TELEMEDICINE Thyroid Health Practice with a Functional Medicine Approach

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All Posts in Category: Health Basics

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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Your mouth and your thyroid

Optimise Thyroid function before Dental work!

 If a suspicion of thyroid disease arises for an undiagnosed patient, all elective dental treatment should be put on hold until a complete medical evaluation is performed.

Patients with history of thyroid diseases should be carefully evaluated to determine the level of medical management, and they should be treated in a way that limits stress and infection. 

Oral manifestations of hypothyroidism

The common oral findings in hypothyroidism include the characteristic enlarged tongue, distortion of the sense of taste, delayed eruption of teeth, poor periodontal health, altered tooth morphology and delayed wound healing.

Before treating a patient who has a history of thyroid disease, the dentist should obtain the correct diagnosis and etiology for the thyroid disorder, as well as past medical complications and medical therapy.

Dental Management of Hypothyroidism

Hemostasis - Patients with long standing hypothyroidism may have a decreased ability of small blood vessels to constrict when cut and may result in increased bleeding. Local pressure for an extended time will probably control the bleeding from the small vessels adequately.[10]

Susceptibility to infection - Patient with hypothyroidism may have delayed wound healing associated with an increased risk for infection because of the longer exposure of the unhealed tissue to pathogenic organisms. Hypothyroid patients are not considered to be immunocompromised.

Patients who have hypothyroidism are susceptible to cardiovascular disease from arteriosclerosis and elevated LDL.

Drug actions and interactions - Patients who have hypothyroidism are sensitive to central nervous system depressants and barbiturates, so these medications should be used sparingly.

It has been found that recent exposure to a surgical antiseptic that includes iodine (such as Povidone) can increase the risk of thyroiditis or hypothyroidism. Patients with underlying thyroid antibodies and a tendency toward autoimmunity appear to be at more risk.

Drug interactions of l-thyroxine include increased metabolism due to phenytoin, rifampicin and carbamazepine, as well as impaired absorption with iron sulfate, sucralfate and aluminum hydroxide. 

When l-thyroxine is used, it increases the effects of warfarin sodium and, because of its gluconeogenic effects; the use of oral hypoglycemic agents must be increased. Concomitant use of tricyclic antidepressants elevates l-thyroxine levels. Appropriate coagulation tests should be available when the patient is taking an oral anticoagulant and thyroid hormone replacement therapy.

Source

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What Are The Differences Between Functional Medicine And Conventional Medicine

A science-based, natural way to become healthy again

Functional Medicine is patient-centered medical healing at its best. Instead of looking at and treating health problems as isolated diseases, it treats individuals who may have bodily symptoms, imbalances and dysfunctions.

As the graphic of an iceberg shows, a named disease such as diabetes, cancer, or fibromyalgia might be visible above the surface, but according to Functional Medicine, the cause lies in the altered physiology below the surface. Almost always, the cause of the disease and its symptoms is an underlying dysfunction and/or an imbalance of bodily systems.

If health care treats just the tip of the iceberg, it rarely leads to long-term relief and vibrancy. Identifying and treating the underlying root cause or causes, as Functional Medicine does, has a much better chance to successfully resolve a patient's health challenge.

Using scientific principles, advanced diagnostic testing and treatments other than drugs or surgery, Functional Medicine restores balance in the body's primary physiological processes. The goal: the patient's lifelong optimal health.

How Functional Medicine Heals a Key Health Care Gap

Today's health care system is in trouble because it applies a medical management model that works well for acute health problems to chronic health problems, where it is much less successful.

If you have a heart attack, accident or sudden lung infection such as pneumonia, you certainly want a quick-thinking doctor to use all the quick-acting resources of modern medicine, such as life-saving technology, surgery and antibiotics. We are all grateful about such interventions.

However, jumping in with drugs, surgery and other acute care treatments too often does not succeed in helping those with chronic, debilitating ailments, such as diabetes, heart disease or arthritis. Another approach is needed.

The Two-Pronged Healing Approach of Functional Medicine

To battle chronic health conditions, Functional Medicine uses two scientifically grounded principles:

  • Add what's lacking in the body to nudge its physiology back to a state of optimal functioning.
  • Remove anything that impedes the body from moving toward this optimal state of physiology.

Plainly put, your body naturally wants to be healthy. But things needed by the body to function at its best might be missing, or something might be standing in the way of its best functioning. Functional Medicine first identifies the factors responsible for the malfunctioning. Then it deals with those factors in a way appropriate to the patient's particular situation.

Very often Functional Medicine practitioners use advanced laboratory testing to identify the root cause or causes of the patient's health problem. Old-fashioned medical diagnosis helps too, in the form of listening carefully to the patient's history of symptoms and asking questions about his or her activities and lifestyle.

