic.  If they are treated they will usually feel better.

Remember, a low or suboptimal ferritin level may be the first indicator of iron levels that are beginning to drop.  It may take weeks or even months before the other labs become abnormal enough to get the attention of your medical provider.

​That is why I consider the optimal range for ferritin to be 30-40 ng/mL.

​Benefits of Correcting Low Ferritin

​Besides reducing symptoms, why should you correct your ferritin level?  Let’s discuss the most obvious:

​1. Low Iron Impairs Thyroid Function –

​One of the biggest reasons to correct your ferritin level is its effect on​ the thyroid.

Many studies have shown that low iron impairs proper thyroid function.

That makes sense when you think about how so many of the symptoms of low iron/ferritin are the same as the symptoms caused by low thyroid – fatigue, hair loss, etc.

Replacing low iron levels should result in an improvement in your thyroid function.  This is especially important if you have known hypothyroidism.

​2.  Improves Hair Growth and Stops Hair Loss –

Iron plays a critical role in normal hair growth and repair.

Low iron/ferritin is an important and common cause of hair loss in premenopausal women.  In many of those situations, the hair loss is often blamed on genetics or thyroid problems when it’s actually from low iron.

Another study showed that in healthy women of childbearing age, a ferritin level of < 30 ng/mL was strongly associated with telogen hair loss.

As I discussed earlier, there is often a difference between a “normal” lab result and an “optimal” lab result.

If you are having hair loss and your ferritin level is < 30 ng/mL, it may be worth taking an iron supplement to see if the hair loss improves.

​Low iron is not the only nutrient that can cause hair loss.  Other nutrient deficiencies should also be considered, including selenium, zinc, and l-lysine.

​3.  Improves Energy Levels

​One of the primary symptoms associated with low iron and ferritin is fatigue or ​decreased energy levels.

This is thought to be ​caused by a couple of reasons:

​- Iron helps carry oxygen to peripheral tissues.  Oxygen is required for normal energy production in the mitochondria of the cells.  When the iron is low, oxygen transport may be impaired.

– Iron is directly involved with normal thyroid production.  Thyroid hormone is also involved with ​mitochondrial energy production.

Low energy production typically manifests as a sense of ​fatigue or lack of energy.

​Optimizing the ferritin level therefore helps to ensure that ​the mitochondria are producing energy at their peak ability which will increase the feeling of having ​a higher energy level.

​4.  Improves Exercise Tolerance

​As I just discussed, iron plays an important role in delivering oxygen to peripheral tissues.  This includes skeletal muscle.

A decrease in energy production in skeletal muscles will result in a decrease in strength and exercise capacity.

This will typically present as an increase in heart rate and worsening shortness of breath (more than you would expect at your level of fitness) while exercising.

This makes sense if you think about it.  If you have less oxygen getting to your tissues, then the heart rate will increase and the respiratory rate will increase to try to compensate.

If your amount of exercise decreases, typically your body weight will increase which worsens insulin and leptin resistance.

If you are experiences more shortness of breath during exercise than you think you should be having, you may want to consider checking your iron and ferritin levels.

​5.  Improves the Immune System

​A critically important yet rarely considered role of iron in the body is how it affects our immune system.

​Low iron changes immune function and limits the cellular response to bacteria.

Other nutrients such as zinc and vitamin D also affect the immune system, but if you are getting frequent infections, you may want to think about checking your iron and these other nutrient levels.

​The Cause of the Low Ferritin May Also Be Causing Other Nutrient Deficiencies

​If you are deficient in one nutrient such as iron, there is a good chance that you may also be deficient in others.

That is because the root cause of the low ferritin or iron may also be causing other nutrients to be deficient.

For example, if you aren’t absorbing iron because of low stomach acid or dysbiosis, that issue may also be reducing the amount of vitamin B12 that is being absorbed.

​Also, some nutrients are required for the normal absorption and metabolism of others.  For example, vitamin C is needed to absorb iron.

This is something to keep in mind if you find a deficiency of a nutrient such as iron, but correcting it doesn’t completely resolve your symptoms.  You may need to look for other nutrient deficiencies.

​Treatment of Low Ferritin

If you decide to take iron supplements in order to increase your ferritin level, there are some things to keep in mind:

​- ​Not enough iron is bad, but too much iron is also bad.  That is why I would not recommend supplementing with iron unless you know your ferritin level and your monitor it regularly.

​- Liquid iron is typically better tolerated than capsule/tablets.  This is because of the absorption issues ​I have discussed earlier.  Liquid iron is typically more rapidly absorbed and causes less constipation.  If you don’t tolerate liquid iron or if your ferritin level doesn’t improve, you may have to change to capsules.

​- B12 deficiency is commonly associated with low ferritin.  Make sure you monitor for both nutrients.  It is highly likely that you will need to supplement for both.

Don’t take iron within 2-4 hours of taking your thyroid medication.  Iron impairs the absorption of thyroid hormone, so always take iron as far away as possible from when you take your thyroid medication.

​- Extremely low levels may require IV iron infusions.  This will depend on the cause of the low ferritin, which should always be investigated.

My recommended brands for iron and B12 are listed below (click on each to be taken to Amazon.com):

​I typically recommend rechecking ferritin (and B12) levels 2-3 months after starting treatment and continuing treatment until the root issue has been investigated and corrected.

​Can Low Ferritin Cause Weight Gain?

​Yes, but most likely due to its relationship with the thyroid.

​Low ferritin reduces thyroid hormone production because of heme-dependent thyroid peroxidase.

Also, low thyroid results in insulin resistance and leptin resistance, both of which lead to weight gain.

What About High Ferritin Levels?

​A high ferritin level may mean that there are high iron levels in the body, but it can mean other things as well.

If someone has normal or even low iron levels but their ferritin is high, it typically means that there is some type of inflammation occurring in the body.

​That is because ferritin is what we can an acute phase reactant.

If the ferritin is >150 mcg/dL and the iron is normal or low, then other inflammatory markers should be tested, including CRP and ESR.  This will need to be ​investigated under the direction of a knowledgeable medical provider.

​Summary

​Iron is a nutrient that is critical to many vital functions in the body.  

A deficiency of it can cause many negative symptoms.  These include fatigue, poor exercise tolerance, shortness of breath, and hair loss.

Ferritin is an indicator of the amount of iron stored in the body.  When ferritin is low, it indicates that the body is deficient in iron.

High ferritin levels typically indicate that an inflammatory process is occurring in the body.

Other nutrient deficiencies may be associated with low iron and should be investigated.

​Finding the root cause of the low ferritin level and correcting it is crucial for long term correction success.

Now it’s your turn…

​Have you ever had low ferritin levels?

What was the cause?  Did treatment help reduce your symptoms?

What treatment helped?

Please leave any questions or comments below.

How to Naturally Lower Cholesterol Levels

​Have you​ been told you that your cholesterol level is too high?

​Has your doctor even recommended a prescription medication to lower it?

​Is a high cholesterol level dangerous?  Is there anything that you ​can do to help?

In this article, I will discuss how you can lower your cholesterol level naturally WITHOUT medication.

​The discussion will include which foods you should avoid, which foods you should eat, supplements that help, and other lifestyle changes that ​can help ​get your cholesterol level back into the optimal range.

Ready, set, go…

​What is Cholesterol?

Cholesterol is a lipid molecule that is produced by all animal cells.  It is an essential structural component of all animal cell membranes.  In fact, about 30% of cell membranes are cholesterol.  The vast majority of cholesterol is made by the liver.

​Within the cell membrane, cholesterol plays a role in intracellular transport, cell signaling and nerve conduction.

Cholesterol is also a precursor to the production of hormones, bile acids, and vitamin D.

Cholesterol is transported inside lipoprotein particles throughout the body.  These lipoproteins come in 2 primary forms – LDL and HDL (there are also VLDL and IDL particles, which I will not discuss in this article).

It is believed that ​low density lipoproteins (LDL) particles (as well as IDL and VLDL) promote the development of atheromas in artery walls while high density lipoproteins (HDL) particles promote the removal of those atheromas from the artery walls.

​That is why most people call LDL the “bad” cholesterol while HDL is the “good” cholesterol.  ​More recent research has shown a much more complicated picture than that, but ​that is general description of each lipoprotein.

The belief is if you can reduce the ​amount of LDL in the body, it will reduce the incidence of atherosclerosis (the laying down of plaque in the arteries).  Therefore, less plaque = less heart disease.

But is it really that simple?

​​Is It Dangerous to Have High Cholesterol?

Keep in mind that cholesterol is essential for the body.  We must have cholesterol to have normal cell membranes.

We also must have cholesterol to make many of the hormones in the body, including estrogen, testosterone, adrenal hormones and vitamin D.

Cholesterol is vital for forming memories and other critical neurological functions.

It also is the foundation for bile acids, which are required for fat digestion and the absorption of nutrients from our food.

So, cholesterol isn’t bad.  ​But high cholesterol is bad, right?  Not necessarily.

What may be bad is when you have too much of the wrong forms of lipoproteins.  The small, dense LDL particles are believed to be the ones that increase the risk for plaque formation.

​However, this increased risk may be more theoretical than actual.

Multiple studies have attempted to show that a high cholesterol level (especially LDL) increases your risk for heart disease.

This meta-analysis from JAMA in 2016 involving 316,000 patients​ did show that lower levels of LDL​ were associated with lower rates of coronary events.

​However, a systematic review and meta-analysis from the American Journal of Clinical Nutrition in 2015 looked at 40 studies involving over 361,000 patients.  They were unable to draw any connection between cholesterol levels and an increase in ​heart disease risk.

Another systematic review from Cardiovascular Medicine Research in 2015 looked at 19 cohort studies of cholesterol levels and mortality in the elderly.  To their surprise, not only was a high LDL level NOT associated with an increased risk of ​death, the exact opposite was found.  People with the highest LDL levels lived ​longer!

​So should we worry about cholesterol levels?  My honest answer is I’m not sure.

​People who live healthy lifestyles and eat natural, healthy foods have lower cholesterol levels than people who eat the standard American diet and have unhealthy lifestyles.  The exception to this is people that have familial hyperlipidemia.

​Cholesterol levels can then be used as an indicator o​f the diet and lifestyle that a person is living.  You yourself probably know that when you are not eating well, your cholesterol levels increase, especially the LDL.  When you aren’t exercising, your HDL level drops.

​Elevated levels of small, dense LDL does appear to slightly increase cardiovascular risk.  Plus, I believe it is good to monitor our HDL and LDL levels as a way of measuring how healthy we are living.

​How to Naturally Lower Cholesterol Levels

​So if your cholesterol levels are higher than you or your doctor would prefer, what can you do about it?

Chances are, your doctor will recommend that you start a statin drug.  There is no doubt that these drugs will drop your cholesterol levels.

However, there are many side effects and even dangers that come with this class of medication (read my article here). There are also questions about how much they really prevent bad outcomes.

​Of note, there are many experts that believe statins can reduce the risk of MI because of their anti-inflammatory and anticoagulant actions, NOT because they lower cholesterol.

In my opinion, if you have familial hyperlipidemia and​/or if you are a man with established heart disease, you should probably be taking a statin drug (if you can tolerate it).

Everyone else (women, people with high cholesterol but no history of heart disease) should discuss it with ​their doctor first and really focus on diet and lifestyle as the ​primary means of reducing it.

Now let’s talk about some things that you can do to naturally lower your cholesterol levels…

Avoid These Foods (Foods that Raise Cholesterol)

​There are several things that you can do to lower your cholesterol, but like most health issues, you should always start with your diet.

Let’s list some things that should definitely be avoided if your cholesterol is too high:

​1.  Sugar

​One of the most powerful things that you can do to lower your LDL cholesterol level is to remove the majority of sugar from your diet.  The average American eats over 150 pounds of sugar every year.

We have all been told for years that too much fat in the diet raises cholesterol levels and sugar is harmless except for being empty calories.  That just isn’t true!

