Upcoming Issue Highlights

Finding A Natural Hormonal Balance

Hormones are chemicals that send signals between cells in the body, regulating everything from a person’s blood pressure to how well they sleep at night. These physiological messengers are produced throughout the body, and through their communication with our organs and one another, they help maintain a balance designed to keep a person happy and healthy.

Sometimes, however, the delicate balance of hormones is disrupted. Sustained hormonal imbalance can have severe and potentially fatal complications, so diagnosis and treatment is critical for general health and well-being.

For example, subclinical hypothyroidism (SCH) is diagnosed when peripheral thyroid hormone thyroxin (T4) is within normal levels, but thyroid-stimulating hormone (TSH) is elevated. Clinical manifestations of SCH can be subtle and may include systemic hypothyroid symptoms (e.g. fatigue, obesity, headaches, dry skin, hair loss, cold intolerance, constipation and low sex drive), changes in mood and cognition, hypercholesterolemia, impairment of ventricular diastolic function and increase in C-reactive protein.

According to Leonid Ber, MD, senior medical scientist with Illinois-based NOW Foods, Inc., provider of the Protocol For Life Balance line of supplements, health care practitioners are paying close attention to SCH because recent studies revealed significant increase in the likelihood of critical cardiovascular events in these patients. “Prior to this, only fully manifested hypothyroidism was subject to concern and intensive intervention.However, now we know that subclinical form of hypothyroidism also has serious circulatory consequences—it roughly doubles the cardiovascular risk1,” said Dr. Ber.

Prevalence 

While it is estimated that 80 percent of women today suffer from some type of hormonal imbalance, Amber Lynn Vitse, LMT, CN, ayurvedic practitioner and educator, noted it’s an equal opportunity issue— affecting both men and women, in a widening range of ages.

“In women of child-bearing age, the prevalence of reproductive hormone-related discomforts and symptoms continues to grow, affecting younger women and with more severe symptoms. And now we are finally identifying the imbalances and their effects in men,” she said, adding that men and women as young as their 30s are experiencing problems previously associated with menopause and what is now termed andropause. “This is on top of the usual PMS (premenstral syndrome), endometriosis, fibrosis and other concerns in women of child-bearing age. But certainly those seeking hormone therapy are predominantly in their 40s to 60s, men and women.”

“The prevalence of SCH is three to eight percent in the general population without known thyroid disease,” said Dr. Ber. “The occurrence is significantly higher among middle age women than men. However, after the sixth decade of life, the prevalence of SCH in men approaches that of women. The diagnosis of SCH appears to be on the rise, however, better detection might be the culprit.” 2 

Cause & Effect 

One explanation for the rising incidence of conditions stemming from hormone imbalance could simply be our aging population— that more aging Baby Boomers means more people reaching menopause and andropause. But Dai Jinn, chief science offi-Cer with Arizona-based RLC Labs, Inc., a company primarily focused on thyroid issues, expressed that an increase in environmental stasis correlates to more hormone disruptors being introduced.

“An underactive thyroid, our specific category of focus, has always been present, whether deterioration of thyroid hormone production due to age or through the presence of antibodies,” said Jinn. “However, we are seeing greater numbers of hypothyroid patients with environmental factors, which can include increasing bombardment of halides (e.g. chlorine, fluorine and bromine) as well as hormone disrupting chemicals (e.g. BPA in plastic) and lack of wholesome foods (being replaced by processed and genetically modified foods).” 

At Healing From Within Healthcare in Los Angeles, CA, the majority of clinical presentations Holly Lucille, ND, RN has seen have some degree of underlying hormone imbalance influencing it. “I think that this number has risen, perhaps because of our awareness of the endocrine system and all of its connections, but I would also say because of the increasing environmental influences, which act as endocrine disruptors.” 

Even as there are genetic tendencies or predispositions to disease manifestation, Dr. Lucille recognizes that lifestyle plays an immeasurable role.

“I always say that genetics can load the gun, but our lifestyle pulls the trigger,” she said. “We actually have more control over our gene’s than they have over us. Almost 99 percent of the conditions I see linked to hormonal imbalances are lifestyle related.” 

