As Dr. K mention’s in the introduction to his book, poor thyroid function is like the engine light in your car turning on—it’s an indication to open the hood, investigate the engine, and repair what’s wrong. You don’t want to just take a drug or a supplement that will make the engine light go off.

The gut-thyroid connection can be a vicious circle as hypothyroidism causes poor digestive health, and poor digestive health may cause hypothyroidism. This is why it’s so important to appropriately manage Hashimoto’s and hypothyroidism, which involves more than finding the right thyroid medication. For the most part however, America’s addiction to processed foods, sweets, and stressed-out lifestyles leaves most people in need of some serious gut repair.

How poor gut health impacts the thyroid
For 90 percent of Americans, hypothyroidism is caused by Hashimoto’s, an autoimmune thyroid disease. Since most of the immune system is situated in the gastrointestinal (GI) tract, poor gut health is a significant factor in triggering and exacerbating autoimmune diseases such as Hashimoto’s. An important step in taming Hashimoto’s is to repair gut health.

Conversely, appropriately managing Hashimoto’s and restoring thyroid function can help improve digestive function. Studies show both T4 and T3 protect the intestinal lining from ulcers. Studies also show hypothyroidism can cause intestinal permeability, or “leaky gut,” which allows undigested food into the bloodstream and instigates an immune attack. These are examples of the thyroid-gut vicious cycle and how you may need to go after both fronts at once.

Gut flora and T3
Our digestive tracts host an array of bacteria that contribute to our health in a number of ways. One way is in the production of active thyroid hormones. A whopping 20 percent of thyroid function depends on a sufficient supply of healthy gut bacteria to convert T4 to T3. When diets are poor and digestion falters, dysbiosis, an overabundance of bad bacteria, crowds out the beneficial bacteria, thus hampering the production of active thyroid hormone. Studies have also shown that bacterial gut infections reduce thyroid hormone levels, dull thyroid hormone receptor sites, increase the amount of inactive T3, decrease TSH, and promote autoimmune thyroid disorders. Additionally, some studies have found connections between Yersinia enterocolitica and Hashimoto’s disease—antibodies to this bacteria are 14 times higher in people with Hashimoto’s. Maintaining healthy gut flora and addressing bacterial overgrowth is an important component of good thyroid function.

Low stomach acid
Hypothyroidism contributes to hypochlorhydria, a condition in which stomach acid is too low. For someone with acid reflux this may sound like a good thing, but in fact low stomach acid often causes heartburn. When hydrochloric acid is low the stomach cannot digest food thoroughly. The food in the stomach begins to rot and putrify. The small intestine attempts to reject this rotting mess, so the putrified food shoots back up into the esophagus. Though the food is not acidic enough for the small intestine, it is too acidic for the delicate tissue of the esophagus and causes painful heartburn. When this poorly digested food eventually does make its way into the digestive tract, it contributes to intestinal inflammation, infection, and leaky gut.

Although hypothyroidism can contribute to low stomach acid, low stomach acid can also contribute to hypothyroidism. It’s estimated more than 90 percent of the population suffers from hypochlorhydria, due to nutrition-poor diets of processed foods. The digestive dysfunctions stemming from low stomach acid likewise set the stage for autoimmune disease, chronic stress, and poor absorption of nutrients, all of which can lead to hypothyroidism.

Poor gallbladder function
Many people don’t realize how important the gallbladder is for proper digestion. It secretes bile to emulsify fats, which in turns aids in mineral absorption and prevents irritation of the GI tract. Hypothyroidism can cause the gallbladder to become sluggish and congested. A sluggish gallbladder increases the risk of gallstones; studies show more gallstones and bile duct stones among those with hypothyroidism.

A sluggish gallbladder also hinders the liver’s ability to detoxify. Poor liver detoxification not only hinders the conversion of T4 to T3, but also prevents the elimination of excess estrogen. As a consequence excess estrogen leads to an over abundance of the thyroid-binding proteins that transport thyroid hormones through the bloodstream. Too many thyroid-binding thyroid hormones prevent thyroid hormones from getting into the cells and hypothyroid symptoms ensue.

Repairing the gut begins at the plate
The topic of repairing digestive health is discussed in my book, and is worthy of a book in itself. However a few key points are worth mentioning again:

Food intolerances
The Elimination/Provocation Diet requires you eliminate gluten, dairy, eggs, soy, corn, and yeast for two to three weeks, and then reintroduce each food every 72 hours to monitor reactions. It’s imperative to eliminate problem foods to support gut health. And of course if you have Hashimoto’s you should be on a strict gluten-free diet anyway, as the book explains.