​Sugar calories are deadly calories. Sugar causes heart attacks, obesity, type 2 diabetes, cancer and dementia, and is the leading cause of liver failure in America.

The biggest culprit for most people is sugar-sweetened drinks.  The average American gets over 1/3 of their daily sugar calories from soft drinks!  When you add sweetened tea, coffee, and energy drinks, that number ​is even higher.

Excess sugar intake leads to insulin resistance, elevated triglyceride levels, low HDL levels, increased levels of low density LDL particles, and​ an increase in inflammation​.  All of these cause an increased risk of heart disease, independent of any other risk factors.

A JAMA Internal Medicine study from 2014 showed that people eating the highest amount of sugar had a 400% higher risk of heart attack than people eating the lowest amount of sugar!  The study showed that your risk of heart attack doubles if you get 20% of your calories from sugar.

That is a scary statistic, especially when you realize that over 10% of Americans get ​more than 25% of their calories from sugar!

Several countries worldwide have battled this epidemic by ​taxing soft drinks, banning junk food television advertising, and eliminating processed foods, junk food and sugar-sweetened beverages from schools. This study even calculated the potential health benefits of taxing soft drinks in the US.

I am personally not a fan of using government intervention as a way of controlling behavior in society, but it underscores the importance of increasing education in the areas of nutrition and health and putting pressure on companies to produce healthier food options.

​2.  Refined Carbohydrates

​Refined carbohydrates, also known as simple carbs or processed carbs, are just as dangerous as sugar. The average American eats almost 150 pounds of processed flour each year.

​​Refined carbs are carbohydrates that have been processed in a way that removes the majority of nutrients and fiber from them.  When they are consumed, they are almost instantly converted into sugar in the body.

Examples of refined carbs includes bread, rolls, pizza, pasta, white rice, and most ready-to-eat cold cereals​.

In a way, refined carbs are even more dangerous than table sugar.  In fact, blood sugar levels rise higher when you eat processed flour than if you ate table sugar!

​If you are over the age of 30, most of you will remember the low-fat craze of the 1980s and 1990s.  At that time, it was felt that saturated fats were the absolute worst thing that you could eat.

​Massive advertising campaigns were launched encouraging people to eat less fat.  The unintended result was people replaced those fats in their diets primarily with refined carbs.  Obesity, type 2 diabetes, and heart disease levels increased ​dramatically.

Finally, the medical community has realized their error and are SLOWLY changing their attitudes about refined carbs.  This study showed that while eating a diet high in saturated fat is not good for you, it is still significantly better than eating a diet high in refined carbs.

​3.  Alcohol

​Friends and family members that ​love a good wine often spout to me the benefits of alcohol consumption and how it reduces heart disease.

​So what does the research say?

​I think the research is clear that occasional alcohol is okay and may even have some mild benefits.

The key is that you should choose low carb options and drink no more than 1-2 drinks.

​Alcohol tends to increase your cravings and appetite for bad foods.

If alcohol is something that you really want to have as a part of your life, at least keep these things in mind:

Beer is made from grains (oats, barley, wheat and rye), malt (sugar) and yeast.  It was originally brewed to provide nourishment for adults (and children!), especially during times when food was scarce.  Realize that when you drink beer, you are basically drinking a liquid meal.

Cider is fermented apple juice.  Every 12 ounces of cider can have up to 30g of sugar!

Sweet liqueurs are similar to cider.  They typically are loaded with sugar.

Rum is a low carb drink.  However, most people mix it with high carb drinks such as sodas or energy drinks.

Red wine​ is generally low carb.  ​It also contains resveratrol which is a potent anti-oxidant.  ​Light to moderate consumption has been associated with a decrease in LDL, reduced atherosclerosis, and reduced oxidative stress.  The danger is it tends to be often consumed with high carb foods such as pasta, pizza, etc., and it can increase your appetite for those types of food.

White wine as a general rule often contains more sugar and carbs than red wine.  5 ounces of wine equates to about 125 calories.  Again, it may increase your cravings for foods that should be avoided.

Keep in mind that even if you drink in moderation, it will typically STOP weight loss and may even cause weight gain in my professional experience.

​4.  Trans Fats

​Trans fats, also called trans fatty acids, are a type of unsaturated fat that occur in small amounts in nature, but have become widely consumed due to industrialized food production.

Trans fat is formed through an industrial process that adds hydrogen to vegetable oil, which causes the oil to become solid at room temperature.

This partially hydrogenated oil is less likely to spoil, so foods made with it have a longer shelf life.  Many restaurants also cook with it in their deep fryers because it needs to be changed less often.

​Trans fats are commonly found in food such as margarine, ghee, snack food (such as chips) packaged baked goods, and fried fast foods.

Trans fats have been shown to lower HDL and raise LDL levels and may lead to an increase in heart disease.

This is just another example about why it is dangerous to eat out in restaurants excessively.  You really don’t know what you are eating or how they prepared your food!

5.  Caffeine

People have tried to vilify caffeine for years, blaming it for anything from high blood pressure to stroke, cardiac arrhythmias, and heart disease.

But is caffeine really that bad?

The answer is probably not if consumed in moderation.

This literature review from 2017 showed that moderate caffeine intake is not associated with increased risks of total cardiovascular disease; arrhythmia; heart failure; blood pressure changes among regular coffee drinkers; or hypertension in baseline populations.

There is no evidence that I could find that suggests that caffeine intake increases cholesterol levels. Now, if you are adding a bunch of sugar to your coffee or tea, that is a different story.

My only caution would be in people who are suffering from adrenal fatigue.  Caffeine puts added stress on the adrenals to produce cortisol levels which can be harmful when they are already strained from physical, mental, or emotional stress.  In those situations I typically recommend stopping all caffeine until the adrenals have had time to recover.

By the way, there is also a suggestion that excessive caffeine intake make cause a decrease in bone density.  According to this article, as long as you optimize your vitamin D level, eat foods with adequate calcium content, and don’t drink more than 3 cups of coffee per day, the risk should be minimal.

Eat These Foods (Foods That Lower Cholesterol)

​So we’ve talked about the bad, now let’s talk about the good.  All of the foods in this segment have shown cardiovascular benefit in studies.

​1.  Omega-3 Fats

​Omega-3 fats belong to the long chain poly-unsaturated fatty acids.  The ones that have been shown to be beneficial for the heart and cholesterol are Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA).

These fatty acids come from marine microorganisms that are eaten by fish.

​The fish with the highest omega-3 concentrations include fatty fish like tuna, salmon, sardines, mackerel, albacore and herring.

Omega-3 fatty acids primarily reduce triglyceride levels and lower VLDL levels.  They also appear to have anti-inflammatory and anti-thrombotic effects.

If you aren’t a fish fan, if you are a vegetarian,  or if you have a sensitivity to fish, supplements are also available which I will discuss later.

​2.  High Soluble Fiber Foods

Foods high in soluble fiber have been shown in studies to lower LDL cholesterol.

Soluble fiber attracts water and turns to a gel-like substance during digestion.  This slows digestion and makes you feel full for a longer period of time.  It also binds to cholesterol and may reduce its absorption in the intestines.

Examples of foods high in soluble fiber include oats, kidney beans, brussel sprouts, apples and pears.

Soluble fiber is also available as a supplement.  These include psyllium, pectin, and guar gum.

​3.  Olive Oil

​Olive oil is full of healthy, monounsaturated fats, primarily oleic acid.

Oleic acid is believed to be a potent anti-oxidant that reduces inflammation​.

​Regular consumption of olive has been shown to reduce the risk for cardiovascular events and stroke.  It also appears to reduce the risk of oxidation of LDL particles.

There are studies that suggest that olive oil may decrease the risk for dementia, type 2 diabetes, rheumatoid arthritis, and even cancer.

It even has anti-bacterial properties.  One study showed that taking 30gm of extra virgin olive oil per day can eliminate a helicobacter pylori infection in 10-40% of people.

It is important to use extra virgin olive oil because it has the most anti-oxidants and bioactive compounds in it.

​4.  Garlic & Onions

​We have been told for years that consuming garlic and onions are good for our heart.

However, a study from 2007 showed no reduction in LDL or heart disease in people consuming either raw garlic or garlic supplements.

Onions appear to have more benefits on lower cholesterol, primarily because they contain flavonoids such as quercetin.  This study showed that quercetin from onions lowers LDL levels in ​overweight patients.

​5.  Herbs -​

​Consumption of several herbs have been shown to result in a mild or even moderate reduction in cholesterol levels.

​These herbs include basil, artichoke, eggplant, fenugreek, arjun, genseng, and yarrow.

A systematic review published in 2003 showed a reduction in total cholesterol from the use of these herbs of up to 39%.

Supplements That Lower Cholesterol

​If you just have a hard time eating the good foods that can lower cholesterol levels, there are some supplements available that can help:

​1.  ​Omega-3/Fish Oil

​As discussed earlier, fish oil can substantially lower triglyceride and VLDL levels.

However, many people do not​ eat much fish, so supplementation may be necessary.

Click here for my preferred brand.

If you are vegetarian, vegan, or have a sensitivity/allergy to fish, algal oil is a great source of omega-3. You can get it here.

​2.  Niacin

​Niacin is a naturally-occurring B vitamin that has been used to raise HDL cholesterol for years.

Studies have shown that taking niacin can raise HDL levels by up to 25%.  It also lowers LDL by 5-20% and triglycerides by 20-50%.

​Unfortunately, the large controlled studies AIM-HIGH and HPS2-THRIVE showed that despite the increase in HDL levels, adding niacin did not result in a reduction in cardiovascular events.

However, I still believe niacin is a good choice (after dietary changes) for people who have low HDL and high triglycerides, or those who don’t want to take a statin or who cannot tolerate statins.

Click here for my preferred brand.

​Red Yeast Rice

​Red yeast rice has shown in studies to reduce total cholesterol levels 16-31%.

​Click here for my preferred brand.

​Essential Oils – lavender, cypress, rosemary

​Several essential oils can have an effect on your heart health and may help lower cholesterol levels.

Lavendar oils help lower anxiety and cortisol levels.

Cypress oil helps promote circulation and lowers cholesterol levels.

Rosemary oil is an antioxidant that helps stabilize blood sugar and reduces blood lipid levels.

The best way to use these is to add a few drops to a diffuser which allows you to inhale them gradually while breathing normally.

Other ​Ways to Lower Cholesterol

​Exercise

​Aerobic exercises such as walking, jogging, cycling, and swimming are great for the heart, lungs, and stress level.  They also helps lower lipid levels.

Resistance training such as weight-lifting has also shown to improve lipid profiles by increasing HDL and lowering total cholesterol and LDL.

​Get Better Sleep

​Most of us have terrible sleep habits and poor sleep hygiene.

​Not only does that make us tired and grumpy, studies show that sleep deprivation results in lower HDL levels and higher triglyceride and LDL levels.

​Improving sleep is foundational to almost any health issue we could discuss.  I have yet to meet a person that is chronically sleep-deprived that is healthy and feels good.

Developing good sleep habits is critical to improving your sleep.  These include:

  • ​Develop a consistent sleep schedule – Go to bed at the same time every night and get up at the same time every morning.
  • ​Keep your bedroom cool and dark.
  • ​Avoid stimulants, especially in the evening.  This includes caffeine and cold medications.
  • check​Avoid electronic screens (TV, computer, tablet, or phone) for at least 2 hours before bed.
  • checkConsider trying meditation for 20 minutes before bed to help empty your mind and relax you.

​If you are doing all of this and are still having sleep issues, it may be necessary to try a supplement.

1. Melatonin – Melatonin does NOT make you sleepy.  It simply helps you relax which allows the normal sleep cycle to progress.  Take it at least 30 minutes before going to bed.