Vitse added that over the last 15 years, we have become more aware of the role of the gut in hormone metabolism and balance.“Antiobiotics destroy the natural flora. If [patients] never worked to get it back and their diet does not provide it, gradually and inevitably they go downhill. Further, the liver must do its job well, and the toxins accumulated over a lifetime,” she said. “Overweight and obesity worsen the prognosis; many toxins are stored in fatty deposits. Every time that person loses a little weight they actually feel worse as they must process the toxins released from fatty tissue. That journey becomes seemingly insurmountable for many people.” 

Finally, the most important lifestyle related issue, according to Vitse, is the accumulation of chronic modern day stressors and how patients are coping and or responding to them.

Traditional Approaches 

Many of Dr. Lucille’s patients come to her already diagnosed with “perimenopause” or “menopause,” and given a medication such as a synthetic hormone or an anti-depressant, which are situations with which she takes issue. “First, those two things are not diagnoses at all. They are simply normal life stages and shouldn’t be so symptomatic,” she said. “These ‘solutions’ have fallen out of favor because they don’t work. They fall terribly short at understanding the mechanism behind these issues and the complex nature of the endocrine system.” 

Hormone balancing therapies include both drug-based and nutrient-based options. Among the drug-based options are hormone replacement therapy (HRT), which imitates hormones synthetically; and bioidentical hormone replacement therapy (BHRT), which replicates human hormones in structure and function. But according to Bradley Bush, ND, director of clinician affairs for Wisconsin-based NeuroScience, Inc., a company offering health care providers a personalized approach to medi Cine through a model it calls “Assess and Address,” both leave much to be desired in terms of safety.

“More than a decade ago, the Women’s Health Initiative (WHI) released a study on HRT that pointed to increased risks of cancer, blood clots and heart attacks or strokes.This led many to switch to BHRT,” said Dr. Bush. “While BHRT often helps alleviate symptoms, there have been no long-term studies of its safety. People also question whether it’s wise for a body in middle age to ingest the level of hormones designed for someone much younger. The concern is that people are pumping up their hormone levels, but not necessarily balancing them.” 

Levothyroxine, for instance, is a synthetic form of the hormone thyroxine most commonly recommended for correcting SCH, even though thyroxine level in this condition remains normal. “However, utilization of levothyroxine is recommended only when TSH level exceeds 10 mIU/L.When TSH is still elevated but remains between 5 and 10 mIU/L, levothyroxine is not indicated,” said NOW Foods’ Dr. Ber. “In this case, most practitioners utilize nutritional, nonhormonal forms of intervention and continue monitoring TSH and T4 levels.” 

“The use of levothyroxine for treatment of hypothyroidism has fallen out in favor for the natural approach of using naturally desiccated thyroid (NDT), mainly due to NDT containing not only the inactive T4 hormone, but the active T3 hormone,” added RLC’s Jinn. “The very factors that may cause hypothyroidism in the first place may also influence the conversion of the inactive T4 to active T3.Without the active T3 hormone, patients are not getting the relief from symptoms of hypothyroidism.” 

Natural Approaches 

At Harvest Park Naturopathic Medicine, the private practice of Jared K. Skowron, ND, people are often seeking help with cortisol imbalances due to stress, fatigue, fibromyalgia, a range of gynecological issues as well as slow thyroid conditions.

“Nutritional deficiencies are a huge cause of these conditions in addition to stress.We often test for iodine, magnesium and other nutritional levels, which are deficient in people who would seemingly have a normal diet,” he said. “Patients are looking for another option, instead of being on thyroid hormone for their entire life. Natural medicine has wonderful, successful and side effect free treatments to help all of these patients.” 

Dr. Skowron noted that lately he has been asking his patients to look at the salt in their kitchen. “So many patients are aware of ‘sea salt’ and its many benefits, however most of these do not contain iodine, and patients are becoming overweight and tired from mild hypothyroidism,” he explained. “The lab work from their PCP shows that their TSH is normal, and they go on for years with these symptoms.Patients should make sure any salt they have contains iodine, or that they eat food with iodine, such as kelp or seaweed, which is such a rarity in our diet.” 

