Monthly Archives: May 2010

Beware the Zombie Thyroid!!


Beware the Zombie Thyroid!!

Periodically, I update metabolism.com with interesting problems from my medical practice. Last week I was reminded of a particular thyroid disease which is little known and deserves more attention. In my patient’s case, she had an inactive thyroid (hypothyroid) due to Hashimoto’s thyroiditis for several years which, on its own switched to become an over-active thyroid (hyperthyroid). I call this event a “Zombie Thyroid”. Don’t bother trying to look this term up since ‘Zombie Thyroid’ is my own terminology. A Zombie Thyroid is, of course, one which returns from the dead. Most times when the thyroid is destroyed by either natural forces or by human intervention, the destruction is complete and irreversible. Rarely however, a thyroid which ceased function for years resumes producing thyroid hormone and may even becoming “hyper” or over-functioning. Such was the case of my patient last week. Confusion may result because the newly risen thyroid begins adding thyroid hormone to the blood of someone already taking thyroid hormone replacement for hypothyroidism (under-functioning thyroid). Recognizing the Zombie Thyroid can take months or years due to the rarity of the condition and the subtlety of the changes that occur on blood testing.

The Zombie Thyroid occurs in the setting of either autoimmune thyroid disease such as Hashimoto’s thyroiditis or a structural thyroid disease, multinodular goiter. Hashimoto’s is the most common cause of naturally occurring hypothyroidism in women under the age of 60 years. Hashimoto’s occurs when the body creates an antibody to the thyroid, resulting in destruction or impairment of the thyroid tissue. It is thought that the thyroid can ‘return from the dead’ if the body begins to produce more of another type of antibody that results in stimulation of the thyroid tissue. The switch from under active to over-active can take months or years. During this time the combination of taking thyroid hormone pills for Hashimoto’s plus the new supply of the body’s own thyroid hormone production can result in disturbing and seemingly unexplainable high thyroid levels. Once it is clear that the thyroid is producing thyroid hormone again it is possible to make appropriate adjustments in medication to return the situation back to normal.

Another situation involving the Zombie Thyroid is seen in elderly people who have had an enlarged and lumpy (nodular) thyroid for years. Some of these “multinodular goiters” produce adequate amounts of thyroid hormone but others can be associated with thyroid hormone deficiency (hypothyroid). When the multinodular goiter causes hypothyroidism, the patient will be treated with thyroid hormone replacement just like the Hashimoto’s patient. Over time the nodules may slowly begin to wake up and begin producing thyroid hormone. If the patient is already taking thyroid hormone due to the previous diagnosis of hypothyroidism, the combination of the two sources of thyroid hormone can result in excess or “hyper” thyroidism. In the elderly the doctor may suspect the elevated thyroid hormone levels are the result of a medication error perhaps due to the patient’s forgetfulness. If no action is taken serious complications of hyperthyroidism can develop such as irregular heart beat, congestive heart failure, excessive fatigue, and mental or mood impairment. Some elderly patients become withdrawn and lose weight mimicking depression, a situation known as “apathetic hyperthyroidism”. Recognition of the Zombie Thyroid is essential to restoring the thyroid levels and the patient’s clinical status back to normal.

Don’t let yourself or loved one become a victim of this ‘back from the dead’ thyroid. Alertness is the key to recognizing and treating the Zombie Thyroid. Ask your own physician for advice if you suspect this condition.

This article is for educational purposes only and is not meant as medical advice. The disclaimer of metabolism.com applies to this and all my blogs.

Gary Pepper, M.D., Editor-in-Chief, metabolism.com

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A Lazzara, member, comments on Gastric By-Pass Surgery


A. Lazzara, member of metabolism.com, posts the following to the discussion of gastric by-pass surgery for weight loss.
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Thank you for posting this but you havent posted all the information just parts of it.

Most people who have bariatric surgery really DO it as a last resort.

While you are right about that the one sole gastric bypass surgery is NOT a quick solution to the problem, however there are other bariatric procedures that are available to consider. One of them being the latest one called vertical sleeve which just cuts your stomach smaller and does not do all the plumbing that the drastic gastric bypass does. Another form is the popular lapband which is just a band thats inserted over your abdominal to restrict the food.

Any of the bariatric doctors do WARN the patient that with the gastric bypass that you run the risk of malabsorption and that can be detrimental in the long run.

As far as bariatric procedures are concerned I know TEN people who had various bariatric surgeries. I know 8 of them that are doing great! I know my cousin had the gastric bypass and she didnt do well. She has to go back in and get it removed because it was dangerous for her. But this was when gastric bypass first started out as a new procedure. The other person i dont know what procedure she had done but her situation is that she stopped taking the vitamins that she was supposed to take so she became ill. Shes doing better now that she is taking her supplements.