2.  Travacor – If you are having a lot of stress, anxiety, and mood issues which are affecting your sleep, this may help.  It contains a blend of taurine, L-theanine and 5-HTP which help regulate mood and promote normal sleep.  Take it an hour before bedtime.

3.  Kavinace Ultra PM – If you are still having problems getting to sleep or staying asleep, this supplement may be very helpful.  It contains the same ingredients as Travacor but with the addition of melatonin and phenylbutyric acid which makes it even more powerful.  Take it an hour before bedtime.

​Manage Your Stress

​Lack of sleep is a form of stress, so you can expect that any other stress will have similar results on the body.

Sure enough, this study showed that stress results in lower HDL, higher LDL, and higher triglyceride levels.

Stress can be caused by mental, physical, or even spiritual issues.

It is important to remove whatever stresses that you can from your life.  That may mean seeing a marriage counselor, or changing jobs, or avoiding certain people.

If you can’t avoid all stress, there are still some things that you can do:

  • ​Relaxation exercises such as yoga
  • check​Spend 20 minutes per day in prayer or meditation
  • check​Start doing something you enjoy – hobby, sports, etc.
  • checkGo outside!  Walking or hiking in nature can do wonders for your stress.
  • checkCount your blessings and write them down.
  • Do something good for someone else expecting nothing in return, especially for someone less fortunate than you.
  • Donate your time or money toward a worthy cause.
  • checkMake yourself smile everyday (even when you don’t feel like it).

​Summary

​If you have been diagnosed with high cholesterol levels and want to lower then without taking a medication such as a statin, there are several things that you can do.

The cornerstone of treatment ​should be to change your diet.  Sugar and refined carbs will need to removed as much as possible.  You probably also need to reduce your alcohol intake and fast foods.

Increasing your consumption of fish, fruit, and vegetables can also be very helpful, as well as cooking with extra virgin olive oil and adding many healthy herbs and spices to your food.

Finally, like with almost any condition we could discuss, cholesterol levels will improve with regular exercise, improving your sleep and reducing stress.

Now it’s your turn…

​Have you been diagnosed with elevated cholesterol?

What you have tried in the past that works?  What didn’t work?

Leave any questions or comments below.

The Dangers of Statin Drugs

​1 in 4 Americans over the age of 40 are taking a statin drug such as atorvastatin, rosuvastatin, simvastatin, and pravastatin.  That equates to over 40 million people in the US alone!

We know that statins lower cholesterol levels which reduces the risk of heart disease, myocardial infarction, and stroke.

But is it really that simple?  What does the data really show?  Should so many of us be taking these medications?

In this article I will discuss this class of drugs and why they are recommended.  I will also discuss the many potential side effects that statins can cause, most of which you may not have even heard about.

I will also give my recommendations on who should consider taking statins and who should not.

Let’s get started…

​What is Cholesterol?

​Before we get into treatments for high cholesterol, we need to discuss cholesterol and what it does in the body.

Cholesterol is a lipid molecule that is produced by all animal cells.  It is an essential structural component of all animal cell membranes.  In fact, about 30% of cell membranes are cholesterol.  The vast majority of cholesterol is made by the liver.

​Within the cell membrane, cholesterol also functions in intracellular transport, cell signaling and nerve conduction.

Cholesterol is also a precursor to the production of hormones, bile acids, and vitamin D.

Cholesterol is transported inside lipoprotein particles throughout the body.  These lipoproteins come in 2 primary forms – LDL and HDL (there are also VLDL and IDL particles, which I will not discuss in this article).

It is believed that ​low density lipoproteins (LDL) particles (as well as IDL and VLDL) promote the development of atheromas in artery walls while high density lipoproteins (HDL) particles promote the removal of those atheromas from the artery walls.

As a result, most people call LDL the “bad” cholesterol while HDL is the “good” cholesterol.  Again, more recent research has shown a much more complicated picture than that, but we will stick to this narrative for the sake of this article.

The belief is if you can reduce the ​amount of LDL in the body, it will reduce the incidence of atherosclerosis (the laying down of plaque in the arteries).

​What Are Statins?

​Statins are a ​class of drugs that lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver.​

Statins block the enzyme in the liver that is responsible for making cholesterol. This enzyme is called hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). Scientifically, statins are referred to as HMG-CoA reductase inhibitors.

Examples of these drugs include atorvastatin (Lipitor®), simvastatin (Zocor®), rosuvastatin (Crestor®), and pravastatin (Pravachol®).

Over 40 million people in the US are currently taking ​a statin.  That equates to about 1 out of every 4 US adults over the age of 40 taking this class of drug!

If​ 2013 guidelines released by the American College of Cardiology and American Heart Association are followed, it is estimated that the number of people taking a statin ​could rise to 1 out of every 2 adults!

Even more shocking, statins are now being ​used for children as young as 8 years old with elevated LDL levels.

​So the obvious next questions should be:

1.  Do statins work?

2.  Are statins safe?

Let’s try to get some answers.

​Do Statins Work?

​There are multiple studies that show that reducing LDL cholesterol results in a reduction in cardiovascular disease and events.

Studies have also shown that statins can reduce atheroma progression.

Various other studies have shown a reduction in cardiovascular death in patients taking statins by as much as 25-40%.  Here is one of those studies for reference.

​It is considered standard of care to place a patient that has suffered an MI on a statin, regardless of their cholesterol level.  This is called secondary prevention (preventing an MI from occurring in someone who has already had an MI).

Because of some of these studies, experts now recommend statins for primary prevention, meaning giving them to patients that have multiple risk factors for developing an MI in the future.

However, there are becoming more critics regarding statins and their beneficial effects.

Much of this controversy stems around the fact that almost all of the large studies regarding statins were sponsored by pharmaceutical companies that were making the statin being tested.

Another controversy is in regard to how the numbers accumulated in the study were calculated.

Let’s spend a moment to explain this further.

​Relative Risk Reduction vs. Absolute Risk Reduction

​I don’t want to bore you with ​a statistics lecture, but please bear with me.  This concept is critical to your understanding of the true benefit vs. harm caused by statin drugs or any other study you are reading.

​When a study states that a drug reduced the incidence of something by a certain percentage, it is important to note whether the reduction was an absolute risk reduction (ARR) or a relative risk reduction (RRR).  There is a huge difference between the meanings of those 2 statistical terms.

​The absolute risk reduction is the change in the risk of an outcome of a given treatment or activity in relation to a comparison treatment or activity.  I know, that sounds confusing.

​The relative risk reduction is a measure calculated by dividing the ​absolute risk reduction by the control event rate.

To better understand this concept, let’s imagine a study that was designed to determine if a new drug reduced the incidence of heart attacks.  One group was given a placebo while the other group was given the new drug.  There were 5000 people in each group.

So suppose the placebo group in the study had 100 people suffer an MI​ during the study.  This equated to 2% of th​at group.  Let’s say the drug group only had 50 people suffer an MI.  That means 1% of people taking the drug suffered an MI.

The relative risk reduction in this study would be 50%.   That sounds incredible!

However, the absolute risk reduction was only 1%.  Instead of 2% of the people suffering an MI, only 1% did that were taking the drug.  100 people would have to take the drug in order to prevent 1 person from having an MI.  That term is called the number needed to treat (NNT).

The use of relative risk reduction can be deceiving and is a way of manipulating statistics to make the outcome look better than it really is.

​If the absolute risk reduction is small like in the above example, then the potential side effects and consequences of taking the drug should be considered.  If the side effects are minimal, then giving it to people in order for a small percentage of them to get benefit might be worth it.

However, if the side effects are substantial, then it would not make sense to give it to a large number of people that will receive more harm than good from it.

​There have recently been 2 independent meta-analyses of studies that have questioned the use of statins, especially for primary prevention.  This meta-analyses did not find any benefit in statin use for primary prevention.  This one didn’t either, and even went so far as to scold the pharmaceutical companies for adversely influencing study results.

​​Side Effects of ​Statin ​Drugs

​So what are the most common side effects of statins?

You will be aware of some of these listed below, but several may surprise you.

I have been in medical practice for over 21 years, and I was not aware of some of these prior to looking at the research in depth during my preparation for this article.  You can bet that your doctor is not aware of all of them either.

​1.  Muscle Pain

​Muscle pain is the most common and well-known of the side effects caused by statins.

In my personal experience, up to a third of my patients have been unable to tolerate them primarily because of muscle aches and pains.

Some patients develop almost flu-like symptoms.  Others state that many of their muscles just feel “sore.” Still others ​can develop tendonitis and other musculoskeletal disorders.  Rarely, more serious conditions such as rhabdomyolysis or autoimmune muscle diseases can develop.

This study confirmed a substantial increase in these conditions in people taking a statin drug.

Fortunately, the majority of these issues will resolve once the medication has stopped.

​2.  Liver Inflammation

​Statins commonly cause an increase in liver function tests (LFTs) found on routine labs.

The most common of these tests are the AST and ALT.

This is such a well-known side effect of statins that it is considered acceptable as long as these tests do not rise more than 2-3x their normal ranges.

Fortunately, serious liver damage is relatively rare with statin use.

My primary concern  with this side effect is it has the potential to mask liver function test elevations that could be caused by other potentially dangerous conditions.

​For example, if a patient is on a statin and has mildly elevated LFTs, it could cause their medical provider to ignore it because they assume that the elevation is due to the statin drug.

Also, even a mild impairment of liver function has the potential to affect detoxification and other essential functions that the liver provides.

​3.  Increased Blood Sugar and Diabetes Risk

​Statins have been shown to increase the risk of development of type 2 diabetes.  This particular study showed a 9% increased risk.  For every 255 people that were put on a statin, one person developed diabetes as a result of taking the drug.

In this study, statin use was associated with an increase in blood plasma glucose in people with or without diabetes.  This rise was independent of other factors including age, aspirin use, beta blocker use, or ACE inhibitor use.  In non-diabetics, statin use increased their glucose level by 7 points, while in diabetics the glucose level increased 39 points!

The increase in glucose appears to be dose-dependent.  The higher the dose of statin drug, the higher the glucose level.

4.  Depletes CoQ10

Statins interfere with the production of mevalonic acid, which is a precursor in the production of CoQ10. Statin users routinely have low CoQ10 levels when it is tested.

CoQ10 is used for energy production in the cells.  It is a critical component of cellular respiration and production of ATP, the primary fuel used in cell function.

A deficiency of CoQ10 is generally considered to be one of the primary reasons why statins cause muscle pain.

The heart is the most energy-demanding organ in the body, so it makes sense that a CoQ10 deficiency can increase the risk of acute heart failure.

​CoQ10 deficiency can also cause symptoms such as fatigue and brain fog and has been implicated in things such as dementia and other neurodegenerative disorders.

5.  Reduces Vitamin K2

The risks of vitamin K2 deficiency have only come to light in the past few years.  Most medical providers are not aware of its importance.

Vitamin K2 helps move calcium into the proper areas of your body, including your bones and teeth.  It also helps remove calcium from places where it shouldn’t be, such as in our arteries and soft tissues.

A deficiency of vitamin K2 has been shown to result in an increase in arterial calcification.  It also increases the risk for osteoporosis.

Statin drugs inhibit the synthesis of vitamin K2 which increases the risk of atherosclerosis, or calcification of arteries.

These risks appear to decrease with proper vitamin K2 supplementation.  Since the vast majority of people are also deficient in vitamin D (your level should be at least 50), I typically recommend a supplement with both vitamins K2 and D3 such as this one.

6.  Reduces Glutathione and Other Selenoproteins

Statins also block the production of selenium containing proteins.  The most important of these appears to be glutathione peroxidase.

These proteins play a vital role in protecting the cells of the body from oxidative damage that comes from hydrogen and lipid peroxides.

When you are low in glutathione peroxidase, you develop a high level of free radicals and inflammation that results in damaged tissue.  This is felt to result in an increased risk for heart failure and atherosclerosis as well as myalgia and other muscle/tendon issues.

