THYROID AND IODINE: ARE YOU GETTING ENOUGH IODINE ?

Read in 7 minutes
Iodine is an essential component of thyroid hormone production.Iodine is the naturally occurring element, which is a solid at room temperature. Iodide is the form when it combines with another element like potassium or sodium, which is usually what is added to iodised salt.Most iodide is found in the oceans and evaporates into the atmosphere and is returned to the soil by rain. Soil and groundwater can become iodine deficient because the iodine cycle is not as efficient in many geographical regions of the world.Iodine deficiency is common in many hilly and mountainous regions of the world.
IODINE DEFICIENCY DISEASES:
Iodine deficiency is associated with many conditions, all of them related to thyroid function.
In Adults:
  • Goitre
  • Hypothyroidism
  • Impaired mental function.

In pregnancy:

  • Miscarriage
  • Stillbirths
  • Congenital anomalies.
In newborns and children:
  • Cretinism
  • Mental retardation
  • Neonatal goitre
  • Neonatal hypothyroidism.
  • Developmental delay
The biggest problem of iodine deficiency occurs when pregnant women are deficient in this mineral, because mental retardation in the child as a result of iodine deficiency is irreversible.Studies have shown that even in mildly iodine deficient women children were born with lower IQ.
WHERE DO YOU GET YOUR IODINE?
Your body does not make iodine so you have to get it from food or supplements.Iodine content in food can vary because the quantity present in soil varies.
The commonest sources of iodine are:
  • Seaweeds like kelp, nori,wakame.
  • Eggs, dairy.
  • Some fish
  • Iodized salt
  • Supplements

IODIZED SALT:

Worldwide iodine deficiency diseases are still a major public health problem in many countries.Mountainous areas, such as the Himalayas, Alps, and Andes regions, and river valleys prone to flooding, especially in South and Southeast Asia, are among the most iodine-deficient regions in the world.To counter the adverse effects of this condition the program of salt iodization was started in many countries.

Salt iodization is a process whereby potassium iodide is added to common salt during the manufacturing process so that people consuming adequate amounts of iodized salt will not be iodine deficient. Iodized salt was first available in the United States in 1924. Though populations  in United States and Canada are considered to have adequate iodine levels, according to the Statistics Canada website,a 2009 study among Canadians aged 3 to 79, showed that a moderate deficiency of urine iodine levels was found in 7% of the population while 15% had an excessive intake.A deficiency and an excess are both cause for concern.
 In India several studies have shown that despite a program of salt iodization since the 1960ties, goiter and other Iodine Deficiency Disorders still remain a problem in many regions.

HOW MUCH IODINE DO YOU NEED IN A DAY?

The standard recommendation is:

  • Non-pregnant adults 150 microgram/day
  • Pregnant and breast feeding women 250 microgram/day. However, the recommendations for the upper limit vary from 500-1,100 mcg of iodine daily.
  • Tolerable upper limits of iodine intake: 1100 microgram/day

CAN YOU GET ADEQUATE IODINE FROM IODIZED SALT?

This is open to debate because of various reasons. The amount of iodine present in the iodized salt depends on the conditions of storage, relative humidity and the packaging material used. In fact, a 2008 study from the US states that “Forty-seven of 88 samples (of Iodized salt) fell below the USFDA recommended Iodine content while 6 exceeded it.” 

The World Health Organization (WHO) recommends that you should take 5 grams of salt a day. This quantity of iodized salt should ideally contain 400 microgram of Iodine. However, most people use a lot more salt than the recommended 5 grams. A lot of the salt intake is from processed food which is not iodized salt. Excess salt has been associated with higher incidence of high blood pressure.

Instead of getting your iodine from iodized salt perhaps it is better to get it from a multivitamin multimineral supplement containing 150 microgram of Iodine.

IS THERE A PROBLEM OF TOO MUCH IODINE?

