I LOVE LUCY, BET YOUR SWEET BIPPY, AND THYROID HEALTH
Talk to mainstream doctors about thyroid health and you’d swear you’ve been transported back fifty or sixty years to the days of Lucy, Ethel, and Ernestine the telephone operator. Mainstream medical management of thyroid health is about as modern as being stunned by Elvis’s pelvic gyrations on The Ed Sullivan Show.
Testing for thyroid status by most doctors means a single value, a thyroid-stimulating hormone (TSH) level. More severe degrees of hypothyroidism—i.e., lower levels of thyroid hormones—are signaled by higher levels of TSH. In other words, someone with a TSH level of 8.0 mIU/mL has more severe hypothyroidism than someone with a TSH value of 3.0 mIU/mL. Doctors continue to advise people that TSH values of 4.5 or 5.5 mIU/L are normal, ignoring evidence revealing that ideal—not average, not acceptable—thyroid status is 0.2 to 2.0 mIU/mL.18 It is therefore a common situation for someone to have a TSH of 3.5 mIU/mL with symptoms of cold hands and feet, fatigue, and inability to lose weight, as well as high cholesterol, high blood pressure, thinning hair, and depression, but be advised by the doctor that everything is fine, and given prescriptions for statin drugs, blood pressure drugs, and antidepressants instead. The doctor’s failure to factor in the newest information, evidence that flies in the face of old practices, can be hazardous to your health.
A TSH value alone is inadequate. How about levels of free (i.e., unbound to proteins and inactive, only the free and active) T4 and free T3 levels? Those are important, too. How about antibodies that damage the thyroid such as thyroglobulin and thyroid peroxidase antibodies? These values tell us whether an autoimmune destructive process is at work and whether thyroid status should be expected to change over time and iodine avoided until antibody levels normalize. Antibody levels can be tracked to assess whether efforts such as wheat elimination and vitamin D allow antibody levels to drop as inflammation subsides.
There is also reverse T3, a T3 hormone lookalike (mirror image) that blocks the action of real T3 and can be responsible for symptoms of hypothyroidism even when all other values appear normal. It is not entirely clear why some people develop this situation, though it is more common in the presence of adrenal gland dysfunction and prolonged emotional or physical stress.
A full thyroid assessment therefore includes:
TSH—aiming for an ideal range of 0.2 to 2.0 mIU/mL
Free T3 and free T4—aiming for an ideal range in the upper half of the “reference range” provided by the lab. (Note that weight loss and acute illness can transiently drop T3 levels and do not require correction.)
Thyroid antibodies—with levels above the reference range suggesting increasing degrees of thyroid inflammation that damage the thyroid
Reverse T3—with levels at the high end or above the reference range suggesting increasing levels of blocked T3 status
To further complicate matters, we are also increasingly exposed to industrial chemicals such as bisphenol A (BPA), phthalates in shampoos and conditioners, vinyl chloride from plastics, pesticides, herbicides, polychlorinated biphenyls (PCBs), perfluorooctanoic acid from Teflon, and others that disrupt the endocrine system.19 These chemicals disrupt glandular function at the hypothalamus, pituitary gland, thyroid, and elsewhere. They also block conversion of inactive T4 thyroid hormone to active T3, meaning that the millions of people who take the T4 thyroid hormone alone—you know, the formerly patent-protected and more costly form, levothyroxine, vigorously marketed to doctors—suffer persistent symptoms of hypothyroidism because they cannot convert T4 to T3 and lament their cold hands and feet, fatigue, and inability to lose weight that most doctors dismiss as products of your imagination. This is why there is a booming movement away from levothyroxine and toward products that provide both T3 and T4, such as Nature-Throid and Armour Thyroid.
Bottom line: The simple rules your doctor follows to identify thyroid dysfunction no longer apply. Many doctors therefore fail to recognize thyroid problems even if they bit them.
The most common mistake is following the advice of a doctor who declares, “Your TSH of 3.8 mIU/mL is in the normal range. You’re fine.” You can now appreciate how inadequate that assessment can be. The solution is to find a healthcare practitioner who completely evaluates, then corrects, the increasingly common problem of thyroid dysfunction.
IS BRAIN STEW ON THE MENU?
