http://www.thekitchn.com/feedburnermain
Caramel apples are just not my thing, y’all. I have never been able to reconcile the sweet and gooey (or crunchy and tooth-breaking) coverage of what is already a very sweet fruit. Sure, they look gorgeous, but do they actually taste good? Well, here’s one more reason to avoid candy and caramel apples: your health.
http://www.thekitchn.com/feedburnermain
I just celebrated my one-year anniversary of living in the South. My move here from Los Angeles — where I had spent the majority of my life — was quick, unexpected, and more than a little jarring. But I pretty much instantly fell in love with the slower pace of life here in New Orleans, the open friendliness of the people, and the feeling that the neighborhood I moved to was a real community, rather than simply a group of people living near each other.
I’m not going to lie and say I never get homesick for the city where I grew up and all the friends and family I left behind. But whenever I need a little reminder of why the place I live is so special, I just take my dinner outside and eat it on the porch.
http://www.thekitchn.com/feedburnermain
Kitchen disasters can ruin meals, cause you physical harm, or simply make a big, annoying mess. Sometimes the best way to let out your feelings is to text a friend, with a message comprised entirely of emojis, just to make your feelings extra clear. That feeling right there? This is exactly what we’re testing you on today.
Are you prepared for the hardest emoji quiz of your life? In this quiz I described some common kitchen disasters only using emojis. Let’s see how well you really know the emoji lexicon.
http://www.thekitchn.com/feedburnermain
Have you heard of whipped banana oatmeal? Neither had we before two weeks ago, but once it entered the conversation, we couldn’t stop talking about it. Would it be creamy? Would it be banana-y? Or would it be more like one-ingredient ice cream — a sneaky treat you’d never know had origins in the fruit world.
Well, we at The Kitchn decided to settle the debate once and for all — we’d just have to try this oatmeal for ourselves, obviously. We just never expected to get such strong opinions as a result.
http://chriskresser.com/
Whenever we talk about thyroid function, we’re generally looking at lab values or certain markers, and in particular, we’re talking about TSH, or thyroid-stimulating hormone, and in the case of subclinical hypothyroidism, TSH is high, but the thyroid hormones, specifically, free T3 and free T4, can still be in the normal range.
In this episode, we cover:
4:22 The prevalence of subclinical hypothyroidism
8:56 The laboratory reference range for TSH
15:30 Clinical consequences of subclinical hypothyroidism
[powerpress]
I’m Chris Kresser and this is Revolution Health Radio.
This episode of Revolution Health Radio is brought to you by 14Four.me. 14Four is a diet and lifestyle reset program I created to help you dial in the four pillars of health—nutrition, physical activity, sleep, and stress management. Whether you want to lose weight, boost your energy, treat a chronic health problem, or just maintain your current good health and extend your lifespan, these are the four areas you need to focus on before anything else. In the 14Four program, I walk you through every step of the process, from cleaning out your pantry and shopping for the right foods to recipe and meal plans to video demos of workouts that you can do at home without any special equipment to guided meditation and stress management programs to daily sleep tips to personalized recommendations for what to do after you finish the reset. 14Four is a great option whether you’re just getting started with this stuff or you’ve been on the path for a while. In fact, I do a 14Four myself three or four times a year to hit the reset button and give myself a boost. To learn more about how 14Four can help you achieve your health goals, head over to 14Four.me.
OK, now back to the show.
Chris Kresser: Hey, everyone, it’s Chris Kresser. Welcome to another episode of Revolution Health Radio. Today we have Dr. Amy Nett, our staff physician from the California Center for Functional Medicine, whom you’ve met before if you’ve been listening to the show. We had Dr. Nett on previously, and this episode we’re going to talk about subclinical hypothyroidism, which is an issue we see a lot in our patients at the clinic, and so I thought it would be a good idea to have Amy on to talk about this a little bit further. So, Amy, welcome again to Revolution Health Radio.
Dr. Amy Nett: Well, thank you and thank you for having me on the podcast again. I think this is a great topic to talk about because, as you mentioned, we see it a lot in the clinic and it’s increasing in the US adult population, so something that I think we all need to dive into a little bit more.
Chris Kresser: Yeah, let’s start there. We know now, at least according recent statistics, that this may even be more common than type 2 diabetes, which is, of course, an epidemic problem.
Dr. Amy Nett: Exactly, it is, so let’s first also just define subclinical hypothyroidism so people know what we’re talking about. Whenever we talk about thyroid function, we’re generally looking at lab values or certain markers, and in particular, we’re talking about TSH, or thyroid-stimulating hormone, and in the case of subclinical hypothyroidism, TSH is high, but the thyroid hormones, specifically, free T3 and free T4, can still be in the normal range.
Chris Kresser: Right, and even just to take a step back a little bit further for those of you who are not familiar with thyroid physiology and how it works, it can get a little complex, so we’ll just keep it simple for the sake of this discussion, but I want to give you a quick overview so you’re not completely lost while you’re listening to this.
