What’s up Doc?

It can feel a bit intimidating when you walk into a doctors office with an issue you want to raise, but you are unsure of how your physician will react.  I have personally experienced dismissal of symptoms or denial of requests for tests, and it can be difficult to stand up for yourself or others when a person who seemingly has authority shoots down your thoughts, feelings or requests.  I try and look at it from their perspective and your research into your symptoms may be more thorough and researched than what they have had the time, knowledge and training to do, and they know it.  You need to be your own advocate as you are the expert on you.  This does not mean you need to get adversarial with your doctor, but just be prepared to ask for what you think is necessary.  If they dismiss you out of hand, it is time to find a new doctor.

I want to reiterate that I am not a doctor and you should do your own research with your own trusted physician on any issues you have.  That being said, here are some things you consider discussing and tests you should bring up with your doctor to ensure you aren’t missing out on a fixable health issue.  Also, make sure that when you run blood tests that you reach out to your doctors office prior to your appointment and request a copy of your lab report.  You have a right to that information and if they resist giving you the report, I must reiterate that it is time to find a new doctor.  Much of the following information is not inclusive and is written in order to simplify often complex issues.  Also it would be really technical and boring, and you aren’t interested in this blog because you want to go to medical school…..unless you are.

Thyroid Tests

We discussed my thyroid issues (hypo) in a previous post but here is how you really determine whether or not you have a thyroid problem.  TSH stands for Thyroid Stimulating Hormone and is secreted by the pituitary gland. It is responsible for telling your body how much or how little thyroid hormone to make.  Higher amounts of TSH will often indicate that your body needs more thyroid hormone and lower amounts will indicate they need less.  The lab tests you should be requesting are

• TSH
• Free T3
• Free T4
• Thyroid Antibodies (Hashimoto’s)
• Reverse T3

While TSH tests are the standard way doctors determine whether or not you have a thyroid problem, TSH number doesn’t always ensure an accurate thyroid diagnosis.  The ranges doctors usually use for TSH are anything under 0.5 mIU/L and anything over 4.0 mIU/L to determine if you are hyper (too much) or hypo (too little).  Most holistic doctors say that their patients feel best anywhere between 1.0-2.0 mIU/L.  Patients, including myself sometimes have thyroid symptoms when TSH is higher than that.

The standard treatment protocol for doctors in cases of hypothyroidism is to prescribe a T4 only synthetic hormone like levothroid/levothyroxine etc.  However quite a few people including myself do not respond to T4 and this is a problem.  T4 is considered a less active form of the hormone and your body and organs are required to convert the T4 hormone to the active version T3.  For some reason some people, including myself, don’t convert the T4 into T3 efficiently which creates a major disconnect from how we feel vs. how your doctor thinks you should feel.  Since your T4 will be fine, your TSH will usually be fine, but you won’t actually be getting the active version of the hormone responsible for ensuring your metabolism is running at peak efficiency.  Confused yet? I am confused at how many terminator movies there are…5, 6?

Why do you need to make sure to have all the tests run above? Because your doctor can determine if the ratio between Free T3 and Free T4 is off which will then indicate, more than TSH levels, whether or not your body is running on all cylinders. If your ratio of those two hormones is less than 2 (FT3/FT4<2) it is an indication that your body is not making the active version of the hormone very well.  Now look what you made me do!  I hate math.  Another thing to consider is if you have high levels of estrogen and or testosterone those hormones can bind with your T’s and render them inactive. You will want to have more than just a thyroid panel when you see your physician but more on that later.

Cholesterol

We hear so much negativity about cholesterol and have for so many years most people aren’t aware how important cholesterol is to the functioning of our bodies.  Cholesterol is a precursor to 5 important hormones our body needs to survive including progestagens, glucocorticoids, mineralocorticoids, androgens, estrogens among other important hormones like vitamin D. Cholesterol is also a substance that is required in the creation of all cell membranes, is important to repair cell damage, and instrumental in the production of bile acids which aids digestion of fats and absorb nutrients.  Butter believe me that if you didn’t have cholesterol you would cease to function. Most people also think there are two types of Cholesterol called HDL and LDL and that one is good and one is evil.  I may not be the first one to tell you this but this is a gross misrepresentation of many incorrect assumptions/studies.

If you wonder why fat and cholesterol are considered evil, you can blame carnivorous bunnies.  Yup that’s right, scary carnivorous bunnies, just in time for Easter.  Back in the early 20th century, a Russian scientist named Ignatowski fed rabbits a diet of eggs, milk and meat and found that the diet caused damage in the poor creatures hearts.  I guess no one told the scientist that rabbits are biologically adapted to being vegan aka herbivores.  When you look up safe foods for bunnies to eat, nothing on the many lists I perused, including anything but grasses, veggies, herbs, and some fruits.  Another Russian scientist after him used a cholesterol rich diet diluted in vegetable oil to produce atherosclerosis in the hearts of more poor little bunnies.  Shocking that foods not meant for a species then fed to that species would cause health issues….said no one ever.  Also, why do Russians hate bunnies?

