Monthly Archives: August 2008

How To Reduce High Blood Pressure Naturally

We covered the basics of high blood pressure regulation and hypertension in the last issue of Health Bytes. Now we will explore some possible alternatives to treat this condition.

Prior to addressing what can reduce blood pressure, we should briefly address often over looked contributing factors to high blood pressure.

Other than a poor diet, obesity, certain diseases, sedentary lifestyle, and a genetic predisposition, there are several contributing factors to hypertension. Lifestyle factors, environmental factors, and stress management can all play their part. Adjusting and addressing each of these factors can play a strong part in the non-pharmacological treatment of high blood pressure.

A study in the American Journal of Epidemiology, depicted the hypertensive effect of chronic alcohol consumption. Studies from the New England Journal of Medicine correlate nicotine consumption from cigarettes and smokeless tobacco with an elevation in blood pressure. Even the daily consumption of coffee has been implicated in hypertension, as reported in the American Journal of Cardiology.

Researchers from the Lancet stated back in 1976, that cadmium toxicity has been shown to independently increase blood pressure. Other researchers reported similar effects from lead in the American Journal of Epidemiology. The best safe guard against lead and cadmium toxicity is to remain acutely aware of their sources and avoid them when possible. Lead can be found in municipal water supplies, household lead pipes, and shooting ranges. Cadmium sources include industrial paints, and cigarettes.

How an individual handles stress can be a strong factor in blood pressure regulation. Hans Selye, one of the first major researchers on stress, described what happens in the body during the fight or flight response. He found that any problem, imagined or real can initiate the fight or flight response, which results in an increase in heart rate, breathing rate, muscle tension, and blood pressure. The journal Psychosomatic Medicine, and the Medical Journal of Australia, have clinically proven that stress reduction techniques from various disciplines of mind/body medicine such as biofeedback, meditation, yoga, and relaxation exercises, have all shown success in reducing blood pressure.

Exercise, diet, supplements, and certain herbs can produce a hypotensive effect.

It has been known for quite some time that weight control reduces the risk of high blood pressure. Not only does physical activity help with weight control but moderate exercise, specifically aerobics, helps lower blood pressure directly. Back in 1990, a study in the Journal of the American Medical Association stated that those who engage in regular aerobic activity may not need medication for mild hypertension.

Diet can be a powerful strategy to combat hypertension. Consuming a diet as close to the diet utilized in the Dietary Approaches to Stop Hypertension (DASH) clinical trial would be a great first defense. Such a diet is rich in fiber, high in potassium, calcium, and magnesium from vegetables, fruits, legumes, whole grains, low fat dairy or dairy substitutes fortified to match the nutritional profile of dairy, low in sodium and saturated fat, with total fat from monounsaturated and polyunsaturated sources totaling 30% of calories, and conducive to weight loss. Reducing sodium may not just be limited for the treatment of high blood pressure. In the December 1, 1999 issue of the Journal of the American Medical association, researchers studied the relationship between dietary sodium and cardiovascular disease risk in overweight and non-overweight individuals. They concluded that high sodium intake is strongly and independently associated with an increased risk of cardiovascular disease and all cause mortality in overweight individuals.

Coenzyme Q10, magnesium, calcium, potassium, L-taurine, garlic, hawthorn, Coleus Forskohlii, and maitake mushrooms have been found to produce hypotensive effects.

According to the research of Karl Folkers, a deficiency of coenzyme Q10 was found in 39% of patients with hypertension compared to 6% of those with normal blood pressure. Providing these patients with supplemental coenzyme Q10 for eight weeks resulted in a 10% or greater decrease in blood pressure in various double-blind studies from the text, Biomedical and Clinical Aspects of Coenzyme Q10. Vol. 5. Magnesium levels have been found to be consistently low in individuals with high blood pressure. In a study from the January 1983 British Medical Journal, supplemental magnesium lowered blood pressure in 19 out of 20 hypertensives.

Crossover clinical trials regarding the ability of magnesium to reduce blood pressure have been printed in the August and November 1998 Journal of Hypertension.

In 1994, in the American Journal of Hypertension, a study examined the possible hypotensive effects of calcium supplementation. After 14 weeks, the high calcium intake lowered systolic blood pressure by an average of 17 mmHg , and diastolic blood pressure by 11 mmHg.

The mineral potassium was also found to reduce blood pressure. Research in the British Medical Journal revealed that moderate oral potassium supplements are associated with a long term reduction in blood pressure in patients who have mild high blood pressure.