For treatment, Functional Medicine practitioners use a combination of natural agents (supplements, herbs, nutraceuticals and homeopathics), nutritional and lifestyle changes, spiritual/emotional counseling, and pharmaceuticals, if necessary to prod a patient's physiology back to an optimal state. In addition, educating the patient about their condition empowers them to take charge of their own health, ultimately leading to greater success in treatment.

Treating Symptoms Versus Treating the Person

In the dominant health care model today, medication is used to get rid of people's symptoms. If the patient stops taking the medication, symptoms generally return.
Functional Medicine approaches health problems differently. Instead of masking the problem, it aims at restoring the body's natural functioning. Although Functional Medicine practitioners may prescribe pharmaceuticals, they are used to gently nudge the patient's physiology in a positive direction so the patient will no longer need them.

For example, conventional doctors would normally prescribe pharmaceuticals like Prilosec, Prevacid or Aciphex to treat acid reflux or heartburn. When the patient stops taking such drugs, the heartburn symptoms come back. In contrast, a Functional Medicine practitioner might find that a patient's acid reflux is caused by Helicobacter pylori bacteria. Eradicating the Helicobacter pylori might very well lead to the end of heartburn symptoms, permanently.

It's also important to note that in Functional Medicine, treatment for similar symptoms might vary tremendously for different patients, according to their medical history and results of laboratory tests. Factors that can come into play in producing the same symptoms include toxic chemicals, pathogenic bacteria, parasites, chronic viral pathogens, emotional poisons like anger, greed or envy, and structural factors such as tumors or cysts.

The Roots of Functional Medicine

Sir William Osler
You may be surprised to learn that Functional Medicine isn't new. It actually represents a return to the roots of modern scientific medicine, captured in this statement by Sir William Osler, one of the first professors at Johns Hopkins University School of Medicine and later its Physician-in-Chief: "The good physician treats the disease; the great physician treats the patient who has the disease."
Another important saying by Osler is "If you listen carefully to the patient, they will tell you the diagnosis." This encapsulates the importance placed in Functional Medicine on taking a thorough history from the patient.

Dr. Ron Grisanti of www.functionalmedicine.net

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Vitamin C

Vitamin C is an essential nutrient for humans. It is a cofactor in at least eight enzymatic reactions, including several collagen synthesis reactions that are important in wound-healing and in preventing bleeding from capillaries. Vitamin C also acts as an antioxidant against oxidative stress.

Unlike many other animals, humans are unable to make Vitamin C from glucose because of their lack of one vital enzyme. Thus, humans must ingest Vitamin C – this is why it is called essential.

Functions

Vitamin C is an important antioxidant, and of particular importance is its antioxidant function with lipids (fats). The LDL (or “bad”) cholesterol is protected from free radical damage by Vitamin C. It helps to form strong connective tissue, repair wounds, improve gum health, and reduce bruising.

Vitamin C is able to regenerate Vitamin E.

Sources

Good food sources for Vitamin C include Acerola cherries, Seabuckthorn, Rose hip, red chili peppers, green peppers, guavas, papaya, oranges, cantaloupe, kiwi fruit, broccoli, cauliflower, Brussels sprouts, grapefruit, and strawberries. Fresh foods eaten immediately after harvest are the richest sources as the content declines rapidcly in foods once they have been picked or sliced.

Therapeutic uses

Scruvy is a deficiency disease associated with lack of Vitamin C. Fatigue is one of the first deficiency signs of Vitamin C. Other signs include bleeding gums, haemorrhages under the tongue, impaired wound healing, joint pains, loose teeth, easy bruising, frequent infections, and cardiovascular disease.

Vitamin C can support the immune system by enhancing the activity of the white blood cells and production of immune-mediating chemicals. When the body is under a lot of stress, both emotional and physical, vitamin C may be excessively excreted (and found in urine samples) and greater intake may be necessary.

Because vitamin C can regenerate vitamin E, it is important to include it in any therapeutic antioxidant combination.

Many clinicians have seen benefits using doses from 1000 to 20,000 mg daily.

Safety and toxicity

Vitamin C is considered extremely safe. However individuals with glucose-6-phosphate dehydrogenase deficiency have been shown red blood cell destruction when large doses of Vitamin C were given intravenously.

Patients who are homozygous for haemochromatosis may experience increased iron uptake with vitamin C ingestion.

Several reviews raised no concerns that Vitamin C can cause kidney stones.

All excess vitamin C is disposed of through the urinary system.

Functional medicine considerations

Vitamin C insufficiency should be suspected when a patient is fatigued, especially if they show echymosis (bruises) or petechiae (caused by a minor bleed).

Source: Clinical Nutrition – A functional approach
Picture: http://www.ars.usda.gov/is/graphics/photos/k3644-12.html {{PD-USGov-USDA-ARS}}
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