One of the most common things we hear in the clinic from our patients is the journey from one doctor to another for multiple health challenges.
Many don’t get a diagnosis, or, may have one or two things come up in their blood work, but go on to still feel mediocre…
They see a gynaecologist for reproductive hormones.
An endocrinologist for thyroid function.
A cardiologist for heart challenges.
They often feel confused or lost in the referral process, or, feel left with little to no answers…
Today, I wanted to share five key insights that we often look for in our patients’s annual tests, that prompt us to do more investigation into methylation, metabolic, immune system, digestive, or inflammation problems.
It’s common for us to have patients that come to us with markers that are gently mentioned after a round of blood work, but put in the ‘waiting’ timeline until blood markers merit the need for medication.
This happened to me when I was 33 and felt like the walking dead.
I was 18months postpartum and incredibly tired, 24kgs overweight, and felt so winded after walking to the bus stop to go to work which was just 800 metres from my front door…
When I went to the doctor to get my bloods done, I was told that everything looked normal, but I needed to cut down on high fat foods as my cholesterol ranges were getting onto the high side.
I needed to lose 24kgs and I was exhausted, and the only marker that we needed to wait to medicate was cholesterol.
But, there was a whole lot more to the puzzle…
Lately, we’ve been talking to patients with one or two little things that are now at the point where they are needing medication (or have been taking medication for it for several years), and after a couple of years, the doctor is starting to bring up the thyroid or fatty liver or insulin resistance…
Women are more likely to have hypothyroidism largely due to the oestrogen impact on the thyroid’s ability to produce enough T3 and T4.
So let’s look at the what annual tests & pathology can be hinting or if something may be sneaking up on you…
1. Changes in Cholesterol (for the worse)
This is one of the first signs that thyroid function is slowing down.
According to the Endocrine Society, “if your metabolism is slowed, which is what occurs with sluggish thyroid function, the breakdown or elimination of cholesterol is also reduced, which leads to higher circulating cholesterol levels in the bloodstream.”
Statins are the top two most prescribed medications in Australia, according to an independent review done by NPS Medicine Wise.
Dr. David Brownstein, MD, published an entire book on statins and the connection between thyroid and cholesterol led his father to a major cardiac event. He learnt that supporting the thyroid and reproductive hormones improved his qualify of life within a short period of time (weeks not years).
2. High Blood Pressure (or elevating)
The next four of the top ten most prescribed medications are blood pressure medications…
Thyroid problems can cause hypertension, most commonly diastolic, because of increase peripheral vascular resistance (PVR). PVR is the resistance in the flow of blood, which is essential to cardiac [heart] function.
Poor methylation often linked to a high homocysteine marker in blood work, is precursor to cardiovascular risks.
When we see rises in blood pressure, it’s really important to check methylation.
It’s like the body is becoming a pressure cooker that can’t release the steam from it’s valve.
High blood pressure, increasing insulin resistance, and high homocysteine commonly come in at the same time.
This usually ignites as progesterone is lowering due to the HPA Axis Recalibration which effects the metabolism and nervous system.
Then as oestrogen goes down, the body becomes more sensitive to inflammation (and insulin resistance), so many women start to see evident changes in their blood work and in their blood pressure measurements.
“Hypothyroidism and menopause transition seem to go hand-in-hand, since both usually affect middle-aged women. This has led researchers to believe there might be a connection between perimenopause and thyroid function.”
3. Changes in Oestrogen
For women, because of oestrogen, it adds another factor to consider when it comes to thyroid function, insulin resistance, inflammation, and the immune system.
Your body likes and got used to monthly oestradiol.
It’s an inflammation reducing and insulin sensitising hormone.
There is an oestrogen receptor on every cell in the body.
Oestradiol goes up and down every month during menstrual cycles, with high highs, and, low lows
during peri-menopause.
It’s very common for us to see the immune system react during and after peri/menopause when we look at our patient’s haematology (full blood exam).
We start to notice subtle .1 or .01 changes in small count lines like the white blood cell count (as well as many others).
Or we’ll notice that the uric acid becomes low (which is positive because you don’t have gout), but can be a sign of a struggling immune system or increase in histamines.
We start to see CRP go up (an inflammation marker), which can be linked by genetic challenges triggered by an environment experiencing more inflammation, due to lowering oestrogen.
