Helping Yourself in Thyroiditis

Helping Yourself in Thyroiditis Dr. Dana F. Flavin, M.D. Executive Director Foundation for Collaborative Medicine and Research www.collmed.com INTRODUCTION Every patient has a right to a treatment, and every physician has the obligation to find one. If our traditional, standard treatments do not have any success in patients, then the physicians must look for new and alternative possibilities to help those patients. I was tired of hearing stories of failures from our conventional medicine by colleagues and patients, and the patients being told, „There isn’t anything else that we can do“! I was tired of seeing people suffering, knowing that there were possibilities to help. My colleagues would tell me „We don’t have enough data, “and I would answer „When will we have enough data? “ I saw these people suffering, and I suffered with them. I decided it was time to do something NOW! I began to look for help for all of these patients suffering from inflammatory diseases, viruses, autoimmune diseases and even cancer. This has not been an easy task, but a rewarding one. For over twenty years I have been searching the literature for the mechanisms of inflammation and how we can stop it. I first began to look for new or old substances that could inhibit pathways of toxicity in our bodies, preventing cancer, and fighting inflammatory diseases. I was overwhelmed, when I saw that many of these substances were natural food derivatives, vitamins and fatty acids. I had read of Paracelsus and Hippocrates saying the cures were around us, and that it was only a matter of dosage, but to be honest, I was skeptical. How could a food or a vitamin possibly be potent enough to stop diseases like Multiple Sclerosis, Rheumatoid Arthritis, Ulcerative Colitis, Morbus Crohn, fulminate viral infections etc. etc. I doubted there could be anything so simple, and I had no idea then, how very complicated it would become for me to find these answers. My first inclination that toxicity could be affected by nutrients was during the time I was writing a ten chapter book on the mechanism of toxicity in cancer development at the Food and Drug Administration. I had been appointed the literature on the mechanisms of action of toxicity in inflammatory diseases. There Science Assistant to the Associate Bureau Director for Toxicology at the age of 30, and was still somewhat of a beginner in the whole area of inflammatory diseases. I had studied several years of medicine, but concentrated mostly on Pharmacology. While I was on the third chapter of my book, I read that one of the enzymes that is activate in cancer and in tumor promotion was inhibited by Vitamin A. I was stunned! How on earth could a simple vitamin have an effect on cancer, on toxicity, and on the development of a disease? The more I read, the more I learned, and the more I learned the more I realized that indeed nutrients can have a pharmacological activity depending on the application and their dosage. I become totally involved in my work, and have not let up since in my pursuit of knowledge to help relieve the suffering of patients. After obtaining another degree, this time in Nutrient Biochemistry, summa cum Laude, I moved to Germany. I decided to complete my degree in Medicine. I began my studies full time, but still searched the literature every week. There was almost a logarithmic increase in information elaborating on more biochemical influences from diseases in the body. There were, in addition, more causes of toxicity, and most important, many newly discovered, or rediscovered, natural substances that could be effective in my search for inhibitors to apply where our school medicine had failed. I was very busy. My studies were extremely strenuous, especially since they were all in German, but my pleasure came from my weekly reports and literature searches giving me more depth and more insight into what had now become my personal cause, stopping suffering. This book is not designed to replace conventional medicine, but rather to benefit the patients where conventional medicine has either failed, had too many side effects, or where there were no treatments. In some cases, these nutrient supplements are combined with conventional medicine to decrease the dosage of the medicines required and/or to decrease the side effects. Most cases only need the nutrients; however, in extreme cases, or in situations where the patients are under other stresses, it is sometimes necessary to coordinate the conventional medicines with nutrients and diet. The requirement for steroids is most often eliminated, except in acute attacks of inflammation in autoimmune diseases such as asthma or multiple sclerosis. Here, the use of steroids for a short period of time is not only useful, but often mandatory and many times life saving. After many years of research and completing my studies, I began treating patients with natural substances where they were needed. In certain viral diseases, there were no treatments. These cases were very difficult, and often I had to use every bit of new knowledge I had researched over twenty years, to help these patients. When I began curing children with toxically enlarged livers and spleens from mononucleosis in 24 hours, I realized I had indeed come very far. Then, more patients came to me, with Rheuma, Multiple Sclerosis, Ulcerative colitis, a debilitating disease of the intestines, etc., and each and every one was dramatically improved on my natural nutritional supplements. I was