Then in 1955 a scientist named Ancel Keys furthered on the bunny research and postulated that fats, specifically saturated fats, raised levels of LDL (Low Dense Lipoprotein) which he claimed was “responsible” for the negative health outcomes in humans with elevated levels of this “bad” substance.  When Keys was looking through health data for his study, anything that didn’t fit this hypothesis was thrown out.  Keys picked 7 countries with data that supported this theory out of the 22 he had studied/access.  This means, if we do the math, 22-7=15 countries where the data indicated something other than his theory.  Let’s do more calculations together. Is 15 higher or lower than 7?  I’ll wait…….. If you did the calculation right, it means the study omitted twice as much data which showed something other than his fat/cholesterol theory.  And you wonder why I am such a skeptical person.  

So what is HDL (High Density Lipoprotein) and LDL (Low Density Lipoprotein) and why is one considered good and the other bad?  Your liver makes both HDL and LDL daily.  Your body makes about 80% of the cholesterol you need to survive which can vary depending on how much you get from your diet. The substances HDL and LDL are a combination of a fat and protein and act as carriers for fats, cholesterol and other substances your body needs to survive or repair itself.  HDL is the anti LDL so to speak as it goes in and cleans out the old LDL or any that has stuck to the wrong spot and recycles it in the liver.  So really HDL and LDL are like little cars driving around your body, providing whatever hormones, fats vitamins or other important building blocks your cells need to function properly.  LDL is like a Subaru Outback ferrying passengers to places they need to go, and HDL is like a tow truck removing old, broken down or illegally parked cars. Continuing with the car analogies, trying to lower LDL artificially is like driving with the parking break on, because you are limiting or slowing the ability of your body to function or repair itself.

Sometimes LDL particles go bad and they become damaged small dense LDL (SDLDL). How LDL goes bad and either is created as small and dense or gets damaged and becomes short and stupid is still being studied since this particle size discovery is relatively new, but more on that later. These smaller naughty cholesterol particles can very easily buildup, and are being theorized as the real cause of the atherosclerosis we see commonly in those with heart disease, heart attacks and other negative health issues.  There are varying sizes and buoyancy of LDL particles. Those that are light and fluffy, just like vegan bunnies, are technically the good kind of LDL (type a).  So let’s say you are running low on vitamin D or estrogen, what do you think your body will do to ramp up production of one of these necessary hormones?  Studies have shown that people with low levels of vitamin D on average had higher levels of LDL and lower levels of HDL.  Inversely those with higher vitamin D levels had high HDL and lower LDL.  Let’s try to sum up why this is important.  Your body needs the LDL to do the work when there is damage or a hormonal need, but when the work is done HDL production ramps up to clean up the excess LDL that is no longer needed.

So “high” LDL is a possible symptom of a hormone deficiency, inflammation or damage to cells, or an issue related to how much cleanup your HDL or liver is not doing.  How then do statin drugs, used to reduce cholesterol, work to distinguish the good and necessary LDL and target the small dense LDL?  The answer is they don’t. Statins can also come with some very dangerous possible side effects including nerve damage, diabetes and even cancer. Let’s Look at this another way, we have possibly confused the substance our body needs to function or heal itself with the actual cause of health issues.  This is the epitome of correlation does not equal causation.  When did you ever blame the band-aid for the cut to your finger?  “Reducing band-aids will lower the number of cuts” is a ridiculous idea, but not too far off with the prevailing cholesterol myth. How is treating a bodies reaction, but not the root cause of an issue going to solve anything?

So if high LDL is just a symptom not a cause of negative health issues, what is?  Scientists do believe one of the culprits is our old frenemy, sugar.  Triglycerides or the fat created by our sugar over-consumption is actually contributing to heart disease, inflammation, and diabetes.  While LDL carries fats, proteins and other substances, very low density lipoproteins (VLDL) mostly carry triglycerides and for some reason triglycerides make it more difficult for the HDL to recycle VLDL.  Taking a quote from the link above about triglycerides “hypertriglyceridemic states are associated with increased VLDL production and delayed VLDL clearance from circulation.” AHA! So triglycerides created from excess sugar consumption increase VLDL and make it difficult to remove which would in essence increase your reported levels of LDL.  Trigyceride heavy VLDL is also the precursor to SDLDL. Is some of this starting to make sense now? Sugar makes it difficult to remove the bad form of LDL which is the kind that easily gets stuck in arteries.

The next time you see your doctor make sure they order a full panel of cholesterol tests which should include;

• Triglycerides
• LDL-c
• HDL-c
• CRP
• Homocysteine
• Lipoprotein (A)
• Apolipoprotein B
• Vitamin D
• LDL Particle Number
• LDL Small
• LDL Medium
• HDL Large
• LDL Pattern
• LDL Peak Size

We have discussed correlation does not equal causation but sometimes we do have to take notice of a statistic. Were you aware that most heart attacks occur in men and women with “normal” levels of LDL cholesterol?  Would you be surprised that women over 65 with higher LDL and total cholesterol on average live longer than those that have “normal” levels.  And would it be shocking to any of you that for decades studies have shown that total cholesterol has little to do with cardiac risk at all?  I personally have known three people to have had heart attacks.  Two of them had low or normal levels of LDL along with total cholesterol,  and the other has Familial Hypercholesterolemia. FH is a genetic trait which involves an inability to recycle LDL in the liver due to impaired cholesterol receptors. In FH more LDL is circulating than can be removed and as we learned from before, if you cannot clear LDL or it takes longer to recycle it like with triglyceride heavy VLDL, it then becomes damaged SDLDL, which is the dangerous cholesterol vehicle.  Gosh this is complicated!  All I really know at the end of the day is that I have not contributed financially to a Nicholas Cage movie in many, many years and so therefore I am saving lives.