The debate about the relationship between hypothyroidism and menopause has been ongoing for quite a while. That’s partly because thyroid function itself dwindles, albeit slowly, as we age. But, lowering oestrogen is also connected to an increase in TSH (hypothyroidism). (This is why it’s more common for women to suffer from thyroid problems then men.)
Oestrogen affects the thyroid gland’s ability to produce enough T3 and T4 to meet the needs of the body. This causes a domino effect that starts with the gallbladder and liver, and eventually circles back to the thyroid gland. It’s all connected.
4. Liver Function: Methylation, the Active Free T3 Conversion, Cholesterol, & Gall Bladder
85% of methylation happens in the liver.
So if you are not feeling quite right, and are noticing changes in your fasting glucose, blood pressure, cholesterol or thyroid markers, methylation important to consider.
Many oestrogen dominant symptoms seem to persist even after menopause, because of poor liver detoxification, often linked to poor methylation.
The liver has a direct impact on the clearing of oestrogen out of the blood stream, regardless of you age.
The conversion from Free T4 and Free T3 (thyroid hormones) into Active Free T3 biologically occurs largely through the liver.
This is like the on/off hormone for the metabolism.
Active Free T3 gives you energy, touches every cell in the body, increases metabolism, and increases circulation.
Dr. Sara Gotfried, MD, is an advocate for women’s detoxification. She refers to the fact that in medical school doctors are taught to “assume” that the body naturally detoxes and there is no need for medication intervention. Her personal experience with fatigue and weight gain, combined with treating thousands of women has told a different story.
She’s found that the start of hormone imbalances (especially during peri/post menopause) start because of poor detoxification.
Non-alcoholic fatty liver has increased by 25% in patients with fatty liver disease worldwide
Cholesterol & Gall Bladder Connection
We often look early and often at liver and gall bladder function, checking your Liver Function Test AND your cholesterol panel.
Whilst poor liver detoxification can be the start of poor thyroid function and poor methylation and is often the larger part of the puzzle, the liver and gall bladder work closely together.
And this is where common changes in cholesterol start to kick in.
The liver is solely responsible for producing cholesterol in the body, and the gallbladder simply stores and concentrates the bile produced by the liver, which can contain cholesterol as a component.
The gallbladder concentrates the bile by removing water, which can increase the concentration of cholesterol within it.
Hopefully you can see how important checking your liver function is every year now :).
Now cholesterol has a big impact on the gall bladder.
Three out of every four galls stones are cholesterol galls stones.
Another reason to keep an eye on thyroid function (TSH)… if symptoms present and cholesterol starts to go up, there’s a good chance there is sluggish thyroid function and possibly a conversion issue due to liver-gall bladder poor detoxification.
With time, gall stones can accumulate and require removal or the gall bladder to be removed…
5. Insulin Resistance
In Sept of 2014, the NIH released a study on insulin resistance in subclinical hypothyroidism.
It concluded that subclinical hypothyroidism [that means one that is not necessarily taking thyroid medication] has an increased risk of insulin resistance [which also doesn’t merit the need for medication unless the insulin resistance is so great that it is diagnosed as diabetes].
Thyroid hormones T3 and T4 maintain a fine balance of glucose homeostasis by acting as insulin agonistic and antagonistic. Hypothyroidism can break this equilibrium and alter glucose metabolism, which can lead to insulin resistance.
At this point, when insulin rises, it can also increase a spike in high blood pressure or high cholesterol.
Thyropause is when Peri/Post Menopause meets Insulin Resistance & Thyroid Dysfunction.
It’s very common for many of the symptoms [of insulin resistance and subclinical hypothyroidism] to be considered to be a part of “menopause”.
Hopefully you can see why becoming a detective with your annual blood work is really important.
Even though your blood work is “normal”, subtle changes in your haematology, liver function, cholesterol, thyroid function, and glucose or HBA1c provide important implications into how changing hormones are affecting you.
If you don’t quite understand how to read your tests, and you are noticing changes in your body, we encourage you to watch The Low Oestrogen Window webcast, you can watch more here: https://naturalhormonebalance.co/free-training-low-oestrogen/
If you are in peri-menopause, have a thyroid problem, are waiting for your blood work to get to a point where you can get medicated, or past menopause, it’s not too late.
If you have been diagnosed with a condition, it’s not too late either.
Addressing the bigger picture and the cause is the linchpin to getting your life back.
If you have been reading and watching our content and are ready to get support from us, we offer a Free Introductory Consultation over the phone. You can organise that here: https://calendly.com/nz-naturopathy/intro-consult