According to the American Thyroid Association (ATA) the tolerable upper limit of iodine intake is 1100 microgram per day. In fact, the ATA advises against the ingestion of iodine and kelp supplements containing in excess of 500 mcg iodine daily. A study from China in The American Journal of Clinical Nutrition (2012) shows that amongst euthyroid (normal thyroid function) adults subclinical hypothyroidism appeared in the participants who took 800 μg/d of Iodine.

Therefore, excess iodine intake can be harmful and has been associated with :

  • Hyperthyroidism
  • Hypothyroidism
  • Congenital hypothyroidism because of excess Iodine intake by mother.

High doses of Iodine are sometimes recommended by some practitioners. It is often quoted that the Japanese people living in Japan consume very high amounts of Iodine through their diet of seaweed. Is it possible that the Japanese people have a different gut microbiota which helps them process the excess iodine differently? (Reference: Dr. Justin Sonnenburg, PhD, “Microbiology: genetic pot luck.” Drs Justin and Erica Sonnenburg have written an excellent book The Good Gut: Taking Control of Your Weight, Your Mood and Your Long-term Health)

High doses of iodine are appropriate in the treatment of severe hyperthyroidism before thyroid surgery and as potassium iodide following a nuclear accident. However, this is always done by a qualified physician.

HOW DO YOU KNOW IF YOU HAVE IODINE DEFICIENCY?

This question does not have a simple answer.

Urine Iodine Concentrations: Iodine levels cannot be reliably measured in individuals because of the considerable day-to-day variation in iodine intake. Median urinary iodine concentrations (UIC) have been widely used as a biomarker of population iodine intake. This does not necessarily apply to individuals.

Thyroglobulin: Serum thyroglobulin can be used as a marker of iodine levels in the body. However, this is not a test in isolation of other thyroid function tests. Sometimes Anti Thyroglobulin Antibodies may interfere with the test result. Also keep in mind that Thyroglobulin is not a test for thyroid cancer. (Thyroid Function Tests)

Dried Urine Iodine Test: This test is easily available in USA and Canada and is done by special laboratories. Though not done in India, samples can be shipped to USA and tested. Some testing companies also test Bromine, Fluorine, Thyroglobulin, and some heavy metals in addition to Iodine.

KEY POINTS

  • Iodine is very important for thyroid health.
  • Low iodine in pregnant women is avoidable but irreversible cause of mental retardation in children.
  • Pregnant women must ensure adequate iodine intake BEFORE pregnancy. Extra iodine is needed during pregnancy and breast feeding. Check your antenatal vitamins contain adequate iodine.
  • Iodine deficiency exists even in iodine-adequate countries.
  • Excess iodine intake has adverse effects.
  • Iodized salt may not be best source of iodine.
  • Supplement with multivitamin multimineral containing at least 150 micrograms of Iodine.

YOU MAY LIKE READING

Dietary Goitrogens

Thyroid Hormone Replacement

Hashimoto’s Thyroiditis

REFERENCES 

  1. http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11733-eng.htm
  2. Dasgupta, Purnendu K., Yining Liu, and Jason V. Dyke. “Iodine nutrition: iodine content of iodized salt in the United States.” Environmental science & technology 42.4 (2008): 1315-1323.
  3. Diosady, L. L., et al. “Stability of iodine in iodized salt used for correction of iodine-deficiency disorders. II.” Food and Nutrition Bulletin 19.3 (1998): 240-250.
  4. De Groot, Leslie, et al. “Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society clinical practice guideline.” The Journal of Clinical Endocrinology & Metabolism 97.8 (2012): 2543-2565.
  5. Sang, Zhongna, et al. “Exploration of the safe upper level of iodine intake in euthyroid Chinese adults: a randomized double-blind trial.” The American journal of clinical nutrition 95.2 (2012): 367-373.
  6. Leung AM, Braverman LE. Consequences of excess iodine. Nature reviews Endocrinology. 2014;10(3):136-142. doi:10.1038/nrendo.2013.251.
  7. Hehemann, Jan-Hendrik, et al. “Transfer of carbohydrate-active enzymes from marine bacteria to Japanese gut microbiota.” Nature 464.7290 (2010): 908-912.
  8. Sonnenburg, PhD, Justin L. “Microbiology: genetic pot luck.” Nature 464.7290 (2010): 837-838.
  9. Zimmermann, Michael B., et al. “Assessment of iodine status using dried blood spot thyroglobulin: development of reference material and establishment of an international reference range in iodine-sufficient children.” The Journal of Clinical Endocrinology & Metabolism 91.12 (2006): 4881-4887.

