TELEMEDICINE Thyroid Health Practice with a Functional Medicine Approach

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All Posts in Category: Testing

Inuvi Diagnostics / PURA

We no longer accept results from Inuvi Diagnostics / PURA for the preparation of our thyroid reports.  We made a similar decision regarding Genova Diagnostics results a few years ago.

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Vitamin B-12

Vitamin B12 plays an important role in the body and if you are feeling tired or weak it could be a sign you are deficient.

There are two types of vitamin B12 in the body, these are active B12 and inactive B12, both make up Total B12. The simple difference between the two forms is that active B12 is the form used by the body.

WHAT IS ACTIVE B12?

Active B12 is when B12 binds to transcobalamin protein (known as Holotranscobalamin or HoloCT) and is made available to cells for use in the body, hence being called active B12. 

The most widely used B12 test on the NHS checks total levels of B12. Active B12 typically makes up 10% - 30% of the total B12 in the body, so being in the “normal,” range of the total B12 might hide a B12 deficiency. It’s the levels of active B12 you really need to be concerned with if you are worried about thyroid issues, fatigue or any other symptoms associated with a vitamin B12 deficiency.

WHY TEST YOUR B12 LEVELS?

The two main reasons to check your Vitamin B12 levels are:

  • You’re concerned about a thyroid disorder
  • You are experiencing unexplained fatigue

WHAT ARE THE SYMPTOMS OF VITAMIN B12 DEFICIENCY?

Some of the symptoms of vitamin B12 deficiency include:

  • Fatigue
  • Anaemia
  • Neurological features
  • Sore tongue
  • Bone marrow suppression
  • Cardiomyopathy

Low vitamin B12 levels

B12 as a key co-factor in metabolic methylation is involved in several vital biological processes. Therefore, the increase of food sources high in vitamin B12 (see picture) and supplementation - ideally with a methylated form of B12 - are important for rapid restoration of the B12 status, which is indicated by low serum levels.

High vitamin B12 serum concentrations without supplementation: the pitfalls of interpretation

High active B12 concentrations may be due to excessive levels of the vitamin, increased levels of its transport proteins [1] or related to autoimmune or haematological disorders [2].

High or supraphysiological serum B12 levels without supplementation have been associated with many health problems kidney failure, blood disorders, cancer, and liver or autoimmune diseases. [2,3]  All conditions may show elevated concentrations of B12 transport proteins.

Elevated serum B12 levels may also be associated with a functional deficiency of the vitamin. Functional deficiency is caused by a failure of uptake into processing within the cells, Uptake can be reduced due to abnormal increases of B12-binding proteins or the formation of immunoglobulin-B12-complexes.It is unknown, whether B12 should be supplemented in these conditions.

Recent findings in diseases associated with oxidative stress have revealed that intracellular oxidative stress results in local functional B12 deficiency [4]. Treatment with glutathione and/or vitamin C, a key  regenerator of intracellular glutathione, may provide therapeutic benefit.

As supraphysiological levels may serve as a new important diagnostic marker in serious conditions unrelated to the individual patient’s B12 status, further investigations to rule out an underlying health condition need to be initiated, if supplementing with glutathione and vitamin C fails to improve levels.

References:

[1] Jeffery J, Millar H, Mackenzie P, Fahie-Wilson M, Hamilton M, Ayling RM. An IgG complexed form of vitamin B12 is a common cause of elevated serum concentrations. Clin Biochem 2010; 43:82–8.

[2] Remacha AF, Zapico E, Sarda MP, Rojas E, Simo M, Remacha J, et al. Immune complexes and persistent high levels of serum vitamin B12. Int J Lab Hematol 2014; 36:92–7.

[3] Andres E, Serraj K, Zhu J, Vermorken AJ. The pathophysiology of elevated vitamin B12 in clinical practice. QJM 2013; 106:505–15.

[4] Solomon LR. Functional cobalamin (vitamin B12) deficiency: role of advanced age and disorders associated with increased oxidative stress. Eur J Clin Nutr 2015; 69:687–92..