The non-essential amino acid L-Taurine may exhibit hypotensive properties. The Japan Heart Journal depicted research showing the correlation between supplemental taurine and reduced blood pressure levels.

Garlic has proven its ability to reduce blood pressure. One fine example in a randomized, placebo-controlled, double-blind trial conducted by general practitioners, printed in the August British Journal of Clinical Practice, depicted a reduction in diastolic and systolic blood pressure values after 12 weeks of supplementation with a specific garlic product.

According to the July American Journal of Chinese Medicine, Hawthorn (crataegus oxycantha) may have a mild blood pressure lowering effect.

Forskolin, an extract from the herb Coleus Forskohlii, which has a long history of use in Ayurvedic systems of medicine, may yield hypotensive effects due to its stimulation of a specific cellular regulating chemical, which in turn may result in relaxation of the arteries, as was originally reported in the March Journal of Ethnopharmacology and the July Journal of Cyclic Nucleotide Research.

The November issue of Nutrition Review, discussed the functional properties of edible mushrooms. One mushroom in particular, maitake (Grifola frondosa), has shown great promise as a hypotensive in animal studies in Tokyo.

Alternatives to the pharmacological treatment of high blood pressure are currently available. However, it is important to note that all of the aforementioned substances should be discussed with your primary care physician prior to ingestion. Herbs for example, can potentate the action of antihypertensive medication, promoting complications.

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A Little Lizard Spit Can Help Diabetics Lose Weight and Improve Blood Sugar

I just attended a conference on the latest wonder drug to be launched in the battle against diabetes type 2 (the kind of diabetes you take pills for, not insulin injections). The drug, Byetta, was derived from an unlikely place, the saliva of the Gila Monster. These ugly and venomous lizards eat 3 times per year. How about that for metabolism? Helping them accomplish that is a chemical in their digestive tract that turns insulin on when needed (if you are a lizard that would be every 4 months, or so). Since diabetics don’t make enough insulin this wonder drug is ideal for helping them get more of what they need.

As if that isn’t enough, Byetta (the synthetic version of Gila Monster spit) turns off feelings of hunger. What is the result in humans? You guessed it, weight loss. Not just any old weight loss but a weight loss that keeps on going and going and going. In one unofficial study the weight loss continued for up to 82 weeks.

Is there a downside to all this? Certainly. First of all, the medicine must be self administered as an injection twice a day. Second, some people feel nausea using Byetta. But I think the nausea is part of feeling full, which is how the drug causes reduced food intake.

Byetta is marketed by Amylin Pharmaceuticals and Eli Lilly Company and is available by prescription only. If you suffer from Type 2 diabetes you may want to ask your doctor if lizard spit is right for you.

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Backward Science Influences Your Thyroid Hormone Treatment

I have written several times about the inability of our scientific community to solve the riddles of the treatment of hypo (low) thyroid function. In the most recent study trying to discover the best way to treat hypothyroidism, defective approaches in my opinion, again defeated the good intentions of researchers. The study “Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life” was published in the prestigious Journal of Clinical Endocrinology and Metabolism.

This study was designed to examine the best doses of thyroid medication for treating hypo (low) thyroid function, and came to some startling conclusions. The first conclusion was that when treating patients with hypothyroidism adjusting the dose of thyroid medication does not affect the symptoms that these individuals had. Even more surprising was the conclusion that hypothyroidism (low thyroid levels) was not causing the symptoms the patients were complaining of.

For those who suffer from hypothyroidism and those whose job it is to treat these people, a study like this comes as a jolt of disappointment. Both groups are left wondering what they are to do next. For the treating physician, further doubt is shed on the rightness of continuing to adjust thyroid medication in response to patients’ complaints.

It is far easier to not find something than to find something. That seems like common sense. In a scientific study of disease treatment, it is far easier to not discover benefits of a new treatment than to find something that helps. There are two main reasons for not discovering something. The first reason is that whatever treatment being tested truly has little or no effect. The second reason is that the researcher is using insensitive methods to observe the effect. For example, even a large telescope will not see the brightest objects in the sky if the lens is dirty.

How do medical studies go wrong? Not having enough people in a study is a common reason. Another reason is using tools which are too insensitive to detect the effect of treatment. In studies of treatment of hypothyroidism like this one, it also seems common to produce a negative outcome by setting up the experiment backwards. Let’s look at these defects as they apply to the latest study.