Vitamin D

Vitamin D is not really a vitamin at all but a hormone created in your skin from cholesterol and ultra violet light from the sun, specifically UVB.  We have discussed how important cholesterol is to vitamin D production, but why is vitamin D so important?  Vitamin D is another hormone that is pivotal to bone health as well as heart, kidney, lungs, muscles and brain, so basically it is important for everything.  Vitamin D is also important for weight maintenance as low levels affects your hormone leptin in a bad way.  Leptin is a hormone that tells you to stop eating when you are full.  Please don’t email me and say that your mother or spouse is named leptin as a joke…it isn’t funny.

So why are we so deficient in this all powerful sunshine hormone, even those who regularly sunbathe?  You can blame our obsession with cleanliness, sunscreen and windows as to why most are deficient in the all important hormone.  Your body uses cholesterol and other substances which reacts to UVB light to create vitamin D, but the catch is that it takes at least 48 hours to fully be absorbed in the body.  So that lovely soapy shower you took after your beach day is now killing you slowly….just kidding! What it is doing is reducing your vitamin D which can be absorbed and turned into calcitrol in the liver, which is its active form.  Sunscreen works to block UV rays and therefore less vitamin D can be created on the skins surface.  Most windows block UVB rays but do not block UVA light.  Why does that matter you say?  UVA light destroys vitamin D on the skin.  UVB makes it and UVA breaks it.

Most doctors will follow the party line and list that your vitamin D or 25-hydroxy should be 30 ng/ml for optimal health.  Other data shows that we should be getting around 50 ng/ml as that is what tribes that spend their days in the sun have on average.  Also, some doctors recommend even more than that to help prevent certain cancers.  No matter the levels that each recommend, the preferred method of getting your vitamin D is from the sun. Safe sun exposure can reduce the LDL naturally which could prevent levels being too high and prevent the creation of the SDLDL.  So go ahead and take your lunch outside or go for a walk, but please like I mentioned in my last post, I don’t want to know if you did or did not shower afterward.

Hormones

Hopefully you are all aware of the hormones testosterone, estrogen and progesterone, and if not, I don’t actually know you do I?  Both men and women have varying levels of all of these hormones and yes, that means men make estrogen and women make testosterone too.  Beta HCG is a hormone that can be found in pregnant women and it is this hormone that is detected with a home pregnancy test.  Some tumors including many testicular, and prostrate cancers secrete HCG.  So it may be possible to detect these cancers in men if they take a home pregnancy test.  In another blog post I will discuss why women are diagnosed more often with skin cancers while pregnant, and what it also has to do with pre-eclampsia, which I had as well.  Just repeat after me….everything is connected.  Some of the hormones you should be testing for are;

• Pregnenolone
• Progesterone
• Estrogen
• Testosterone
• FSH
• DHEA
• Cortisol

For men low levels of the hormone testosterone have been linked with high levels of triglycerides, type 2 diabetes and coronary artery disease.  We have already discussed why high triglycerides are a problem because they assist in the creation of the really bad version of cholesterol SDLDL.  High testosterone in men can cause infertility, high blood pressure and aggression so there really does need to be a balance of this hormone.  Low estrogen in women before menopause can cause those same sort of symptoms normally found in older women including but not limited to weight gain, osteoporosis and hot flashes.  High levels of estrogen can cause chronic fatigue, loss of muscle mass and hair loss.  Also, as a cosmic joke, high estrogen can also cause weight gain.  There are a lot of other symptoms that come high and low hormones in both men and women and it would definitely benefit you to ensure your levels are in the sweet spot for your age and gender.

Roman emperor Marcus Aurelius wrote “the object of life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane.”  If you feel you may have a health issue and your doctor is either dismissing you because your blood levels look “fine” or as an example they suggest you go on a statin as your cholesterol is getting “high”, please consider getting some of these other tests to make sure you aren’t missing something important.  Believe it or not, doctors don’t know everything, through no fault of their own, and research is constantly evolving.  What we know today will change tomorrow.  A famous non bunny torturing Russian, Leo Tolstoy said “wrong does not cease to be wrong because the majority share in it.” Galileo could have used Tolstoy at his trial for sure.  In our lifetime we were told to eat margarine instead of butter and only recently we found that trans fat in margarine is very bad for our health as one example of majority wrong.  There are always a few brave scientists and researchers that go against the “doctrine” of the day and we should be listening for that voice of reason amongst the rantings of the insane.