Thyroid-stimulating hormone is the hormone that’s secreted by the pituitary gland, and its job is to tell the thyroid gland how much thyroid hormone to produce. The pituitary is kind of like the control tower that monitors thyroid hormone levels in the blood, and if they’re low, what it will do is produce higher amounts of TSH, or thyroid-stimulating hormone. It’s kind of like shouting at the thyroid gland to tell it to make more thyroid hormone. On the other hand, if thyroid hormone levels are high in the bloodstream due to hyperthyroidism or maybe doses of thyroid medication that are too high, you’ll see TSH drop because the pituitary is naturally trying to limit the amount of thyroid hormone that’s produced by the thyroid gland.
So just keep that in mind. When we’re talking about high TSH, sometimes people get confused because that might sound like hyperthyroidism if you’re not familiar with the physiology, but if you just keep in mind that TSH has an inverse relationship with thyroid hormones—when it’s high, it suggests that the thyroid is under-functioning, and when it’s low, it suggests that the thyroid gland is over-functioning. Just keep that in mind as we go through the discussion.
How prevalent is subclinical hypothyroidism, Amy?
Dr. Amy Nett: Well, some estimates are putting subclinical hypothyroidism somewhere in the range between 4 to 20 percent of the US adult population, and you mentioned that’s probably even more common than type 2 diabetes, which based on a 2012 estimate put it at around 9 percent of the US adult population—so type 2 diabetes around 9 percent and subclinical hypothyroidism up to as many as 20 percent.
Chris Kresser: Yeah, that’s a big range, and I imagine part of that is differences in how it’s detected and different definitions of subclinical hypothyroidism, but as I’ve written about in my thyroid eBook, the conventional ranges that are used to determine thyroid function are definitely inadequate, and I think if we use the tighter ranges, you’re going to see prevalence that’s at the higher end of that spectrum.
Dr. Amy Nett: Yeah, I agree. So you mentioned TSH, and that’s certainly the main marker that we use, and that’s really how we screen thyroid function, so anytime we have a patient joining the practice, we always look at TSH. And the other thing that’s important in the sort of intro to thyroid measurement, how we’re monitoring thyroid function, is understanding that it’s also important to look at the free thyroid hormone levels. When you see a thyroid panel, you’re going to see a number of different measures. It might say total T4, total T3, but what we really measure is the free T4 and free T3. This is because thyroid hormones are actually very strongly bound to proteins in the blood, but thyroid hormones are only active when they’re free, meaning it’s only those free thyroid hormones that bind to the cellular receptors and exert their physiological effect on the cell.
Chris Kresser: Right. That’s a great point, and at the same time, every part of the thyroid panel can give us useful information. As Amy mentioned, we start with TSH and total T4 and total T3, and the reason we start with that—I mean, there are a couple of reasons. First of all, those are the basic screening markers. They’re cheap and readily available, and if a patient doesn’t have any thyroid issues, that’s all they’re ever going to need. But also, total T4 is what’s produced by the thyroid gland. The majority—I think over 90 percent—of the hormone that’s produced by the thyroid gland itself is total T4, and then that is later converted into T3, and then the total thyroid hormones are converted into free thyroid hormones. So total T4 and total T3 can tell you a lot about what the thyroid gland itself is actually producing, which is, of course, useful information. And then, as Amy mentioned, you don’t want to stop there because if you just look at total T4 and total T3, you don’t really know what amount of available free thyroid hormone is there to act on the tissues, and that’s ultimately what will really determine peripheral thyroid hormone metabolism and function. So all of these markers give us some information, but free T4 and particularly free T3 are probably the most accurate markers in terms of what’s really happening with thyroid function.
Dr. Amy Nett: Yeah, and then just to be complete in terms of what we’re looking at for thyroid function when we’re evaluating for possible hypothyroidism, the other thing you and I always include is looking at antibodies. And specifically, when we’re talking about low thyroid function, we’re talking about antibodies to TPO and thyroglobulin, and these are seen in Hashimoto’s, which, Chris, you’ve talked and written about pretty extensively, and we’re not going to go into that too much today, but it is important to know if low thyroid function is due to Hashimoto’s because that’s an autoimmune condition and we’re going to approach treatment a little bit differently.
Chris Kresser: Right. There is another antibody that we will occasionally measure: thyroid-stimulating immunoglobulins, or TSI antibodies, and those are implicated in Graves’ disease, which is the autoimmune condition that causes hyperthyroidism, but again, as Amy mentioned, we’re not going to go into detail on that here because we’re focusing on subclinical hypothyroidism. But just in the interest of being complete, those are all the things that we might want to check for when we do a thyroid panel.
So let’s talk a little bit more. I mentioned earlier, Amy, this problem with the laboratory reference range for TSH, so let’s talk a little bit more about that because it’s important.
Dr. Amy Nett: It is, and anytime you go to most conventional medicine physicians, and even if you just look at your lab results, you’re going to see that most commonly the reference range for TSH goes up to an acceptable limit of about 4.5, but in functional medicine, we actually consider a TSH of above 2.2 or 2.5 to be elevated beyond the optimal functional range. And, Chris, I think you’ve talked about this in prior podcasts before, how the limit of 4.5 was initially established, taking essentially all comers for lab values, which included patients who hadn’t necessarily been screened for hypothyroidism.
Chris Kresser: Yeah, that initial study was on the NHANES cohort, the Nurses’ Health Study. A lot of research has been done on that group, and not only did they not exclude people with undiagnosed hypothyroidism, they didn’t even exclude people with diagnosed hypothyroidism, which just seems crazy. So they took a whole bunch of people and they measured their TSH, but they included people with known and then undiagnosed hypothyroidism, which would skew the range much higher than it should be otherwise.
