Saturday, February 6, 2010

Hypothyroidism and Depression

Here's a few questions/answers on hypothyroidism I just answered today.

1) How prevalent, if known, is depression as a secondary problem to hypothyroidism?

While listed in the textbooks as a common symptom of hypothyroidism, clinically, most depression I see is not associated with hypothyroidism.

When I see a patient with depression one of the first things I do is run routine lab tests. Part of these tests includes a check of thyroid function (TSH,T3,T4). The vast majority of the time the thyroid functions are normal.

Interestingly enough, most patients I diagnose with hypothyroidism do not have any symptoms of depression at all and if they do have symptoms it is usually fatigue.

2) Can hypothyroidism first begin progressing very gradually, and then suddenly escalate?

Yes, it can. We know this by watching the TSH (Thyroid Stimulating Hormone), a hormone secreted by the front portion of the pituitary. A high TSH indicates an under active thyroid gland (hypothyroidism); while a low TSH indicates over activity of the thyroid (hyperthyroidism).

This is counterintuitive to most people, as one would think the opposite to be true. I.e. Low TSH=Hypothroidism; High TSH=Hyperthyroidism.

This is the case as it is the pituitary that is secreting the TSH, not the thyroid. If the thyroid is not secreting its hormones (T4, T3) effectively, the pituitary will know (because it ill see less of those hormones) and will increase its secretion of TSH. If the thyroid is secreting too much T4, T3, this will tell the pituitary to secrete less TSH.

The escalation of hypothyroidism will be seen biochemically as an increase in the TSH. The physician will then increase the amount of thyroid hormone they are giving the patient. The escalation can also be seen clinically, usually as an increase in fatigue, prompting the astute clinician to check the TSH with subsequent manipulation of the thyroid med dose.

3) Must a person take thyroxine lifelong, or can this disorder spontaneously remit?

When dealing with true hypothyroidism spontaneous remission will not occur. I make this statement definitively as hypothyroidism is a result of the thyroid gland losing its ability to make the thyroid hormones T4 and T3. These hormones are made via the modification of a substance within the thyroid known as thyroglobulin.

In the most common type of hypothyroidism known as Hashimoto’s Thyroiditis, the body begins to think the thyroglobulin is a foreign invader and begins to attack it. This is an autoimmune phenomenon as antibodies are created that then destroy the thyroglobulin. If there is no thyroglobulin, the body has no way to make the thyroid hormones. Thus, the only way to get the hormones would be via medication i.e. Thyroxine.

The medication will have to be taken for the person’s entire life.

4) Is the depression from hypo any different from a clinical depression that just comes for no reason, or the type that is triggered by chronic stress?

Yes, it is. Clinically, patients present more with fatigue complaints than with true clinical depression. When a patient presents with classic clinical depression, they are rarely hypothyroid. Even if a patient does have depression with concomitant hypothyroidism, treatment of the hypothyroidism will generally not eradicate the depression. Even though we learn in medical school and residency that we should always think of hypothyroidism when we diagnose depression, it is rarely the case that it is found.

Hope these answers help!

dr jim

Me and Mr Bones, fighting the fight against the medical establisment's dietary ignorance and we will not stop until everyone knows the truth.

Look for me and Mr. Bones March 6th on TV 55 (7:30 am-8:00 am)!

Monday, February 1, 2010

Glyceroneogenesis and Weight Loss

Huh? Lol.

Here was my response to questions posed to me on my fan page in face book.

The Question;

Yesterday, JayCee mentionned something about a mechanism where your body can accumulate or at least not lose fat because of dietary protein intake. I've heard about diabetics having to restrict carbs and protein. If someone is experiencing a weight loss stall while keeping the carbs very low, they should eat less meat/protein, not less fat.

How many grams of protein do you think is too much?

Do you have to use a glucometer to know? Are milk proteins worse than other proteins?

I've heard cheese is insulinogenic. I don't really know what that means practically. Does it mean we should avoid cheese for weight loss purposes?

My response:

Alrighty, finally read through the link as posted by JayCee. Very interesting read. Now I must state at the outset I had never come across the term Glyceroneogenesis, so the article was helpful in defining that term.

Yes, glycerol is the backbone of the triglyceride molecule and once released from the 3, what are referred to as acyl groups (an acyl group is simply one of the fatty acid chains that was attached to glycerol) it (the glycerol molecule) can now be used to make glucose. I knew that glycerol was not created from glucose, but yes, other biomolecules such as amino acids can produce glycerol.

Now let me get to some very insightful questions. Let me just also add that I am absolutely astounded at the depth of biochemical questions coming from non medical people. WOW. I wish the doctors would start asking questions as thought provoking as these are.

Ok, with a weight loss stall one definitely has to lower protein intake. Proteins are made up of amino acids. Amino acids can be either glucogenic, that is, they can be used to make glucose; or ketogenic, and they can be used to make ketone bodies. When an amino acid is used to make a glucose molecule that process is referred to as gluconeogenesis. That was what I thought JayCee meant when I originally read the word glyceroneogenesis.

Now I knew all about glycerol production and degradation, I just never knew they developed a term to define it. So just like gluconeogenesis literally translated means the production of new glucose; the term glyceroneogenesis would refer to the production of new glycerol molecules.

Ok, so back to protein. Yes, one can definitely over consume protein, allowing the glucogenic amino acids to be converted to glucose, this can cause a sugar rise, subsequent release of insulin and that is what is causing your weight loss stall or possibly weight gain. Yes, you can use a glucometer to see if you are consuming too much protein, good call. I’ll often tell my diabetic patients, or my patients trying to loose weight, that if they are consuming low carbs and their sugars are still elevated, or if they cannot loose weight, to back off of their protein intake.

Click on the link to see the glucogenic (and ketogenic) amino acids;

Now, here’s where we have to be careful. Let us not forget about that glycerol molecule which formed the backbone of triglycerides. Glycerol can also be converted to glucose, so theoretically on could eat too much fat, create too much sugar, and now your problems start all over again. JayCee’s link was correct in stating that protein consumption, like carbohydrates, can cause a release of insulin at the level of the pancreas. Fat does not tend to do this.

Your next question asked was/is milk protein worse than other proteins. About 80% of the protein found in milk is casein. Now milk is an interesting topic because we humans are the only species that consume milk beyond our infancy; and also the only species that consumes other species milk. In nature, you do not see a calf suckling on a deer teat, or a pig suckling on a cow teat, well, you get my point I’m sure. I have a problem with milk in general because as an adult, we probably shouldn’t be consuming milk in the first place. Many people have milk allergies and this is due to the casein found in milk. Another problem is that some studies have suggested a link between milk proteins and autoimmune diseases, such as type 1 diabetes. I generally tell my patients to avoid milk.

Cheese being insulinogenic? Dunno. Of course we get cheese from milk, which is where the whey protein comes in, and whey is often touted as being a highly absorbed protein, but how would it be insulinogenic. Well, I know some cheeses do have some glucose, also it’s that whole glucogenic amino acid thing all over again; maybe that’s what’s happening. I’ll have to do a little more research on that one.

No, I generally don’t tell my patients to avoid cheese.

Hope that helps and thanks for the great questions!

dr jim

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