Picture source

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Leptin and Leptin Resistance: Everything You Need to Know

Obesity is usually not caused by greed, laziness or a lack of willpower.

Leptin resistance may be one of the main reasons people gain weight and have such a hard time losing it.

If you’re concerned you may be resistant to leptin, there are several steps you can take to live a healthier lifestyle — and possibly improve or reverse your resistance.

Many people are told that "eat less - exercise more" is the answer to losing weight. 

Scientists discovered already over 25 years ago that a hormone called leptin is involved in obesity - and even breast cancer.  

When our body does not respond to Leptin - called leptin resistance - we have a leading driver of fat gain in humans

What is Leptin?

Leptin is a hormone that is produced by your body's fat cells. It is often referred to as the "satiety hormone" or the "starvation hormone." It works directly on the brain — particularly an area called the hypothalamus. The more body fat we carry, the more leptin we produce

Its main role is regulation of energy, like the number of calories we eat and expend, as well as how much fat we store in your body. Leptins job is to tell your brain that — when you have enough fat stored — we don't need to eat and can burn calories at a normal rate when our fat storage is full.

Apart from this Leptin also has many other functions related to fertility, immunity and brain function.

Leptin is a hormone produced by the fat cells in our body. Its main role is to regulate fat storage and how many calories we eat and burn.

Impact on Our Brain

High levels of leptin tell our brain that we have plenty of fat stored, while low levels tell our brain that fat stores are low and that we need to eat  When we eat, our body fat goes up and leptin levels go up, so we eat less and burn more.

Conversely, when we don’t eat, our body fat goes down, our leptin levels drop, telling us toeat more and burn less.

What Is Leptin Resistance?

People who are obese have a lot of body fat in their fat cells - and very high levels of leptin. Logically, obese people should now naturally limit their food intake as leptin tells them via their brain to do so. 

However, their leptin signaling may not work - the brain doesn't seem to see it and erroneously thinks that our body is starving — even though it has more than enough energy stored. This is known as leptin resistance and now believed to be one of the main biological contributors to obesity. 

If you have leptin resistance your Resting Metabolic Rate [RMR] is likely to be below normal, making you burn 500 to 600 calories less each day than someone of equal body mass.

Our brain then encourages us to:

  • Eating more: We must eat in order to prevent starvation.
  • Reduced energy expenditure: In an effort to conserve energy, our brain decreases our energy levels and makes us burn fewer calories at rest.
Thus, eating more and exercising less is not the underlying cause of weight gain but rather a possible consequence of leptin resistance, a hormonal defect. Willing ourselves to overcome the leptin-driven starvation signal is next to impossible. 

Impact on Dieting

Leptin resistance may be one reason that many diets fail to promote long-term weight loss. 

If you’re leptin-resistant, losing weight still reduces fat mass, which leads to a significant reduction in leptin levels — but your brain doesn't necessarily reverse its leptin resistance.

When leptin goes down, this leads to hunger, increased appetite, reduced motivation to exercise and a decreased number of calories burned at rest Our brain then thinks that we are starving and initiates various powerful mechanisms to regain that lost body fat.

This could be a main reason why so many people yo-yo diet — losing a significant amount of weight only to gain it back shortly thereafter.

What Causes Leptin Resistance?

Several potential mechanisms behind leptin resistance have been identified. These include 

  • Inflammation: Inflammatory signaling in our hypothalamus 
  • Free fatty acids: Having elevated free fatty acids in our bloodstream 
  • Having high leptin: Having elevated levels of leptin in the first place seems to cause leptin resistance.

Most of these factors are amplified by obesity, meaning that we might be "trapped" in a vicious cycle of gaining weight and becoming increasingly leptin resistant over time.

Can Leptin Resistance Be Reversed?

The best way to know if you are leptin resistant is to look in the mirror.

If you have a lot of body fat, especially in the belly area, then you are almost certainly leptin resistant.