I”ve been to many bariatric seminars and i strongly recommend the vertical sleeve. Out of the ten i mentioned I know two of them had that done and are doing fantastic. They do not get malabsorption and just mainly control what they eat. If people are concerned then i suggest they opt for the lapband and if its not for them they can have it removed.

I personally cannot have ANY of these procedures even if i had the money for it. In 1996 I had acute pancreatitis(which left me diabetic) and they did abdominal surgery on me therefore the bariatric doctors will not touch anyone who had any kind of abdominal surgery due to that it might cause complications. How i dont know though. I’m hoping to find out.

Do know this that you can have any surgery and STILL gain the weight back. You can still eat tons of milk shakes with the lapband or constantly eat small portions with the vertical sleeve and re-stretch out your stomach. So they aren’t a cure all.

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Weight Loss Step by Step by Step.


Johnna and Hank came to me for a nutrition consultation.  They both wanted to lose weight and had tried several programs but none that they really felt comfortable sticking with.  They found most were too complex and time consuming and frankly just not palatable!  I introduced them to my Step by Step program, a simple guideline for incorporating healthy habits into daily living.  The first week Johnna lost six pounds and Hank lost eight!  They found a new way to incorporate some time for themselves into their busy schedule and even got the kids involved.   Contact us for more information about my Step by Step program and Five Steps to a Healthy Being.  Metabolism.com clients get a special discount!  Beth Ellen DiLuglio, MS, RD, CNSD, CCN, LD/N

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Common Liver Disease Responds to Vitamin E


Vitamin E May Be of Help in Common Liver Disease:

Over the years the medicinal qualities of vitamin E have been both praised and criticized. For decades there has been a debate whether this vitamin could prevent cancer or heart disease. Large studies have pretty much determined that cancer and heart disease don’t respond to vitamin E supplementation. For that reason many physicians believe that vitamin E treatment is worthless for any purpose. This assumption is incorrect. For example, a recent study in the New England of Medicine has shown vitamin E to be of great use in the treatment of a common liver disease resulting from fat accumulation in the liver (steatosis).

The liver normally store some fat but in excess it can lead to inflammation of the liver, a condition called steatohepatitis. In up to 15% of those with steatohepatitis, cirrhosis and liver failure can result. Steatohepatitis itself is relatively common. In my endocrinology practice several patients per day show evidence of this liver disease, manifested as abnormalities on routine liver blood tests. Patients most likely to show characteristic abnormalities on liver blood tests are those with high cholesterol (particularly if taking the cholesterol lowering medications known as statins), diabetes, and obesity. If the blood tests are particularly abnormal an ultrasound of the liver is usually obtained to be sure nothing else is occurring, such as liver cancer or cirrhosis. Simple steatosis itself is generally easy to diagnose on the ultrasound.

A recent study in the New England Journal of Medicine (Volume 362, No. 18) demonstrates that vitamin E is beneficial for treating steatohepatitis. 247 subjects with evidence of steatohepatitis not due to alcohol use or diabetes were given various treatments. The group getting 800 IU vitamin E per day showed a 43% improvement in measures of steatohepatitis. Also examined as a possible treatment for steatohepatitis was Actos (pioglitazone), a popular diabetes drug. Although the results with Actos were promising they weren’t as good as the results with Vitamin E.

As always, the researchers conclude that further studies will be needed to confirm this benefit. Before using vitamin E in your own program be sure to check with your physician first. Vitamin E can act like a blood thinner, so its use in people who have bleeding abnormalities or on drugs that influence blood clotting, is of particular concern.

This article is for educational purposes only and is not intended as medical advice. The disclaimer for metabolism.com applies to this and all my posts.

Gary Pepper, M.D., Editor-in-Chief, metabolism.com

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What to expect from a Nutrition Consultation


What exactly is a Nutrition Consultation? That is Question Number One from the public! Well, a nutrition consultation is something that takes into account someone’s medical and weight history; blood work/laboratory values; activity; habits; Calorie, protein, carbohydrate, fat and fluid needs; nutrition support needs and personal goals. A good nutrition assessment will take all of this into account in order to get a full picture of a client and what their specific needs and recommendations are.

A very common issue is that people think they are eating way too much at night and want to cut down on their intake a night. Most of the time, these folks aren’t eating enough during the day and find themselves so hungry at night that they make up for missed meals and more! In this case, I teach that food is the best appetite suppressant around! If you eat good, solid, healthy meals and snacks, you won’t feel so hungry later on in the night.

Of course, sometimes people experience “emotional eating” where they are counting on food to meet an emotional need that they have. At first it may feel like the need is fulfilled. Food is comforting, nurturing, it can seem like a “companion”. HOWEVER, food is fuel, not emotional support. When we mistake food for emotional support, we stop looking for the real, underlying emotional issues that need our attention. That is when food becomes a distraction, a past time, even an addiction. I urge clients to look at food as food and not an emotional crutch or distraction.
On the other end of the spectrum are the folks who need to gain weight and can’t seem to gain no matter what they do. A nutrition consultation will provide an assessment of exactly how many Calories they need to maintain and to gain weight. It will provide guidance for consuming healthy foods and not empty Calories, as well as recommendations for maintaining lean body mass.