Then more recently, in the last 10 or 15 years, they’ve done studies where they excluded anyone with diagnosed hypothyroidism, which is just basic, but then they also used different methods of screening for hypothyroidism that didn’t involve TSH to determine whether people had undiagnosed hypothyroidism, and if they did, they excluded those people as well. And they basically found that a normal TSH for people that don’t any thyroid problems is somewhere between 0.5 and maybe 2.2 or 2.5, depending on the study that you look at. As you can see, that’s very, very different than 4.5 being the upper end of the limit.
Dr. Amy Nett: Yeah, so anytime we see a TSH of above either 2.2 or 2.5, that’s going to be an indicator for us to go ahead and order the rest of those thyroid markers. That’s when we’re going to order the free T4, free T3, and thyroid antibodies.
Chris Kresser: And that’s especially true if we see people with thyroid symptoms or symptoms that could be attributed to poor thyroid function.
Lab markers, as I’ve often said before, they’re a snapshot in time, and you never want to rely exclusively on lab markers without assessing the entire clinical picture. I mean, of course, there are certain lab markers that are more definitive than others, but in the case of TSH, if we see a TSH of 2.2 but the free T3 and free T4 are totally normal and all the other markers are normal and the person is healthy and doesn’t have any sign of [low] thyroid function, we may still follow up just to be thorough, but we’ll be less likely to consider that an abnormal result because, as it turns out, there is quite a bit of variability in TSH, so why don’t we talk about that a little bit.
Dr. Amy Nett: Yeah, there is quite a bit of variability, and before I move on to that, I’m also going to mention for your older listeners that some of the more recent research is suggesting that when we reach our 80s, a TSH of above 3 is actually normal. It seems to reflect probably some age-related changes rather than actual thyroid pathology, but one study even suggested that a higher TSH in people over 80 is associated with lower total mortality. So like you said, we really need to assess these lab values in the context of the whole person, taking age into account and symptoms.
Chris Kresser: Exactly. So variability, yeah, let’s talk a little about that.
Dr. Amy Nett: Right, because we use TSH as our most common screening tool, but one of the complicating factors is this variability we see in TSH with levels changing by about 50 percent, which is pretty significant when we’re talking of normal TSH values around 2. What this means is if you have, let’s say, an average or a normal TSH of 2, it can measure anywhere between 1 and 3 throughout the course of the day, which would be completely normal. We’ve said that if we see a TSH of 3, we’re going to want to dig in a little bit further, get some more markers, and start thinking about hypothyroidism, but it turns out this is actually completely normal variability. Our thyroid-stimulating hormone has a diurnal rhythm, meaning a daily rhythm, with changes throughout the day.
Chris Kresser: Right, and I’m sure a lot of listeners will be familiar with the concept of a diurnal rhythm from cortisol, which we’ve talked about before, one of the hormones produced by the adrenals that’s involved in the stress response, and it’s typically high in the morning and it tapers off throughout the day. And melatonin is produced in the opposite rhythm.
So it turns out that TSH has a similar diurnal rhythm. It’s not as clearly defined as the cortisol rhythm, but as Amy said, the crucial thing here to realize is that if you see a TSH of 3, in my mind, that is not yet grounds for diagnosing someone with hypothyroidism or even subclinical hypothyroidism and then giving them medication. That is a sign that more investigation needs to be done. And if you look in the research, you’ll find that in a research setting what’s recommended is to do multiple tests of TSH and then average them out to get a mean value. That is not always practical in a clinical setting, depending on the patient’s availability and resources, but at the least, we want to see two measurements of TSH and preferably more than that before we really decide what’s going on. So when we follow up with the initial thyroid panel where we do TSH and total T4 and total T3 and we order free T3 and free T4 and the antibodies, we’ll always include another TSH there so that we can get at least one more reading and see what’s going on.
Dr. Amy Nett: Yeah, that’s a really good point. We never want to initiate treatment based on a single elevated TSH. The more markers we have, the better, but certainly we need to be looking at a minimum of two different measurements.
Chris Kresser: Let’s move on and talk a little bit about the clinical consequences of subclinical hypothyroidism. Why does this matter? Why should patients be paying attention to this?
Dr. Amy Nett: Absolutely. Well, when we talk about subclinical hypothyroidism, some people with subclinical hypothyroidism certainly experience the symptoms of hypothyroidism. Hypothyroidism has a pretty broad range of symptoms because thyroid hormones affect essentially every cell in our body. They play a particularly important role in determining our metabolism. So some symptoms of hypothyroidism are going to include feeling tired or sluggish despite adequate amounts of sleep. We also see weight gain or weight loss resistance, meaning difficulty losing weight. We also see low mood or depression and other cognitive issues, which might be slowed thinking or brain fog. Another really common symptom is cold intolerance, meaning either having cold hands and feet or you could be the only one in the room wearing a down jacket when everyone else seems comfortable in a short-sleeved t-shirt. We also see constipation, and frequently we can see hair loss and then weak or brittle nails and sometimes dry skin, all reflecting low thyroid function.