DIETARY GOITROGENS AND THYROID FUNCTION: IS THERE A LINK?

Read in 4 minutes
This blogpost was prompted by a comment on a Whatsapp group about dietary goitrogens and thyroid disease. That discussion was related to soy. 
If you have hypothyroidism,the most important question that you’d like to be answered is:
Should you avoid food like soy and cruciferous vegetables (dietary goitrogens)?
 
WHAT ARE GOITROGENS?
According to Wikipedia “Goitrogens are substances (whether in drugs, chemicals, or foods) that disrupt the production of thyroid hormones by interfering with iodine uptake in the thyroid gland. “
( In this post i will not discuss drugs or endocrine disrupting chemicals that affect thyroid function).
What are the common food that well-meaning healthcare practitioners sometimes ask you to avoid if you have hypothyroidism?
The commonest ones are soy and cruciferous vegetables. Cabbage, kale,broccoli, brussels sprouts,bok choy, cauliflower are the commonest cruciferous vegetables that you eat.
SOY AND GOITRE
The alleged association of soy with goitre has probably originated in animal studies and few isolated case studies reported in the sixties ,where few infants fed a soy formula had developed goitre.
What is the true association of soy and thyroid function? In an article in the journal Thyroid (2006) the authors looked at 14 trials (though thyroid function was not the primary health outcome in any trial). They commented that “the findings provide little evidence that in euthyroid, iodine-replete individuals, soy foods, or isoflavones adversely affect thyroid function.”
What about soy interfering with supplemental thyroid hormone absorption?
An interesting case study reported in Endocrine Practice: May 2001 discusses a patient who needed very high doses of thyroid hormone replacement after she had undergone a thyroid gland removal for cancer.On enquiry it turned out that she was taking a “soy-cocktail “protein supplement immediately after taking her synthetic thyroid hormone! Once the intake of both were separated, she needed a lesser dose of thyroid hormone!So this was not a problem of soy being a goitrogen, but a problem of food interfering with  thyroid pill absorption.
Is it only soy that interferes with supplemental thyroid hormone absorption? NO!
Iron, calcium, proton-pump inhibitors like Omeprazole,coffee, cholestyramine and other food also interfere with thyroid absorption. 
This is why we recommend that you should take your thyroid pills on an empty stomach. Preferably avoid eating or drinking anything (other than water) one hour before and one hour afer taking your thyroid meds.Another suggestion from my practice partner Dr.Natasha Iyer is to take your thyroid meds in the middle of the night if you wake up to use the washroom. But no nibbling then!
What about cruciferous vegetables as goitrogens?
In animal studies very high intake of cabbage and turnip have been associated with hypothyroidism.However, animal studies cannot be extrapolated to humans!
A study reported in the New England Journal of Medicine, May 2010 talks about an 88 year old Chinese woman who was brought to the emergency department in myxedema coma (severe hypothyroidism leading to coma).She did not have thyroid dysfunction before. She was taking 1 to 1.5 kilograms of raw bok choy everyday for several months in the belief that it would take care of her diabetes! I don’t know whether her diabetes was affected of but it sure sent her into coma!
However, a small study which  looked at 10 people who ate 150 grams of cooked Brussels Sprouts everyday for 4 weeks, did not show any adverse effects on thyroid function.
IMPORTANT TAKEAWAYS
  • If you have hypothyroidism you can eat soy, cabbage, bok choy, cauliflower, broccoli, kale as long as you do not over-indulge!
  • Supplemental thyroid hormones should be taken away from food or supplements for best absorption.
You may be interested in reading the following posts:
(Watch for post on iodine and thyroid to be posted later).
REFERENCES
  1. Bell, MB, FACE, David SH, and Fernando Ovalle, MD. “Use of soy protein supplement and resultant need for increased dose of levothyroxine.”Endocrine Practice 7.3 (2001): 193-194.
  2. Chu, Michael, and Terry F. Seltzer. “Myxedema coma induced by ingestion of raw bok choy.” New England Journal of Medicine 362.20 (2010): 1945-1946.
  3. McMillan, M., E. A. Spinks, and G. R. Fenwick. “Preliminary observations on the effect of dietary brussels sprouts on thyroid function.” Human & Experimental Toxicology 5.1 (1986): 15-19.

