THYROID HORMONE REPLACEMENT-ONLY T4 OR A COMBINATION OF T3 AND T4?

Read in 6 minutes

Hypothyroidism is a condition where your thyroid gland produces insufficient amounts of thyroid hormone. The most common cause of hypothyroidism is an autoimmune condition called Hashimoto’s Thyroiditis, where your body’s own immune system attempts to destroy your thyroid tissue.

WHAT IS THE BEST TREATMENT FOR HYPOTHYROIDISM?

  • Is it Levothyroxine T4 (Synthetic T4, Synthroid, Thyronorm, Eltroxin)?
  • Is it a combination of T4 and T3 (Levothyroxine and Cytomel)?
  • Is it compounded bioidentical combined T4 and T3?
  • Or is it thyroid glandular extracts?

The truth is there is no one right answer! It depends on what works for you!

LEVOTHYROXINE (T4) MONOTHERAPY

Using Levothyroxine to replace thyroid hormone in hypothyroidism is the standard of care all over the world. This is the view endorsed by major thyroid and endocrine associations worldwide. However, many people on synthetic T4 alone have not felt their best despite progressively increasing their T4 dosage. This can happen because of several reasons, some of them being low iron storage, poor gut health causing improper absorption of T4 or wrong time of taking T4 in relation to meals. For optimal T4 absorption, you should not take any food or supplements one hour before and one hour after taking T4. In such people who still experience fatigue, weight gain and “brain fog” and their test reports are in the” normal” range, while on T4 only, what should the doctor do? Should you consider a combination of T4 and T3? I get a lot of my patients at this point, when their regular doctor has decided that they need an anti-depressant in addition to T4 or even worse, they are told it is “all in their head” (ironically this may not be far from the truth when we consider the Type 2 Deiodinase(DIO2) enzyme in the brain! More on this later).

COMBINATION THERAPY WITH T4 AND T3 (T4/T3)

Triiodothyronine (T3) is the more active form of thyroid hormone. Your thyroid gland produces T4 and a small quality of T3. Most of the T3 in the blood comes from conversion of T4 in tissues like liver, kidneys and brain. This conversion happens through the action of certain enzymes called Deiodinases. Several studies in the past few years have suggested that in some patients, treatment with combined T4/T3 instead of monotherapy with T4 may show better results, particularly in terms of psychological well-being. Why is this so? One of the possible explanations could be a genetic variation in the DIO2 (Type 2 Deiodinase) gene, which affects the conversion of T4 to T3 in the brain. This DIO2 gene variation does not affect blood levels of thyroid hormones. So your blood levels of thyroid hormones may remain in the normal range, but you don’t feel well. However, this genetic test is not routinely available yet, other than in research settings. So what should you do? A trial of combined T4/T3 is definitely a worthwhile option.

What combinations of T4/T3 are available?

1) Synthetic T4 and Cytomel (T3)

2) Compounded combined T4/T3

Which should you choose? Depends on many variables. But as always, adequate knowledge in their use is extremely important.

WHAT ABOUT THYROID GLANDULAR EXTRACTS?

Thyroid glandular extracts are prepared from thyroid glands of pigs. Armour Thyroid and Naturethyroid are the common ones. It is a combination of T4 and T3 and on US Pharmacopeia, which means that it has standardized dosage of T4 and T3. Use of thyroid glandular extracts sometimes becomes an emotional issue, with one camp being all in favor of it and another completely against it.

One crossover study of 70 patients by Hoang et al in The Journal of Clinical Endocrinology & Metabolism (2013) found that people on Armour Thyroid felt better and about 48% of them preferred Armour over T4 mono therapy. There were no adverse effects on thyroid glandular extracts. However, one major question that this study did not answer was whether there was any change in thyroid antibody levels when on porcine glandular extracts. The study did not measure thyroid antibodies in the patients. Many of us in Functional Medicine do not recommend porcine glandular extracts in patients with positive thyroid antibodies because of the risk of increased autoimmunity from an animal protein.