overwhelmed at how all these natural compounds when put in the right combination could stop suffering, and allow patients to begin to live normal lives again. This book is devoted to all of my patients and to my colleagues who had faith in my goal to find new treatments, support measures and nutritional supplements, and who helped me develop these through their testing them for me. Most important, I would like to say to all those patients who thought there was nothing else that could help them. There is! CHAPTER I The Mechanisms of Toxicity in Autoimmune diseases: What is Inflammation and why is it there? Do you remember when our Grandmother’s told us „If it hurts, it is helping!” Well, that may not be entirely true, but our bodies are trying to help us in inflammation to eliminate something that it thinks is bad for us. Often pain is a savior that leads us to the doctor to investigate what might be wrong, either in our bodies, or sometimes in our minds. Regardless, it is a messenger to warn us. When we have a bacterial infection, for example, the inflammation brings in white blood cells to destroy the bacteria. In fact, they gobble up the bacteria, and kill it right inside these white blood cells that are there to protect us. Sometimes, there are too many bacteria, or the cells are not strong enough to eliminate all of them and we then need to rely on antibiotics. The main problems are seen, when we have an illness that is caused by our immune system erroneously recognizing a part of our tissues, or proteins, which are called antigens, and attacking it. In cases of viral infections there often isn’t any good treatment available. In viral infections, the inflammatory cells cannot get to the virus, and try to destroy the tissue where the virus is hiding. In the former situation, it is most often an autoimmune disease. This is when our bodies, for some reason, (some think it may have to do with viruses too) don’t recognize a certain surface substance or antigen that is actually a normal protein in our bodies, and our immune system thinks it could be harmful for us. The list of autoimmune diseases, like Rheumatoid arthritis, Morbus crohn, Ulcerative colitis, Systemic Lupus Erythematosus, Multiple Sclerosis, Autoimmune hepatitis, and many, many more is very long and each disease is responsible for a tremendous amount of suffering, robbing their victims of a normal happy life. The quality of life for those constantly in pain is so miserable that they often live a daily hell. What happens in our bodies when there is an autoimmune disease is that our antibody producing cells, the B-cells (part of the Th-1 system), release antibodies to substances that should be recognized as part of our own body. Instead, our body thinks it must be attacked. Indeed, that is what happens. The antibodies are substances that are designed to bind onto the „bad“protein structures, like a specific key to a lock. No other antibody can fit in that lock, but hundreds of antibodies can be produced, in fact, thousands can be produced, to continuously try to destroy that substance they are bound to. If those substances are a membrane around a joint, the whole joint is in pain, and is inflamed. As if that alone were not bad enough, there are substances formed in the body that work with the antibodies to enhance their toxicity. These substances are general in inflammations, but there ability to determine the intensity of the inflammation and the pain of the inflammation is overwhelming. An antibody without these substances is not very effective to cause inflammation and pain. Indeed, that is why I decided to see if we could change the effect of these substances. One group of these substances is called prostaglandins. These are what we inhibit when we take aspirin. If we could take aspirin everyday when we have pain and inflammation, without any side effects, then I wouldn’t have written this book. And, if the new, what are called, „Non Steroidal Anti-inflammatory Drugs“ were without side effects, again, I wouldn’t need to write this. Unfortunately, the side effects of these drugs can not only dangerous, in some situations, they have been deadly. The side effects include, stomach ulcers, intestinal bleeding, and even kidney failure, is not uncommon. Another group of substances in the body that enhance toxicity are the cytokines. These chemical substances are formed and released from various cell types, including most of the white blood cells. They often set off chains of reactions leading to a myriad of factors that elaborate the toxicity and inflammation to the body. We need them to fight bacteria and fungus, but we sure don’t want them, fighting against our own bodies as we see in autoimmune diseases. There are also enzymes in defense cells and in the blood and blood vessels that generate toxic products such as superoxide’s, peroxides and gases. These include xanthine oxidase, NADPH oxidase, inducible Nitric Oxide Synthase, t mention a few. It is like butter turning rancid in seconds to be toxic to something. These products from the enzymes are very effective in destroying bacteria and fungi, but alas, are also capable of destroying tissues, as seen in arthritis, organs in hepatitis, and causing death, in septic shock. As you can see, I have had a lot of toxic substances to work against to help my patients get better. I read about each and every prostaglandin, cytokine, enzyme and all of their products and started to develop a plan of defense for our bodies. I saw that just decreasing one