A holistic natural approach that involves detoxifying the body, cleaning up the diet and changing the body composition for the better offers a total revamp of lifestyle that will have a positive effect on every person that can carry over into other areas of their health, like cardiovascular and blood sugar, according to Vitse.

“Even if a patient decides to or is required to use a synthetic HRT, they will benefit so much more from the hormone therapy if they also alter lifestyle and use nutrition therapy,” she said, adding that practitioners can help patients collaborate with their traditional therapy using the natural complementary therapies to clean them up and support their organs.

Just as it is common practice to test a diabetic’s blood sugar before administering insulin, Dr. Bush noted that it is useful to test neurotransmitters and hormones as an objective means for assessing nervous system function and its attendant symptoms relating to hormonal imbalance. “Assessing neurotransmitter levels identifies an individual’s specific imbalances, guides therapeutic decisions, objectively establishes the need for nutritional supplementation and monitors the effectiveness of interventions.” 

NeuroScience, Inc.’s “Assess and Address” program allows practitioners to individually address their patients’ biochemical imbalances by dealing with the root of symptoms and achieve better outcomes more rapidly. Today, the company utilizes data from more than 600,000 collected test panels to help practitioners interpret individual test results and develop patient care plans that take the whole person into account.

“Neurotransmitter and hormone function can best be supported with nutrientbased programs. This means choosing lean proteins, minimally processed carbohydrates, and fats from polyunsaturated sources like fish and monounsaturated sources, such as avocado, nuts, seeds and olive oil,” said Dr. Bush. “Performing laboratory tests, followed by correction of dietary constituents through improved nutrition and supplementation, can naturally and safely balance neurotransmitter levels and hormones and provide symptom relief.” 

Supplements 

Although Dr. Lucille treats individually, she generally strives to replete any nutrient deficiencies detected with a multivitamin/mineral.“I tend to recommend adaptogens as many people benefit from them and tolerate them very well,” she said, adding that she will use endocrine glandulars, hepatoprotective and detoxification nutrients such as calcium deglucarate and DIM.

Vitse uses detoxifying and inflammationreducing medical foods when necessary as an augmentation to proper diet. “Gut healers and symptom reducers set the stage for repopulating the gut with good floral balance,” she continued.“Most adults have a difficult time re-establishing healthy colonies, and prebiotics are very useful in this area. Some people need a regular supplement to assist in hormone processing and there are a few good companies out there for this. I arm clients with an education on how to keep themselves detoxified and use their diet medicinally.” 

NeuroScience offers more than two dozen products designed to target imbalances that control the release of hormones in the body.Some of the most popular are in its new Adrenal Health Solutions line. Recently, the company introduced Calm-CP, which targets elevated cortisol levels; AdreCor with SAMe, Which provides strong methylation support to enhance the production of epinephrine; and AdreCor with Licorice Root, which offers strong and immediate support for cortisol in a less-stimulating formulation than original AdreCor. Additionally, NeuroScience updated its formulation of AdreCor, which addresses depletions in adrenal biochemistry.

“Recent studies conducted by NeuroScience, Inc. assessed the effects of AdreCor with Licorice Root and Calm-CP on cortisol levels in healthy participants,” said Dr. Bush. “Subjects took either product twice daily for four days. The results of the study showed that AdreCor with Licorice Root consistently increases salivary cortisol levels over time, while Calm-CP consistently decreases them.” 

The main natural approach to treatment for hypothyroidism should be the use of NDT, according to RLC Labs’ Jinn. Two of the company’s staple products, Nature- Throid and Westhroid, are Prescription Versions of NDT, which currently falls under the federal monograph of Thyroid USP (under the specification of United States Pharmacopeia). “Under Thyroid USP, the desiccated thyroid gland is derived from pigs and the specific levels of T3 and T4 are very carefully monitored and tested to ensure consistency and reliability from batch to batch (the exact same consideration as the prescription synthetic thyroid medications),” Jinn said.

RLC Labs also offers two dietary supplements, a-Drenal and i-Throid, which were designed to offer complementary support to the company’s principal hypothyroid drug. The main ingredient in a-Drenal is the desiccated adrenal gland, and various adaptogenic herbs, like cordyceps, ginseng and rhodiola, along with pantothenic acid (B5) to aid in combating adrenal fatigue. Meanwhile, the function of i-Throid is to offer main ingredients (iodine) in a solid dosage from the traditional Lugol’s solution therapy.