The most disturbing trend in the study of hypothyroid treatment is using the backward approach to the questions. Most of these studies start by denying the existence of an almost universal observation, which is that patients respond to adjustment of thyroid hormone treatments. Instead, like this study, they start by asking, “Is there a response to thyroid hormone adjustment?” The authors of this newest study admit that not all patients treated with thyroxine (thyroid hormone) feel well. Other researchers have admitted that many of these sufferers respond to changes in thyroid hormone treatments. So why not ask a question like, “What are the differences between responders and non-responders in thyroid hormone treatment?” When studies using poor techniques can find no effects of treatment changes they deny the experience of patients and doctors alike. When these results become the medical gospel it causes doctors to be skeptical of their patients’ complaints and to feel that treatment adjustment is useless.

There can be no doubt of the profound effect of publications such as this study on doctor’s treatment perspective. I recently attended a conference of endocrinologists where this study was reviewed by an expert from Harvard University who was totally convinced of the study conclusions. Not one endocrinologist in the audience questioned the statement that adjustment of thyroid hormone treatment has no effect on patient complaints or that hypothyroidism causes symptoms at all. Skepticism of patient experience seems more acceptable than contradicting these experts.

Just a few more words on why I found the present study defective. The number of patients tested was 56 who were taking a wide range of doses of thyroid medication at the start of the study. The average endocrinologist can see two or thee times that number of thyroid patients in a single week. By comparison studies conducted by wealthy pharmaceutical companies can have many thousands of test subjects. Using a small number of very diverse patients to start with almost guarantees confusion in the results.

How reliable were the tools used to judge patient symptoms? The questionnaires used in this study are designed for general use in every clinical situation. It is a very good chance that these questionnaires are too insensitive to analyze the types of experiences that thyroid disease produces.

As I have concluded in the past when reviewing this type of study, the best hope for those suffering with hypothyroidism is to find an open minded endocrinologist who has faith in their own experience and the experience of their patients, and will use good judgment when adjusting thyroid hormone treatment in response to their patient’s history.

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Fumbling the Treatment of Hypothyroidism (becomes a national pastime)

In the July/August ’05 issue of Endocrine Practice, an influential journal read by endocrinologists throughout the United States, researchers again tackled the question of whether treating hypothyroidism (underactive thyroid) with a combination of conventional t4 therapy (Synthroid, Levoxyl, levothyroxine) along with t3 (Cytomel) was superior to using t4 alone. In my opinion this study was a fumble. It failed to show that the addition of t3 to conventional t4 improved the level of fatigue or depression of the hypothyroid patients studied.

What could have gone wrong, I asked myself? Having recently reviewed a previous study that failed to show improvement with combination therapy, I was sure the next set of researchers were going to get it right. Why do I feel so confident of a positive effect of t3 on patients with hypothyroidism? It is because so many patients of mine and my colleagues who are still suffering with symptoms of hypothyroidism on t4 treatment alone, have shown impressive improvement when t3 was added. How could this benefit have been missed by dedicated researchers again?

As I mentioned, in a previous review of a study of combination therapy that showed negative results I pointed out the deficiencies in the research that resulted in that misstep for science. Could the same research errors have occurred in the new study, I wondered? Sadly, the answer is probably yes.

What exactly went wrong here? First and I think most importantly, the researchers studied patients with hypothyroidism regardless of whether they had complaints of fatigue or depression. How, I ask, is it possible to measure improvements in fatigue and depression in people who don’t have those complaints? If I studied the effect of an acne cream on those who didn’t have acne doesn’t it make sense that the study would show that the cream didn’t cause an improvement in pimples. So it is with this study. If it ain’t broke, how are you going to fix it? What is most aggravating is that this was the same approach of studying patients without symptoms taken by the previous study.

Another big problem was that when the researchers in this study added t3 to the t4 they unintentionally made these patients more hypothyroid by failing to give enough of the thyroid medication. If you ask me this should have disqualified the study right then and there. How can you study the benefits of thyroid hormone therapy of any type if you make the patients worse then when they started? I rest my case.

I suppose we just have to wait for our research scientists to discover what they are doing wrong in their studies of hypothyroidism, before they can get it right. Hopefully doctors treating hypothyroidism will maintain an open mind about the subject until then.

Note: t3, brand name Cytomel, is a prescription drug. Only a patient and their physician can decide if using t3 is an advisable choice.