Sometimes we forget how far we have come in Medicine. George R Murray’s account “The life-history of the first case of myxedema treated by thyroid extract” in BMJ 1920 reads like a beautiful story.Dr. Murray mentions that Dr. Michell Clarke in 1892 had failed to find success in using thyroid glandular extracts because his butcher had been providing him with thymus instead of thyroid glands to make glandular extracts! At least we don’t have to depend on our butcher!

 

For Readers in India: 

As far as I know Cytomel (T3) is not available in India. Compounded combined T4/T3 is not easily available either. More importantly, thyroid hormone is not easy to compound so quality control in the compounding pharmacy is very important. Moreover, compounded hormones are more expensive than the synthetic T4 (Thyronorm, Eltroxin). Thyroid glandular extracts are made from pig thyroid glands and not available in India.

You may be interested in Autoimmunity

REFERENCES:

Murray, George R. “The life-history of the first case of myxedema treated by thyroid extract.” British medical journal 1.3089 (1920): 359.

Panicker, Vijay, et al. “Common variation in the DIO2 gene predicts baseline psychological well-being and response to combination thyroxine plus triiodothyronine therapy in hypothyroid patients.” The Journal of Clinical Endocrinology & Metabolism 94.5 (2009): 1623-1629.

Hoang, Thanh D., et al. “Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study.” The Journal of Clinical Endocrinology & Metabolism 98.5 (2013): 1982-1990.

Pepper, Gary M., and Paul Y. Casanova-Romero. “Conversion to Armour thyroid from levothyroxine improved patient satisfaction in the treatment of hypothyroidism.” Journal of Endocrinology, Diabetes & Obesity 2 (2014): 1055-1060.

Wiersinga, Wilmar M. “Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism.” Nature Reviews Endocrinology 10.3 (2014): 164-174.

Schmidt, Ulla, et al. “Peripheral markers of thyroid function: the effect of T4 monotherapy vs T4/T3 combination therapy in hypothyroid subjects in a randomized crossover study.” Endocrine Connections 2.1 (2013): 55-60.

AUTOIMMUNITY: A FUNCTIONAL & METABOLIC MEDICINE PERSPECTIVE

Read in 3 minutes

Worldwide there is an unprecedented rise in autoimmune conditions. Did you know that you may have autoimmune antibodies in your blood many years before you develop the disease? Studies have shown that Thyroid Antibodies or Antibodies for Lupus or Rheumatoid Arthritis, Type 1 Diabetes (and many more) may be present in your blood 4 to 15 years before you develop the disease! 

There are about 80 different autoimmune conditions and they are all potentially serious chronic diseases. All of them involve an underlying problem with your immune system. You need your immune system to work well because it protects you from outside invaders. Your immune system tries to protect you by identifying, killing and eliminating invaders that may harm you. Sometimes problems with your immune system can cause it to mistake your own healthy tissue as harmful and attempt to repeatedly attack and destroy them. This is when you develop an autoimmune condition. “Autoimmunity “means immunity against the self.

Your body is combating something-an infection or toxin or allergen or dysregulated stress response and somehow that immune response gets misdirected to your thyroid tissue, nerve layer, skin, kidneys or even the whole body. Your immune system is very highly developed. Therefore, why should it get confused between friend and foe? One possible explanation is molecular mimicry, where your own tissue seems similar to an invader, either structurally or immunologically. Another explanation is “bystander activation”, where your own tissue is destroyed as collateral damage because your immune system is dealing with an infection or inflammation. The underlying dysfunction common to all autoimmune conditions is chronic inflammation.

Different autoimmune conditions affect different organs or organ systems. For example in Hashimoto’s your immune system makes antibodies against your thyroid tissue, in Multiple Sclerosis (MS) your immune system attacks myelin which is a fatty layer that wraps around your nerve fibers ,in Rheumatoid Arthritis (RA) it is the lining of your joints that are attacked. Some conditions like Systemic Lupus Erythematosus (SLE) or lupus, the skin, joints, kidneys or brain may be affected. Depending on which autoimmune condition you have, you will meet different specialists. For example, if you have MS you will meet a Neurologist, RA or SLE a Rheumatologist, Psoriasis a Dermatologist and so on. But as Dr.Yehuda Shoenfeld,Professor of Medicine at Tel Aviv University in Israel, says there should be a separate specialty of Autoimmunology.