Chris Kresser: Right. The constipation is interesting, and this is where all of these things can relate. T3 thyroid hormone, which we’ve been discussing, is required to activate intestinal motility and also the production of stomach acid, which then leads to the production of pancreatic enzymes. So as you can see, it plays a really crucial role in digestion because if you’re not producing T3, you won’t get the acid production, the enzyme production, and the motility, and it can lead to not only constipation, but then that can increase the risk of SIBO and other digestive problems. That’s just one example of how even subclinical hypothyroidism can contribute to other issues that can turn into chronic problems. But there are other examples, too, so why don’t we talk about some of those.
Dr. Amy Nett: Yeah, and not only that, but as though those symptoms weren’t enough, hypothyroidism can also be associated with an increased risk of cardiovascular disease. That’s another reason it’s important to recognize potential hypothyroidism and initiate proper treatment.
Chris Kresser: Some people who are listening might be familiar with the High Cholesterol Action Plan, which is my digital program where I talk about what to do—or not do, in some cases—if you have high cholesterol. In that program, I talked about how back in the ‘60s and ‘70s doctors would use a low dose of thyroid hormone to treat high cholesterol, and the reason for that is that T3, again, one of its many roles is to activate the LDL receptor on the outside of cells. The LDL receptor is what LDL particles bind to, and it removes LDL from the circulation and takes LDL cholesterol and everything else that the LDL particle carries and removes that from the circulation and puts it into the cell. So if someone has low levels of free T3, then they may have poorly functioning LDL receptors, and that can lead to high cholesterol and high LDL particle number.
That explains why studies have shown that patients even with TSH levels between 2.5 and 4.5, which, remember, would be considered normal in the conventional paradigm, show improvements in cardiovascular disease risk factors, including lipid profiles, endothelial cell function, which is better functioning of the blood vessels, and decreased thickness of the blood vessels, when their thyroid function improves. So the cardiovascular connection with thyroid hormone and the function of the thyroid system is really important to understand.
Dr. Amy Nett: Yeah, and there was actually another really recent study—it was actually just published last month—that looked at another potential, we’ll say, association between low thyroid function and cardiovascular disease risk. Specifically, this study noted that there is an association between subclinical hypothyroidism and atherosclerosis, but they looked a little bit further and specifically looked at the role of oxidation. Oxidation of LDL plays a pretty important role in the development of atherosclerosis or arterial plaques. So this study, again, it looked at oxidative stress in patients with subclinical hypothyroidism, and we just said that oxidation of LDL can make it a more atherogenic form that contributes to the development of those atherosclerotic lesions, and one of the major pathways of LDL oxidation is what’s called the lipoxygenase pathway. This pathway creates certain fatty acid oxidation products known to increase plaques, and they’re considered reliable biomarkers for oxidative stress. So this study looked at lipid peroxidation as measured by concentrations of these specific fatty acids, looked at the association between lipid oxidation, TSH levels, and then the carotid intima-media thickness, and you’ve talked about the IMT before, which is a biomarker of subclinical atherosclerosis. And this study did find that with subclinical hypothyroidism, especially when the TSH got even higher, up to about 10, there was a higher risk of atherosclerosis, and it seemed to be associated with that lipid peroxidation. So another interesting mechanism in terms of how the subclinical hypothyroidism or low thyroid function is contributing to atherosclerosis.
Chris Kresser: Absolutely. In the interest of time, we won’t go through too many more examples here, but there are several. The important thing to understand, as Amy said before, is that there are multiple connections between the thyroid system, thyroid hormone, and virtually every other system of the body because of thyroid hormones’ downstream effects on all cells in the body. Changes in thyroid function will affect the endocrine system. It will affect metabolism. It will affect digestion. It will affect cognitive function and mood, reproductive health, etc. You name it, the thyroid system is going to affect it, so this is, again, why even subclinical hypothyroidism is something that’s important to pay attention to.
Dr. Amy Nett: And when you mention all that, I think it would be tempting to see, “Well, why not just start low-dose thyroid hormone? If you see a slightly elevated TSH, then just initiate treatment.” But with most things, there really is that sweet spot for not overtreating, and so that’s why we want to be aware of subclinical hypothyroidism and have some guidelines in terms of when to start treatment. One study was done—I think it actually just came out this month—that looked at about 241 women who had subclinical hypothyroidism—it is more common in women—and they looked at TSH levels ranging from about 4.5 to 10, and they were followed up over a five-year period. Of these 241 women with subclinical hypothyroidism, only 19 percent actually went on to require thyroid hormone replacement, and about almost 23 percent had a spontaneous normalization of the TSH, and then more than half of the patients continued to meet the criteria for mild subclinical hypothyroidism but didn’t actually require thyroid hormone replacement. I think this study really supports the option of monitoring thyroid function rather than rushing to initiate treatment because it’s not always indicated.
Chris Kresser: A really, really important point, and I just want to emphasize this a few different ways. In functional medicine—you’ve probably heard me say this—we’re always trying to address the underlying cause of a problem. Another way to think about that metaphorically is as a tree. If we’re looking at the tree, we want to be addressing the root of the problem rather than the branch. Now, having said that, in some cases it’s necessary to also address the symptoms, to do something to relieve the symptoms if the symptoms are intense and severe, just to give the patient some temporary relief while we’re continuing to investigate and address the underlying cause or the root of the problem.