STRESS AND AUTOIMMUNITY

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Does stress induce Autoimmune Disease? Or is stress a cause of Autoimmunity? The precise answer to the question of whether stress is an inducing agent or a causative agent is in the realm of medical minutiae, but there is no doubt that stress has a major impact on your autoimmune disease. This is not new information for most of you. Many of you have experienced worsening of your symptoms soon after some stressful event in your life or you have even tried to blame your significant other for “causing” stress in your life! Though it is true that empathic stress (later blog post) can affect you, it is not stress that is the problem; it is how you deal with it that decides your health! We do need some amount of stress to be alive! Is it eustress (positive stress) or distress (negative stress) that is affecting you?

In my patient intake form I have a section that talks about how you gauge your stress levels. Most of you fill in your health-related stress as an 8 or 10 out of 10. (One lady said it was 11 out of 10!). For many of you this stress comes from the physical pain or the uncertainty of not knowing what happens tomorrow or from being unable to work or from the lack of response to a particular drug or various other factors. In this blogpost I would like to focus more on the solutions to address stress, rather than the problem.

WHAT IS STRESS?

Dr. Hans Selye, who is considered to be one of the pioneers of stress research, in 1936 defined stress as “The non-specific response of the body to any demand for change. Everyone knows what stress is, but nobody really knows.”

YOUR STRESS RESPONSE IS DECIDED BY MANY FACTORS.

Some of the important factors affecting your stress response are:

  • Intrauterine influences-your mother’s stress when she was pregnant with you.
  • Your childhood experiences (ACE score, explained below)
  • Your gender
  • Your socioeconomic status
  • Your stress management strategies.

Intrauterine influences: Some of the factors that influence your stress response are operative when your mother was pregnant with you! There are many scientific studies that describe how stress experienced by women during pregnancy had adverse influence on the health of the children. The Dutch Winter Hunger Study and the Project Ice Storm study are among some of the often-quoted ones. The effects on the child depended on when during the mother’s pregnancy she had experienced the adversity. For example, children born to mothers who had experienced stress during the last part of their pregnancy were at higher risk for diabetes, heart disease and increased fat mass. The baby in the uterus predicted that it was being born into a world of scarcity and therefore needed to conserve fat! Some of these adverse health effects were trans-generational (affected at least 2 subsequent generations)! This is a truly fascinating field of study called Developmental Origin of Health and Disease (DoHAD).

ADVERSE CHILDHOOD EXPERIENCES (ACE) AND HEALTH

Dr. Vincent Felitti and Dr. Robert Anda’s landmark study of 1998 found a strong relationship between exposure to abuse or household dysfunction during childhood and multiple risk factors for many diseases in adults, including Autoimmune Disease. The higher the ACE score, the higher the incidence of disease. This effect was more pronounced in women and Autoimmune Disease.

We know that factors like sexual or physical abuse have a lot of adverse health effects, but when you check your ACE score you will realize that factors like living with an alcoholic caregiver or someone with mental illness or even being insulted or put down often has many adverse health influences. The point of this study is not to blame your parents but to realize how your health challenges may have an explanation in your childhood experiences and more importantly, these effects are not permanent! You can get better! A recent book Childhood Disrupted: How Your Biography Becomes Your Biology and How You Can Heal by Donna Jackson Nakazawa is a good book to read. Nakazawa is an award winning author who shares her journey through successfully dealing with Guillain Barre Syndrome (GBS).

