Thyroid Blood Tests Unreliable?

I reproduce one of Dr John Briffa’s blogs for you here as it is a great, if slightly technical so bear with it, explanation of why many people present with the signs of underactive thyroid, but are not treated as blood tests come back ‘normal’. I see this all the time and, as you know, I prefer to measure it by basal temperature and sometimes with a much more comprehensive blood test that measures free levels of T3 and T4 as well as TSH and thyroid antibodies for immunity problems to do with the thyroid. Have a read:

“This morning, I saw this piece of news on the BBC website which reports on the accusation some doctors (endocrinologists) have leveled that some doctors are misdiagnosing and mistreating thyroid disease. The main gripe appears to be the fact that some doctors are willing to entertain the diagnosis of low thyroid function (hypothyroidism), even when blood tests are normal. Moreover, thyroid hormone can be initiated in these patients, which may be harmful.

Key to understanding why some doctors do not put their full and utter faith in conventional blood tests when assessing thyroid function is a knowledge of the normal physiology of the thyroid. The thyroid is responsible for producing thyroid hormones which stimulate the metabolism and facilitate energy production in the body’s cells. The two main thyroid hormones are T4 and T3. A lack of thyroid hormone can lead to symptoms such as fatigue and lethargy, mental fatigue, low mood and/or depression, weight gain, sensitivity to cold, cold extremities, hair thinning and loss of eyebrow hair in the outer margins.

In an effort to stop this happening, thyroid hormone levels are monitored in the brain. If the levels of these fall, the pituitary gland (at the base of the brain) is instructed to secrete a hormone known as thyroid stimulating hormone (TSH) which is designed to instruct the thyroid to produce more thyroid hormone. As thyroid hormone levels go up, this is sensed by the brain, which then reduces its production of TSH. This mechanism is believed to maintain adequate thyroid hormone levels in the majority of individuals.

However, if for whatever reason the thyroid fails to produce sufficient thyroid hormone levels, TSH levels may continue to rise, to the point that they become higher than normal. This finding, coupled usually with a low T4 level in the blood, is used generally used to diagnose low thyroid function (hypothyroidism). Sounds good so far, except that there are a number of reasons for why someone’s TSH level may not always be relied upon to give a definitive measure of someone’s true thyroid status.

One reason concerns the ‘normal’ ranges of hormones themselves. Some individuals believe that these are simply set too wide. What is regarded as ‘normal’ is essentially arbitrarily set. Many labs here in the UK set an upper limit of normal of TSH of 4.0 mU/L. However, other labs, I have noticed, set an upper limit of more than 5. Last week I saw a patient who came with a previous blood result from last year that stated an upper limit of 5.6. And now consider this: some years ago the American Association of Clinical Endocrinologists recommended that the upper limit of TSH be lowered from 5.0 to 3.04. Overnight, as a result of this change, the number of individuals who could be classified as hypothyroid on the basis of their TSH level more than quadrupled.

Now, if assessing thyroid status with TSH levels is such a precise art, how is it that upper limits of TSH vary so widely?

Another reason why TSH may not reflect true thyroid status relates to the fact that the brain and peripheral tissues (outside the brain) can sense thyroid hormone levels different. Imagine, for a moment, that the tissues in the periphery are somewhat resistant or ‘numb’ to the effects of thyroid hormones (in a way similar to the situation when tissues become resistant to insulin). But let’s imagine there is no such problem in the brain. Then what can happen is the brain thinks there’s enough thyroid hormone around, while the rest of the body is in fact deficient in thyroid hormone and therefore exhibiting the symptoms and signs of hypothyroidism.

Even if the brain correctly senses a deficiency of thyroid hormone, that does not mean the pituitary will automatically respond appropriately. It is recognized that thyroid failure can be secondary to failure of the pituitary gland to produce sufficient TSH. This condition, known as secondary hypothyroidism, is traditionally characterized by low levels of TSH. However, it is possible that less severe failure of the pituitary may lead to ‘normal’ levels of TSH in individuals who have a genuine problem with hypothyroidism.

To my knowledge, none of these mechanisms have been nailed down. However, all of them, to my mind anyway, represent plausible explanations for how someone with signs and symptoms suggesting hypothyroidism can end up with ‘normal’ thyroid hormone test results.

Further doubt about the validity regarding ‘normal’ TSH levels comes from research which has linked higher TSH levels (though still within the ‘normal’ range) with an increased risk of weight gain and cardiac-related death. See the previous blog posts here and here for more about this.

So, bearing this in mind, I don’t think it’s too unreasonable that some practitioners do not to put their full and utter faith in conventional thyroid blood tests and their traditional interpretation when assessing thyroid status. It seems that some practitioners seem to be aware of the limitations of the traditional approach, and may prefer to treat the patient rather than the test results. It is, I believe, possible for individuals to present what looks, on the face of it, to be a clear case of hypothyroidism but, at the same time, yield ‘normal’ thyroid function tests. It is also possible for these individuals to find their health transformed on the initiation of thyroid hormone therapy.