The second thing to understand that’s important about that—and this is really true in the case of thyroid problems—is that it’s not always black and white that something is a root or a symptom. In many cases, it’s both. If you take thyroid, it can be both an underlying cause of a problem and it can be an effect or a symptom of a deeper problem, and that’s really the trickiest thing about addressing particularly subclinical hypothyroidism. In most cases, for me—I’m curious to hear for you, Amy—when I see subclinical hypothyroidism, I’m usually going to do more investigation into what I consider to be more fundamental pathologies, like gut dysfunction or heavy metal toxicity or mold- or biotoxin-related illness or chronic infection because I know that all of those things can compromise thyroid function and will, in many cases, do it in a way that shows up or manifests as subclinical hypothyroidism rather than frank hypothyroidism. At the same time, if someone comes and they have just grossly abnormal thyroid function and positive antibodies, of course, we’re going to dive right in and start treating their thyroid because in those cases, even if there are other underlying factors that are contributing to the thyroid problem, the patient probably won’t feel better—certainly won’t feel mostly better—if we don’t address their thyroid. I feel like that’s important to point out because it explains why you don’t necessarily want to jump in with thyroid hormone replacement right away early in the process.
Dr. Amy Nett: Yes, I would agree absolutely that whenever I start thinking about hypothyroidism, I really want to start, as we’ve talked about, peeling the layers of the onion and seeing what’s going on underneath, where else can we address inflammation, where can we modulate the immune system. But having hypothyroidism myself, I can tell you from personal experience it feels pretty miserable, so if I see someone with enough symptoms that are really consistent with hypothyroidism, I probably will initiate some treatment. It might be with a very low dose of thyroid hormone, but really using it as a bridge because it takes a little bit of work and it can take a little bit of time to figure out what the true root cause is.
Chris Kresser: Absolutely. Whether you do something to address the thyroid issue in the meantime while you’re continuing to explore those root causes, that’s really just a clinical judgment call. There’s room for different approaches with different people depending on your preference and the patient’s preference, and you may want to experiment with some different forms of thyroid hormone replacement initially or other things like just supporting them with nutrients that are beneficial for thyroid function, especially if they’re low in any of those nutrients.
Dr. Amy Nett: Yeah, there are a lot of different approaches, and I think the take-home point from that is that it’s definitely something to consider, but I rarely consider it the answer, and it’s just whether or not it can be useful as a bridge. But there are so many different ways to support the thyroid, and I’m seeing that in the majority of our patients who initially have labs consistent with subclinical hypothyroidism, most often we are able to bring those numbers back into range by treating the underlying cause.
Chris Kresser: Just for a little perspective on why it’s important not to overtreat—you mentioned, Amy, why don’t we just dive in and start treating right away? Well, there’s often a cost to that. If you undertreat, there’s a consequence, and if you overtreat, there’s a consequence, and thyroid function is no different. Even subclinical hypothyroidism, which is really kind of mirror of what we’re talking about now, where you have a TSH that’s below the reference range and normal free T4 or free T3 or maybe high-normal T4, has been associated with poor cognitive outcomes in studies, and this makes sense because the thyroid system is really kind of the idle of our engine, if you want to think of it that way, like if you pull up to a stop sign in your car and it’s idling there. If the idle is too low, then the car’s going to be shaking and it’s not going to run correctly, but if the idle is too high, the life of the engine is going to be shorter. It’s going to burn itself out more quickly, and that’s exactly kind of what the thyroid system does for us.
We see a lot of patients who come to us and they’re overmedicated, so they’re taking a higher dose of thyroid hormone than they should, and they’re not often aware of this. Their TSH is suppressed sometimes even to zero or as close to zero as you can possibly get, and that’s a concern because that can increase the risk of stroke, and it can impair cognitive function, as I just said with the study, and it’s a reason that you need to be cautious and not cavalier in terms of what you do with thyroid hormone replacement, whether you’re talking about using drugs or desiccated thyroid that you can get over the counter or anything that affects thyroid function.
Dr. Amy Nett: Right, and as you mentioned, there are also so many different ways to support the thyroid, and especially once we start seeing subclinical hypothyroidism, different ways to approach that.
One, I think, really interesting and kind of exciting study that came out—again, it just came out this month—looked at the role of Hashimoto’s thyroiditis and oxidative stress parameters, looking at patients who had evidence for Hashimoto’s and then had normal thyroid function, subclinical, and overt hypothyroidism. They found that total oxidant levels and oxidative stress index levels were higher and that total antioxidants—so antioxidants being beneficial, the total antioxidant status—were lower with overt hypothyroidism. So overall, we saw that indicators of oxidative stress would increase and antioxidant markers would decrease pretty significantly in each phase, going from normal thyroid function to subclinical hypothyroidism to overt hypothyroidism in these various subgroups of patients with Hashimoto’s. This suggests that oxidative stress increases continuously during the development of hypothyroidism, so this is going to be a really interesting area to follow up on because it certainly begs the question as to whether antioxidant treatment could actually help prevent progression to overt hypothyroidism.