Primitive people obviously did not obtain the two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), from fish oil capsules bought at a health food store. Nor did they come from plants, nuts, or seeds, as they contain no EPA and DHA. There are only two concentrated food sources of nutritionally essential EPA and DHA: seafood and brains of animals. After all, DHA, in particular, is the most plentiful fatty acid in brain tissue, ours as well as that of elk, gazelle, wild boar, and other creatures humans used to consume. Before modern tastes shifted and food became microwavable and cellophane-wrapped, we did not flinch at the thought of consuming liver or heart, and we certainly did not throw away the brain.
We modern folk are therefore left consuming fish rich in omega-3 fatty acids or taking fish oil supplements. Potential benefits come only from the EPA and DHA of fish oil, not the linolenic acid of meats and organs, flaxseed, chia seeds, walnuts, and other sources. While linolenic acid is an omega-3 fatty acid and provides health benefits of its own, it does not yield the same benefits as EPA and DHA—only EPA and DHA can do that, just as only vitamin C can correct vitamin C deficiency. (And ignore the silly marketing hype of krill oil that provides relatively minor quantities of EPA and DHA, although it is a source for the interesting carotenoid, astaxanthin.) Omega-3s are essential, not optional, fatty acids, with deficiency associated with impaired mental performance, stunted childhood development, depression, dry skin, dermatitis, and neuropathies, effects that don’t look good in your newest pair of Jimmy Choos.
But there’s a problem: Increased industrialization of the earth has contaminated fish with mercury and other contaminants, particularly carnivorous species that consume other fish and thereby concentrate toxins, a process called biomagnification. Consuming fish high on the ocean’s food chain (tilefish, king mackerel, shark, swordfish, ahi tuna) can thereby cause biomagnification of toxic compounds in creatures that consume them, such as us. Once again, it would be wonderful if we could mimic the behavior of a primitive human and just eat plenty of fish but, in today’s world, that virtually guarantees mercury toxicity.20 Our compromise is to eat fish no more than two or three times per week, preferably not those listed as the worst at biomagnification, while taking up the slack in omega-3 fatty intake with fish oil supplements, since the process of fish oil purification removes nearly all mercury and other contaminants.21 (Cod liver oil is the exception with unacceptable levels of mercury and other contaminants in some brands.)
You can observe the benefits of EPA and DHA, since they reduce triglyceride levels substantially, typically 30 percent. Clinical studies demonstrate that higher intakes of EPA and DHA yield reductions in sudden cardiac death, heart attack, heart rhythm disorders, autoimmune inflammatory conditions such as rheumatoid arthritis and lupus, reduce risk for a variety of cancers, and improve brain development in children. Some of the best evidence for preventing cognitive decline and Alzheimer’s dementia involves EPA and DHA from fish oil. EPA and DHA also reduce blood pressure modestly, reduce risk for stroke, and reduce the symptoms of ulcerative colitis and depression, just as you’d expect by providing something that is intrinsically necessary for human survival.22, 23, 24, 25, 26, 27, 28
The real power of EPA and DHA does not become fully evident until they are added to the other Wheat Belly strategies. Triglycerides, for example, starting at a high level of 500 mg/dl, can be reduced to around 300 mg/dl with 3,600 mg of EPA and DHA. When the other strategies discussed here are added, a final level of 45 mg/dl would be typical�
�complete reversal to ideal levels, reflecting the powerful synergies among these strategies. (Nobody needs prescription drugs in any form to reduce triglycerides, by the way.) Likewise, reduction in blood pressure with EPA and DHA alone is modest, typically no more than 5 mmHg in systolic or diastolic values, but the combined synergistic effect of the complete program can be profound, often sufficient to be able to stop several blood pressure drugs. Of course, this means following the Wheat Belly strategies in their entirety, not cherry-picking because of cost or convenience.
I advocate an EPA + DHA intake of 3,000 to 3,600 mg per day (the dose of omega-3 fatty acids within fish oil, not the quantity of fish oil itself), divided in two (e.g., before breakfast, before dinner), as this is the quantity that yields a level of omega-3 fatty acids in the bloodstream of 10 percent or more (i.e., 10 percent of all fatty acids in red blood cells are composed of EPA and DHA). At this level, health benefits are maximized, especially protection from cardiovascular disease, dementia, and inflammation.