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Reducing Blood Pressure Naturally

High blood pressure, known as hypertension, is known as the ‘silent killer’ because most people can’t tell when their blood pressure is high. Elevated blood pressure can lead to a greatly increased risk of heart attack, stroke, and other serious illnesses. Along with high cholesterol and smoking, hypertension is one of the most serious causes of atherosclerosis or hardening of the arteries.

Keeping blood pressure under control is essential for long-term good cardiovascular health. Two studies involving natural therapies for reducing blood pressure were recently conducted. These studies revealed that nutrients, such as calcium, vitamin D, and antioxidants help lower blood pressure.

The Calcium/Vitamin D Connection

When we think of calcium, we automatically think of strong bones. One of the most important aspects of calcium is to prevent and treat osteoporosis. What many people don’t realize is that, according to a new German study, calcium and vitamin D supplementation is also effective in reducing high blood pressure.

In this study, which appeared in the Journal of Clinical Endocrinology and Metabolism, researchers found that calcium and vitamin D supplementation is effective in reducing blood pressure, including pregnancy-induced hypertension. In addition, they recognized that calcitropic (vitamin D-related) hormones are associated with blood pressure. Therefore, the researchers sought to determine if short-term supplementation with calcium and vitamin D might improve blood pressure.

Working with women over the age of 70, researchers found that when the women took calcium and vitamin D, they successfully reduced their systolic blood pressure and reduced levels of parathyroid hormone. (Parathyroid hormone regulates the body’s calcium levels. Too much of this hormone can result in calcium being withdrawn from bones.) The study reiterated the fact that calcium should always be taken with vitamin D because the body can’t absorb calcium without it. In addition, the study showed that inadequate calcium and vitamin D intake could play a contributory role in the progression of high blood pressure and cardiovascular disease in elderly women.

According to Dr. Helmut W. Minne and colleagues from the Institute of Clinical Osteology in Hamburg, Germany, ‘A short-term supplementation with vitamin D and calcium is more effective in reducing blood pressure than calcium alone.’


Researchers at the University of California, Irvine, have found that a diet rich in the antioxidant vitamins C and E can help lower high blood pressure. Vitamins C and E are powerful antioxidants that protect against damaging natural substances called free radicals. Vitamin C fights free radicals in water and is complemented by vitamin E, which fights free radical destruction in the fatty regions of the body.

Dr. Nostratola D. Vaziri, the study’s leading author, and his team tested the theory that antioxidants might help reduce high blood pressure by protecting the body’s supply of nitric oxide, a molecule that relaxes blood vessels. During the study, they found that supplementing the diet with vitamins C and E raised levels of nitric oxide in the body. The study, published in Hypertension: Journal of the American Heart Association, showed that although hypertension is a highly complex medical problem that has many causes, nitric oxide and oxidative stress are major contributors to the disease.

‘Antioxidants are powerful regulators of blood pressure, and our studies show that multiple types of these chemicals, found in a diet heavy in fruit and vegetables, could help mitigate high blood pressure,’ Vaziri said.

Millions of men and women suffer from high blood pressure. The discovery of natural alternatives for treating this prevalent condition offers even more reasons for the importance of supplementing with these important nutrients every day.

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Cortisol Regulation and Your Health: The Real Story

Cortisol is a hormone (chemical) produced by the adrenal glands which is essential for life. Without cortisol the blood pressure would drop and shock followed by death would occur. Cortisol is also thought to play a role in general maintenance of the body’s tissues and functions. Conditions of excessive adrenal cortisol production known as Cushing’s syndrome cause high blood pressure, thinning of the skin, storage of fat in the abdomen, defective immune function, and mood disorders such as depression. People who take steroids such as Prednisone, Dexamethasone, and Hydrocortisone in high doses over long periods of time can also develop the complications of Cushing’s Syndrome.

Several products now on the market claim to help regulate cortisol levels to assist in weight loss. The theory is that stress due to our environment or to dieting itself leads to excessive cortisol production which then leads to fat (and weight) accumulation in the body. These products then claim to reduce these harmful cortisol effects on the body.

As a practicing endocrinologist and author of a textbook chapter on the effects of cortisol on the body, I think I understand this problem fairly well. Over the last 25 years I have treated a number of individuals with excessive cortisol levels due to Cushing’s Syndrome. The treatments must be monitored very carefully to avoid dropping the cortisol levels too low, as well as to prevent serious side-effects of the medications themselves. Since cortisol is essential for life, too much lowering of this hormone can be as bad as too much cortisol.