Chris Kresser: Or simply dietary and lifestyle changes that reduce the likelihood of oxidative stress happening in the first place. Oxidative stress—along with inflammation—is characterized as basically every modern inflammatory disease that we know about, and oxidative stress goes hand in hand with the modern diet and lifestyle, so eating a lot of highly refined and processed industrial seed and vegetable oils and refined flour and sugar, not exercising at all, not exercising enough, too much sitting, exposure to environmental toxins, like heavy metals and BPA, not sleeping enough, not managing your stress—all the things that we talk about all the time, these are all contributing factors to oxidative stress.
I think one of the important takeaways from this is that improving thyroid function, we often think of things like thyroid hormone replacement or desiccated thyroid or even nutrients that support thyroid function, like zinc and selenium and iodine, but there are certainly other things that are important to consider, too, like we just mentioned. If oxidative stress is a contributing factor, and someone is eating a standard American diet and following a standard American lifestyle, then it’s entirely possible that switching to a nutrient-dense, paleo type of diet, getting more sleep, adding more physical activity to their routine, and doing some meditation or mindfulness practice could have a significantly positive effect on thyroid function without taking a single pill or any medication at all.
Dr. Amy Nett: Exactly. I think to sort of summarize a lot of what we’ve been covering, it’s really the idea that subclinical hypothyroidism, we need to be aware of it in part because it may progress to overt hypothyroidism, it can be associated with some of the symptoms of frank hypothyroidism, including the complications such as cardiovascular disease, and while we need to be aware of it, we don’t always need to start treatment with thyroid hormone replacement. There are a lot of different ways to address thyroid health.
Chris Kresser: Absolutely.
I hope this has been helpful. It’s definitely an emerging field. You can see studies being published on it all the time, and we’ll keep up with the research as we always do and with our own clinical experience and what we’re experimenting with and figuring out in our work with patients.
I want to thank you, Amy, for coming on the show again and talking about this. It’s always a pleasure, and I look forward to having you back next time.
Dr. Amy Nett: Well, thank you. I look forward to coming back.
Chris Kresser: All right, and Amy, I think, has a few spots for new patients right now. She’s getting almost completely full, and unfortunately, I had to close my practice to new patients again recently. But if you do need help with this kind of thing, Amy is fantastic. I can’t recommend her highly enough, and hopefully she’ll still have a few spots left before her practice fills as well.
Dr. Amy Nett: Absolutely. I am still accepting new patients, so I would always be happy to work with anyone new.
Chris Kresser: OK, so you can get more information about how to work with Amy at CCFmed.com. That’s the California Center for Functional Medicine website, our clinic website.
That’s it for this episode. Again, if you enjoy the show, make sure to leave us a review on iTunes. It really helps spread the word. And for more information, a free eBook on thyroid function you can find at ChrisKresser.com, a lot of articles that I’ve written over the years condensed into one eBook that we’re offering for free there, so check it out if you’re interested in this topic.
OK, thanks, everyone, for listening. Talk to you next time.
That’s the end of this episode of Revolution Health Radio. If you appreciate the show and want to help me create a healthier and happier world, please head over to iTunes and leave us a review. They really do make a difference.
If you’d like to ask a question for me to answer on a future episode, you can do that at ChrisKresser.com/PodcastQuestion. You can also leave a suggestion for someone you’d like me to interview there.
If you’re on social media, you can follow me at Twitter.com/ChrisKresser or Facebook.com/ChrisKresserLAc. I post a lot of articles and research that I do throughout the week there that never makes it to the blog or podcast, so it’s a great way to stay abreast of the latest developments.
Thanks so much for listening. Talk to you next time.
http://www.marksdailyapple.com/
Through my personal experience and through coaching and working with thousands of people over the years, I’ve had the privilege (and sometimes surprise) of more or less seeing it all. And, I’d like to think I’ve picked up some helpful perspective along the way. I thought I’d highlight some of that perspective on the unique challenges or “spirit” of health at each age—how to live well and take care of yourself through each of life’s phases. Look for part two next week!
Let me jump right in with the young ‘uns….
You lucky ones are as close to Grok instinct as it gets. Embrace it for all it’s worth. Don’t be in a rush to surrender your inner cave child.
Get muddy. Get sweaty. Climb trees. Build forts. Skip stones. Make plenty of dirt pies (and don’t hesitate to taste them). Stay outside as long as your parents will let you. Play as hard as you can. Run so fast that your legs feel like they’re going to propel right out from underneath you.
These years aren’t the time for life or health to feel too complicated. In fact, don’t worry about what it means to be healthy for now. Just try to understand that you’ll thank your parents and/or other adult figures for limiting your junk food and pushing meat and vegetables. Cave children need these. Teddy Grams and Gold Fish won’t help you reach your wild potential. That would be a major shame and so not worth the sugar crashes.
Think instead about pushing your limits, discovering your abilities, reveling in all that you notice about yourself and the world around you. Explore—and experiment—as much as you can. Discover awe in small things the way Grok Jr. would’ve—in animal encounters, cloud formations and large sticks.
Childhood should first and foremost feel like a rush—hitting up against your limits, pushing them further. Ask yourself—and test—on a daily basis—how high can I jump, how far can I throw, how long can I run, how fast can I climb?
Sure, some wet blanket people may try to tell you that play isn’t productive. I’m not suggesting you get yourself in trouble with these folks, but don’t believe them, okay? The outdoors calls you—although school gyms and trampoline parks can be fun, too. Still, spend as much time under the sun as you can.