In spring 2013, RLC will also be introducing Westhroid-P, which will incorporate the same Thyroid USP with only two inactive ingredients, inulin and MCT (medium chain triglycerides), for the ultra-sensitive patients.

Once the diagnosis of SCH is established, NOW Foods recommends adherence to the current guidelines which suggest levothyroxine intervention once TSH level exceeds 10 mIU/L. The company’s Protocol For Life Balance Ortho Thyroid product offers additional nutritional support that can be combined with levothyroxine. “If TSH is elevated but does not exceed 10 mIU/L, Ortho Thyroid supplementation can be utilized and TSH level monitored, but levothyroxine is not prescribed at these levels,” said Dr. Ber.

A key ingredient of Ortho Thyroid is an amino acid L-tyrosine (1 g per serving), which serves as a precursor for catecholamines (DOPA, dopamine, norepinephrine and epinephrine), melanin and thyroid hormone, Dr. Ber explained.
“Intake of tyrosine from a typical diet is about 18 percent lower than that for phenylalanine, so if the conversion from phenylalanine to tyrosine is inadequate, it is important to provide supplemental tyrosine to assure optimal thyroxin, as well as catecholamine synthesis.”3 

Another noteworthy ingredient is standardized guggul extract, which has been shown to support thyroxin production. Dr. Ber noted it is important since the mechanism by which guggul affects thyroid function is different from that of TSH because the latter is already elevated in individuals with subclinical hypothyroidism.4 

Practitioners’ Advice 

Dr. Lucille suggested that integrative practitioners continue to look at things more comprehensively and “understand that hormonal imbalances are ‘multifactorial’ in nature, having many influencing factors, and the treatment approach must match that pattern.” 

And this treatment approach, according to Dr. Skowron, means working with other practitioners to find the best solution for each patient. “Every practitioner in an integrative world needs to respect another’s value. This door swings both ways; if a conventional physician does not believe in natural treatments, they won’t recommend them to their patients, and if a natural practitioner does not like the idea of pharmaceuticals, they may avoid a necessary treatment to keep a patient alive in a severe case. The only solution is exposure and open-mindedness.”

References: 

1 Tseng FY, Lin WY, Lin CC, et al. Subclinical hypothyroidism is associated with increased risk for all-cause and cardiovascular mortality in adults. J Am Coll Cardiol. Aug 21 2012; 60(8):730-37.

2 Fatourechi V. Subclinical Hypothyroidism: And Update for Primary Care Physicians. Mayo Clinic Proceedings. 2009;847(1):65-71.

3 Banderet LE, Lieberman HR. Treatment with tyrosine, a neurotransmitter precursor, reduces environmental stress in humans. Brain research bulletin. Apr 1989;22(4):759-762.

4 Tripathi Y, Tripathi P, Malhotra O, Tripathi S. Thyroid stimulatory action of (Z)-guggulsterone: mechanism of action. Planta medica.2007;54(04):271-77.

Healthy Take Aways

 Sustained hormonal imbalance can have severe and potentially fatal complications, so diagnosis and treatment is critical for general health and well-being.

 Hormone imbalances affect both men and women, in a widening range of ages.

 While there are genetic predispositions to disease manifestation, environmental factors, lifestyle and one’s reaction to stress are leading to increased cases.

 While BHRT often helps alleviate symptoms, there have been no longterm studies of its safety.

 Detoxifying the body, cleaning up the diet and changing the body composition for the better offers a holistic natural approach that will have a positive effect for hormone balance that can carry over into other areas of a patient’s health.

FOR MORE INFORMATION:

 www.amberlynnvitale.com 

 Harvest Park Naturopathic Medicine, www.naturopathicanswer.com 

 Healing From Within Healthcare, www.drhollylucille.com 

 NeuroScience, Inc, (888) 342-7272, www.neuroscienceinc.com 

 NOW Foods, (888) 669-3663, www.nowfoods.com 

 RLC Labs, Inc., (877) 797-7997, www.rlclabs.com