toxic substance was not enough. We needed combinations of inhibitors to prevent the suffering from these diseases. We needed to be able to protect ourselves from unnecessary toxicity, without at the same time lowering our defenses against an overgrowth of bacteria, fungi, parasites or indeed cancer. Many of these toxic substances are inhibited by steroids, such as prednisone, and hydrocortisone. However, the problems come, when we apply these steroids over a long period of time. Then our entire immune system is weakened, our bodies don’t heal properly and our muscles weaken, including our heart. These effects in addition to water retention, hair loss, weight gain, acne, and so on, often cause the patients tremendous difficulties and not that rarely, death. There is no doubt, that short term use of steroids, can be not only effective, but life saving. It is however, not such a good idea to continue a patient on them for their entire life, especially when something safer and just as effective can be used instead. There is an alternative nutrient that can be given instead of steroids, which inhibits the same toxic cytokines as cortisone, dexamethasone, and prednisone. It was a surprise to me as well, when I read that it was fish oil. (Not cod liver oil, that is different because it has high levels of vitamin D and A, which can be toxic.) The omega 3-fatty acids, from normal fish oil, such as from salmon, shift the synthesis of the same toxic cytokines that the steroids inhibit, but fish oil does not have any negative side effects. I couldn’t believe this when I read it. So, all those stories of people taking fish oil for rheuma were not some fiction story, but it actually worked. I was also interested in what could go wrong in the treatments. I found out, for example that red meat could reduce the efficacy, of fish oil. In fact, a diet with lots of pork, beef, and animal fats could shift the toxicity right back to the cytokines I wanted to suppress. Different fats cause the development of different products. I saw this in a few patients who ate a steak and in the following morning or during the night, had pains and inflammation. I also found out that the iron was enhancing the reaction of toxicity, and that a little iron in the body was good, but too much was not. In fact, in the olden days they used to bleed the patients, or put leeches on them to suck out the blood. Pretty barbaric, I must admit. Sometimes, however, they still do blood letting as part of a treatment, as in viral hepatitis; and sure enough, the men, who have more stored iron in their livers, do respond better to some of our conventional antiviral treatments for example, with a newly synthesized substance, that is also in our bodies, called interferon Remember the old saying „Feed a cold, starve a fever“? Well, a cold in its beginning needs our immune system strong to fight it, and destroy the cold infected cells, but once a fever sets in, from these cytokines, and then animal fats increase the toxicity and the fever. It is amazing how so many of these old sayings are valid. I asked myself after I had read all of this, „What else can we give to stop toxicity? “ I began to read more about antioxidants, and how they helped decrease these toxic superoxide radicals and peroxides and indeed helped us to enhance natural substances in the body that could decrease toxicity. I had known about antioxidants, like vitamin E, vitamin C, carotenes, and natural substances called flavinoids in lots of vegetables and red fruit juices back in the late ´70´s, and how they prevented cancer induction, but I didn’t realize at the time that they could and were effective in helping to fight against toxicity in inflammatory diseases. Some of the ancient treatments from China and Japan, North Africa and South America for inflammatory diseases have many, many different types of antioxidants, even more than we had ever known about years ago. Some of the other nutrients that I read about in helping diseases were some of the B vitamins, such as Riboflavin, which has very similar substances as the marine distal, silymarin, used in liver toxicity. One can use the vitamin form, or the plant form, and I often include Nicotinamide. Not niacin, that is different and causes a flush, plus it does not have the same activity that is needed in inflammation. Nicotinamide, or niacinamide, is also a B vitamin, a little different than the normal nicotinic acid, seen in most vitamin supplements, and it has more anti-toxic effects. It inhibits a rather toxic substance called Tumor Necrosing Factor. The name itself sounds pretty toxic, and indeed it is. Some scientists tested nicotinamide in animals with skin diseases, or in pancreas diseases and it helped eliminate the toxicity. Imagine a simple vitamin, is not so simple, and can even work like a drug, or medication if given in the correct combination and/or in the right dosage. One last area of toxicity that is pretty interesting is in relation to a gas, called nitric oxide. Nitrites in general can cause toxicity also to bacteria, and that is why they are used in sliced meats, to prevent bacterial growth. Unfortunately, when they are consumed by patients who have inflammatory diseases they can enhance the toxicity that is why I recommend a diet without cold cuts too. I found out that thiol groups, little SH groups, like alpha lipoic acid, methionine, and N-acetylcysteine, could also have an effect on the gas toxicity, and decrease it by binding it. I was amazed that even garlic and