And for the record, you’re right: recess is the golden part of the day, and it should be. Trust me—that’s the stuff you’ll really use the rest of your life. If you make recess a daily habit throughout your entire life, you’ll give me and every other person on this site a major run for his/her money. Keep up the good work!
You’re coming off those years when you played hard and slept hard. Now you probably just want to sleep period—until noon anyway.
Life is, most likely, much busier than just a few years ago. With homework, activities, an after school job and friends, health may not command much (if any) attention. Maybe you even consider it something “old people” (i.e. people over 25) think about.
It’s true you’re still in the thick of growing—pretty quickly actually. It probably feels like the adults in your life endlessly fuss over you with this rule or that. From your perspective it’s totally unnecessary and annoying. You seem to bounce back from whatever choices you make with no perceptible effect. Energy drink? Pizza for lunch three days in a row? Your friend’s brother’s cigarettes? What’s the big deal?
These might seem like Teflon years—when you can do what you want without noticeable consequences. Save the salads and exercise for when you get older and need to take your body seriously, right?
However, these are the years when you’ll see some of your peers (or yourself!) begin losing their grip on vitality if you can believe it. Maybe you observe it already. Certain friends have started to put on extra weight. You see some people struggle on the more intense gym days.
Recess is no more. After school doesn’t mean playing outside. Riding the bus or commuting by car is the norm for getting to and from. At home there’s plenty of homework and an array of online diversions to keep you sedentary. Food is often whatever friends are grabbing at a drive-thru or from concession stands. Caffeine is the thing to drink—and even show off (how grande can you go?). This is the life of the every-teen, isn’t it? No biggie.
Except you deserve better. And there’s the rub….
Take that in for a minute. You deserve better. Absorb it. Consider what it might mean for you. Make a point of remembering it—even if you aren’t ready to act on it or even claim it yet. Carry it with you until something in your life or thinking brings it to a head—tomorrow, next month, next year, two decades from now. Trust me—this truth will change your life someday—maybe many times over.
For now, imagine you aren’t just sauntering around the school halls each day. Picture yourself on a class trip climbing a 14,000 foot mountain in the Rockies. Would you be able to do it? Be honest, and don’t automatically assume yes. I’ve seen these kinds of trips pick off a surprising percentage of teenagers (not to mention adults). Your little kid self probably would’ve been pumped at the opportunity. How much have you—your motivation and your abilities—changed?
See, it’s so easy at this age to let peer behavior influence our choices and coerce us into letting go of so many things about ourselves that we should never surrender—aspects of ourselves and our best interest we’ll regret giving away one day. Yet, in the social moment, no one wants to look like they care too much. As “old” as I am, I get it.
But try to care about your bigger (and not just social) self-interest. Try to see that what you do today matters for how you can live your life now (and, yes, what will come down the line for you later). But focus on today. When we’re honest, that’s usually the better motivation for all of us.
What are you putting your time and life into these days? What is it asking of you? How is it pushing you to develop your physical potential? How is it encouraging you to enjoy exercising that? You can probably see that screen time, junk food and all the other common adolescent traps don’t offer very inspiring answers to these questions.
You’re at an age when intellectualizing health won’t make much of an impact, but living it should. Enjoy what you used to enjoy as a younger kid in a renewed way—whether in team sports or in your own pursuits. Trust me, you aren’t limited to what’s being offered in school. Seek out martial arts, parkour, community running and walking clubs, biking events, community swim times, hiking and other outdoor activity groups. You’re no longer a child, but don’t be so quick to cede your wild, primal potential. Casting off your ability to play means abandoning yourself at a fundamental level. Don’t surrender your physical vitality and creativity before you even graduate high school.
As you grow into your interests (a big part of life at this stage), decide (or find!) what stokes your inner fire. Don’t apologize for your choices if they aren’t what your peers or parents would choose for you. What will YOUR active, adventurous life look like? There’s no need to have it all figured out at this point, but begin to ponder it. Envision claiming it. Step toward that however it makes sense each day.
So, you’re no longer under your parents’ roof. You have a totally new level of autonomy—and some new responsibilities.
You’re suddenly in a position to make (much of) your own weekly schedule. Maybe you even make your own food (or at least eat at the cafeteria where you have a plethora of choices). The fact is, no one is watching or directing or dictating whole aspects of life anymore. A skeptic might joke, “What could possibly go wrong?”
On the one hand, I tend to think we expect too little at this age. Older adults in our lives assume we’ll make stupid choices and generally chalk up this time of life to burning off one’s inner dumba$$ instinct. It might sound like a heyday at the outset, but is that ALL you really want from life today?
You’ll see plenty of people your age, maybe even good friends, organize these years around short-term gratification (e.g. Captain Crunch at every meal and frequent Mountain Dew pick-me-ups) and even varying levels of self-destructiveness (e.g. binge drinking, drug use, chronic sleep deprivation, risky sexual behavior). Underlying this tendency, I think, isn’t just entitlement to sabotage but also maybe the sadder belief that this is your last/only chance to “live it up.”
We perpetuate an enormously destructive lie in this culture—that these years will be your best. Trust me, if you’re living your life to its full potential and aren’t beset by horrible tragedy just after graduation, this won’t be true. Believe it now, and you’ll coerce yourself to live with a pressured immediacy that can end up narrowing your experience almost as much as the opposite extreme of the spectrum—where people can’t loosen up enough to step away from the term papers and service projects. Either extreme offers an impoverished and caricatured vision of what this stage can be.