Of course, there is a risk to treating with thyroid hormone, and they most certainly should not be doled out like sweeties. There is some thought, for instance, that thyroid hormone therapy can increase the risk of osteoporosis. However, if treatment is really surplus to requirement, then side effects such as a rapid pulse, undue anxiety and sleeplessness usually give this away.

And while there are risks to treating, what I think is sometimes forgotten is that there are risks associated with NOT treating too. Because if someone has genuine hypothyroidism (even if blood tests are normal), then not treating can consign them to a life of fatigue, low mood, depression and weight gain about which they often can do very little. Make no bones about it: undiagnosed and untreated hypothyroidism can have a devastating effect on health and quality of life.

Worse still, individuals with a genuine problem can end up being persuaded that, in the light of normal test results, their issues are all in their mind or perhaps simply due to ‘depression’. The suggestion appears to be that the tests can’t be wrong and that the doctors who treat such individuals must be. Are we to believe that individuals whose symptoms strongly point to low thyroid function improve out of sight on thyroid hormone therapy can only be exhibiting some glorified placebo response? Or perhaps their recovery was just a figment of their imagination. Or their doctor’s. Silly people.” John Briffa blog, March 09.

Biocare – Repeat Prescription Service

For those of you who take Biocare products regularly, please note that they have a repeat order service whereby they will send you your regular items as often as you wish ie. once a month/2 months, 3 weeks or whatever you need. This would be useful for the loads of you taking bio-acidophilus, for example. No need to think and order – let them do it for you.

Green and Blacks’ Response to Dairy-Labelling on Our Chocs!

With thanks to those of you who have forwarded me your responses to letters you have written to G&B since they dared to add the words ‘milk powder’ onto our fave Maya Gold chocolate. Here is one (edited and highlighted) letter so the rest of you can see that it’s, well, as clear as mud…Basically, the bars are the same as they always were, don’t have milk powder in the ingredients despite them adding it to the label (!) but may contain traces of dairy from previous production of milk choc bars on the same factory line. Phew. Glad that’s clear then…at the end, I’ve recommended my choices for guaranteed dairy-free choc.

“Green & Blacks announced changes to the dairy allergy statements on the wrappers of our dark chocolate bars in May 2008. There has been no change to the recipe of these bars; the change is simply in the way in which the risks of dairy cross contamination are being communicated on bar wrappers. I will outline the background behind this decision below:

As you are aware, there are no milk ingredients in the recipe of our Dark chocolate bars and this continues to be the case. However, the bars are produced on the same production line as Milk chocolate bars within our range. The bars have previously, therefore, carried the following statement to reflect this: Manufactured in a factory that handles dairy ingredients.

A recent audit revealed that traces of milk residues can still be found on manufacturing equipment despite intensive cleaning. Therefore, in order to ensure that consumers are at minimum risk, our allergen statements will be changed and we will clearly state on pack that milk residues may be present in dark chocolate bars across the range. This will be indicated by the inclusion of Organic Whole Milk Powder within the ingredients list itself and a Contains Milk Ingredient statement on pack. The Vegan labelling was also consequently removed from pack. The new packaging has already been printed and is filtering through to supermarkets over the next few months, as you have noted already with some of our bars.

Therefore, there is actually no change to the risk to allergy-sufferers as the recipes and ingredients that go into the making of the bars have not changed. What we are now clearly stating on pack is that we cannot guarantee the absence of milk. It is almost certainly going to be present albeit at a low level. This packaging change ensures that consumers, especially milk allergy sufferers, are aware of the possibility and this represents a positive step in consumer communication (not! Ed).

Partially in response to customer feedback, we are currently considering the possible addition of a few explanatory lines on pack to further clarify the reasons for the addition of Organic Whole Milk Powder to the ingredients list. This would be a positive step in ensuring that consumers are not unnecessarily alarmed when spotting these changes on pack. (Surely they should just stick to the ‘may contain…’ line. Ed)

…we are planning to provide a dedicated production line by the end of 2009. Our hope is that we can make product available early in 2010. (Hoorah!)

My recommendations for guaranteed dairy-free are Kinnertons dark choc bar from Sainsbury’s and Celtic Dark Choc little bars from Holland & Barrett. Enjoy!

Memory Loss Tactics

Do you feel like your memory is getting worse? It happens to all of us as we age, but a growing body of medical evidence suggests that lifelong stimulation is the key to building and maintaining brain cells, staving off memory loss and maybe even preventing Alzheimer’s disease.

Research has found that doing interesting work (paid or volunteer), pursuing hobbies and engaging in an active social life can help. Take up playing an instrument or singing, language lessons, learning something new or simply do the daily crossword in the paper. And, try all of these with a smile – studies show that a positive emotional state is also good for your brain. Dr Weil E News Mar 09.

Daily mushroom intake cuts breast cancer risk by 60%

 

New research from China shows that eating a daily portion of fresh mushrooms could cut the risk of breast cancer by up to two thirds, reports the Daily Mail.

Scientists at the University of Western Australia in Perth carried out the study in a bid to build on earlier research showing that certain fungi have anti-tumour properties.