There are several things you can do:

  • Avoid processed food: Highly processed foods may compromise the integrity of your gut and drive inflammation
  • Eat soluble fiber: They can help improve your gut health as food for the microbiome. 
  • Exercise: Physical activity may help reverse leptin resistance
  • Sleep: Poor sleep is implicated in problems with leptin 
  • Lower your triglycerides: The best way to lower triglycerides is to reduce your carb intake 
  • Eat protein: Eating plenty of protein can cause automatic weight loss, which may result from an improvement in leptin sensitivity

Though there is no simple way to eliminate leptin resistance, you can make long-term lifestyle changes that may improve your quality of life.

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PLAC Test – a clever way to check your cardiovascular risk

Cholesterol testing alone is not enough - 50% of heart attacks occur in patients with normal cholesterol.

Arteries are blood vessels that supply oxygen-rich blood to your heart and other parts of your body. Atherosclerosis is a disease in the arteries in which the build-up of plaque can decrease blood flow to the heart or brain.Plaque is made up of fat, cholesterol and other substances found in the blood. Over time, the amount of plaque can increase, causing narrowing of the arteries. When this happens, it is more difficult for the blood to flow.

The majority of heart attacks and ischaemic strokes are caused by ruptured plaques.

When the plaque ruptures, the flow of blood to the heart or brain can become blocked, which results in a heart attack or stroke. 

The PLAC Test goes beyond what routine cholesterol testing can do by identifying active cardiovascular inflammatory disease. The PLAC Test measures an enzyme that, when elevated, indicates arterial inflammation, making heart attack or stroke more likely.The PLAC Test provides additional information that, when combined with standard cholesterol tests and an exam, can help determine whether or not you are at an increased risk for a heart attack or stroke.

A PLAC test can be useful if you have two or more of the following risk factors:

  • Male 45 years or older or female 55 years or older
  • Family history of early heart disease or stroke
  • Diabetes
  • Obesity
  • Smoker
  • Borderline high or elevated cholesterol levels

Are You at risk of a heart attack or stroke?

The PLAC test is part of our Comprehensive Heart Risk Assessment.

Source: http://placelisa.com/

Cholesterol testing alone is not enough.
50% of heart attacks occur in patients with normal cholesterol.
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Bedwetting

Babies need to be in nappies as they cannot control their bladder. As they get older and turn into little people their nervous system is moving along nicely and the frequency of bedwetting goes down and eventually stops. 

Bedwetting is one of the most common disorders among children. It occurs in up to 20% of 5 year olds and 10% of 10 year olds, with a spontaneous remission rate of 14% per year. Weekly daytime wetting occurs in 5% of children, most of whom (80%) also wet the bed. Approximately 5% to 10% of all seven-year-olds have enuresis.

The reasons for bedwetting involve the inability to awaken from sleep in response to a full bladder, coupled with excessive nighttime urine production or a decreased functional capacity of the bladder.​

​Children who wet the bed may do so for emotional reasons. They may feel insecure due to the arrival of a new baby, a change of school or because of the parents' marital problems. In these cases, the child needs love and reassurance.

Why do some children have a problem?

There are numerous possible reasons why children - and their families - suffer from bedwetting: 

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  • Slower central nervous system development
  • Food allergies or intolerances
  • Infections (kidney or bladder)
  • Diabetes
  • Excess water consumption prior to bed
  • Being scared of the dark
  • Laziness
  • Side effects of medication
  • Caffeine (some give this to their kids – and I highly suggest not doing it), e.g in tea, coffee and many fizzy drinks

Vitamin B12, folate and iron levels 

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Pak J Med Sci. 2015 Jan-Feb; 31(1): 87–90.Pak J Med Sci. 2015 Jan-Feb; 31(1): 87–90

A study from 2012 found significantly lower mean vitamin B(12) and folate levels in patients who suffered from bed wetting. These findings were confirmed in a study in 2015 which also identified that average blood iron was significantly higher. 

A February 2018 study in the Journal of Pediatric Urology may offer hope for those pursuing non-drug options. 

Based on these results, the authors concluded that supplementation with vitamin D and omega-3 fish oil could help prevent nighttime bedwetting episodes among children seven to 15 year of age:

  • Vitamin D – 1,000 IU minimum but children frequently take up to 2,000 IU daily under the guidance of their physician.
  • Omega 3 – 1,000 mg daily, can be taken as a capsule, gummy or liquid.