I was fascinated when I first heard about supposed over-the-counter cortisol regulators. From a medical point of view it would be a great advance if these products could do what they claim. I was skeptical however, because if a product could decrease cortisol levels it could also kill you by dropping levels too low. If these products really worked as well as the advertisements stated wouldn’t there be people dying from overdoses?

Since then I have reviewed the claims of adrenal gland regulation by over-the-counter products. I have reviewed their lists of ingredients. These products seem more appropriate as hair gel then cortisol regulators. I found nothing to indicate they have any beneficial effects on cortisol levels what-so-ever. What is amazing to me is that with nothing to substantiate their claims, no regulatory agency has stepped in to stop their sales. I suggest you ask you own doctor their opinion of these supposed cortisol regulators before spending your hard earned money on them.

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(Oops! They did it again.)

The editors of the latest research on the controversial subject of combination therapy (t4 plus t3) for treating hypothyroidism have missed the point again.

A recent article published in the Annals of Internal Medicine (March 15, 2005) attempted to answer the question about whether combining t3 (Cytomel) with t4 (Synthroid, Levoxyl, Levothroid) for treating under active thyroid (hypothyroidism) produces a better outcome than using t4 alone.

Although the latest studies of this controversy lump all hypothyroid patients together, the most recent one showed an impressive preference for combination therapy by 18 of the 28 patients who got t3 added to their conventional t4. And this happened without adjustment of t3 dosing which is often required for the best results.

I was excited and impressed with these results. But guess how the editors who published this study interpreted these results? With a dry and simple statement that dismissed these findings as showing “no difference” between combination treatment and treatment with t4 alone. They concluded by stating that treatment with t4 alone is “sufficient”, leaving one to conclude that adding t3 produces no benefits. I have to scratch my head in wonder.

What could explain the resistance of these experts to see combination t3 and t4 as an exciting improvement in treatment of hypothyroidism? Perhaps it is the old bias against combination t3 and t3 products. These products which include names like Proloid were withdrawn from the market decades ago. How can we physicians rationalize our abandonment of combination hormone treatment leaving our patients to struggle on their own with their symptoms? By denying that in many cases combination treatment can be superior we can avoid having to deal with this failure of our accepted teachings.

For now each hypothyroid patient must decide with their own physician whether combination therapy is right for them. Keep an eye on for more updates on the latest in this debate.

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A Wrong Turn in the Treatment of Hypothyroidism?

Effective treatment of hypothyroidism is a major concern since this disorder affects so many young people and can lead to years of disabling symptoms. As I have expressed in another article on this website, “Hypothyroid? Will You Benefit From T3 (Cytomel)?”, I am an advocate of combining t4 and t3 to treat hypothyroidism particularly for the patient who has failed to achieve a return to normal function when their hypothyroidism is treated with conventional t4 alone. For this reason I looked forward to reviewing a recent study of this controversial subject in the prestigious Journal of the American Medical Association, Combined levothyroxine (t4) plus liothyronine (t3) compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial by PW Clyde, and colleagues. Unfortunately I was greatly disappointed in this most recent research.

The study was conducted in 46 hypothyroid patients who were divided randomly into two groups. One group continued to receive their standard dose of t4 and the other group was switched to a lower dose of t4 and had a small dose of t3 added to it. The result was that there were no physical or psychological differences between these two groups of subjects after four months. The conclusion was ‘Compared with levothyroxine alone, treatment of primary hypothyroidism with combination levothyroxine plus liothyronine demonstrated no beneficial changes…’.

What went wrong with the good intentions of these researchers? Dividing their group of hypothyroid patients randomly without regard to their pre-study response to conventional treatment with t4 makes it almost impossible to identify those who are likely to benefit most from intervention with t3. The target group should have been those who are doing poorly on t4 alone. The number of patients looked at, 46, is a tiny number, making it unlikely that any differences in treatment would be seen. It is easy to miss seeing any difference in treatments when you look at a small number of individuals. Finally, the amount of t3 (7.5 micrograms) administered is barely sufficient to produce a clinical effect, further reducing the chance of observing any benefit.