​7.  Increases Cancer Risk

​This is another risk that is not well known.

Studies have shown an increased risk of ductal and lobular breast cancer in patients that have taken a statin drug for 10 or more years.

In this study from Taiwan, statin use was also associated with an increased risk for prostate cancer.

In this letter to the editor in the Journal of Clinical Oncology, the authors discuss the fact that several cholesterol-lowering drugs, including statins, have been shown to increase cancer risk in rodents.

​The authors felt that statins themselves may not be carcinogenic,  but ​their increase in cancer risk may result from their ability to lower blood lipids. ​It is documented that lipoproteins, particularly LDL (your “bad” cholesterol), ​work in the immune system by binding and inactivating all kinds of microorganisms and their toxic products.  Many of those microorganisms have been implicated in the development of many cancers.

Maybe LDL isn’t so “bad” after-all!

​8.  Increases Parkinson’s Disease Risk

​As I explained earlier, cholesterol is essential for normal brain function.

Statins obviously reduce cholesterol levels.  They also secondarily reduce ketone levels in the brain.

Ketones are an essential energy source for the brain.  They have also been shown to be protective against brain diseases such as Parkinson’s Disease.

​This study from Penn State showed an increase risk of Parkinson’s Disease in patients taking statin drugs.  Conversely, an elevated cholesterol level was associated with a lower risk for Parkinson’s.

​9.  Increases Cataract Risk

​This study from JAMA showed an increased risk for cataracts in statin-users compared with non-users.

​This was also shown in a review of PubMed, EMBASE, and Cochrane review databases that found that for every 10,000 people taking a statin, there were 307 extra patients with cataracts.

10.  ​Memory Loss (Possibly)

Up to 25% of the cholesterol in our body is in the brain.

Cholesterol is essential for normal brain function.  It is a vital component of the connections between brain cells (neurons) called synapses.

It only makes sense that if you deplete the cholesterol levels in the body, it has the potential to affect brain functions such as memory and thinking.  Statins also reduce CoQ10 and Vitamin K2 as I discussed earlier, both of which are vital for normal brain function.

Several studies have suggested that statin use can increase the risk for development of Alzheimer’s and other types of dementia.

This study showed a significant increase in acute memory loss within 30 days of taking a statin.

However, subsequent studies like this one have actually suggested that prolonged statin use is associated with a decrease in dementia.

The jury is still out on this issue, but you need to be aware of the possible link.

​So Who Should Take a Statin Drug?

Most people will agree that statins are extremely effective at lowering cholesterol levels in the body.  That fact is not in question.

The question I ​have attempted to answer in this article is:  Are statins effective at reducing heart disease and death due to cardiovascular disease?

The short answer is yes.

However, the even bigger questions should be:

When including potential side effects, do the benefits of taking a statin outweigh the risks?

Who should be taking a statin medication?

​After my personal review of the research and listening to many authorities on the subject, I personally would recommend statin therapy to the following groups:

​With just about everyone else, I believe the data shows that dietary and lifestyle changes should be front and center in the treatment of someone with high cholesterol.  Changing a diet is massively more effective than a statin at reducing cholesterol levels.

In my opinion, there is not enough data to support the use of statins in primary prevention.  In other words, if you have never had a heart attack but you have high cholesterol and several other risk factors for heart disease (family history, overweight, high blood pressure, smoking, diabetes, etc.), taking a statin medication may not be ​necessary.

What about women?

The data supporting the use of statins in women is very weak.  They just don’t seem to work well.

If a woman has progressive heart disease, then they should definitely consider statin therapy.  Otherwise, they really need to focus on their diet and lifestyle first!

Of note, it can be argued that the reduction is death in patients taking statins may have nothing to do with cholesterol-lowering at all!

Some experts instead argue that the reduction in risk by statins may be due to their anti-inflammatory and anticoagulant effects instead of their cholesterol-lowering abilities.

​Don’t Forget CoQ10

​If you and your doctor decide ​you should take a statin drug, PLEASE consider taking a CoQ10 supplement.

As I have shown above, statins dramatically reduce CoQ10 levels in the body which can result in several serious conditions, including acute heart failure, muscle pain, fatigue, and brain fog.

The effectiveness of CoQ10 supplementation has been mixed in several studies, although using the ubiquinol form of CoQ10 appears to offer the most benefit.

Researching this topic has caused me to make a change in my personal practice.  For patients taking statins, I believe that ALL of them should be taking a ubiquinol/CoQ10 supplement.  Click here for my brand of choice.

​Summary

Statins are the 3rd most commonly written medication in the US, accounting for billions of dollars per year.

While there are multiple studies showing the​ benefit of statins in reducing plaque progression in arteries and reduction of death in patients that have had a previous MI, the recent guidelines recommending statins for primary prevention have been called into question.

​Statins are not benign drugs.  They can cause many side effects, some mild and some very serious. These include, muscle pain, liver irritation, cancer, cataracts, nutrient depletions such as CoQ10 and glutathione, and others.

Anyone considering taking a statin should be ​aware of these potential side effects so that a truly informed consent can be made.

Patients with familial hyperlipidemia and men who have had a previous MI should strongly consider taking a statin medication.

The data supporting the use of statins in women is weak, unless you have familial hyperlipidemia.

If you are taking a statin, I strongly recommend taking a ubiquinol supplement, vitamin K2 (if you aren’t on a blood thinner), and monitoring your glucose level periodically.

Now it’s your turn….

Are you taking a statin drug?

Have you had any of the side effects that I discussed?

Leave any questions or comments below.

Hypothyroidism and Depression – Is There a Connection?

​Is there a connection between hypothyroidism and depression?

Will taking thyroid medication reduce or even eliminate depression symptoms?

Do you still have depression even though you are on thyroid medication?

In this article, I will discuss the connection between hypothyroidism and depression, how thyroid medications can often help both conditions, and other causes of depression that you should consider…

​The ​Connection Between Hypothyroidism and Depression

​It is a​ well known fact​ in medicine that hypothyroidism is ​often associated with ​symptoms of depression. You will commonly find it listed as a symptom of hypothyroidism.  Click here for an example.

Doctors are even taught to check thyroid lab tests in any patient that presents with new symptoms of depression.

But how exactly are they connected?  We aren’t completely sure.

​However, we do know these connections:

  • ​Hypothyroidism and depression share similar symptoms.
  • Depression symptoms resolve in some people that are treated for hypothyroidism.
  • Thyroid hormone increases serotonin levels in the brain.
  • checkThyroid Releasing Hormone (TRH) is sensitive to serotonin.  Low serotonin levels may stimulate TRH production, while high serotonin levels may lead to lower TRH production.

​​Basically, depression symptoms can sometimes (but not always) be due to hypothyroidism.  If you ​treat the hypothyroidism, the depression symptoms will reduce or even resolve.

Let’s talk about depression a bit more…

​What Is Depression​?

​So what is depression anyway?  Most of us have no problem explaining the common symptoms that we call depression.

​When several people share a similar group of symptoms, ​medical organizations ​like to give it a name. This is to make things more simple, but​ it also makes it easier to bill insurance.

​The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) lists the following criteria required to diagnose depression:

  • Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

    Note: Do not include symptoms that are clearly attributable to another medical condition.

    1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
    2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation.)
    3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
    4. Insomnia or hypersomnia nearly every day.
    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
    6. Fatigue or loss of energy nearly every day.
    7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
    8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
    9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

​What ​this fails to take into account is what condition or conditions caused the symptoms in the first place!

If you are fatigued, moody, and are gaining weight since you hit menopause, should you be treated the same way as someone that just went through a divorce, or someone that is anemic​, or someone who has​ an autoimmune disease?

Of course not!

​Don’t think of depression as a ​diagnosis.  Instead, think of depression as a group of symptoms that may be caused by many different conditions.

In other words, it is a side effect of one or more other problems.  In order to properly treat the depression, the root cause must be identified and addressed.  This is the foundational principle of functional medicine.

​Possible Causes of Depression:

​1.  Hormone Imbalances

​​An imbalance in one or more hormones commonly results in symptoms of depression.

​An abnormality in these hormones should be ​one of the first things that you consider and test for when you are investigating the cause of your depression.

Examples of hormone imbalances includes menopause, low testosterone, and hypothyroidism.​

​2.  Nutrient Deficiencies

​Nutrient deficiencies ​commonly cause anemia and other conditions that result in depression symptoms.

These include B12, folic acid, and iron.

If you don’t test for them you will never know if you are deficient or not!

​3.  Gut Dysfunction

​Gut dysfunction can lead to the nutrient deficiencies listed above, it can result in a decrease in neurotransmitter production such as serotonin, and it is a primary reason why​ autoimmune disorders develop.

Most diseases in the body ​is worsened or even starts with gut dysfunction.  In fact, when I have a difficult patient and I’m not sure what to do, I start with working on their gut.

​Gut issues include lack of stomach acid, SIBO or SIFO, and dysbiosis.

​4.  Inflammatory States

​Inflammation causes a decrease in energy production in the mitochondria of the cells.  This results in fatigue, insomnia, chronic pain, and other symptoms of depression.

Examples include insulin resistance, leptin resistance, autoimmunity, and acute and chronic infections.

Most of these can be detected with proper lab testing.

​5.  Insomnia

​Lack of sleep causes mood swings, fatigue, poor concentration, and other symptoms of depression.

​6.  Alcohol Use

​Alcohol abuse ​has been shown to be associated with depression in several studies.

​7.  Stress

​Stress (particularly chronic stress) has been closely associated with depression.

​8.  Spiritual/Religious Issues

​Studies have shown that pursuing religion and spiritual beliefs can help reduce depression symptoms.  ​Guilt and conviction of not following or pursuing your personal religious beliefs could be a major source of stress that will need to be addressed.

​IT IS IMPORTANT TO REALIZE THAT it is possible and even probable that your depression is multifactorial – meaning ​it could be ​caused by several of the reasons listed above.

Treating only one of the causes may not significantly reduce your symptoms.  It will be necessary to address ALL of the causes to get the most benefit.

​Hashimoto’s and Depression

​Since up to 90% of hypothyroidism is caused by Hashimoto’s Thyroiditis, it deserves discussion as well.

As you know, Hashimoto’s is an autoimmune disorder that if left un​treated will ​slowly and gradually destroy the thyroid gland, resulting in hypothyroidism.

​One of the things that makes Hashimoto’s even more difficult than hypothyroidism is the fact that the TSH will often be in the “normal” range even though the patient may be having significant​ symptoms such as depression, constipation, fatigue, etc.

That is ​important because if the TSH is normal, very few doctors will give those patients thyroid medication, even if they have are having symptoms.  As we will discuss later in this article, thyroid medication can often greatly reduce depression symptoms.

Studies show that patients with Hashimoto’s are at increased risk of developing both depression and anxiety, even when their TSH is normal.

In fact, it appears that thyroid antibodies themselves can ​actually cause depression symptoms.

​It is therefore ​crucial to get a complete thyroid panel, including free T4, free T3, TPO antibody, and thyroglobulin antibody levels.  That will give you a​n indication of whether you are deficient in thyroid hormone​ at the cellular level and if you have ​autoimmune thyroid disease.

If someone is having depression symptoms and they have a normal TSH but a low free T3, starting a trial of thyroid hormone medication may be warranted.

They may also benefit from other Hashimoto’s therapies that help reduce antibody levels.  These can include selenium and zinc supplementation, vitamin D supplementation, LDN therapy, and others.  I discuss many of these in other blog articles on my website.

Click here to read more about ​treatments for Hashimoto’s.

​Treatment of Depression with Thyroid Medication

​Studies have shown that thyroid medication can be very effective in treating depression and depression symptoms.

It can ​reduce depression symptoms when added to an SSRI (the standard conventional treatment for depression) as shown in this study.

​Giving T3 medication has also been shown to be effective at treating depression even when patients are resistant to standard SSRI treatment.