Most fish oil in capsule form is the ethyl ester form, the form that results when the triglyceride form harvested from fish is treated with alcohol. You can also buy the triglyceride form, processed through additional steps to re-create the original structure, that is somewhat better absorbed, though more costly, and must be stored tightly sealed in the refrigerator. Quality fish oil in either form is non-fishy in odor and faint yellow in color (not brown, representing oxidation or rancidity). You can do fine with either liquids or capsules. Look for higher-potency products, as this makes obtaining our target level easier. For example, a fish oil capsule that contains 750 mg EPA and DHA means that four or five capsules per day achieve our goal, but 300 mg EPA and DHA per capsule means ten to twelve capsules per day will be needed. Most liquid fish oil contains 1,500 mg or more of EPA and DHA per teaspoon. That handily and easily supplements the cod or salmon you enjoy during the week. And never fall for the absurd marketing hype of much more costly prescription fish oil.
Fish oil—not krill oil, not flaxseed—is an irreplaceable component of your health effort.
MAGNESIUM: POSITIVELY NECESSARY
Remember those darned phytates in wheat and other grains, pest-resistant compounds enriched in content by agricultural scientists to fend off fungi and insects, that bind magnesium and other positively charged minerals in the human intestinal tract, preventing absorption and causing you to flush them down the toilet? It means that, for years, minerals provided by diet were wasted whenever any grains were on your plate. Modern advice to include grains in every meal and snack causes deficiencies of all positively charged minerals such as magnesium, calcium, iron, and zinc, even though farmers saved a few dollars on pesticide bills. While intakes of calcium, iron, and zinc typically normalize just by saying good-bye to wheat and grains, magnesium is the exception.
The odds are stacked against us in obtaining magnesium from food and water in the modern world. Magnesium deficiency is alarmingly common, given reliance on water filtration that removes all magnesium, reduced magnesium content of modern vegetables, and widespread drug prescriptions for acid reflux and ulcers that reduce magnesium absorption.29, 30 Phytates from a single bagel or sandwich block magnesium absorption—with intake at low levels to begin with—by 60 percent.31 The more grain is consumed, the more magnesium is blocked. Add it all up, and magnesium deficiency is the rule, rather than the exception, and a diet rich in “healthy whole grains” ensures deficiency.
The Recommended Dietary Allowance (RDA) for (“elemental”) magnesium is 320 mg per day for adult females, 420 mg per day for adult males. Most of us obtain about 245 mg per day—well below the RDA—while not even factoring in the impaired absorption caused by grains or drugs. And, if we recognize that the intake set by the RDA is just enough and not necessarily ideal, most of us have fallen far behind. Magnesium deficiency has real health implications. Because it provides structural integrity to bone tissue, lack of magnesium contributes to osteoporosis and fractures later in life. Earlier in life, magnesium deficiency is associated with hypertension, higher blood sugars, muscle cramps, low birth weight in infants, migraine headaches, and heart rhythm disorders such as premature atrial and ventricular contractions, atrial fibrillation, and sudden cardiac death.32, 33 (Anyone who has worked in a hospital cardiac unit has witnessed the power of intravenous magnesium replacement to miraculously subdue life-threatening heart rhythms.) Oddly, magnesium deficiency reveals itself to an exaggerated degree during withdrawal from grain-derived opiates, typically experienced as leg cramps and disruption of sleep during the first few days.
Magnesium repletion provides benefits by both meeting ongoing daily needs and replenishing depleted stores. Women supplementing magnesium demonstrated 1.8 percent increase in bone density over one year, compared to reduced bone density in women not taking magnesium.34 In a study of a combination of nutrients, 25 mg of elemental magnesium improved bone density 4 percent over one year, more than that achieved by the prescription drug alendronate (Fosamax).35 Magnesium reduces blood pressure: Supplementing with magnesium intake of 410 mg per day reduces systolic pressure by 3 to 4 mmHg, diastolic pressure by 2 to 3 mmHg.36
Beyond wheat and grain elimination, enthusiastic intake of nuts and seeds also contributes magnesium. Almonds contain 80 mg magnesium per ounce; peanuts contain 50 mg per dry roasted ounce or 2 tablespoons peanut butter; spinach, 156 mg per cooked cup. The real magnesium superstars are seeds: pumpkin seeds, 191 mg per ¼ cup; sesame seeds, 126 mg per ¼ cup; sunflower seeds, 114 mg per ¼ cup. Spinach and seeds are therefore the richest magnesium sources.