 

ACE
From Viletti, Anda Study on ACE

Do you know your ACE score? Check here to download the form and find out.

IS IT ADRENAL FATIGUE?

During consultation some of you tell me that you have “Adrenal Fatigue” or that your “Adrenals are fired”. Is that true? In medical terms what you mean is that you have a dysregulated stress response or the medical terms HPA Axis (Hypothalamo-Pituitary-Adrenal Axis) dysfunction or Allostatic Load. What does it mean? (I will explain this concept in details on a webinar/series of blog posts later. On this post I’d like to focus on the solutions rather than the problem). Humans have had to deal with stress since time immemorial. What has changed now? Stress for our hunter-gatherer ancestors involved physical stress and was usually short-lived. Our bodies were used to short-lived stress and not the type of ongoing stress that we experience now.

WHAT CAN YOU DO TO TAKE CARE OF YOUR DYSREGULATED STRESS RESPONSE?

  1. Meditation
  2. MBSR (Mindfulness Based Stress Reduction)
  3. Expressive Writing
  4. Yoga
  5. Tai Chi,Qigong
  6. Art Therapy
  • MEDITATION:

As a long-term meditator and someone who has read many scientific papers on the neurobiology of meditation, this is my number one go-to when it comes to dealing with your dysregulated stress response. As I always say, the side effects of meditation are all good! What type of meditation should you do? My suggestion is to try several different ones and find out which one you like.

However, there are a few things to keep in mind when we talk about “therapeutic meditation”. • You need to elicit the Relaxation Response (RR) According to Dr. Herbert Benson from Harvard the relaxation response is a state of deep rest that elicits the following changes

  • Decreased heart rate
  • Decreased blood pressure
  • Decreased rate of breathing, and
  • Decreased muscle tension.

A Relaxation Response occurs when you meditate for at least 30-45 minutes. If you have never meditated before, start with 5-10 minutes of a guided meditation on an app or CD.

The best results of meditation have been shown in long-term meditators but meditating for as little as 8 weeks have shown many benefits!

  • MBSR (Mindfulness Based Stress Reduction):

According to Dr. Jon Kabat Zinn “Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally”. Dr. Kabat Zinn is Professor of Medicine Emeritus at the University of Massachusetts Medical Centre, where they have done many clinical studies on the health effects of MBSR. In one study of patients with psoriasis, MBSR along with photo therapy (UVB) or photo chemotherapy (PUVA) was found to show faster clearing of skin lesions.

  • EXPRESSIVE WRITING:

Professor James Pennebaker PhD, Professor of Psychology at the University of Texas, in a study found that writing about traumatic events was associated with fewer visits to the health center! It also improved immune function. No one has to read your writing and please don’t bother with punctuation or grammar! Check here to read about the guidelines for Expressive Writing.

  • YOGA
  • TAI CHI
  • QIGONG
  • ART THERAPY

REFERENCES

  1. Schulz, Laura C. “The Dutch Hunger Winter and the developmental origins of health and disease.” Proceedings of the National Academy of Sciences 107.39 (2010): 16757-16758. Cao-Lei, Lei, et al.
  2. “DNA methylation signatures triggered by prenatal maternal stress exposure to a natural disaster: Project Ice Storm.” PLoS One9.9 (2014): e107653.
  3. Felitti, Vincent J., et al. “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.” American journal of preventive medicine 14.4 (1998): 245-258.
  4. Benson, Herbert, Martha M. Greenwood, and Helen Klemchuk. “The relaxation response: psychophysiological aspects and clinical applications.”The International Journal of Psychiatry in Medicine 6.1-2 (1975): 87-98.
  5. Kabat-Zinn, Jon, et al. “Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing photo therapy (UVB) and photo chemotherapy (PUVA).” Psychosomatic medicine 60.5 (1998): 625-632.
  6. Pennebaker, James W. “Writing about emotional experiences as a therapeutic process.” Psychological science 8.3 (1997): 162-166.
  7. Book: Expressive Writing: Words that Heal by James W Pennebaker.