The 4-R program
In the book Dr.K goes over the basics of restoring gut integrity, which is known as the 4-R program. The remove phase removes harmful foods from your diet and eradicates bacterial and/or parasitic infections. The reinoculate phase restores healthy gut flora, necessary for T3 conversions, with probiotics. The replace phase includes support for hydrochloric acid, digestive enzymes, and gallbladder function until your GI tract is up and running on its own again. Lastly, the repair phase includes the use of specific herbs and nutrients to reduce gastric inflammation and regenerate the intestinal walls.

Manage stress and blood sugar swings
Chronic stressors lead to either too much or too little of the stress hormone cortisol. Studies show both extremes weaken the integrity of the GI tract. Blood sugar imbalances from diabetes, insulin resistance, or hypoglycemia are the most common chronic stressors today, and contribute to poor GI and thyroid health.

Address small intestinal bacterial overgrowth
Although dysbiosis in the large intestine has been the target of attention for some time, newer research is showing the importance of addressing dysbiosis in the small intestine. Dr.K finds a monosaccharide diet to be quite effective in managing this issue. As Dr.K mentioned in last month’s article, this is a diet akin to the GAPS diet that eliminates all grains, starchy vegetables (such as potatoes), and sweeteners except for honey. It also includes daily consumption of homemade bone broths, which are soothing to the gastric lining. For people who find a gluten-free diet isn’t delivering the expected benefits, a monosaccharide diet may be the next step.

Don’t remove the engine light
The topic of restoring digestive health is vast and formidable, and this overview in no way constitutes a comprehensive approach. Instead it is an introduction to some fundamentals of thyroid health that go beyond thyroid meds and supplements. As Dr.K mentions in the introduction to his book, poor thyroid function is like the engine light in your car turning on—it’s an indication to open the hood, investigate the engine, and repair what’s wrong. You don’t want to just take a drug or a supplement that will make the engine light go off.

Given the deleterious combination of poor diets, blood sugar imbalances, and the chronically stressful lives so prevalent today, the gut is usually the first to complain. Don’t ignore what it has to say with the use of over-the-counter medicines. When it goes down other systems in the body quickly follow suit, including the thyroid (the brain is also severely impacted, which will be the topic of my next book). When you set about recovering your thyroid health, it’s imperative you address digestive health as well.

Writing in JAMA, researchers detail an investigation using Medicare claims data between 2002 and 2007. During that period, the overall number of lumbar stenosis operations declined slightly, while use of the most complex approach increased some 15-fold.

In examining 2007 data, the researchers found that more complex fusion operations had double the rate of major medical complications and double the 30-day mortality of decompression alone. The average hospital charge for the more complex procedure was some $80,000 — versus $24,000 for decompression.

An editorialist concludes that “conflicting economic incentives are clearly at work,” noting that a surgeon’s reimbursement for the more complex approach can be ten times that of simple decompression. Current financial incentives and market forces in medicine, he says, amount to “a formidable economic and social problem.”

 Archives of Internal Medicine article (Free)

Archives of Internal Medicine commentary (Subscription required)

American College of Physicians/American Pain Society guideline on managing low back pain (Free)

General practitioners rarely follow guidelines when managing new episodes of low back pain, reports the Archives of Internal Medicine. (The analysis was conducted in Australia, but the guidelines assessed match those in the U.S.)

 Researchers examined data on some 1700 visits to GPs for new low back pain from 2005 to 2008, after national guidelines for treating musculoskeletal pain were released. Among the findings:

 Although guidelines recommend acetaminophen as a first-line analgesic, it was prescribed for only 18% of patients. NSAIDs and opioids were prescribed for 37% and 20%, respectively.

• One fourth of patients were referred for imaging, despite guidelines advising against routine referral.
• Only one fifth of patients received advice and education as recommended.

 These findings were similar to those from the period before guideline publication.

 The authors conclude: “The results indicate that in most cases, usual care is not evidence-based care and so is not likely to provide the best outcomes.”

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OBJECTIVE: The purpose of this study was to investigate the effects of phototherapy on delayed onset muscle soreness (DOMS) as measured using the Visual Analog Scale (VAS), McGill Pain Questionnaire, Resting Angle (RANG), and girth measurements.
BACKGROUND DATA: Previous research has failed to prove the beneficial effects of phototherapy on DOMS.
METHODS: This was a randomized double-blind controlled study with 27 subjects (18-35 years) assigned to one of three groups. The experimental group received 8 J/cm2 of phototherapy each day for five consecutive days using super luminous diodes with wavelengths of 880 and visible diodes of 660 nm at three standardized sites over the musculotendinous junction of the bicep. The sham group received identical treatment from a dummy cluster. The controls did not receive treatment. The study was completed over five consecutive days: on day one baseline measurements of RANG and upper arm girths were recorded prior to DOMS induction. On days 2-5, RANG, girth, and pain were assessed using VAS and the McGill Pain Questionnaire.
RESULTS: The experimental group exhibited a significant decrease in pain associated with DOMS compared to the control (p=0.01) and sham groups (p=0.03) based upon the VAS at the 48-h period. The McGill Pain Questionnaire showed a significant difference in pain scores at the 48-h period between the experimental and the sham groups (p=0.01). There were no significant differences day to day and between the groups with respect to girth and RANG.
CONCLUSION: The results of this study provide scientific evidence that phototherapy as used in this study provides a beneficial effect to patients who may experience DOMS after a novel exercise session.