onions were high in these substances, and that they often worked hand in hand with a mineral called selenium. I decided to use cysteines, methionines, alpha lipoic acids and other natural substances where I could judge the dosage better, but still recommend lots of garlic and onions. Last but not least, I looked at what could inhibit some of these radical generating enzymes. One enzyme is called xanthine oxidase, and is most commonly known for gout, but it is also toxic without uric acid crystals. It generates a superoxide radical. Another Enzyme that does the same is NADPH oxidase, located in white blood cells, and in the blood vessel walls. I was quite surprised to find out that licorice root could inhibit the former one, and that a plant called gingko biloba could indeed inhibit the latter. What all this was telling me was that plants, vitamins, natural nutrients and food substances, not to mention diet, all could change the outcome of diseases. As I began testing this in one patient after another, and began to see the incredible positive results of decreased inflammation, no more toxicity, remissions in patient after patient, I KNEW we could help those patients who thought nothing else could stop their suffering. I was seeing this in case after case, and the patients were learning to help themselves. It was quite remarkable to hear one patient after another tell about how many years they suffered, and how nothing helped until they took my recommendations. I was delighted, and at the same time very surprised myself that the theory indeed worked in so many patients and so well. Only a few patients had the need for some of the conventional medicines with their treatment, but this was fortunately, very seldom. I told them not to be discouraged, it was still helping, but sometimes they needed additional protective substances or some of our conventional medicines combined with these nutrients. Those who did take some of the conventional medicines had fewer side effects from these drugs, and still did not, in the majority of all cases, need steroids. Inflammation can be stopped successfully with nutrient supplements and diet, more than I had ever dreamed could be possible when I began to put this puzzle together twenty two years ago. TOXICITIES IN INFLAMMATION: Xanthine oxidase, NADPH oxidase, inducible Nitric Oxide Synthase, Antibodies, macrophages, lymphocytes, ADP ribosylase, Bradykinins, COX 2(Prostaglandin E2), Cytokines, IL-1b, 2, 6, etc., Tumor Necrosing Factor a, leukotrienes, complement, peroxynitrite, superoxide radicals, hydroxy radicals, nitroxy radicals, and many more yet to be discovered substances. INHIBITORS OF INFLAMMATION: Omega-3 fatty acids, Vitamin C, E, beta carotene, flavinoids(including silymarin), nicotinamide, gingko biloba, coenzyme Q, melatonin, methionine, alpha lipoic acid, n-acetylcysteine, selenium, taurine, lysine. Many, many plants are also included her such as devils claw, licorice root, spices etched. ATTENTION: No nutrient supplements should be taken until the patient has had a thorough examination by his or her physician, and an accurate diagnosis of his or her illness established. In addition, all treatments natural or otherwise should be accompanied by a physician or health expert in these areas. All compounds, natural or synthetic, have the potential of having side effects and must be supervised by health experts. eg. Patients who are on blood thinners must be monitored for any changes following vitamin E and selenium consumption as they can prolong bleeding time and the dosage of their blood thinning medication may need to be changed. This may also lead to problems with patients who have ulcers, hemorrhoids, any bleeding disorders or high blood pressure. BIOCHEMICAL MECHANISMS OF NUTRIENTS IN INFLAMMATION Toxicity Inhibitor _______________ _________________ IL-1ß IL-2 IL-6 etc. Omega 3-Fatty Acids Xanthine oxidase TNFa iNOS Tumor Necrosing Factor (TNFa) Nicotinamide Inducible Nitric Oxide Synthase (iNOS) ADP ribosylase Xanthine Oxidase (XO) Flavinoids/Silymarin PGE2 Curcumin Superoxide radicals Alpha tocopherol/Vit E Singlet Oxygen Cats Claw, Boswellia serrata Devils claw Peroxynitrite Methionine Selenium Superoxide radicals Ascorbic acid/Vit C Beta carotene Alpha Lipoic acid Nitric oxide N-acetylcysteine Methionine NADPH oxidase Gingko biloba There are many other substances that are also very helpful in inflammatory diseases, and sometimes with extremely complicated illnesses they may be needed in addition to what is already mentioned. Coenzyme Q, quercetin, etc. and many other substances have also been shown to be effective oxygen radical scavengers. VIRAL PROTECTIVE NUTRIENTS Protection Enhancement: Nutrient: ______________________ _________________ Glutathione Peroxidase N-acetylcysteine Selenium Tetrahydrobiopterin Zinc (synthesis) Folic acid Interferon gamma Succus Liquiriteae (increased) (glycyrrhicinic acid) Complement inhibition ß-glucuronidase inhibition Th-1 lymphocytes increased Alpha Lipoic acid (anti-viral, anti-cancer) Methionine N-acetylcysteine Allergies Toxicity: Prevention: Cytokine Activation of Mast cell Omega-3-fatty acids Histamine Release. Mast cell Histamine Release Vitamin B 6 Histamine Degradation Vitamin C ___________________________________________________________________ Protection Against Apoptosis/Nerves/Brain: Dehydroepiandosterone (DHEA) Melatonin Arginine Chapter II Autoimmune Thyroid Disease (Grave´s Disease and Hashimoto´s Disease) The thyroid is responsible for our metabolism