PREDICTIVE AUTOANTIBODIES—YOU MAY HAVE AN AUTOIMMUNE DISEASE AND NOT KNOW IT!

Read in 5 minutes

Any disease condition is a continuum. This means that you do not move from being well to having a disease overnight. Just as in Type 2 Diabetes, where you may have dysregulated blood sugar levels (Dysglycemia) many years before you develop the disease, so it is with many autoimmune conditions. You may have autoantibodies in your blood many years before developing the disease. Despite recent advances in treatment, there is a large percentage of people in whom long-term remission of the autoimmune disease cannot be achieved. This leads to poor quality of life and sometimes an early death. As this oft-quoted Benjamin Franklin axiom says “an ounce of prevention is worth a pound of cure”. Several scientific studies in the last few years have shown that you may have tell-tale evidence in your body 5-14 years before developing an autoimmune disease. An autoimmune condition develops when there is an interaction between your genes, an environmental trigger, your immune system and intestinal permeability. Your genes are present from birth but you do not develop an autoimmune disease until later. So what happens? In any autoimmune disease like it is in any other disease, it is an interaction between your genes and the environment that decides your health. As Dr. Eric Topol, a world-renowned cardiologist, geneticist, digital health pioneer, and medical innovator, says,“healthy aging is 100 percent due to genetics and 100 percent due to your environment”.

Autoimmune conditions develop when your immune system makes antibodies against your own tissue ( Autoimmunity).  This can lead to your healthy tissue losing their ability to function normally. For example, in Type 1 Diabetes, your own body makes antibodies against your own pancreatic cells which produce insulin. Insulin is the hormone that keeps your blood sugar in balance. The other, commoner diabetes is Type 2 Diabetes, in which antibodies to pancreatic tissue is not usually present. (Incidentally, these autoantibodies to pancreatic tissue have been found in about 5% of people otherwise diagnosed as Type 2 Diabetes.Watch for post on LADA , Latent Autoimmune Diabetes of the Adult).

In fact, a new staging approach is being used in Type 1 Diabetes taking into consideration the number of autoantibodies present. The staging starts well before the disease develops. This approach is used to prevent or delay the onset of the disease. Perhaps you can start prevention in your child when you are pregnant! Studies have shown the connection between vitamin D deficiency in mothers and autoimmunity in children.

Rheumatoid Arthritis (RA): RA is an autoimmune disease affecting joints, which is characterized by chronic inflammation, causing pain and stiffness in the joints and a poor quality of life. Half of the patients with RA already have X-ray evidence of joint damage at the time of diagnosis. Like most diseases, RA can be treated better if diagnosed early. Therefore, the ability to predict the disease before joint damage occurs will contribute to a better quality of life.

WHO SHOULD BE TESTED FOR AUTOANTIBODIES?

  • Anyone who has a diagnosed autoimmune condition. Studies have shown that if you have one autoimmune disease, the chances of your developing another one are much higher than in the general population.
  • To test for disease progression in people with autoimmune diseases.
  • Anyone with hypothyroidism who has never been tested for thyroid antibodies.
  • First degree relatives (a person’s parent, sibling or child) of people with an autoimmune condition.
  • Patients with painful and stiff joints who haven’t received a definitive diagnosis of RA yet.
  • Anyone interested in better health.

WHAT TESTS SHOULD YOU DO?

A complete workup is very important. However, the following must be included.

  • C-Reactive Protein: This is a marker of inflammation.
  • Vitamin D3 levels: Vitamin D has a major role in your immune system. Low levels of this vitamin have been associated with increased risk of autoimmune diseases. (Vitamin D)
  • Antibodies: This list increases by the day. There are some specialized tests available in some countries which I have not listed here. (For those of you interested in the detailed medical information, please read the article in Autoimmunity reviews6 (2015) Damoiseaux, Jan, et al.).