Conventional treatment of autoimmune conditions may sometimes make you feel worse. Many of these drugs have serious side effects. However, when used judiciously these drugs can be life changing. But these potentially toxic drugs when used alone, are not a long-term solution. These drugs can temporarily take care of the inflammation while we treat the actual causes of the disease.

WHAT IS DIFFERENT ABOUT THE FUNCTIONAL AND METABOLIC MEDICINE APPROACH?

We know that the following factors influence autoimmune disease:

  • Genes
  • Immune System
  • Environmental Triggers like gluten (Celiac Disease), bacteria, viruses.
  • Intestinal Permeability.
  • Gut Dysbiosis
  • Chronic Inflammation
  • Metal Toxicities like Mercury, Lead, Arsenic.
  • Environmental Pollutants like Persistent Organic Pollutants (POP), Bisphenol-A.
  • Stress (HPA axis Dysfunction)
  • Food Sensitivities
  • Hormonal Imbalance.
  • Vitamin D Deficiency
  • Low Antioxidant Reserve
  • Insufficient Sleep

In the next few posts I will talk about these topics. Meanwhile,

HERE ARE A FEW THINGS THAT YOU CAN DO:

  • Reduce your toxic exposure. Stop using plastic food & water containers. Check your cosmetics & household cleaning products for possible harmful substances. A good place to check is the Environmental Working Group’s website (ewg.org)
  • Eat plenty of fresh vegetables and some fruit.
  • Eat plenty of dark leafy greens.
  • Stop sugar. Sugar causes inflammation.
  • Stop eating processed food.
  • Manage Stress
  • Sleep!

 

5 THINGS THAT YOU MAY NOT KNOW ABOUT BREAST CANCER

Read in 9 minutes

 

Breast cancer is the most common cancer diagnosed in women worldwide. In India more women are affected by it now than ever before.  It occurs about a decade earlier in Indian women compared to those in developed countries. While it is known that there are several factors that can increase a woman’s risk for breast cancer, like being overweight, higher alcohol consumption, smoking, early menarche, late menopause, delayed child-bearing and family history, researches still do not know exactly what causes normal cells to become cancerous. Hormones are considered to play a major role in the development of breast cancer, but there is still a lot that we need to know.

For thousands of years our genetics have not changed, but what has changed is the interaction of our genes with the environment. Our diet has changed dramatically from what our ancestors ate. At no other time in history have there been so many man-made chemicals in our environment, some of which are hormones disruptors. We have now found out that the microbes that live in our intestine can influence our health.

It is obvious that it is an interaction of genetics and environmental factors that have contributed to the alarming increase of breast cancer in recent years.

GUT MICROBES AND ESTROGEN METABOLISM

Many of you know that your gut microbes influence your health. But did you know that your gut microbes can influence how you metabolise Estrogen in your body? Estrogens, while being essential, are also related to some cancers. Higher levels of circulating Estrogens are related to endometrial (uterus), breast and ovarian cancers. Estrogens are metabolized in the liver and some of them enter the gut and interact with the gut microbes. According to Dr. Claudia Plottel, Associate Professor at NYU School of Medicine, “each person’s mix of gut bugs determines how much estrogen is recirculated, making the microbiome a key regulator of each person’s circulating estrogen levels over time”.

Dr. Plottel’s focus of research is the interaction between each woman’s gut microbiome and estrogen.

How can you take care of your gut microbes:

  • Eat food and not “food-like” substances. Eating a diet of plants and unprocessed meat and fish has been shown to change the gut microbiota to a more diverse and healthy profile versus eating mostly processed food.
  • Do not take antibiotics for minor illnesses.(If you do need to take antibiotics,please complete the course!)
  • Avoid sweeteners like sucralose, aspartame, saccharin.
  • Supplement with probiotics.
  • Add fermented food to your diet.