including everything from growth, muscle activity, calcium and phosphate levels, glucose and protein synthesis and sensitivity to catecholamines that stimulate the heart and affect the mood. In other words when this part of our body is not working properly everything and anything can go haywire. The active form of the thyroid hormone is the T3. This actually comes from T4 which has four iodines bound to it and one is released when an active T3 is needed. The rest stays in a form of rT3, which is reversed T3 and is also inactive. Sometimes there are cases where the T3 doesn’t become activated from T4. This is fortunately not very frequent, but none the less it can be a puzzle for many physicians who only look at the basic T3 levels, without differentiating T3 and rT3. The activity of the thyroid comes from the brain hypothalamus, where TRH (thyroid releasing hormone) is released. The TRH causes the further release of TSH (thyroid releasing hormone) from the hypophysis in the brain (pituitary gland) to cause an increase uptake of iodine from the intestines, as well as an increase release of stored thyroid hormone from the thyroid gland. Another activity of the thyroid however, comes from antibodies directed against it. Sometime these are stimulatory antibodies, TSI (Thyroid Stimulating Immunoglobulins), as seen in Grave´s disease. Other antibodies can be destructive and actually inhibit the thyroid activity as we see in Hashimoto´s disease.. GRAVE`S DISEASE: (Parry´s or Basedow´s Disease) Major Manifestations: Hyperthyroidism with diffuse goiter, ophthalmopathy, and dermopathy. All three may not necessarily appear together. Clinical symptoms: Goiter in 70-90% of the patients. Nervousness, emotional instability, inability to sleep, tremors, frequent bowel movements, excessive sweating and heat intolerance. Increased appetite, weight loss, muscle weakness (difficulty climbing stairs). In younger woman, oligomenorrhea or amenorrhea (period disorders). Dyspnea, palpitations, (angina pectoris or cardiac failure in older patients.) Anxious, restless and fidgety. Warm skin and thin hair. Rarely seen, is an increase in glycosaminoglycans in front of the tibia (shin bone), called myxedema. Clubbing of the fingers and toes may sometimes be seen. Ocular symptoms: 50% of patients. Exophthalmia (protruding eyes) less blinking, lid lag, failure to wrinkle the brow on an upward gaze. Mechanical caused changes can lead to ulcers of the eyes, frequent eye infections, swelling and sometimes, optic atrophy. Differential Diagnosis: Psychosis, Anxiety attacks, anorexia, occasionally confused with metastatic carcinoma, cirrhosis of the liver, hyperparathyroidism, sprue, myasthenia gravis and muscular dystrophy, pheochromocytoma(adrenalin producing tumor) or hormone imbalance, and sometimes hyper or hypoglycemia. Grave´s disease is a relatively common disorder that can appear at any age, but seems to be more often in women between the ages of 30 and 50. It runs in families and often overlaps with Hashimoto´s disease and other autoimmune disorders. Strangely enough sometimes the picture changes from Grave´s to Hashimoto´s hypothyroidism and the reverse is also seen. No one knows the cause of this disease, but the expression of its symptoms comes from the release of antibodies that stimulate the thyroid gland, called Thyroid-stimulating immunoglobulins (TSIs) released from the lymphocytes. The symptoms of this disease can start out slowly with predominantly nervousness and sleep disturbances in the beginning, which can lead to the patients being wrongly prescribed sleeping pills or anti-anxiety medications. Some even get sent to psychotherapists if the diagnose isn’t made properly in the beginning. The patients sweat a lot, eat more and in spite of this lose weight. One doctor colleague of mine was delighted that he was getting so thin, but his family was losing patience with his restlessness and irritability. Not until he started losing his hair, did he decided he should do some laboratory tests, and sure enough, the antibodies were elevated not only to his thyroid releasing hormone receptors, but to the enzyme peroxidase in the thyroid gland itself, showing a mixed disease. When he was finally better, after treatment, he was disappointed that he gained weight again, and I told him maybe he should eat more salad and fruit instead of pizzas and beer. Sometimes a disease like this is a message that we also need to change our lifestyle. He did, thank God, and now he is fit and much happier with himself. One of the biggest complications of this disease is the ophthalmopathy. In some cases it is irreversible, because of a build of cells behind the orbit. This can lead to horrible eye problems, and even blindness. The eye lids don’t close properly and the eyes are constantly dry leaving them susceptible to infections. There are different types of operations, laser treatments, corneal protectors etc developed, but it remains a serious problem for some patients. Fortunately this is not in every case, and is often reversible in most cases. Let me tell you how I first started treating this disease. Patient 1: When I first was asked by a Marianne to see if I could conjure up something to help her when she was rejected for a study at the University of Marburg, where a colleague of mine was doing some excellent work on new treatments, I was somewhat hesitant to take on her case. I was not sure how I could help, if all of these other treatments had not helped? However, in the old pioneer