The team, led by Min Zhang, studied the diets of 2,018 women from the southeastern Chinese city of Hangzhou — half of whom had breast cancer —between July 2004 and September 2005. They found that women consuming a third of an ounce of fresh mushrooms every day were 64 per cent less likely to develop a tumour. Dried mushrooms had a slightly less protective effect, reducing the risk by around half.

The effectiveness of the mushroom boosted diet was enhanced further when it was combined with regular consumption of green tea. The risk among women in this group was reduced by almost 90 per cent. NPN Mar 09.

Spice for Period Pain

A recent study has found that a common culinary spice was just as effective as conventional pain killers for dysmenorrhoea.

 

In a double-blind comparative clinical trial 150 women (18 years old and over) with primary dysmenorrhoea (period pain) were divided into three groups receiving either 250 mg capsules of ginger (four times daily), 250 mg mefenamic acid or 400 mg ibuprofen capsules from the start of their period. The researchers found that all treatments were effective and that there were no significant differences between groups in severity of dysmenorrhoea, pain relief or satisfaction with the treatment. The study authors concluded that “ginger was as effective as mefenamic acid and ibuprofen in relieving pain in women with primary dysmenorrhoea.” Nutri News Mar 09

Household cleaners creating drug-resistant bacteria

 

Chemicals used in a whole range of household cleaning products are contributing to the growth of dangerous new antibiotic-resistant bacteria, reports The Observer. According to researchers from Warwick University the problem occurs when detergents, cleaners and disinfectants enter the sewerage system and then end up on farmland in sewage used as ‘soil treatment’. One of the researchers stated: “The inference is clear. We are producing sewage and river water that have more and more drug-resistant bacteria in them and that these are now poised to enter the food chain.” Natural Products News, March 09.

Bath & Shower Care

Just to let you know that Weleda has launched a new Lavender version of their Creamy Body washes. These are really good value and come in Sea buckthorn (very nourishing and orangey, Citrus (smells like gin and tonic to me!), Wild Rose and now Lavender. Also, to remind those of you in love with the heavenly Lavender Bath Milk, that it also comes in Chestnut (for relaxing muscles), Citrus (enlivening), Pine (invigorating) and Rosemary (warming). I have a few of the citrus, sea buckthorn and baby washes left in stock (20% off!) but otherwise click onto Nutricentre or Goodness from the website.

Recipe Book Launched!!!!

 

 

Instead of a recipe this month, how about a whole book full? At long last, I have finished my recipe book! And, though I say it myself, I think it’s rather good. Just click on the picture in the website to view a contents page and 10 free preview pages via Lulu self publishing website. If you like what you see, you can download all 87 pages for just £10. Not bad as it took me years to research and write! Called How To…Eat Well, it is full of all the advice I give to patients every day in-clinic and will save a shed-load of time and money for those of you who want this info to hand easily.

It is split into 16 chapters and 6 of those are full of easy-to-make mostly wheat and dairy free recipes for breakfasts, lunches, dinners, snacks, puddings and drinks. Other chapters include How to Boost Your Metabolism, Why You SHOULD Eat Between Meals and Tips, Tips and More Tips? You will be able to find out which fruit and veg are classed as the pesticide-ridden Dirty Dozen, get past the myths and discover exactly what is a healthy diet, which fish to choose sustainably and how to stock cupboards full of healthy, easy stuff you can always make great meals from even when you’ve ‘got nothing in’.

I have put the preview and link onto my website too, or simply ask me to send you a preview or to buy it with your normal order and I will send it to you direct rather than via Lulu.

Good Housekeeping Food Awards

Now I am doing a lot more feature writing, I have a great excuse for buying loads of magazines and books. I love them. Philip thinks I have invented this ‘need to write’ as a poorly-veiled excuse for magazine purchasing (and he’s probably right! Also, see the sale for more shelf space above – need I say more…?)

That said, I come across some great stuff. I saw in GH the other day a feature on the best food products and I agreed with most of them as they are already in my cupboard. I thought you might like to see the list, but for the full feature, buy GH or look on their website:

Best Time-Saving Ingredient: Dolmio Sauces, Lloyd Grossman Sauces

The Ingredient You Couldn’t Live Without: Filippo Berio Olive Oil, Marigold Bouillon Powder

Best Organic in a Supermarket: Yeo Valley Yogurt, Green & Blacks Chocolate (neither in my cupboard as they both contain dairy. I would choose Provamel Plain Soya Yogurt and Celtic Chocolate, which you can get from Holland & Barrett).

Fave Teatime Treat: Bonne Maman Conserve, Duchy Originals Shortbread (love the conserves but I prefer the BM Apricot and Cherry Compotes especially in yogurt, and Carol Vorderman’s Detox for Life recipe for non wheat shortbread)

GH Cookery Team Fave: Sacla Stir-through Sauces (these are great but often have wheat and dairy. I love their aubergine pesto particularly, though).

Best New Food Product: Riso Gallo 3 Grains, a mix of rice, spelt and barley grains  which you can use like rice or to make a risotto etc. No good for wheat or gluten avoiders, of course. Here, I would use brown basmati, quinoa and millet maybe.