Some folks need nutrition support, especially if they are on medications that deplete nutrients. My professional opinion is that the majority of people in this country do not even meet the RDA’s for many nutrients and I believe that the RDA’s need to be updated to reflect current knowledge and research in the science of nutrition.

A Nutrition Consultation will also help dispel the numerous misleading concept about nutrition that are out there floating around on the internet and in the media. I teach people some very basic concepts so that when they look at the latest headlines or listen to what other people have to say about nutrition, they will be armed with knowledge that will help them to judge what it truly best for themselves. So that is a Nutrition Consultation in a NUTshell.
And as always,
Consider having an individualized consultation!
http://www.metabolism.com/beth-ellen-diluglio/

Beth Ellen DiLuglio, MS, RD, CNSD, CCN, LD/N
In regards to this reply please read the our terms of service at:http://www.metabolism.com/legal_disclaimer/

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Debbi Reveals Her Experience with Weight Gain after Quitting Smoking


In this post Debbi gives advice to Melanie who is concerned about weight gain when stopping smoking:

Debbi writes:

Melanie: Not sure if you have read all of these posts, but a few years back, I quit and gained THIRTY pounds just as you described. Made me feel exactly like you say “humongous slug” and buying bigger clothes every 4 weeks. It drove me back to smoking. Recently, (Nov. 14, 2009), I quit again and gained 13 lb. by Christmas!!! I had to buy new clothes once again & could feel the depression rolling in again, but instead of smoking this time, I started going to the gym like a total maniac. I follow Weight Watchers also. I am 54 years old, 5′ 2″and have weighed 120-125 most of my life – now I’m ‘hanging tight’ at 135 by doing what I’m doing. It will be 6 months smoke-free for me on Friday and I don’t feel too bad about it. I love going to the gym, especially my weight-lifting classes 2x week. I also do Pilates and a lot of walking and rowing. I just came back from a 18 day vacation and only gained 2 lb. – which isn’t bad considering I did NO exercise at all! Hang in there….things WILL even out. I am waiting for the day I can drop these 10 unwanted pounds and I know eventually it will happen. Be proud of yourself for not smoking – I am!

Melanie: Not sure if you have read all of these posts, but a few years back, I quit and gained THIRTY pounds just as you described. Made me feel exactly like you say “humongous slug” and buying bigger clothes every 4 weeks. It drove me back to smoking. Recently, (Nov. 14, 2009), I quit again and gained 13 lb. by Christmas!!! I had to buy new clothes once again & could feel the depression rolling in again, but instead of smoking this time, I started going to the gym like a total maniac. I follow Weight Watchers also. I am 54 years old, 5′ 2″and have weighed 120-125 most of my life – now I’m ‘hanging tight’ at 135 by doing what I’m doing. It will be 6 months smoke-free for me on Friday and I don’t feel too bad about it. I love going to the gym, especially my weight-lifting classes 2x week. I also do Pilates and a lot of walking and rowing. I just came back from a 18 day vacation and only gained 2 lb. – which isn’t bad considering I did NO exercise at all! Hang in there….things WILL even out. I am waiting for the day I can drop these 10 unwanted pounds and I know eventually it will happen. Be proud of yourself for not smoking – I am!
hogan55@cogeco.ca
Debbi
1

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Vitamin B Supplement Harmful in Diabetics?


Several years ago studies suggested that high levels of homocysteine, a naturally occurring amino acid in the blood, could be harmful to cardiac health. B vitamin supplementation is known to lower blood levels of homocysteine. According to the thinking at that time lowering homocysteine levels by taking B vitamins such as B6 and Folic acid should then improve cardiac health. A great deal of publicity surrounding the supposed cardiac benefits of these vitamins led to the promotion of prescription strength B vitamin preparations such as Folbee. These expensive vitamin preparations were then routinely prescribed by physicians for cardiac protective purposes.

Since then several large studies showed no cardiac benefit of lowering homocysteine levels. Worse still, a study just published April 28, 2010 in the Journal of the American Medical Association shows that B vitamin supplementation in diabetics with kidney problems can lead to a doubling of risk of heart attack, stroke or dying. Diabetics with kidney disease are already at higher risk for developing these problems but adding the B vitamins makes the situation much worse. Additionally, kidney function declined faster in those on B vitamin supplements.

The lesson here is to be careful before adopting new therapies based on unsubstantiated research, particularly if you are more vulnerable due to pre-existing medical conditions.

Gary Pepper, M.D., Editor-in-Chief, metabolism.com

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