spirit, and knowing I had helped so many other autoimmune diseases, I felt I should not let her down and at least try to see if I could indeed decrease her symptoms. Endocrinology was never my favorite subject, as it interacted with dozens of different factors in the body relating to metabolism, and since we had predominantly multiple choice in medical school, it was always more than a challenge to put together all of the activities of, for example, thyroid hormones. Marianne is in her late 30´s has two children and loved to smoke cigarettes. She developed the symptoms of Grave´s disease last year in the Spring. At first she thought she was just nervous, and they checked her female hormones, which were in order, and then she began to have protruding eyes. She said she felt like she was looking at a frog in the mirror, and as she had always been a rather attractive, little blond, with a very pretty face and eyes, she was devastated. She went into a treatment at a local hospital and received radioactive iodine. This is taken up by the thyroid and literally destroys the cells that are producing the thyroid hormones. In Germany they make you stay in the hospital as they feel this could be dangerous to other persons, from the radiation that the patients have, but in America the opinion is different, as they feel this toxicity is not dangerous. Regardless, Marianne was treated with radioactive iodine, instead of surgery which was not required in her case as the goiter was rather small. They also put her on prednisone, to decrease the antibodies and hopefully help her eyes. Then she was put on an antithyroid drug for any cells that might be left to knock them out of commission, and sent home. She was on this treatment for months, and then taken off the steroids slowly to prevent any damage to her own steroid producing glands in the adrenals. The problem was, the eyes weren’t getting better and the antibodies were up again. She then came to me, and gave me her whole case history, laboratory data, etc. etc. I put her on a mixture of what I thought would be best after my experience with other autoimmune diseases, and told her to be patient. I had not applied fish oil, selenium antioxidants etc in a thyroid autoimmune disease before, but I hoped it might help. Then I phoned my colleague in Marburg and let him know what I was testing in this patient and then sent him a copy of my combination nutrient support recommendations. I told Marianne she had to cut down smoking to no more than one or two cigarettes a day, as it irritated the eyes and worsened the disease. She was reluctant, but agreed none the less. Then, I waited. After about 4-5 weeks, I received a call from her to tell me the antibodies had gone from over 400 before my treatment, to a negative of less than 4. I was delighted, but still somewhat hesitant, to be too optimistic, as she was on an antithyroid drug, which can sometimes cause a reduction of antibodies after 6 months. I sent an e-mail to my colleague and asked him if this could be a spontaneous remission. He answered that he doubted it, as he had put twenty patients on the treatment I had sent him and the success was astounding. I was more than pleased. Then I phoned Marianne back and told her the good news. We followed here progress, and her eyes responded very slowly. At first the muscles in the eyes were somewhat round, but I was told that was most likely because her thyroid hormone levels needed to be raised somewhat. The low thyroid levels can increase water build up in the muscles behind the eyes. It takes a while to reverse the swelling, and most often the eyes return to normal after many months. That is why one should never consider an eye operation until enough time has gone by to be sure it is even necessary. She has been stable and without symptoms for quite some time now, and we are hoping it remains this way. It seems that through this study I found out that I was actually reducing antibodies in autoimmune diseases. Patient 2: This young man named Marcus had heard about my work through a colleague of mine, and decided to see if I could help him. He was a very quiet, very tall dark haired man about 40 years old. He really had the pronounced eyes from Grave´s and was easy to diagnose, just looking at his surprised, frightened appearance, which was actually merely from the protruding eyes from his illness. He worked on the railroad as a planner for routing trains and hardly spoke except to answer questions I asked. He was actually very shy and quiet. He said the treatment he had had with radioactive iodine, stopped some of his problems, after he had suffered for months with wrong diagnoses. At first they thought his tachycardia (fast heart beat) was from stress from his work, and they put him on a beta blocker treatment to slow down his heart, but he was still very nervous, so they recommended a sedative to slow him down. It wasn’t until he could hardly work, and his eyes began to start bulging that they realized he might have something else wrong with him. This is not to criticize my colleagues, but sometimes we make mistakes, regardless of how thorough we think we are in our work. No one is perfect, alas, and that is why we all need to always work together for our patients. Marcus was surprised that I was recommending nutrients for a disease that was an autoimmune disease, as he said he thought only cortisone could help lower the antibodies. I said,” I used to think so too, until I found out that cortisone lowers the same toxic cytokines