Traditional Approach

Parents and children are often given the following advice by doctors  to curb bedwetting:

Bed alarms – alarms have sensors that detect moisture, which wake the child up as they begin having an accident.

Education and reassurance – diet changes, avoidance of caffeinated drinks and also avoidance of fluid before going to bed.  Make sure the child urinates before going to sleep.

Positive reinforcement – encouraging the child after dry nights.

Medications Commonly used include:

Desmopressin – Taken at night with a small sip of water, this medication can be used for children age 6 or older.  Common reactions listed by Epocrates Drug Database include headaches, nausea, abdominal pain, high blood pressure and rarely seizures, respiratory arrest and anaphylactic allergic reactions.

Imipramine – This medication can also be used for those 6 or older.  Epocrates lists a “black box warning” for this medication, stating that it may increase suicide risk in children, adolescents, and young adults with major depression. Additional common reactions listed include drowsiness, dizziness, and blurred vision to name a few.

Due to the possible side effects of medications, more natural alternatives are desired as first line by most.

​Common strategies to help with bedwetting

  • Shift times for drinking. Increase fluid intake earlier in the day and reduce it later in the day.
  • Schedule bathroom breaks. Get your child on a regular urination schedule (every two to three hours) and right before bedtime.
  • Be encouraging. Make your child feel good about progress by consistently rewarding successes.
  • Eliminate bladder irritants. At night, start by eliminating caffeine (such as chocolate milk and cocoa) and if this doesn’t work, cut citrus juices, artificial flavorings, dyes (especially red) and sweeteners. Many parents don’t realize these can all irritate a child’s bladder.
  • Avoid thirst overload. If schools allow, give your child a water bottle so they can drink steadily all day. This avoids excessive thirst after school.
  • Consider if constipation is a factor. Because the rectum is right behind the bladder, difficulties with constipation can present themselves as a bladder problem, especially at night. This affects about one third of children who wet the bed, though children are unlikely to identify or share information about constipation.
  • Don’t wake children up to urinate. Randomly waking up a child at night and asking him or her to urinate on demand isn’t the answer, either – and will only lead to more sleeplessness and frustration.
  • Don’t resort to punishment. Getting angry at your child doesn’t help him learn. The process doesn’t need to involve conflict.

What can you do to identify the cause of bedwetting in your child?

  • Identify food allergies and remove (gluten and dairy are big)
  • Avoid caffeine and fizzy drinks
  • Limit intake of water and fluids prior to bed
  • Always have them go for a whee right before bed
  • Use a night light 
  • Star board (get a star for each night they don’t wet their bed and a prize at X stars)
  • Taking off their bedsheets self and taking them to the laundry
  • Supplement with Fish oil
  • Give a Multivitamin
  • Give a Probiotic
  • Give a methylated B-complex

A known cause of bedwetting is slower development of the central nervous system + low b12 and low folate contribute to a slowed central nervous system = increased susceptibility to nocturnal enuresis (ie. bedwetting).

If one has low folate and low B12, then their methylation system is going to be less functional.

As their methylation is not up to speed, then the development of the CNS is hindered.

As the CNS development is hindered, so is the nervous system of the bladder which leads to nocturnal enuresis.

Restoring nutrients for CNS development is critical to reducing bedwetting.

The younger the child, the more development they are experiencing. The more development they are experiencing, the more methylation they are utilizing. The more methylation they are utilizing, the more nutrients they require to support methylation.

If the child’s methylation is not supported with nutrients, then bedwetting may show up.

Before you start blindly supplementing your child we would highly recommend to arrange some of the following tests which are all available from CountryHealth:

Which Lab Tests can be useful?

References:

  1. Journal of  Pediatric Urology. 2018 Feb 5. pii: S1477-5131(18)30034-2. doi:10.1016/j.jpurol.2018.01.007. [Epub ahead of print]

Do you want your child to be tested?

We are keen to help you finding the root causes of bedwetting in your child

Why do some kids get dry and others struggle with bedwetting?

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