There are also studies that show using T3 by itself is effective at reducing depression symptoms.

Of note, T3 has also been shown to be effective in treating mood disorders such as bipolar disorder, even when patients have failed multiple mood stabilizing medications.

​So why does thyroid hormone (particularly T3) help with depression?

​These studies show that there is probably a connection between mood and thyroid function.

There may even be a subset of depressed patients that actually have ​hypothyroidism that has not been identified.

There is also the possibility that some patients may have a genetic defect in one of the deiodinase enzymes that converts T4 to T3.  This may result in a decreased level of T3 circulating in the brain.

I believe that it is good medicine to have a complete thyroid panel drawn on all patients that have symptoms of depression.

If you have failed multiple depression therapies and medications, it ​would even be reasonable to try a trial of thyroid medication, especially if your free T3 level is not optimal.

The best thyroid medication to use is Cytomel or liothyronine, which is a T3 only medication.  This is the strongest thyroid medication available and does not require conversion by a deiodinase to work.

This can be done safely if th​ese guidelines are followed, which is further explained in this article:

  • ​Check TSH, free T3, and free T4 prior to starting treatment
  • Start with liothyronine 25mcg daily and titrate slowly over weeks depending on tolerance to the medication.  Most patients will need 50-150mcg daily
  • ​Recheck thyroid labs at least every 3-6 months, or more often if needed
  • checkThe goal for TSH should be in the lower limits of the reference range (or even lower at times depending on the free T3 level)
  • checkThe goal for free T3 should be in the upper limits of the reference range
  • checkIf you are menopausal, bone density should be monitored regularly

​T3 medications can sometimes cause ​side effects such as jitteriness, palpitations, excessive sweating, headache, and other symptoms.  Make sure you communicate any of these with your doctor if you are taking T3 medication.

​Some people simply cannot tolerate liothyronine due to side effects.  In those situations, a compounding pharmacy can make sustained-release T3 (SR-T3) which is typically much better tolerated.

​7 Steps to Consider if You Have Depression

​If you​ are suffering from depression, I would recommend that you follow the 7 steps below to ​help reduce or eliminate your symptoms:

​1.  Get a Complete Thyroid Panel

​Just checking a TSH level is woefully inadequate to truly evaluate your thyroid function.  Instead, I STRONGLY recommend that you ask your doctor to check all of the following tests:

​If either antibody test is >35, then a diagnosis if Hashimoto’s Thyroiditis can be made.

​If the free T3 level is < 3.5, that is an indication of hypothyroidism regardless of the TSH level, especially if you are having several symptoms of hypothyroidism.

​2.  Consider adding T3 medication to your current regimen

​Many people have issues with T4 to T3 conversion due to chronic inflammation and gut issues​.  Adding T3 to your other thyroid medication bypasses the need for the conversion step which will allow more active thyroid to reach the cells of the body, including the brain.

As little as 5-10mcg of liothyronine can be helpful.

​3.  ​Reduce your thyroid antibodies if you have Hashimoto’s

​Reducing thyroid antibodies will help in numerous ways.  This includes reducing systemic inflammation which improves thyroid conversion ​plus helps you feel better in general.  It also reduces depression symptoms directly.  Finally, it typically improves hypothyroidism which will help reduce symptoms.

​4.  ​Identify and treat and nutrient deficiencies

​These include vitamin B12, folate, and iron.  There are lab tests that test for these directly.  Treatment consists of supplements and improving gut health.

​5.  Get good sleep

​It is almost impossible to maintain good overall health if you are getting less than 7-8 hours of good sleep per night.

Here is a fascinating interview of Matthew Walker, a neuroscientist who is considered one of the premiere sleep experts in the world if you want to learn more (warning- there is ​cursing by the host in the interview).

Improving your sleep may actually be the single most potent tool that you can do to combat your depression.

​6.  Manage your stress

This is always an easy thing to say, but a hard thing to do.

Reducing your stress may need to include changing jobs, ending unhealthy relationships, and placing​ healthy boundaries in your life.

​I would also recommend adding meditation and/or yoga to your daily routine.

​7.  Address any spiritual needs

​Depending on your particular situation, this can include speaking to your pastor, priest, or spiritual advisor, and re-committing yourself to pursue a deeper meaning in your life.

​Important Note:  You may still ​need the use of an anti-depressant (at least for awhile), but finding the root causes of your depression and dealing with them directly will greatly improve​ your success in reducing or eliminating your depression symptoms.

​Summary

​Many patients that have been diagnosed with depression also have thyroid issues, including hypothyroidism and Hashimoto’s.

In many cases, adding T3 thyroid medication can reduce depression symptoms, even when their TSH is normal.

If you have depression and hypothyroidism and are taking a T4 only thyroid medication, you may want to talk to your doctor about adding T3 or changing your thyroid medication to one that contains T3.

It is important to get a complete thyroid panel to accurately assess your T3 levels and to check for the presence of Hashimoto’s.

As with most conditions, finding the root causes of your depression will allow you to directly address the issues that apply to you.

​Now it’s your turn…

Do you have a thyroid issue?  Do you also have depression?

Have you tried taking T3 medication to treat your depression?

What has worked for you?  What hasn’t worked?

Leave your questions and comments below.

How to Increase T3 Levels Without Medication

​If you have a thyroid issue and want to feel ​better, then ​increasing your T3 level to the optimal range is the single most important thing that you can do.

Why?

Because T3 is the active thyroid hormone.

Most people have lower than optimal free T3 levels even if they are taking thyroid hormone medication.

So how do you ​increase your T3 level?  That is the ​critical question.

I will try to give you all of the tools you need in this article to start ​increasing your T3 level and get you feeling your best.  Some are simple and straightforward while others are more difficult.

​Here we go…

​What Is T3?

​Let’s start with a quick tutorial about the thyroid which will help you understand some of the terms I will be using and what they mean.

​The thyroid gland is a factory.  It’s job in the body is to make thyroid hormone.

The thyroid depends on the pituitary gland in the brain to tell it how much thyroid hormone to produce. The pituitary does this by secreting Thyroid Stimulating Hormone (TSH).

The majority of hormone that the thyroid makes is T4.  T4 is inactive and is basically the transport form of thyroid.  It serves as a reservoir that the body can draw from when it needs more T3.

A small amount of T3 is also made directly by the thyroid, but most of ​it is produced outside of the thyroid gland ​by converting T4 to T3.  This is done by an enzyme called a deiodinase.

T4 can also be converted into Reverse T3.  Reverse T3 is the anti-thyroid hormone.  It will bind to thyroid receptors in the cells but does not trigger any function.  It therefore effectively blocks that thyroid receptor.

​Too much reverse T3 can result in a substantial reduction of thyroid function in the body.  Therefore in most cases it is best to have as low of a reverse T3 level as possible (<15).  Click here to read more about reverse T3.

​Most​ T3 in the blood is bound to a protein.  When T3 is bound, it is unable to ​attach to the thyroid receptors in the cells.

​A very small percentage of the total amount of T3 in the body is ​not attached to a protein.  We call that the free T3level. Since it is not attached to a protein, it is free to attach to the thyroid receptors in the cells and trigger the functions that it is designed to trigger.

Therefore, the free T3 level is actually a measurement of how much active thyroidhormone is present in the body.

In my practice, I like for the free T3 level to be >3.5 if possible.

​How To ​Increase T3 Levels

​As you can tell from this illustration, there are 4 main areas that ​should be optimized in order to maximize your T3 level:

  • ​T4 hormone production
  • checkT4 to T3 conversion
  • check​T4 to reverse T3 conversion
  • Cellular sensitivity to T3

​Addressing all 4 of these areas will increase your chances of getting your T3 level optimized.

​Let’s break these areas down further, plus I will discuss some other things that you can also do to get your thyroid working at​ optimal efficiency:

1.  Maximize Thyroid Production

​There are over 15 nutrients that are necessary for normal thyroid hormone production.

Most of them are usually found in adequate amounts in the Standard American Diet.  However, it is common to be deficient in some of them.

​Iron and iodine are ​two of the nutrients that are necessary to maximize thyroid production and it is common for people to be deficient in them.

– Optimize Iron

 

​Iron is completely intertwined with the thyroid.

If the iron level is low, thyroid medication doesn’t work as well, and conversion of T4 to T3 is reduced.

Conversely, thyroid hormone is needed to properly absorb iron.

So when thyroid levels are low it leads to iron deficiency which in turn worsens thyroid function, creating a vicious cycle.

Iron is also required for proper adrenal function.  When the adrenals aren’t working it puts an increased strain on the thyroid which can lead to adrenal fatigue and other issues.

​To find out if you are low in iron, you can ask your doctor to order a CBC, serum iron, TIBC, and ferritin level.  If you are low, then treatment with a supplement may be necessary.

As a general rule, thyroid patients tolerate liquid iron better than pills.  It causes less constipation and is usually better absorbed.

If the liquid iron is not adequate to raise the iron levels, it may still be necessary to switch to an oral tablet such as this one.

Remember, low iron ​is often due to a deficiency in your diet, but it could also be a sign of blood loss.  If your iron is low (especially if you are anemic), you need to see your doctor about it.  You could have gastritis, a stomach ulcer, or some type of lesion in your small intestine or colon that is causing the ​blood loss. It could be life-saving to have this investigated.

– Consider Iodine

​Iodine is a tricky subject when it comes to the thyroid, especially if you have Hashimoto’s Thyroiditis.

Many experts are adamant about the importance of iodine while others are afraid ​to use it.

The fact is, iodine is required for thyroid hormone production.  Adequate amounts of iodine are necessary if you want to have optimal thyroid function.

So if you decide to use it, I would use this as a guideline:

  • ​Start low and go slow
  • If you have Hashimoto’s and want to try iodine, make sure you are also supplementing with selenium.  Studies suggest that iodine can increase thyroid antibody levels if you are deficient in selenium.

​Start with 325mcg of iodine per day and continue that for 10-14 days.  You can then increase the dose by 325mcg daily every week as long as you are noticing improvement.

If you notice worsening symptoms then stop it immediately.

Click here for the supplement that I recommend.

Make sure that you monitor your thyroid antibody levels if you have Hashimoto’s.

​2.  Improve T4 to T3 Conversion

​Efficient T4 to T3 conversion is critical for normal thyroid function.

Most conventional doctors are taught to only check the TSH and occasionally the T4 level when monitoring thyroid function.

This assumes that the T4 to T3 conversion process is working normally.  However, in my experience, that just isn’t the case.

​Chronic inflammation in the body (arthritis, diabetes, obesity, etc.) impairs the conversion process.  So does some nutrient deficiencies.

That may be why you are still having typical symptoms of hypothyroidism even though your TSH and T4 levels are in the normal range.

The following list is far from complete, but it ​includes what I have found to be the most common reasons why T4 to T3 conversion is impaired.  Click on each nutrient for my preferred brand.

Zinc

​Inadequate zinc levels typically results in more T4 to reverse T3 conversion and result in worsening thyroid function.  Zinc is also a powerful anti-inflammatory and helps regulate your immune system.  It also is good for your skin.

Selenium

​Selenium is also essential for normal T4 to T3 conversion.  It also helps to regulate the immune system and can help reduce thyroid antibody levels if you have Hashimoto’s.  ​ I typically recommend taking 200-400mcg daily. Click here to read more.

– Reduce ​T4 to Reverse T3 Conversion

​Even though I will discuss this is more detail later, it should be listed  here as well.

Reducing the T4 to reverse T3 conversion will mean that the T4 is being channeled into converting into T3 instead.

​3.  Improve Your Gut ​Health

​​This may surprise you, but up to 20% of the T4 to T3 conversion occurs in the gut!

The amounts and types of gut bacteria play a huge role in thyroid function.

With that in mind, this shouldn’t surprise you:  Most thyroid patients have at least some level of gut issues.