ALCOHOL AND BINGE DRINKING

As somebody who likes red wine, I wish this was not true! But I don’t make the rules! Alcohol consumption is related to higher breast cancer risk in pre-and post-menopausal women. In fact, even light alcohol use by women (≤1 drink/day or ≤12.5 g/day) has been associated with higher risk for breast cancer. Binge drinking, defined as consuming four or more alcoholic drinks on one occasion, is much worse! So ladies, less than one drink a day and no binging (not even on red wine!).

INFLAMMATION

(Not Inflammatory Breast Cancer)

Inflammation is your immune system’s reaction to any injury, toxin, allergen or microbes. Inflammation happens when chemical messengers called cytokines along with white blood cells and proteins rush to an area of damage and help in healing it. Damaged cells also release more chemicals that can increase inflammation.

Is all inflammation bad? No! You need inflammation to fight illness and injury. However, there are 2 types of inflammation: acute and chronic. Acute inflammation is short term and helps you to tide over immediate injury and goes away when the insult is absent. Chronic inflammation is long-term and this means that the immune system is working overtime. Chronic inflammation is the “bad guy/gal”. Chronic inflammation is related to many different diseases including cancer, heart disease, stroke, high blood pressure.

Chronic inflammation can be caused by

  • Chronic infections such as hepatitis B
  • Periodontitis (Inflammation of the tissue around the teeth, often causing shrinkage of the gums and loosening of the teeth)
  • Toxic exposure
  • Lack of sleep
  • Having excess body fat. Fat cells produce inflammatory chemicals.
  • Insulin resistance, diabetes.
  • Unmitigated stress
  • A diet low in fresh vegetables and fruit
  • High intake of sugar, processed food and trans-fats.

Measuring blood levels of HsCRP will provide a good measure of the level of inflammation in your body. High HsCRP is associated with higher risk of breast cancer in all women. In an article in Nature Scientific Reports it was mentioned that this association was more pronounced in Asian women compared to European and American women.

ENDOCRINE DISRUPTING CHEMICALS

Endocrine-disrupting chemicals (EDCs) are substances in our environment, food, cosmetics, cleaning products that interfere with hormone production, metabolism, or action. Although the exact manner in which EDCs disrupt hormone action are not completely understood, there is enough evidence to suggest that many of them cause major harm to us. In fact, the problem of EDCs is serious enough that the World Health Organization and the Endocrine Society have produced documents on them.

Breasts are the only organs in the body that continue to change long after birth (during puberty, pregnancy and lactation). Therefore, the exposure of breast tissue to different substances throughout a woman’s life will have diverse effects depending on the time of exposure, the amount and also the mixture of different chemicals. What is alarming with respect to EDCs is their potential effects on the unborn child in utero and during early development.

Some of the EDCs affecting breast cancer risk are BPA, dioxins, DDT, Atrazine, Parabens, Pthlates,PFOA, Organic Solvents, DES, Polycyclic Aromatic Hydrocarbons, Vinyl Chloride.

For more information: www.ewg.org , www.breastcancerfund.org

VITAMIN D

Most of you know that vitamin D is important for calcium metabolism and bone health. However, many scientific studies in the last few years have indicated that Vitamin D has many actions that go way beyond maintaining your bones. Vitamin D regulates expression of genes important in development and progression of breast cancer & it is also an immune-modulator. Low levels of vitamin D3 have been associated with higher risk of breast cancer. Additionally, women with low vitamin D3 levels have shown worse prognosis after being diagnosed with cancer of the breast. Levels of 40-60 ng/ml (approx. 100-150 nmol/L) have been found to be protective against breast cancer (and many other conditions).

What can you do: Check the levels of Vitamin D3 in your blood.If levels are below the optimal levels, you will need to supplement with vitamin D3.

Can you get enough from exposure to sunlight?