PMID: 16875447 [PubMed - indexed for MEDLINE]

Effect of 655-nm low-level laser therapy on exercise-induced skeletal muscle fatigue in humans.Leal Junior EC, Lopes-Martins RA, Dalan F, Ferrari M, Sbabo FM, Generosi RA, Baroni BM, Penna SC, Iversen VV, Bjordal JM.
Laboratory of Human Movement, University of Caxias do Sul, Caxias do Sul, RS, Brazil. ecplealj@ucs.br

OBJECTIVE: To investigate if development of skeletal muscle fatigue during repeated voluntary biceps contractions could be attenuated by low-level laser therapy (LLLT).
BACKGROUND DATA: Previous animal studies have indicated that LLLT can reduce oxidative stress and delay the onset of skeletal muscle fatigue.
MATERIALS AND METHODS: Twelve male professional volleyball players were entered into a randomized double-blind placebo-controlled trial, for two sessions (on day 1 and day at a 1-wk interval, with both groups performing as many voluntary biceps contractions as possible, with a load of 75% of the maximal voluntary contraction force (MVC). At the second session on day 8, the groups were either given LLLT (655 nm) of 5 J at an energy density of 500 J/cm2 administered at each of four points along the middle of the biceps muscle belly, or placebo LLLT in the same manner immediately before the exercise session. The number of muscle contractions with 75% of MVC was counted by a blinded observer and blood lactate concentration was measured.
RESULTS: Compared to the first session (on day 1), the mean number of repetitions increased significantly by 8.5 repetitions (+/- 1.9) in the active LLLT group at the second session (on day 8), while in the placebo LLLT group the increase was only 2.7 repetitions (+/- 2.9) (p = 0.0001). At the second session, blood lactate levels increased from a pre-exercise mean of 2.4 mmol/L (+/- 0.5 mmol/L), to 3.6 mmol/L (+/- 0.5 mmol/L) in the placebo group, and to 3.8 mmol/L (+/- 0.4 mmol/L) in the active LLLT group after exercise, but this difference between groups was not statistically significant.
CONCLUSION: We conclude that LLLT appears to delay the onset of muscle fatigue and exhaustion by a local mechanism in spite of increased blood lactate levels.

PMID: 18817474 [PubMed - indexed for MEDLINE]

Effects of low-level laser irradiation on rat skeletal muscle injury after eccentric exercise.Liu XG, Zhou YJ, Liu TC, Yuan JQ.
Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China.

BACKGROUND AND OBJECTIVE: The effect of photobiomodulation on delayed onset muscle soreness remains unknown. This study represents the first investigation of this treatment using an animal model.
METHODS: Seventy-two Sprague-Dawley rats were randomly divided into five groups: sedentary control group, exercise control group and three exercise-plus-laser groups. Downhill running was used to induce muscle injury in the gastrocnemius muscle. He-Ne laser irradiations were administered to the injured muscles immediately and at 18 and 42 h after exercise in the three exercise-plus-laser groups at 12, 28, and 43 J/cm2, respectively. Histological examination and serum creatine kinase (CK), muscle superoxide dismutase (SOD) and malondialdehyde (MDA) analyses were done at 24 and 48 h after exercise.
RESULTS: The exercise control group exhibited a marked inflammation in the gastrocnemius muscle and significant elevations in serum CK activity and muscle MDA level after downhill running. He-Ne laser irradiation at 43 J/cm2 inhibited muscle inflammation, significantly enhanced muscle SOD activity and significantly reduced serum CK activity and muscle MDA level at both 24 and 48 h after exercise, whereas the irradiation at 12 or 28 J/cm2 slightly inhibited muscle inflammation and significantly reduced serum CK activity at 48 h after exercise only (P < 0.05).
CONCLUSIONS: Low-level He-Ne laser therapy could exert therapeutic effects on eccentric exercise-induced rat muscle injury through enhancing muscle anti-oxidative capacity and reducing the inflammatory reaction. The photobiomodulation was dose-dependent, and the 43 J/cm2 dose was the most efficient among the doses used.

PMID: 19697999 [PubMed - in process]

Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist and will be available as a once-daily injection.

Results of clinical trials of liraglutide suggested an increased risk for pancreatitis, compared with other diabetes medications. The most frequent side effects included headache, nausea, and diarrhea. Animal studies showed an increased risk for tumors of the thyroid gland, but it is not clear whether the drug also causes thyroid problems in humans.