Why?  Because when the thyroid is low it makes your intestines move slower which can lead to constipation.  It can also increase your risk of developing SIBO (small intestinal bacterial overgrowth), yeast overgrowth, and acid reflux (GERD).

Low thyroid also causes less stomach acid to be produced which further reduces the absorption of nutrients.

​All of this also predisposes you to develop increased intestinal permeability, better known as leaky gut syndrome.

A leaky gut then allows foreign proteins to enter the bloodstream.  One such protein is called LPS.

LPS has been shown in studies to lower T3 levels in the blood.

Have I convinced you how important gut health is to thyroid function?

So what can you do to improve your gut function?  ​

The first step is to make a proper diagnosis.  That can usually be done with a thorough history.

– Betaine with Pepsin

​Pharmaceutical companies want us to think that almost all of us produce too much stomach acid.

If you are having heartburn after eating dinner, it’s because you have too much acid, right?

Wrong!  The problem is not too much acid, instead the acid is going to the wrong places (your lower esophagus instead of staying in your stomach).

In reality, many people don’t produce ENOUGH stomach acid, also called hypochlorhydria.

Studies show that up to 40% of people over age 40 have hypochlorhydria.  By the time you reach 60 years of age that number goes to over 50%!  In fact, up to 30% of people over 60 have achlorhydria, which means they don’t produce stomach acid at all.

​So take that information and just imagine how much worse those numbers get when you add proton pump inhibitors, H2 blockers, and antacids that so many people take on a daily basis.

Remember, stomach acid is critical for 3 primary functions:

  • ​Acid in the stomach causes the breakdown and digestion of food which allows nutrients to be extracted and absorbed into the body.
  • ​An acidic stomach serves as a barrier against bacteria, yeast, and other organisms that grow normally in the intestines.  Without adequate stomach acid, these organisms will colonize the stomach and create all sorts of problems including gastritis and ulcers.  H. pylori is an example.
  • The acidity of the stomach is what triggers the pancreas to release digestive enzymes which further break down the food we eat so that nutrients can be extracted from it.

​If you want to read more about this subject in detail, I highly recommend the book “Why Stomach Acid Is Good For You” by Dr. Jonathan Wright.

​Okay, so what can you do about this?

I would suggest a trial of Betaine Hcl with Pepsin.

Betaine is actually a capsule containing a small amount of hydrochloric acid.  Pepsin is a digestive enzyme.

Start by taking 1 capsule at the beginning of each meal.  If you are tolerating it without side effects, then after a few days increase ​your dose to 2 with each meal.  You can continue ​to add a capsule every few days until you begin noticing a mild burning in your stomach.  When that occurs, decrease your dose by 1 capsule from what you were taking when the symptoms occurred.

In my experience, most people need 1-3 capsules per meal.  However, if you have a long history of PPI, H2 blocker or antacid use, you may need more.

Get my preferred brand here.

If you are currently taking a PPI, H2 blocker, or antacid on a regular basis, I would suggest trying to wean off of those before trying the Betaine.

If you are on a PPI such as Nexium or Prilosec, try converting to an H2 blocker such as Zantac or Pepcid. It will be easier to wean off of those medications than it will be a PPI.

Also, if you currently have an active stomach ulcer, I would not recommend a trial of Betaine until after the ulcer has completely healed.

– Digestive Enzymes

​Digestive enzymes help to break down food which allows your body to extract the vital nutrients in the food.

They also help break down immune complexes in the blood which helps treat autoimmune conditions.

Click here for my preferred brand.

​- Probiotics

​High potency, multi-strain, multi-species probiotics cah greatly reduce local inflammation in the gut as well as reduce systemic inflammation.  I always recommend a probiotic to all patients with hypothyroidism (especially Hashimoto’s) for at least 2-3 months.

It is somewhat controversial whether you should take probiotics on a daily basis.  Many experts feel that is unnecessary.

I usually break it down to whether the patient has any gut issues or not.  If they do, they should take a daily probiotic.  If they don’t they can probably used them only during times of sickness or severe stress.

Click here for my preferred brand.

– ​Other Gut Imbalances

​If after reading this you believe you may have other gut imbalances such as SIBO, SIFO (small intestinal fungal overgrowth), or leaky gut, those issues will need to be addressed if you want to optimize your T3 level.

That ​will require sitting down with a doctor that is familiar and comfortable with those conditions.

​​4.  Lower Your Reverse T3

Reverse T3 and T3 are inversely proportional to each other.  As one rises, the other will fall and vice-versa.

That is because they both are produced from T4.

​​So reducing your reverse T3 production will mean that more T4 is being converted into T3.

So how do you do it?

Think of the reverse T3 level as indirect marker of inflammation in the body.  Any inflammation will typically cause the reverse T3 level to rise.

Therefore, ​most of the things I list below address various forms of inflammation.

– Reverse Insulin Resistance and Leptin Resistance

​High levels of insulin and leptin tell your body to create MORE reverse T3.

It will be very difficult to lower your reverse T3 levels unless you address these issues.

Click here to read more about how to treat insulin resistance and click here to read more about how to treat leptin resistance.

– High Intensity Interval Training (HIIT)

​Adding HIIT exercise to your regular routine will create a demand for more thyroid hormone in your body.

In effect, it will push your T4 conversion more down the T3 pathway and reduce your reverse T3.

– Stop Restricting Your Calories

​Calorie-restricted diets will put your body into “starvation mode.”  When that happens, T3 production is rapidly reduced and reverse T3 levels soar.

This is one of the ​ways that excessive calorie restriction damages your metabolism.  Click here to read more.

– Reduce Inflammation

​Besides insulin resistance and leptin resistance, there are other sources of chronic inflammation that will result in an elevated reverse T3 level.

These can include other autoimmune conditions, environmental toxins, and even obesity itself.

It is critical to get a thorough history and physical exam including blood work to identify all possible sources of inflammation in your body so that each be addressed directly.

There are some blood tests that you can request from your doctor that are nonspecific markers of inflammation in your body.

The most common tests are the erythrocyte sedimentation rate (ESR) and the c-reactive protein (CRP).  If either is above the reference range, it is a sign that there is unidentified inflammation in your body that should be addressed.

– Take a T3 Medication

​The quickest way of lowering the reverse T3 level is to take a T3 only medication.

This bypasses the conversion process altogether.  Your need for T4 will decrease which will also result in a dramatic decrease in reverse T3.

​5.  Manage Stress and Optimize Your Adrenal Function

​The adrenal glands and the thyroid gland are closely linked.

As cortisol levels increase, so does the TSH, which makes the thyroid function worse.

Also, as thyroid function decreases, this puts even more stress on the adrenals to make up the difference.

Eventually, the system can no longer keep up and adrenal fatigue results.

In my experience, literally ALL hypothyroid patients have some degree of adrenal fatigue.

That is why I​ recommend that most hypothyroid patients take an adrenal supplement.

For the sake of this article, I would suggest a few basic things to help manage adrenal issue:

  • ​Take an adrenal adaptogen – Essentially all patients would benefit from these herbs that help balance the adrenal function.
  • ​Take an adrenal glandular – Use this if you are having severe stress or severe fatigue.  Typically only needed for 3-6 months.  Avoid if you have an allergy to it.
  • checkCut out caffeine – Caffeine may give you a temporary boost, but it also adds additional stress to your adrenals and will ultimately make your symptoms worse.
  • Start doing regular meditation and/or yoga – This will drop cortisol levels and let your adrenals rest.

​If ​you feel you need to learn more about this, click here for my article on adrenal fatigue.

6.   Optimize Your Liver Function

Up to 60% of thyroid conversion occurs in the liver.

Obviously, making sure your liver is healthy and functioning well is critical if you want your T3 levels optimized.

Your liver can be assessed by having your liver function tests monitored.  The primary test are AST and ALT.

If either test is >20, it is a sign that you have some liver impairment.

By far, the most common cause of liver impairment is insulin resistance.  The insulin resistance can result in excessive fat deposits in the liver resulting in a fatty liver.

Reducing any liver dysfunction may result in the single greatest increase in your T3 level of any therapy that we have discussed.

​7.  Improve Your Diet and Lifestyle

​The foundation of any successful health plan always includes 5 things:

  • Healthy diet
  • Activity level/exercise
  • checkStress management
  • Good sleep hygiene

​If that foundation isn’t established, all of the supplements, medications, and other therapies will fail miserably.

​I realize that this is easier said than done, but it is critical if you want to feel your best.

In the case of this article, you must be eating healthy, exercising, sleeping well, and managing your stress in order to maximize your T3 production.

If you need a simple place to start, consider the Whole 30 Diet or the Ketogenic diet.

If you are having trouble with those or if you feel you need more instruction, I would recommend hiring a nutritionist for some one-on-one instruction.  You are worth it!

I would also recommend hiring a personal trainer that will give you a personalized exercise program that will be safe and effective.

​Summary

​Raising the T3 level is easy for some people and hard for others.

The key to success is identifying WHY yours is low and addressing the root causes.

These can include poor diet, lack of exercise, nutrient deficiencies, and excess stress.

There could also be unidentified sources of inflammation in your body or your liver and gut might not be working as efficiently as they should be.

Finally, it may also be the situation of needing a different thyroid medication.

Find a doctor that is willing to investigate all of these potential causes and is open to trying different thyroid medication.

​Now it’s your turn…

What have you tried to increase your T3 levels?

What has worked and what hasn’t?

Leave any questions or comments below.

Why is My T4 Low (and What Can I Do About It)?

Do your lab tests show that your T4 level is low?

​​What ​does that mean exactly?

Do you also have symptoms such as fatigue, weight gain, hair loss, constipation, and depression?

If you answered yes, you most likely have ​hypothyroidism which usually causes a low T4 level.

In this article, I will discuss the T4 lab test, what it means when it is low, symptoms that may be associated with a low T4 level, and I will also give some treatment tips that will help raise it to​ an optimal level.

Let’s get started…

​What is T4?

So what is T4 anyway? 

In order to answer that question, we need to talk about the thyroid gland and how it works.

​The thyroid gland primarily produces 2 types of thyroid hormone – Thyroxine (T4) and Triiodothyronine (T3).

The vast majority of the thyroid hormone produced is thyroxine (T4).  Not nearly as much triiodothyronine (T3) is produced.

Both of these hormones are produced ​in response to a hormone secreted by the pituitary gland called Thyroid Stimulating Hormone (TSH).

​The association of TSH and T4 gives us valuable information about how well the thyroid gland is working. That is why these tests should always be tested together.

​So what is the purpose of T4 in the body?

T4 is not nearly as biologically active as T3, but it still helps regulate how much T3 is available in the body.  ​

Most of the T3 in the body is actually produced from peripheral conversion of T4.  

​More specifically, as the body needs T3, an enzyme called a deiodinase will cleave off an iodine molecule from T4 which converts it into T3.

You can therefore think of T4 as a storage reservoir for the body to use to make T3 as it needs it.  This is the primary purpose of T4.

Causes of Low T4

​So what happens if the T4 level is low?

If the reservoir of T4 becomes low in the body (sort of ​like most of the lakes in the Texas Panhandle where I live), then there is not enough substrate that the body can use to produce T3.

The T3 levels then ​also drop, and symptoms of hypothyroidism develop.

​Why does the T4 level drop?

Let’s discuss the most common causes:

​1.  Autoimmune Thyroiditis (Hashimoto’s) –

​There are many theories about how and why autoimmune disorders ​develop.

​It is generally accepted that 3 things must be in place for an autoimmune disorder to develop.

  • Genetic Predisposition – You have a variation in one of your genes that may make it more likely to develop an autoimmune condition.
  • Leaky Gut – The bacterial levels and types of bacteria in your GI tract may be inadequate​.  Also, gaps between the cells in your intestines may widen which allows foreign proteins and toxins to enter the bloodstream that wouldn’t normally get through.
  • Trigger – A physical or emotional event may occur (injury, surgery, major life stress, etc.), or you may be exposed to an environmental toxic of some sort which can damage your immune system and cause it to ​function improperly.