as fish oil, without the side effects." Then I explained to him that my colleagues and I were seeing reductions of antibodies from patients on this combination I had put together. He said he would go ahead and try it. We had higher antibodies in Marcus, than in my earlier cases, and it took about 6 weeks to bring them down to anything as good as the other patients, in other word to a negative status, but indeed it worked. His eyes however, were still protruding, and we need to make sure he is constantly under the care of an ophthalmologist until they are either totally reduced, or if they do not go back completely he must always be careful of protecting his eyes with glasses to block the wind, ultraviolet protection and eye drops daily to increase the moisture and protection. As one sees this is not an easy task and each case is different. At least Marcus does not need any beta blockers, or sedatives, and can live a relatively normal life. I want to mention this as it is important. Many, many foods contain iodine. I never realized that many animal foods are supplemented with iodine, salts, breads, cookies, candies etc, until I had a list a mile long. One must first ask, and then one must be cautious not to overdo any foods where iodine might be lurking. The possibility of reactivating the thyroid even if much of it is destroyed means a change in diet, and continuously taking the nutrients. We do not know if one can remove these nutrients from the daily regime without reactivating the antibodies to cause further symptoms. Strangely enough, although many swear that by destroying or removing the thyroid, the antibodies should not make a difference anymore, I am not seeing this. Instead, many patients don’t have a reduction is a general feeling of sluggishness and lack of energy until the antibodies are reduced. I cannot explain this, but there appears to be a reaction going on somewhere else in the body in relation to the antibodies that is yet to be identified. I only see that they feel better when the antibodies are down to negative, even though the thyroid is not producing any thyroid hormone anymore. Marcus is now taking a higher dosage of thyroid hormone as he had a drop in the T3-T4 levels after my nutrients. It is always recommended to keep checking on the levels of both antibodies and thyroid hormone levels in the blood. This enables to establish a safe healthy thyroid hormone activity level which is imperative for the well being of every patient. Hashimoto´s Disease: (Lymphadenoid Goiter ) Major Manifestations: Goiter, hypothyroidism. Clinical symptoms: Dry hair and skin, fatigue, lethargy, constipation, cold intolerance, stiffness and cramping of the muscles, carpal tunnel syndrome. Intellectual and motor activity reduction, decreased appetite and increase weight. Menorrhagia. Myxedema with a dull, expressionless facies, sparse hair periorbital puffiness, large tongue and pale cool skin that is rough and like dough in consistency. Hoarse deeper voice and decreased auditory acuity. Differential diagnosis: Parkinson´s disease, Alzheimer´s disease, depression. Chronic nephritis or nephritic syndrome. Hashimoto´s thyroiditis is a common inflammatory disease of the thyroid that is actually the most common form of thyroiditis. It is seen predominantly in woman of middle age (4th and 5th decade) and is one of the most common causes of sporadic goiter in children. This is an autoimmune disease where the lymphocytes infiltrate the gland and in the serum one sees increases of immunoglobulins sometimes in the thousands. I was totally surprised at some of the lab data indicating levels of 13,000 anti-TPO(thyroid peroxidase) or also called microsomal antibodies. There is also usually an increase in thyreoglobulin antibodies in about 70% of the cases. This disease is increasing in the United States and in Europe and it is believed that the increase in iodine ingestion is one explanation for this increase, according to Harrison´s, Principles of Internal Medicine, textbook. I was rather surprised at this as I always thought we should take more iodine, only to find out we need to be conservative and cautious in this area too. Since the major symptoms of Hashimoto´s are somewhat slow in coming, it is often thought by patients that they are merely overworked or worn out in general. When the goiter is evident they are usually showing some other symptoms at the same time, such as hair loss or dry skin and sensitivity to cold weather. Quite often Hashimoto´s patients have other members of the family who have this disease or other autoimmune disease. It coexists with pernicious anemia, Sjögrens syndrome, chronic active hepatitis, systemic lupus erythematosus, rheumatoid arthritis, adrenal insufficiency, diabetes mellitus and also Grave´s disease as mentioned above. The high antibody levels do not seem to cause blocking in the kidney, but they do affect the patients in more ways than decreasing thyroid hormone levels. Even Patients who have a substitution for thyroid show other symptoms of tiredness, weakness, sluggishness and a general feeling of being ill without any specific symptom. Many of my colleagues did not believe this until I began lowering the antibodies and the patients improved, even though the hormone levels were always maintained at a normal level. I was not sure at first if could help these patients, as everyone was so convinced the only problem was the low thyroid levels, but when my first patient told me of her difficulties and tiredness, even