This depends on many factors. For example, your skin colour will decide how much of sunlight you absorb. People with darker skin like Asian Indians, will not absorb much! Your absorption will also depend on how much time you spend in the sun and how much of your skin you expose. A study done on 20 young women in Korea reported that their baseline low levels of vitamin D3(about 11ng/ml) did not increase despite sun exposure for 20 minutes daily for 4 weeks during October November.

Amongst my patients in India I sometimes find blood levels of vitamin D3 in single digits in those who do not supplement! The lowest that I have found was 2ng/ml!

How much of Vitamin D3 should you take?

This will depend on your blood levels. If your levels are extremely low you may need a higher dose initially, but to maintain optimal blood vitamin D3 levels it is a good idea to take 4000-5000 IU capsules every day, rather than taking a high dose once a week. I find many people in India take a very high dose for 3-4 months and then stop.It is very important to measure vitamin D3 regularly because all of you will not respond the same way.

ACTION STEPS

  • Take care of your gut health.
  • Avoid binge drinking and keep alcohol consumption to < 1 drink a day.
  • Reduce inflammation.
  • Minimize your exposure to Endocrine Disrupting Chemicals.
  • Maintain optimal Vitamin D3 levels (40-60 ng/ml OR 100-150 nmol/L).

 


 

References:

  1. Gunter, Marc J., et al. “Breast cancer risk in metabolically healthy but overweight postmenopausal women.” Cancer research 75.2 (2015): 270-274.
  2. White, Alexandra J., et al. “Overall and central adiposity and breast cancer risk in the sister study.” Cancer 121.20 (2015): 3700-3708.
  3. Mohr, Sharif B., et al. “Meta-analysis of vitamin D sufficiency for improving survival of patients with breast cancer.” Anticancer research 34.3 (2014): 1163-1166.
  4. Liu, Ying, Nhi Nguyen, and Graham A. Colditz. “Links between alcohol consumption and breast cancer: a look at the evidence.” Women’s Health11.1 (2015): 65-77.
  5. Guo, L. et al. C-reactive protein and risk of breast cancer: A systematic review and meta-analysis.  Rep.5, 10508; doi: 10.1038/srep10508 (2015).
  6. Plottel, Claudia S., and Martin J. Blaser. “Microbiome and malignancy.” Cell host & microbe4 (2011): 324-335.
  7. Soto AM, Sonnenschein C. DDT, endocrine disruption and breast cancer.Nature reviews Endocrinology. 2015;11(9):507-508. doi:10.1038/nrendo.2015.125.
  8. Diamanti-Kandarakis E, Bourguignon J-P, Giudice LC, et al. Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement. Endocrine Reviews. 2009;30(4):293-342. doi:10.1210/er.2009-0002.
  9. Lee S-H, Park S-J, Kim K-M, et al. Effect of Sunlight Exposure on Serum 25-Hydroxyvitamin D Concentration in Women with Vitamin D Deficiency: Using Ambulatory Lux Meter and Sunlight Exposure Questionnaire. Korean Journal of Family Medicine. 2012;33(6):381-389. doi:10.4082/kjfm.2012.33.6.381.

 

Disclaimer:The contents of this blog are for information only. This information is not to be taken as medical advice. Reading this blog does not establish a doctor-patient relationship.Please discuss with a knowledgable medical practitioner before implementing this information.

The “Sitting” Disease

Read in 4 minutes

Do you suffer from the sitting disease? Several scientific studies in recent years have found that prolonged sitting is more harmful for your health than even smoking! Here is what i found out :

  • Sitting continuously for several hours a day puts you at a higher risk for heart disease, high blood pressure , diabetes and weight gain.
  • Extra physical activity does not reduce the effects of prolonged sitting!This means that even if you have exercised for 30-60 minutes in the morning & then spend several hours at work sitting continuously,you are still at a high risk for disease!!All that morning exercise did not count!This was shocking information to me when i read it in Tom Rath’s great book “Eat,Move,Sleep”(I highly recommend that book).
  • A study in monozygotic twins of 32-36 years of age found that the more active twin had better blood sugar control & more brain volume than his less active brother. As we always say, your genes do not decide your destiny!
  • A study from Australia showed that among overweight/obese people ,interrupting sitting time with short bouts of light or moderate intensity walking can reduce after-meal blood sugar & insulin levels.
  • Continuous sitting is related to more coronary artery calcium, which is a marker for heart disease later in life.
  • Too much sitting reduces your bone mineral density makes them  more prone to fractures.