I believe the authors of this study asked the wrong question and used techniques which made it almost impossible to see the differences in treatment outcomes that they were searching for. The negative results of this study will probably inhibit the use of t3 in medical practices throughout the country for years to come. It is little wonder that there are so many people who are unhappy with the treatment they receive for hypothyroidism. Perhaps my comments here will be helpful for those who agree that despite these latest research findings, t3 added to t4 can still be considered a valuable alternative when treating hypothyroidism.

The opinions expressed in this article are not meant to serve as medical advice. Always consult with your health care professional before starting any new course of therapy.

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Hypothyroid? Will You Benefit From T3 (Cytomel)?


[For an additional late breaking news on this subject be sure to check out the book,]

Over 20 years ago endocrinologists had experience with hormone compound pills containing both T4 and T3. Those physicians who had the opportunity to use these compounds know that patients frequently seem to do better with them than with the more traditional T4 (Synthroid, L-thyroxine, Levoxyl etc.). For various reasons most companies stopped producing combination thyroid hormone pills two decades ago.

Why does combination therapy with T4 and T3 appear to provide more benefits than either hormone alone? The reason was clarified in an article published in The New England Journal of Medicine summarized in this news report;

NEW YORK, Feb 10 (Reuters Health) — Patients with hypothyroidism show greater improvements in mood and brain function if they receive treatment with two types of thyroid hormones instead of one, according to a report in the February 11th issue of The New England Journal of Medicine.

Hypothyroidism, where the gland has ceased to function or has been removed, is usually treated with daily doses of thyroxine hormone. But the researchers found that substituting another thyroid hormone, triiodothyronine, for some of the thyroxine dose led to improvements in mood and in neuropsychological functioning.

“There are two thyroid hormones, thyroxine and triiodothyronine,” Dr. Robertas Bunevicius, of Kaunas Medical University in Lithuania, and colleagues explain in their paper.

“Not all tissues that need thyroid hormone are equally able to convert thyroxine to triiodothyronine, the active form of the hormone,” the researchers write. “Nevertheless, most patients with hypothyroidism (reduced thyroid function) are treated only with thyroxine.”

To determine whether patients would benefit from receiving triiodothyronine as well, Bunevicius’ team studied 31 women and 2 men who lacked a functioning thyroid and were dependent on thyroxine.

The research team divided the study into two 5-week sessions. During one session, each patient took his or her usual dose of thyroxine. During the other session, the researchers replaced 50 micrograms (mcg) of the thyroxine dose with 12.5 mcg of triiodothyronine.

On 6 of 17 measures of mood and cognition — a catchall term that refers to language, learning and memory — the patients scored better after receiving thyroxine plus triiodothyronine than after receiving thyroxine monotherapy.

No score was better after monotherapy than after combination treatment, the study group determined. The authors also detected biochemical evidence that “thyroid hormone action was greater after treatment with thyroxine plus triiodothyronine.” But in an editorial, Dr. Anthony D. Toft, of the Royal Infirmary, Edinburgh, Scotland, recommends that physicians should not use thyroxine and triiodothyronine in combination until the study findings are confirmed by additional research.

Toft notes that “most, if not all, of the currently available combined preparations of thyroid hormones contain an excess of triiodothyronine as compared with thyroxine.” Besides, he argues, the majority of patients taking thyroxine “have no complaints about their medication.”

SOURCE: The New England Journal of Medicine 1999;340:424-429, 469-470.

I have used Cytomel (T3) in treating hypothyroidism for over 18 years and I am still surprised and gratified at just how well it works. For those complaining of persistent fatigue, muscle pain, constipation, or weight gain, despite blood tests showing normal levels of thyroid hormone, combining T3 with T4 therapy appears to boost the thyroid hormone action. Combining the two hormones can actually avoid the sometimes frankly negative aspects of simply increasing the level of T4. If you or someone you know has similar problems with thyroid hormone replacement I suggest consulting with an expert health care professional such as an endocrinologist about adding T3 supplementation.

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Should Adults Receive Growth Hormone Treatment?

The controversy surrounding growth hormone use in adults deepens. Recent editorials in the prestigious New England Journal of Medicine have taken a negative view of growth hormone supplementation for adults. Dr. Mary Lee Vance comments, “general use (sic- of growth hormone therapy in adults) now or in the immediate future is not justified.”

My medical practice has recently received a letter from a major health insurer, United Health Care, stating that growth hormone use in adults will no longer be a covered medical therapy. When asked for justification of this curtailment of financial support for growth hormone therapy health insurers are certain to point to comments from experts such as Dr. Vance.