​A common theory is that some of these foreign proteins that enter our bloodstream look similar to proteins in our body.  As a result, ​as our immune system makes antibodies against these foreign proteins, it in effect also ​unintentionally makes antibodies against parts of our body.

This is called molecular mimicry.

​This appears to be what happens in Hashimoto’s Thyroiditis.

The result is these auto-antibodies continuously attack parts of our thyroid gland, ​gradually destroying it.

As the cells of the thyroid gland are destroyed, its ability to produce thyroid hormone is impaired and hypothyroidism will develop.

This typically occurs slowly over many years.

Often patients will have classic symptoms of hypothyroidism, but their labs will remain relatively normal until late in the process.

Hashimoto’s is an extremely common condition.  In fact, in my medical practice I typically diagnose one or more people with it every week!  It is by far the most common autoimmune disorder.

Many experts believe that the vast majority (over 90%) of hypothyroidism in the United States is actually caused by Hashimoto’s.

If you have hypothyroidism, you should periodically have your thyroid antibody levels checked.

Click here to read more.

​2.  Hypothyroidism –

​Hypothyroidism refers to the condition of low levels of thyroid hormone in the body.

​The majority of cases are due to issues with the thyroid gland itself.  Rarely, it can be caused by issues in the brain (hypothalamic dysfunction).

​Since most thyroid hormone in the body is T4, if you are hypothyroid, you will have low levels of T4.

​That, however, ​does not give you enough information.  You need to investigate WHY you have hypothyroidism so that you can be appropriately treated.

​As we discussed earlier, the majority of hypothyroidism is caused by Hashimoto’s Thyroiditis.

​3.  Nutrient Deficiencies –

​There are multiple (at least 13) nutrients that are needed for proper thyroid hormone production and conversion.

A deficiency of even one of them can ​result in a significant reduction in thyroid ​levels which will cause symptoms of hypothyroidism.  It can also cause an increase in thyroid antibody levels if you have Hashimoto’s.

These nutrient deficiencies can include (click on the names for my preferred brands):

​So, should you just blindly supplement with all or most of these supplements if you have thyroid issues?

Of course not!

​You should always see your doctor and be tested for any nutrient deficiencies before supplementing, or at least look for common symptoms associated with particular deficiencies.  If you have a symptom or symptoms commonly seen with one of these nutrient deficiencies, then a trial of supplementation is reasonable to consider.

It is also always best to start with your diet.  Eat a diet high in nutrient-dense, organic foods which will contain a much higher nutrient content than the Standard American Diet.

​4.  Taking a T3 Only Medication –

​If you are taking a T3 only medication, it ​will often result in a drop in your T4 level.

T3 only medications include Cytomel and liothyroinine.  

Why?  It makes sense if you think about it.

​Like we learned earlier, T4 acts as the storage reservoir for T3 in the body.

If you are taking a T3 only medication, then your need for ​that reserve of T4 decreases because you have bypassed the conversion process.  This therefore results in less T4 production by the thyroid gland.

Taking a T3 only medication will typically cause the free T4 level to decrease, the TSH level to decrease, the reverse T3 level to decrease, and the total T3 and free T3 levels to increase.

This can also happen to a lesser extent if you are taking a natural dessicated thyroid (NDT) such as Armour Thyroid, NP Thyroid, or Nature-throid.  That is because these medications contain about 20% T3 and about 80% T4.

The drop in T4 level in this case is expected and what you want.  It is not a sign of inadequate thyroid levels like it is in the other situations.

​Symptoms of Low T4

​Having a low T4 level typically results in all of the classic symptoms of hypothyroidism.  

The list of symptoms can be quite exhaustive, but the most common include:

  • Fatigue
  • Weight Gain
  • checkHair Loss
  • checkConstipation
  • checkCold Intolerance
  • checkDepression
  • checkBrittle Nails
  • checkDry Skin
  • checkMenstrual Irregularities
  • Infertility
  • checkBrain Fog

​For a more extensive list, click here.

The vast majority of doctors have been taught to use the TSH as their sole means of evaluating thyroid function.

In many cases of hypothyroidism, the TSH will remain normal until it has been present for many years. This is true with Hashimoto’s as well.

The T4 and T3 levels will typically drop earlier in the process than will the TSH.

That is another reason why you should ALWAYS ask for a complete thyroid panel when your thyroid is being evaluated.

​How to Raise Your T4

​Fortunately, raising your T4 level is usually straight-forward.

Reversing what is causing your low T4 is the key to successful treatment.

You will either want to increase the thyroid hormone your body produces itself, or you will need to supplement ​what your body produces with a thyroid hormone medication.

​1.  Lifestyle Interventions –

​Improving your diet, beginning an exercise program, improving gut function, and reducing stress should always be the first steps taken when treating ANY condition.  The thyroid is no exception.

​2.  Correct Any Nutrient Deficiencies –

​Identifying and correcting any of the nutrient deficiencies we discussed earlier will result in an increase in your body’s natural thyroid production and T4 to T3 conversion.

​3.  Supplement with a T4 Thyroid Hormone – 

​Taking a T4 only medication such as levothyroxine, Synthroid, or Tyrosint will result in an increase in the T4 level in the body.  

Keep in mind that if you have T4 to T3 conversion issues because of a nutrient deficiency or inflammation in the body (insulin resistance, leptin resistance, an autoimmune condition, etc), raising your T4 level may still not result in adequate T3 levels reaching the cells.  Symptoms of hypothyroidism may still not improve.

​4.  ​Reduce Thyroid Antibody Levels –

​If you have Hashimoto’s, there are dietary, supplement, and medication therapies that can help reduce thyroid antibody levels.  This will improve thyroid function and will help to raise the T4 to an optimal level.

Click here to read more.

​5.  Take T3 Thyroid Hormone –

​In addition to or even in place of T4 thyroid hormone, T3 hormone medication can be taken.

That may cause the T4 level to drop, but that is not a bad thing in this case.

There is an art to using T3 medication, so it is important that you find a medical provider with experience in using it.

Click here to read more.

​Summary

​A low T4 level is commonly seen in hypothyroidism.  It is often present before the TSH level becomes abnormal.

​A low T4 is associated with several symptoms that can dramatically alter your quality of life.

Treatment to increase T4 levels typically involves correcting nutritient deficiencies, reducing inflammation, and taking thyroid medication.

Now it’s your turn…

​Is your T4 level low?

Is your TSH level ​low, normal, or high?

Are you having symptoms of hypothyroidism?

What treatment plan are you using?

Leave any questions or comments below.​

The 9 Best Osteoporosis Natural Treatments

​Osteoporosis is a serious medical condition that is unfortunately getting more common.  

There are ​several medications available for the treatment of osteoporosis, but they have some potentially very serious side effects.

So what are some non-prescription t​hings that you can do to strengthen your bones to treat or prevent any bone loss that you may be having?

In this article I will discuss the 9 best natural treatments for osteoporosis and discuss the research behind each one of them.

Let’s get started…

What is Osteoporosis?

​Osteoporosis is a condition where a person loses bone mass.  It is either due to losing too much bone or not making enough bone.

Bone is living tissue.  It is constantly being broken down and replaced.  When it is getting broken down faster than it is being made, the bones will gradually become weaker which makes it easier for them to fracture even with normal daily activities.

​Unfortunately, osteoporosis is extremely common and is ​becoming more prevalent.

1 in 7 women over 50 have osteoporosis.  About 25% of women over age 65 have osteoporosis of either the hip or lumbar spine.  About 5% of men over age 65 have osteoporosis.

​About half all women ​and 1 out of every 4 men over 50 ​will have an osteoporosis-related fracture in their lifetime.

​This is a very serious issue, because after a hip or vertebral fracture, ​mortality is ​much higher in those people than in the general population ​even as late as 10 years after the fracture!

​Most of those deaths are not ​directly ​due to the fracture.  Instead, the fracture is an indicator of a decline in the health of that person and often leads to other conditions that result in death.

​How to Diagnose Osteoporosis

The density of a bone is measured using a machine called a DEXA scan (dual-energy x-ray absorptiometry).  There are other tests that are used, but the DEXA is considered to be the gold standard.

In this test, ​2 x-ray beams are shot through 2 different bones in the body (usually a hip and the lumbar spine).  The more dense the bone, the less the x-ray will be able to penetrate.  The machine is then able to measure the degree of penetration.

​A DEXA scan will give you a T-score and a Z-score for each bone that was tested.

Without going into a boring statistics lecture, I will try to explain what these test scores mean.  

​Whenever you look at a characteristic found in a large population of people, the results will follow a predictable distribution across a graph.

​If you place the values on a graph, it will produce what is commonly called a Bell Curve.

​This is true ​when you measure bone densities as well.  However, in this case the positive side of the graph is ignored and only the negative side is considered.

​The middle (mean) of the bell curve is the bone density of a healthy 30 year old female, which is the time when the bone density is at it highest point.

​The T-score is how many standard deviations from the mean (or middle of the graph) ​the tested bone scored. The Z-score compares your bone density to ​a normal score for a person of your same age and body size.

​The diagnosis of osteoporosis is made when ​the T-score is less than or equal to -2.5, which is way over on the far left of the bell curve.  That ​means the density of the bone tested is l​ess than the bone density of 95% of the population!

If the T-score is -1.0 to -2.4, the diagnosis of osteopenia is made.  While not considered to be as dangerous as osteoporosis, it still indicates that the person is losing bone mass, especially the lower the T-score.  Those patients should be monitored closely and proactive measures should be taken to reduce any further bone loss.

​Treatment of Osteoporosis

​Okay, so you’ve had a DEXA scan and your T-score is in the osteoporosis range.

Now what?

​Your doctor will probably recommend that you start taking a medication called a bisphosphonate. However, when you get home and read the package insert that came with the medication, what you read may scare you to death!

These medications are far from benign.  The potential side effects range from mild to life-threatening. They include:

​While this class of drugs has been shown to reduce the risk of osteoporosis-related fractures, that reduction might come ​at a cost.  Needless to say, it would be best if this class of medications was avoided completely.  

I believe there are several things that you can do that are natural and much safer than these drugs.

Let’s discuss the best ones below:

​The 9 Best Osteoporosis Natural Treatments

​If you ask your doctor what is the best way to keep your bones strong, he or she will most likely say something like this:  “Eat good, healthy foods and exercise regularly.”

​That is good, sound advice for just about everyone.  However, it is hard to get enough of some nutrients from food, even if you are eating a whole food, nutrient-dense diet.

Because of over-farming, genetic engineering, etc., the nutritional value of food simply isn’t what it used to be.  Even if you are eating a purely organic diet, you will probably be deficient in some nutrients.

This is especially true if you have any digestive or other gastrointestinal issues, which can impair the absorption of what nutrients are in your food.

So what can you do to keep your bones strong and help regain bone loss if your DEXA scan shows you have osteoporosis or severe osteopenia?

​1.  Weight-bearing Exercise

​The first thing that I recommend for all patients with osteoporosis is to participate in weight-bearing exercise on a regular basis.

This includes walking, jogging, dancing, using an elliptical, stair climbing, gardening, etc.

This type of exercise puts a direct burden on the bones and muscles of the lower body​​​ which helps to slow mineral loss.

Studies show that this can beneficial for people with osteoporosis:

– Weight bearing exercise increases both bone density and quality of life.

​- Walking has been shown to preserve bone density in the hip.

Jogging and weight lifting reduce bone loss in postmenopausal women.

Other exercises such as biking and swimming are great for cardiovascular health, but they are not beneficial for strengthening bones.

​2.  Vitamin D

Vitamin D has many functions in the body, including the regulation of calcium and phosphorous absorption.

If vitamin D is low, parathyroid hormone (PTH) increases and triggers osteoclasts​ to release calcium into the blood via bone reabsorption. Over time, this can lead to bone loss and osteoporosis.