Is it continuous sitting or is it a lack of activity that is more important ?

It is both. This means that in addition to regular exercise you need to ensure that you interrupt your sitting time with movement for even as little as 2-7 minutes! This is absolutely do-able!

WHAT CAN YOU DO ABOUT IT:

Set reminders to get up. I have my laptop announcing the time every hour which is my cue to get up. You can get completely engrossed in your work and lose track of time!

Get up to drink water:Do not keep drinking water on your work table. This will make sure you walk to the water cooler! However, if you are someone for whom drinking enough water doesn’t come easily,please do keep a bottle on your table to remind you!

Use an active desk: A treadmill desk or an adjustable standing desk, which is better? Using active desks versus sitting desks have shown definite benefits in improving health,but studies have shown a clear benefit of a treadmill desk over a standing desk for reducing waist size, reducing blood sugar levels & improving heart rate.However, a treadmill desk certainly costs more and occupies more space in comparison to a standing desk.

My temporary low-cost solution: While i wait to get my treadmill desk, here is what i have done. I got a small wooden table to keep my laptop on. I place this on top of my regular table. Initially I tried one of those laptop stands that are meant for use on beds, but i found them too unstable.

Sit on an exercise/ stability ball. Instead of sitting on a chair you can try sitting on an exercise ball while you are at your table.

Set up walking meetings: Instead of having a meeting sitting at your office,go for a walk outdoors. Yes, i know you can’t take written notes while walking but use a voice recorder!

Do share your ideas on what you do to avoid the “sitting” disease on my FaceBook page https://www.facebook.com/drsdkar

Disclaimer:As always, this blogpost is not medical advice but for information only.

Resources:

beware-chair (1)

TED Video.

This is for some of you who would like to explore the subject in (nerdy) detail.

I have learnt a lot from Peter Janiszewski, PhD, and Travis Saunders, PhD, CEP ‘s blog on PLOS.

http://www.medscape.com/viewarticle/842077

http://www.sciencedaily.com/releases/2015/03/150305205959.htm

http://www.ncbi.nlm.nih.gov/pubmed/25003773

http://care.diabetesjournals.org/content/35/5/976

http://care.diabetesjournals.org/content/35/5/976

[BETTER] BRAIN

Read in 9 minutes

Many of you religiously go for an annual health check up . How much has that helped you? Probably not much! You have been told that your blood sugar is a “little on the higher side”, but you are not a diabetic yet & your cholesterol is high. So you leave your doctor’s clinic with a prescription for a cholesterol lowering medicine & the advise that next year if your blood sugar is in the “diabetes range” you will get the treatment for it. You may have even been told that you should exercise (How much? How often? Don’t know!!) & reduce stress and ( heaven forbid!), a low fat diet!!! There is no discussion about the amount of carbohydrates you eat or what type of fat is bad for you. Your level of inflammation (HsCRP) or homocysteine  levels were not even tested (Hint: Because they are not included in the “cost effective” plan you went for!) And the brain certainly did not come up in the discussion!I wish I could tell you to go through a questionnaire & find out how well your brain works. There is a place for questionnaires, but as a Functional Medicine practitioner I am looking for very early changes. According toDr.Eric Braverman of PATH Medical Centre, we lose 10 milliseconds of brain processing speed every decade! Such subtle changes cannot be detected through questionnaires! However, if you are concerned about dementia or know someone with the disease AND you would like to know how to reduce your own risk for it,then please read on.