One of the reasons for the backlash against growth hormone therapy is the explosive proliferation of individuals and companies promoting their own propriety brands of growth hormone substitutes and so-called growth hormone releasers. We receive 10 or more emails daily marketing growth hormone related products. Unfortunately, most of the claims for these products are simply false or at best, unsubstantiated. Only injected prescription growth hormone made by major pharmaceutical companies can be expected to fulfill the goal of growth hormone supplementation. Making matters worse for supporters of growth hormone therapy in adults is that legitimate growth hormone products themselves can be abused for perceived benefits to athletic ability and cosmetic appearance.

Why all the fuss about growth hormone? Is it truly capable of making us stronger, leaner, more energetic, and happier? Dr. Vance and her colleagues point out the lack of large studies which provide the answers to these questions. There are, on the other hand, smaller studies showing improvements in bone density, lean body mass and measures of well being associated with growth hormone therapy. Because of the limited amount of large studies evaluating growth hormone use in adults can we still justify our use of the hormone? As a practicing endocrinologist I have to answer these questions so I can provide my patients with the best existing therapies for their problems.

What exactly is growth hormone? It is a protein based hormone made by the pituitary gland which circulates in our blood in abundant amounts during the first twenty years of our lives but levels then slowly decline as we get older. Growth hormone controls the liver’s production of IGF (insulin like growth factor), formerly known as somatomedin, which stimulates the growth of cartilage which in turn results in increasing size of our bones. Growth hormone also appears to play a role in maintaining muscle mass and probably has multiple functions within the central nervous system (the brain and spinal cord).

If growth hormone is so important to general health why do levels drop off as we age? The decline in growth hormone levels with aging is mirrored by a decline in a host of other critical substances which maintain our health, such as DHEA (from the adrenal gland). One possible reason for the drop in these beneficial substances is for the plain and simple purpose of promoting our aging and eventual death. The survival of our species requires the removal of the old genetic material (use) so it can be replaced by the new (and possibly improved) genetic material (our offspring). Aging and death are required by the laws of evolution and therefore our bodies are programmed to self-destruct. The decline in growth hormone may be one way to serve this purpose.

Growth hormone is expensive. A year’s supply may cost up to 10 thousand dollars making economics another key element in the growth hormone controversy. How can we justify spending this amount of money on everyone who wants to prolong their strength and vitality? Forget about justify…our economy simply can’t afford this expenditure. Who will then decide who gets growth hormone and who won’t? I don’t have the answer either.

In the face of controversy what would be a reasonable approach for the practicing physician to follow? The first principal is to administer growth hormone only to those fail to make a minimum acceptable quantity of the hormone. If a patient is suspected of having growth hormone deficiency based on their history and physical exam a check will be made of the level of morning growth hormone and IGF. If the growth hormone is in the low normal range (below 2) the next step is a stimulation test to see whether the pituitary gland can be forced to release its store of the hormone. There are several tests which stimulate the pituitary release of growth hormone but the simplest is to administer L-Dopa (a prescription drug formerly used to treat Parkinson’s disease) by mouth and measure growth hormone levels in the blood over the next 2 hours. If the level remains below 5, growth hormone deficiency can be diagnosed.

Growth hormone deficient adults are given significantly smaller doses of growth hormone as compared to children being treated to achieve normal height. Even at these lower doses impressive improvements in mood and energy can be achieved. It is hard to measure these effects but statements such as, “Growth hormone changed the quality of my life. The strength and energy I used to have is back in full”, have been use by patients to describe their results.”

What about side-effects from growth hormone treatment in adults? Minor joint pains, carpal tunnel like symptoms, headache, and traces of swelling at the ankle have been described. Unfortunately, experts such as those quoted in the New England Journal use ominous tones when referring to growth hormone side-effects or to the possibility of its causing cancer or cardiovascular disease. These warnings remain largely unsubstantiated by even small studies.

In my practice I generally follow a year or two of treatment with growth hormone followed by 6 months off, simply to defer to the possibility of accumulating negative effects of prolonged GH therapy. The medical community is still waiting the ultimate word on growth hormone therapy in adults but based on reputable studies and my own observations I will continue to offer this treatment to my patients who exhibit the signs, symptoms and blood test evidence of growth hormone lack. As with any medical treatment it is important for each individual to consult with their own physician before embarking on any course of therapy.

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