Vitamin D also stimulates intestinal epithelial cells to synthesize calcium-binding proteins that support the absorption of calcium in the blood.

Vitamin D increases the number and activity of osteoblasts (the cells that build bone) and reduces the activity of osteoclasts (the cells that break down bone).

Vitamin D is synthesized when sunlight hits the skin.

Vitamin D deficiency is now recognized as an epidemic.

Experts state that 75% of population is deficient in vitamin D. When using the goal of 50-80, that number goes to about 95%.

Deficiency is more common in dark-skinned people, the elderly, and people from the north.

You can determine if you are low in vitamin D by asking your doctor to order a 25-hydroxy-vitamin D level with your next blood work.

​The “normal range” for a 25-hydroxy-vitamin D is 30-100 ng/ml, but it is optimal to have it in the 50-80 range.

So what can you do about it?​

​Good dietary sources of vitamin D​ – fatty fish (salmon, mackerel and tuna), dairy products (if you aren’t sensitive), eggs, and ​shiitake mushrooms.

​In my experience, the majority of people will need to take a vitamin D supplement to get the levels in the optimal range.  

A study published in JAMA in 2013 showed that vitamin D supplementation reduced the risk of fractures by 16%.

Vitamin D3 is the best supplementation of choice to increase your vitamin D level.  Click here for my preferred brand.

If your 25-hydroxy-vitamin D level is <30 ng/mL, I typically recommend that you take 10,000 iu (2 capsules) of the ADK daily for 90 days then reduce it to 5000 iu (1 capsule) daily after 90 days.  If your level is >30 but <50, I recommend only taking 1 capsule daily (5000 iu).

You may notice that my recommended amounts are WAY higher than the recommended daily amount (RDA) given by the Institute of Medicine (IOM) in 2011.  They state that everyone should aim for a 25-OH-vitamin D level of 20 ng/ml, which would equate to taking 600 iu of vitamin D3 daily (800 iu daily if you are over age 70).

If you are interested (and are a statistics nerd!), the following video of a talk given by Keith Baggerly, PhD, will show how the IOM made a mathematical error in their calculations when they determined the RDA for vitamin D.

​Dr. Baggerly showed that the actual amounts of vitamin D3 needed are 10x that amount!  In other words, most people under age 70 need about 6000 iu of vitamin D3 daily, while people over age 70 need about 8000 iu daily.

​Please note that for vitamin D to work properly, it is just as ​important that the vitamin K2 and magnesium levels are optimal as well.  I will discuss each of these nutrients below.

​3.  Magnesium

​Magnesium is important for building bone, absorbing calcium, and forming ATP.  It also serves as a cofactor in the production of vitamin D in the skin.

It is estimated that 75% of the population is deficient in magnesium.

Low levels of magnesium in the blood correlates with a low bone density.

​Patients with osteoporotic fractures were also found to have lower magnesium levels than patients without osteoporosis.

Magnesium deficiency may impair the production of parathyroid hormone and 1, 25-dihydroxyvitamin D, which negatively affects the mineralization of bone.

​Good dietary sources of magnesium – nuts, whole grains, dark green vegetables, fish, meat, and legumes.

​Magnesium is often deficient in the ​standard American diet because of lack of those foods plus soil depletion from over-farming.

What about magnesium supplements?

Several studies have shown that magnesium supplementation increases bone density​ and reduces the incidence of fractures.  Click here, here, and here.

Supplementing with 250-400mg per day of Mg is recommended.  Click here for my preferred brand.

Magnesium glycinate​ is preferable over magnesium oxide because​ it causes less incidence of loose stools.

​Please keep in mind that magnesium may interact with other supplements and medications.

​Magnesium can also help with insomnia, headaches, chronic constipation, restless leg syndrome, and anxiety.

​4.  Vitamin K2

Studies have shown that vitamin K2 is absolutely essential when it comes to achieving optimal bone and cardiovascular health.

According to some experts, 98% of the population is deficient in K2.

There are no commercially available tests to determine the level of vitamin K2 in the body.

Elderly patients with osteopenia are usually deficient in K2.  They need K2 to help reduce bone loss that comes with age and to maintain bone health.

In Japan, 360mcg of K2 is the primary treatment for osteoporosis – NOT bisphosphonates!

Vitamin K2 appears to help the body deposit calcium in appropriate locations like the bones and teeth and prevents it from being deposited in bad places, such as arterial walls.

​Vitamin K2 has also been shown to reduce the risk of prostate cancer by 35%.

It has also been shown to reduce the risk of coronary heart disease.  

Good dietary sources of vitamin K2 – cheese, eggs, natto, butter, salami, chicken breast, ground beef

What about vitamin K2 supplements?

​The MK-7 form of vitamin K2 is by far the most potent.​​​

​Since most people are also deficient in vitamin D, I have found that it is easiest to take a supplement that has vitamins A, D3, and K2 together in a single supplement capsule.​​​  

These supplements work synergistically to strengthen bone.

Click here for my preferred brand.

​5.  Strontium

​Strontium is a naturally occurring mineral present in soil and seawater.  It is an alkaline earth metal similar to calcium and barium.

99% of the strontium found in the human body is in our bones.

​The Spinal Osteoporosis Therapeutic Intervention study showed a 41% relative risk reduction of vertebral fractures in patients taking strontium.

​This study showed a reduction in nonvertebral fractures when using strontium.

​Strontium appears to decrease bone resorption and increase bone formation.

It has been shown to increase bone density in both men and women.

A radioactive form of strontium is used to treat bone cancer and prostate cancer.

There is also research that shows it reduces tooth pain and helps prevent cavities.  In fact, many commonly used toothpastes marketed for sensitive teeth ​contain small amounts of strontium.

Dietary sources of strontium – seafood, milk, grains, beans, spinach, celery, carrots and potatoes

What about strontium supplements for osteoporosis?

Strontium is generally well tolerated, but some concerns are begin raised in Europe over whether there is an increased cardiovascular risk when it is used long term.  It has been available as a prescription treatment for osteoporosis in Europe since 2004.

​Strontium is available in the US as strontium citrate.  Click here for my preferred brand.

​You will want to make sure your vitamin D level is optimized.

Do not use strontium if you are on kidney dialysis or if you have a history of severe heart disease.

This may be a viable treatment option for osteoporosis, but please be aware that long-term safety studies are lacking.

At this point, I would reserve its use for only short term use (1-3 years)​ until long term ​studies are available.

​6.  Boron

​Boron is a trace mineral found naturally in some foods and in the environment.

Boron ​reduces the excretion and absorption of calcium, magnesium, and phosphorus, which results in a reduction in bone loss.

​Boron up-regulates the production of steroids such as vitamin D, estradiol and testosterone.

Boron has also been shown to improve brain function, reduce the incidence of arthritis, and is an effective treatment for vaginal yeast infections,

Dietary sources of boron – fruits, vegetables, soybeans, and nuts. The amount of boron in these foods depends on the soil where they are grown.

What about boron supplements for osteoporosis?

​It is always best to get boron from your diet.​​​

A safe daily intake is about 1-10mg.  Click here for my preferred brand.

Doses above 3mg per day are not recommended in breast cancer patients.

Repeated doses of small amounts can accumulate in the body, so pulse dosing is recommended over continuous dosing.

​7.  Testosterone

​Testosterone is a hormone that grows tissue in the body.

It is responsible for muscle growth, bone growth, hair growth, sexual function, sexual drive (libido) and is essential for overall health and feelings of well-being.

Both men and women need testosterone.

Testosterone pellet therapy has been shown to increase bone mass four-fold compared to oral estrogen.

​Testosterone can be ​used as a bioidentical cream, an injection, or as a bioidentical subcutaneous pellet.  All of these can only be provided by a licensed medical professional.

​Click here to read more.

​8.  Soy Isoflavones

​Isoflavones are found in soy products.  The best of these are what are called fermented soy.  They include natto, tempeh and miso.  All of these ​are soy products that have gone through a long fermentation process that make them easier to digest.

Natto ​is fermented soybeans that is sticky and ha​s a very strong flavor.

Tempeh is a fermented soybean cake with a firm texture and a nutty flavor.

Miso is a fermented soybean paste with a salty, buttery texture.  You have probably had miso soup at your favorite Asian restaurant.

They are loaded with vitamin K2 which ​I discussed above.  They also contains boron.

Soy isoflavones significantly increase the bone density of the lumbar spine.

Diets high in soy may decrease bone resorption in postmenopausal women.

​A synthetic derivative of isoflavones called iproflavone ​was shown to prevent rapid bone loss following early menopause.

Consuming 2-4 ounces per day of fermented soy is a reasonable thing to do to prevent and treat osteoporosis.

​Keep in mind that many people are allergic or sensitive to soy.  If that is you, then this is not a good choice.

​Isoflavones may also inhibit thyroid hormone synthesis.  So if you have a thyroid condition, your thyroid levels needs to be monitored if you consume fermented soy to treat your osteoporosis.

Unfermented soy which is found in tofu and other processed forms is not a healthy food option and should be avoided as a general rule.

​9.  What About Calcium?

​Most doctors are taught in their training to recommend calcium supplementation to help maintain bone mass.  ​I myself commonly told my patients in the past to take 1200mg of calcium citrate per day, especially postmenopausal women.

​However, several studies have brought the benefit of calcium supplementation into question.

​In this study, taking higher amounts of calcium beyond the recommended dietary allowance did not result in an increase of hip or spine bone density.

Calcium supplementation in a different study did not result in a decrease in the incidence of hip fractures in older women and even appeared to ​increase the risk.

A study published in JAMA in 2013 was a meta-analysis of 29 studies which showed no significant reduction in the risk of fractures with calcium supplementation. Vitamin D plus calcium did reduce the fracture risk.

​Not only have these studies failed to show a benefit on bone density, some other studies have shown some dangerous consequences of taking calcium supplements:

Dangers of Calcium Supplementation

1. Cardiovascular Heart Disease –

A Johns Hopkins investigation in 2016 showed that taking calcium supplements may lead to an increased risk of plaque buildup in the coronary arteries.

​Another study of 12000 men showed a 20% increase in CVD death in those taking 1000mg of calcium daily.

Eating foods that are high in calcium does not seem to have the same risk.  It is felt that the calcium from food is absorbed at a slower rate. The burst of calcium from supplements may facilitate the calcification of arteries.

​Another theory is that taking more calcium than the body needs may cause it to either be excreted in the urine which increases the risk of kidney stones, or circulated in the blood where it could attach to atherosclerotic plaques or valves.

2. Kidney Stones –

The risk of kidney stones is increased by about 20% in people taking calcium supplements.  Here is another study.

3. Possibly prostate cancer –

This meta-analysis showed an increase in prostate cancer risk with a high calcium intake, but it is hard to know if it was due to the calcium or due to the high dairy intake.

4. Constipation –

A high calcium intake is well known to cause constipation.  It might also interfere with the absorption of iron and zinc.

In people with a sensitivity or allergy to dairy ​or other foods that are good natural sources of calcium, supplementation may be necessary.  However, I would personally limit that to only 400-600mg per day of calcium citrate.

Summary

​Osteoporosis is an extremely common and dangerous condition.

It needs to be monitored closely and aggressively treated when possible.

Like most conditions that affect the human body, eating a whole-food, nutrient-dense diet and exercising regularly (especially weight-bearing exercise) are the mainstays of treatment.

Optimizing the levels in the body of vitamin D, K2, and magnesium are essential to ​maintain and restore bone density.  

Other options for increasing bone mass include strontium, boron, and soy isoflavones.  Optimizing testosterone levels can also help.

Calcium supplements are controversial.  I would typically suggest avoiding them and instead focus on eating foods that are naturally high in calcium.

Now it’s your turn…

Have you been diagnosed with osteoporosis?

What treatments have worked for you?

Leave your questions and comments below…

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