(My posts are somewhat nerdy & I don’t apologise for that! If you are interested in exploring scientific studies,the references are at the bottom of the post. This is my first blog post so please bear with me!)

WHAT IS GOOD FOR YOUR HEART IS GOOD FOR YOUR BRAIN!

 Dementia is a group of brain diseases that affect how you think and remember. The onset is often gradual and worsens over time, ultimately affecting your day to day functioning. Emotional symptoms, decreased motivation & language difficulties may also be associated with dementia. Though the word dementia & Alzheimer’s Disease are used interchangeably,they are not the same.Alzheimer’s Disease is the most common type of dementia. Some of the other dementias include

  • Vascular Dementia
  • Lewy-Body Dementia
  • Fronto-temporal  Dementia
  • Parkinson’s Disease

A Few Facts About Alzheimer’s Disease:

  • There is no known cure for Alzheimer’s Disease yet.Therefore addressing several risk factors is a [BETTER] way to reduce your risk for the disease.
  • Though it commonly occurs in the older age group, Alzheimer’s Disease has been known to occur in people in their 40s and 50s.
  • Early onset disease is sometimes associated with genetic mutations.
  • The exact cause of Alzheimer’s Disease is not known. However experts agree that it occurs as a result of interaction between many factors like age, genetics, lifestyle and coexisting medical conditions like diabetes & heart disease.
  • According to the Alzheimer’s Association, anyone with a brain is at risk for Alzheimer’s Disease!

At [BETTER] Medical Centre  how do we look at your risk for Alzheimer’s Disease?

Our initial patient intake involves an extensive history taking & several laboratory tests.  In our speciality of Functional & Metabolic Medicine we take  a “bird’s-eye view” of the whole person, rather than looking at any one system alone. We know that our systems are interrelated & no organ works in isolation.

What You May Not Know About Alzheimer’s Disease Risk:

Neuroinflammation:

Alzheimer’s Disease (AD) has been known as a neurodegenerative disease of the elderly. However,of late neuroinflammation (inflammation of nerve tissue) has emerged as an important component of AD.A recent article in the journal Aging ,by Dr. Dale Bredesen,  a UCLA professor of Neurology, says there may be 3 different types of AD (Alzheimer’s Disease):

Inflammatory, in which C-Reactive Protein and serum albumin-globulin ratios are increased, Non-inflammatory, in which these markers may not change but other metabolic abnormalities are present and Cortical,which affects relatively younger people.In the same article Dr.Bredesen also mentions that the measuring fasting Insulin & Zinc levels are very important in the workup of someone with brain dysfunction.

High Homocysteine:

Homocysteine is an amino acid in the blood.High levels of homocysteine have been associated with increased risk of heart disease, stroke, vascular clotting & dementia. Deficiency of B vitamins (Folate,B6,B12) is associated with high homocysteine levels. Some people may have high homocysteine because of genetic variation in a gene called MTHFR.

A study from Oxford University,UK looking at the effect of supplementation with B vitamins on homocysteine & rate of brain atrophy in people with mild cognitive impairment found that the rate of brain atrophy was less in those taking B vitamins.

Medications :

An article in the journal JAMA Internal Medicine in March 2015 says that the use of anticholinergic medications increases the risk ofdementia.Some of the drugs showing adverse effects are benzodiazepines, diphenhydramine (Benadryl),tricyclic antidepressants like doxepin (Sinequan),  antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan).It is very important that you do not stop these medicines without the advise of your doctor.

Anaemia:

Low levels of red blood cells may increase the risk of dementia.This was reported in an article in Neurology, the journal of the American Academy of Neurology, in July 2013. Anaemia is not difficult to correct!

Higher Fasting Blood Sugar:

We know that people who have diabetes are more prone to dementia. However even high plasma glucose levels within the normal range (<6.1 mmol/L/109.8 ng/dl) were shown to adversely affect brain structures involved in memory.This is one of  the reasons why we address suboptimal blood sugar levels, even when you are not labelled a diabetic.