This table has a short list:

                      ANTIBODY              AUTOIMMUNE CONDITION
ANA Lupus, Scleroderma, Autoimmune Hepatitis, Sjogren’s Disease, Polymyositis, Dermatomyositis, Mixed Connective Tissue Disease, Juvenile Arthritis, Drug-induced Lupus.
Anti-Cyclic Citrullinated Peptide (Anti CCP) Rheumatoid Arthritis
Anti TPO & Anti Thyroglobulin Hashimoto’s Thyroiditis
Anti TSH Receptor Graves’ Disease
Anti-tissue transglutaminase (tTG) antibodies

Endomysial antibodies (EMA)

Deamidated gliadin peptide (DGP) antibodies

(IgA & IgG tests)

Celiac Disease

 

 

Islet Cell Cytoplasmic Autoantibodies (ICA) & Glutamic Acid Decarboxylase Autoantibodies (GADA) Type 1 Diabetes, Late Autoimmune Diabetes of the Adult(LADA).

WHAT IS THE DIFFERENT ABOUT THE FUNCTIONAL AND METABOLIC MEDICINE APPROACH?

Fig 1: Functional & Metabolic Medicine approach versus Conventional Approach:Fork in the road.

Slide1
Fig 1

WHAT SHOULD YOU DO?

  • Meet a practitioner who understands the Functional & Metabolic Medicine approach to autoimmunity. There are no pharmaceutical drugs that can be used to prevent autoimmune diseases before they develop.
  • Stop smoking (Easier said than done!). Exposure to cigarette smoke has been associated with higher risk of Rheumatoid Arthritis in those susceptible to it.
  • Reduce toxic exposure.
  • Reduce inflammation.
  • Manage stress.
  • Maintain adequate Vitamin D3 levels (Vitamin D)

REFERENCES

  • Avouac, Jérôme, Laure Gossec, and Maxime Dougados. “Diagnostic and predictive value of anti-cyclic citrullinated protein antibodies in rheumatoid arthritis: a systematic literature review.” Annals of the rheumatic diseases7 (2006): 845-851.
  • Catrina, Anca I., et al. “Lungs, joints and immunity against citrullinated proteins in rheumatoid arthritis.” Nature Reviews Rheumatology 11 (2014): 645-653.
  • Damoiseaux, Jan, et al. “Autoantibodies 2015: From diagnostic biomarkers toward prediction, prognosis and prevention.” Autoimmunity reviews6 (2015): 555-563.
  • Nielen, Markus MJ, et al. “Increased levels of C‐reactive protein in serum from blood donors before the onset of rheumatoid arthritis.” Arthritis & Rheumatism 8 (2004): 2423-2427.
  • Notkins, Abner Louis. “New predictors of disease.” Scientific American3 (2007): 72-79.

VITAMIN D AND AUTOIMMUNITY

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In recent years vitamin D deficiency has become like an epidemic all over the world. Besides autoimmunity, low vitamin D is associated with many diseases like heart disease, diabetes, cancer, hypothyroidism and many more. In fact, almost every cell in your body has vitamin D receptors.

There are 2 forms of vitamin D3 that you need to keep in mind. The one that is usually tested by most practitioners is Vitamin D3. Your body has to convert Vitamin D3 to the active form 1,25 Dihydroxyvitamin D3[1,25(OH)2 D3]. Most of you are familiar with the action of vitamin D in protecting your bones and maintaining blood calcium levels—the “classical” actions of vitamin However, scientific studies in the last several years have shown that vitamin D has several other actions as well—the “non-classical” actions. These are the actions of vitamin D on bone marrow, immune system, breasts, prostate, heart, muscles and intestine. With respect to autoimmune disease, the immunomodulatory (affecting your immune system) actions of Vitamin D are very important.