As part of the drug’s approval, the company must conduct additional studies on cardiovascular safety and other adverse effects.

FDA news release (Free)

FDA Q&A on liraglutide safety (Free)

The side effects are worse than the disease. Why not try a natural approach to control your blood sugar, which includes eating right (probably not what you’ve ever been told), proper supplements and exercise? Too hard? Easier to just take a pill or shot? Take control of your health today.

1. Low level laser therapy reduces : Inflammation in activated achilles tendinitis

   BJORDAL Jan Magnus ; IVERSEN Vegard ; BRANDAO MARTINS-LOPES Rodrigo Alvaro ;
   Progress in biomedical optics and imaging ISSN 1605-7422
   2006, vol. 7, no26, [Note(s): 31400G.1-61400G.8]
   Society of Photo-Optical Instrumentation Engineers, Belligham, ETATS-UNIS (2001) (Revue)

   Objective: Low level laser therapy (LLLT) has been forwarded as therapy for osteoarthritis and tendinopathy. Results in animal and cell studies suggest that LLLT may act through a biological mechanism of inflammatory modulation. The current study was designed to investigate if LLLT has an anti-inflammatory effect on activated tendinitis of the Achilles tendon.
   Methods: Seven patients with bilateral Achilles tendonitis (14 tendons) who had aggravated symptoms by pain-inducing activity immediately prior to the study. LLLT (1.8 Joules for each of three points along the Achilles tendon with 904nm infrared laser) and placebo LLLT were administered to either Achilles tendons in a random order to which patients and therapist were blinded. Inflammation was examined by 1) mini-invasive microdialysis for measuring the concentration of inflammatory marker PGE2 in the peritendinous tissue, 2) ultrasound with Doppler measurement of peri- and intratendinous blood flow, 3) pressure pain algometry and 4) single hop test.
   Results: PGE2- levels were significantly reduced at 75, 90 and 105 minutes after active LLLT compared both to pre-treatment levels (p=0.026) and to placebo LLLT (p=0.009). Changes in pressure pain threshold (PPT) were significantly different (P=0.012) between groups. PPT increased by a mean value of 0.19 kg/cm2 [95%CI:0.04 to 0.34] after treatment in the active LLLT group, while pressure pain threshold was reduced by -0.20 kg/cm2 [95%CI:-0.45 to 0.05] after placebo LLLT.
   Conclusion: LLLT can be used to reduce inflammatory musculskeletal pain as it reduces inflammation and increases pressure pain threshold levels in activity-induced pain episodes of Achilles tendinopathy.

   Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes With Chronic Achilles Tendinopathy

   Apostolos Stergioulas, PT, PhD*, Marianna Stergioula, PT*, Reidar Aarskog, PT, MSc , Rodrigo A. B. Lopes-Martins, MPharm, PhD and Jan M. Bjordal, PT, PhD ,||, From the * Faculty of Human Movement and Quality of Life, Peloponnese University, Sparta, Laconia, Greece, the Institute of Physical Therapy, Bergen University College, Bergen, Norway, the Laboratory of Pharmacology and Phototherapy of Inflammation, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil, and the || Section of Physiotherapy Science, Department of Public Health and Primary Care, University of Bergen, Bergen, Norway Address correspondence to Jan M. Bjordal, PT, PhD, Institute of Physical Therapy, Bergen University College, Mollendalsvn 6, 5009 Bergen, Norway (e-mail: jmb@hib.no ).

   Background: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset.

   Hypothesis: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement.

   Study Design: Randomized controlled trial; Level of evidence, 1.

   Methods: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy ( = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm2 and a total dose of 5.4 J per session.

   Results: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group.

   Conclusion: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

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Journal Watch General Medicine summary of 2005 study showing that vitamin D supplementation reduces risk for falls (Your Journal Watch registration required)

High doses of supplemental vitamin D may lower the risk for falls in older adults, reports a BMJ meta-analysis.Researchers examined data from eight randomized controlled trials of supplemental vitamin D (vitamin D2 or D3) in roughly 2400 adults aged 65 or older. Among the findings:

 Supplemental vitamin D at 700 to 1000 IU/day (but not lower doses) was associated with a significant, 19% reduction in falls relative to no supplementation.

• Serum vitamin D concentrations of 60 nmol/L or higher were associated with a 23% drop in falls (lower concentrations showed no significant association).

Researchers also looked at two trials of some 600 older adults and active vitamin D, a metabolite that may be more readily available for people with diminished kidney function. The reduction in falls was similar to that seen with supplemental vitamin D. However, patients taking the active form were more likely to experience hypercalcemia than controls.

 As a potential underlying mechanism, the authors note that vitamin D has direct effects on muscle strength.