Gluten: 

In an interview titled “Dementia:Is Gluten the Culprit?” on Medscape Neurology with Dr.David Perlmutter, Neurologist & author of the book Grain Brain, talks about the possible relation of brain dysfunction with gluten.Do all of you need to be gluten-free? Maybe not! Do this test yourself:Stay off of gluten for 3 weeks ,re-introduce it & track yoursymptoms.You be the best judge. However, as Functional & Metabolic Medicine specialists,we recommend that anyone with an autoimmune disease remains gluten free.

Gut Health,Human Microbiome:

In the last few years there have been several scientific studies showing  a relationship of the microbes present in our intestine with health and disease.Evidence indicates a close relationship of the human microbiome through complex pathways connecting the gut, skin, liver & other organs to the central nervous system. This is why we talk about the gut-brain-immune connection. In fact your gut is considered to be your “second brain”.

Hormones:

Imbalance of hormones like estrogen , testosterone, progesterone , cortisol, pregnenolone, thyroid hormones, parathyroid hormones have been associated with cognitive decline. In fact recent studies have shown that many of these hormones act as neurosteroids,i.e. they have very important protective activity in the brain.

Heavy Metal Toxicities:

Toxicities from metals like Arsenic, Cadmium, Mercury, Aluminum and Lead have been found to be associated with impaired brain function.

Cigarette smoking is associated with higher Cadmium levels.People who eat a lot of fish and those that have old mercury fillings may have mercury toxicity. However many people without any risk are frequently been found to have significantly elevated levels of heavy metals.

Binge Drinking, Heavy Drinking :

Heavy drinking & binge drinking have been associated with an increased incidence of dementia.Alcohol is a poison for the brain.

The Substance Abuse and Mental Health Services Administration (SAMHSA), defines binge drinking as drinking 5 or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days.

Head Trauma:

There is a strong link between serious head trauma and the risk of dementia. So continue using that helmet!

Dr.Daniel Amen who is known as America’s Brain Doctor ,talks about how a detailed brain function assessment along with a SPECT scan can help you to test brain function. Our clinics are affiliated with Dr.Daniel Amen’s clinic in USA.

Sleep:

Sleep is considered to be the “master reset button” of your body. If you have poor quality sleep or Obstructive Sleep Apnea , your brain function will be affected.

We are pleased to have Dr. Adam Moscovitch, Canada’s eminent Sleep Medicine Expert provide Sleep medicine at our facility in Calgary.

What Can You Do to Reduce Your Risk of Dementia?

It turns out that there is a lot that you can do to reduce your risk for dementia!

    • Get a Functional & Metabolic Medical assessment done.
    • Sleep
    • Stress Reduction
    • Maintain optimal blood sugar.
    • Eat a brain-healthy diet. A DASH diet or a Mediterranean diet has shown a lot of benefits.Eat plenty of fresh vegetables & moderate quantity of nuts and fruit.
    • Reduce alcohol consumption.
    • Learn something new. Mental stimulation prevents cognitive decline.
    • Maintain social contacts.
    • Exercise: This increases your levels of BDNF (Brain Derived Neurotrophic Factor).
    • Meditation. We always knew meditation was good for you , but science now has tools to demonstrate what a regular meditation practice can do to your brain. fMRI studies have shown that there was less atrophy of the hippocampus (a brain area associated with memory), in those practicing MBSR (Mindfulness Based Stress Reduction) than in those without.
    • Know the 10 early Signs of Dementia. A very valuable website

http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp?type=alzFooter#signs

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References:

http://www.sciencedaily.com/releases/2015/09/150916165404.htm

http://www.plosone.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pone.0012244&representation=PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358759/

http://www.sciencedaily.com/releases/2013/07/130731164713.htm

http://www.neurology.org/content/79/10/1019#

http://www.medscape.com/viewarticle/819232_1

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775450/

http://www.sciencedaily.com/releases/2013/11/131118141817.htm

http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html?_r=0

Disclaimer:The contents of this blog are for information only. Please discuss with a knowledgable medical practitioner before implementing this information.