Vitamin D has the effect of increasing the activity of the innate immune system while restraining the activity of the adaptive immune system. (Chapter 9). This is the reason why adequate vitamin D3 levels are important for treating and perhaps preventing autoimmune diseases. A substantial number of studies have shown an association between low vitamin D and increased incidence of autoimmune diseases like Rheumatoid Arthritis(RA), Multiple Sclerosis(MS), Psoriasis, Inflammatory Bowel Disease (IBD), Type 1 Diabetes, Sjogrens, Lupus and many more. One example that is often cited is the increasing incidence of MS as one moves away from the equator. This is thought to be related to lesser sun exposure at higher latitudes than at the equator.

1,25 DIHYDROXYVITAMIN D3.

In autoimmune conditions sometimes measuring only vitamin D3 levels may not be enough. A few scientific studies have shown that some people with autoimmune disease have high levels of 1,25 Dihydroxyvitamin D3. This is why sometimes we need to measure both the forms of vitamin D. I remember quite a few occasions when my patients (In India) have called me to say that the lab technician has informed them that “no doctor advises this (1,25 OH)2 D) test” so it is unnecessary!

WHY DO PEOPLE BECOME VITAMIN D DEFICIENT?

Humans obtain vitamin D from either food (fortified), supplements or sunlight exposure. Your blood vitamin D levels depend on several factors.

Air quality: Excessive carbon particles in air from burning of fossil fuels may reduce the amount of vitamin D producing UVB rays from reaching your exposed skin.

Skin color: People with dark skin require about 10 fold more exposure to sunlight to produce the same amount of vitamin D as people with lighter skin color.

How much of your skin is exposed? The more bare skin the bigger the surface area of absorption of sunlight.

Use of sunscreens: Though theoretically use of sun screens can block the UVB rays, rarely do people use adequate quantities of sunscreen to bar all UVB from reaching their skin.

Gut Health: If you have unhealthy gut or you have inflammatory bowel disease (IBD), your absorption of vitamin D from supplements is poor.

Liver and Kidney Health: Some types of liver disease may affect bile production. This can affect vitamin D function. In chronic kidney disease (CKD) the vital step of conversion of vitamin D to its active form is affected and this can lead to severe vitamin D deficiency. This is why patients with CKD have their 1,25 Dihydroxyvitamin D3 measured regularly.

Vitamin D receptor (VDR): If you have a genetic variation in VDR you may need a higher dose of vitamin D supplementation.

How much vitamin D3 you take will decide your blood levels of the vitamin. Very low or very high doses, may both be detrimental unless you monitor regularly.

HOW MUCH VITAMIN D SHOULD YOU TAKE AS A SUPPLEMENT?

How much supplementation of vitamin D you need depends on what your blood reports show. It may not be the same dose for everyone because of individual variations. However, it is a much better idea to take a smaller dose (4000-5000 IU) every day rather than a very high dose once a week or once a month. Sometimes a larger dose may be necessary for a short period of time until your blood levels are in the optimal range.

Ideally you should get your vitamin D from sensible sun exposure AND supplementation.

 WHAT IS MOST IMPORTANT ABOUT VITAMIN D AND AUTOIMMUNE CONDITIONS?

Low vitamin D levels have been associated with many autoimmune conditions like

Rheumatoid Arthritis (RA), Multiple Sclerosis(MS), Psoriasis, Inflammatory Bowel Disease (IBD), Type 1 Diabetes, Sjogrens, Lupus and many more. This is because vitamin D affects your immune system function.

Maintaining adequate vitamin D levels may be a major way to prevent developing autoimmune disease. In fact, studies have shown that maintaining adequate vitamin D levels during childhood can prevent the development of Type 1 Diabetes by 29%! This is true for several other autoimmune conditions as well.

If you already have an autoimmune condition maintaining adequate vitamin D levels will make a major difference to how you heal the disease.

Some of you  may need to measure both vitamin D3 and 1,25 Dihydroxyvitamin D3.