I’m not preaching the straight and narrow route here. By all means, use the time to explore and enjoy yourself. However, develop the discernment to imagine what you want out of these years (in health and other terms) and the self-discipline to make sure you’re acting toward those purposes most days.
So, let me ask you this question. What condition—physical and psychological do you want to live your way into during college? This isn’t a hiatus from life after all—what happens in college stays at college (as much as the culture talks about it this way). I’m sure you could come up with a hundred jokes and many more examples of this principle. Suffice is to say, those “freshman 15” will likely be coming with you post-graduation unless you do something about it. The other effects of a sedentary 4-year college career will leave with you, too.
The fact is, here’s the chance to make your life your own. Remember that very personal question of what your active, adventurous life will look like? Are you planning on living that—or holding yourself captive on some socially dictated detour for 4+ years? This is the time to understand that living your own life to its healthiest (and generally most successful) potential means accepting the responsibility of creating your own path rather than tagging along with the crowd.
So, you found your true love, and now you’re living in holy matrimony or a romantic agreement in which you’re both on the lease. Unlike the string of roommates you’ve had over the years, now there’s this vague expectation that you share everything—share food, share meals, share free time, share responsibility, share social lives, etc. Some elements of this arrangement go better than other. Achilles’ tendon? It just might be a Primal versus non-Primal showdown.
How can it be that someone who makes us so happy can also challenge our efforts to stay healthy? It just happens.
Primal couples exist, but they’re the exception rather than the rule. More are made after the vows, but the majority of married Primal folks, I’d easily venture, go it alone. Perhaps many of their partners exercise and/or eat reasonably cleanly, but many others don’t.
Sure, there are strategies you can employ involving separate shelf space, co-existing food budgets, overlapping food preparation/meal planning that calls in your Venn diagramming skills.
The number one tip I’ve gleaned from coaching Primal clients with non-Primal partners: take independent responsibility for yourself.
I know too many people who have put too much energy into cajoling or complaining about their partners. Some of it comes from feeling like they’re being cheated of convenience they feel they should have. (Why should anyone feel entitled to this?) Some of it comes from feeling like they’re missing out on support. (This is certainly nice, but you partner isn’t responsible for emulating or cheerleading your choices.)
Finally, others feel they’re missing out on a sharing and bonding experience over what some Primal types consider deeply held values. While I get this, I also think people have the choice of sharing instances or elements of their commitments (e.g. now and then sharing a meal—or most of a meal—that fits both tastes, enjoying after-dinner bike rides or weekend hikes together) without requiring mutual adherence to appreciate the occasion.
Some people might call this approach harsh or unsympathetic. I call it realistic and, ultimately, respectful. I’ve seen a lot of people lose the forest through the trees focusing on a tallied list of differences. They took their partners’ choices as personal slights or, even worse, evidence that the other person didn’t care about their relationship. In other words, they wanted to see change—in the other person.
Whether it’s a question of food or the proverbial toilet seat, we all have a choice in long-term relationships to stew in a cauldron of resentment and discontent about our partner’s lack of compliance or “good sense.” Alternatively, we can let that $#!% go—really go—and focus on ourselves.
Are there cases in which partners are so far apart on the spectrum of valuing themselves and their health that not enough is left holding them together? Yes, I’ve seen these cases. And, it’s really not my business whether someone leaves their marriage or not.
That said, I think we benefit when we embrace our own independence within a relationship and demand less from the other person, particularly when our interest is in making them more like ourselves. I’ve suggested to disgruntled clients that for one month they let go of attachment to the idea their partners have any role in their choices—or in their own sense of contentment with life as well as health.
Yes, this flies in the face of what our culture teaches us, but see how it works—30 days or your full-blown misery back!
After battling some inner resistance, it’s amazing how many of them have come back to me happier in their marriages, more centered in their own choices—and (further down the road if they keep it up) in more productive (not perfect, but progressing) collaboration with their partners. The power of self-focus in health as in life—with its emphasis on boundaries and responsibility—can’t be overestimated.
Thanks for reading today, everyone. As mentioned, look for my follow-up on the remaining life stages next week. In the meantime, I’d love to hear your thoughts on health, wisdom and well-being in early life. Share your comments, and enjoy the end of your week.
Originally Posted At: https://breakingmuscle.com/feed/rss
Should you run? If you are a triathlete then the answer is most surely yes. But what if you are a recreational or amateur cyclist? This week I’m exploring the pros and cons of running for cyclists. If you cycle for general fitness and fun, taking up running could be a good way to support your cycling.
I know what you are thinking – why not just cycle more? There are some specific aspects of running to consider.
Originally Posted At: https://breakingmuscle.com/feed/rss
Should you run? If you are a triathlete then the answer is most surely yes. But what if you are a recreational or amateur cyclist? This week I’m exploring the pros and cons of running for cyclists. If you cycle for general fitness and fun, taking up running could be a good way to support your cycling.
I know what you are thinking – why not just cycle more? There are some specific aspects of running to consider.
For now classes are 6pm and 640pm at 2840 Wildwood st in the Boise Cloggers studio.
Book your class NOW!
click this ==>