Unfortunately, most magnesium supplements are better laxatives than they are sources of absorbable magnesium. We therefore choose forms such as magnesium malate, magnesium glycinate, and magnesium chelate that are better absorbed with less potential for uncomfortable moments on the toilet. Examine the bottle for magnesium content (“elemental” magnesium content, not total weight) and aim for a daily intake of 400 to 500 mg per day in addition to inclusion of magnesium-rich foods. The best method, by a long stretch, is to make your own magnesium water, a source of the highly absorbable form, magnesium bicarbonate (see “Magnesium Water” box for recipe). If easier bowel movements are something you desire, then the preferred form is magnesium citrate (65 mg magnesium per 400 mg tablets) two or three times per day to start, as it provokes a modest osmotic effect (i.e., pulling water into the colon), building up to 130 mg (800 mg total weight) magnesium two or three times per day.
Replenishing magnesium is an experience that unfolds over long periods, as evidenced by blood levels (such as RBC levels, not the more common serum levels) that typically require one or two years to rise with supplementation. But this is how you turn the negative experience of wheat and grain consumption into a positive one.
MAGNESIUM WATER
Use Magnesium Water in place of magnesium supplements. This provides the most absorbable and inexpensive form of magnesium available.
A 4-ounce (½ cup) serving of Magnesium Water provides 90 mg elemental magnesium; 4 ounces twice per day adds 180 mg elemental magnesium. You can drink up to 24 ounces per day (8 ounces, or 1 cup, three times per day), which provides a total of 540 mg magnesium per day, especially useful during the first few weeks of your Wheat Belly experience to rapidly restore magnesium, especially if you have any condition that can be blamed on magnesium deficiency, such as migraine headaches, hypertension, or heart rhythm disorders. Most people tolerate the 4-ounce servings without loose stools; build up to higher doses, such as 8 ounces per serving, over time.
Milk of magnesia in the recipe must be unflavored, as flavorings block the reaction that creates the magnesium bicarbonate. Also avoid any brand that contains sodium hypochlorite (bleach). The seltzer should be unsweetened but natural flavorings are okay. Magnesium Water does not need to be refrigerated. Because the reaction involves carbonic acid (from carbonated seltzer) and magnesium hydroxide (milk of magn
esia), the end result is magnesium bicarbonate and water, with little to no carbonation remaining.
Add several drops of your choice of natural extract, such as orange, lemon, coconut, or berry, if desired. For sweetness, add a few drops of one of the flavored stevias available or your choice of sweetener, such as several drops of liquid stevia or monk fruit, to the mixture. I used twenty drops of berry-flavored SweetLeaf, which yields a light sweetness, and is very nice served over ice. Be sure to choose carbonated seltzer without sugar or high-fructose corn syrup. (This is why we avoid tonic water.)
MAKES: 2 LITERS
2-liter bottle of seltzer or other unsweetened carbonated water
3 tablespoons unflavored milk of magnesia (without sodium hypochlorite)
Naturally flavored extract and/or sweetener
Uncap the seltzer and pour off a few tablespoons. Shake the milk of magnesia, and pour out 3 tablespoons (45 ml). (Most brands come with a handy little measuring cup that works perfectly.) Pour the milk of magnesia into the seltzer slowly, followed by the extract and/or sweetener.
Cap the bottle securely, and shake until all the sediment has dissolved. Let the mixture sit for 15 minutes and allow to clarify. If any sediment remains, shake again. Drink as instructed above.
GROW YOUR GARDEN OF BOWEL FLORA
Put away the shovel and cow manure—they won’t be necessary for this garden.
Below the diaphragm, housed within the privacy of your bowels, is an entire universe of microorganisms that interact vigorously with their environment, meaning you. You may not be aware of the bacterial hubbub, but this four-pound population of trillions of living creatures interacts with your body 24/7. You are their sole source of nutrition, while you rely on them to produce metabolites, or by-products, that you need, such as fatty acids and nutrients that you cannot manufacture on your own. While microorganisms populating the skin, mouth, vagina, airway, and other areas—your microbiome—likewise hold implications for health, it’s the population in the bowels (what I call the “poopulation”) that holds the greatest consequences for well-being and health.
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