on thyroid hormone, I decided to at least try and help her. Patient 1: Birgit is a 42 year old owner of a bakery in Holland. One would think life couldn’t be better when one can eat all one wants, but alas, this is not always the case. Birgit spoke perfect German with a lovely French accent which added to her charm as she explained her story. She is a spunky mother of two children, small in size, but rather round in proportions, which I prefer to call „Rubenesque“, after the cute round women in Ruben’s paintings. Her roundness is not from her bakery as much as her hypothyroidism which was discovered after she was first diagnosed as having Grave´s disease. What really was happening was she was showing high levels of the thyroid hormone, T3 and T4, but later, they realized she had antibodies for Hashimoto´s disease too. In fact, at first they had put her on cortisol and then a thyroid suppressing compound called propylthiouracil, which stops the thyroid activity at the gland level. This is normally done in Grave´s disease to stop the hyperthyroid activity. In Grave´s this works, in Hashimoto´s it doesn´t. What was at first confusing was that, she had a swollen eye, and started sweating, losing hair, lost 6 kilos in 2 weeks, and the thyroid hormone levels were up, as were the thyroid stimulating antibodies, although not tremendously. However, what really surprised everyone was that when they measured the microsomal antibodies, they were over 30,000. This is what I call an autoimmune disease. She felt miserable, and the cortisol and inhibition of the thyroid didn´t help a bit. This is the problem with a mixed disease that turns out to be, after the initial stimulation of the thyroid gland, a Hashimoto´s disease. All of this began about 6 months ago, until she was finally desperate as nothing seemed to help her. She realized that the iodine that she was putting in her bakery foods in the form of iodized salt was actually worsening her condition. She went on a campaign to get the iodine out of the salt, but the government had other ideas, and didn’t seem to think her case was important. I told you she was spunky? Well, she was also very courageous, a real fighter for people suffering like herself. I admired her fight, and tried to help as much as possible, but so far it is still only a discussion. She had come to me on a referral, and brought her lab data with. I carefully read the up and down of her thyroid hormones and weight, moods, hair loss, ineffective treatments, etc. and decided to test her on the same treatment as I had given my Grave´s disease patient, in the hope that her antibodies would also decrease as it had done in my Grave´s patients. By this time when was in full blown Hashimoto´s disease and her thyroid levels were low. Whenever I am starting a treatment that has never been done before, it is always a challenge, and it means one heck of a lot of work, just balancing out the whole biochemistry of the body. One can never be sure if it will work or not. I was hopeful, however, especially since I had already seen how successful the Grave´s disease patients responded. I gave her my recommendations and told her to be patient, watch out for any iodine in foods, not to eat pork or beef, and let me know as soon as she had her antibodies tested again. I waited about 4 weeks and when I hadn´t heard anything yet, I phoned her to see how she was doing. She was so sweet apologizing over and over again, for not calling sooner. She said she felt better and her antibodies had dropped several thousand in the first few weeks, but they were waiting another week before they repeated them. I phoned back a week later, and found out the levels were reduced thousands, still a bit high, but sure enough they were slowly dropping down to normal levels. It seems to take longer for Hashimoto´s disease to decrease the antibodies and perhaps that is because they are so incredibly elevated. She said she had taken all of the salt with iodine from the bakery, and thrown it out. Now she only uses regular salt in her bakery goodies. I hope when I get up to Holland she lets me try some of her specialties as I am sure they will be delicious. The most important thing for me to know is that she feels much, much better. Her metabolism is balancing out and now she is having her thyroid hormone levels monitored to make sure she stays in a normal range as the lowering of the antibodies can decrease the hypothyroidism and require a reduction in hormone supplementation for the thyroid gland. One of the things one sees with autoimmune diseases is that they can be really tricky and sometimes go away for a short or sometimes long period of time or as in a mixed Grave´s/Hashimoto´s disease, they can fool the best experts in a week, by suddenly changing completely. Patient 2: Marie Louise is one of the nicest ladies I have met, not that all my patients are not really very nice, but she is special. This charming, tall, dark haired beautiful woman with 2 children is raising them alone, and as if that were not enough with her job as legal assistant, she is taking care of her mother who is dying of leukemia. The mothers condition is already so deteriorated that there is not much one can do, even with miracles, unfortunately, but she doesn´t complain about her struggles, and in spite of her massive Hashimotos´s disease, work, children and stress, she remains cheerful. In fact, I never would have known about her mother had I not asked what she had for stress in her life. She had developed Hashimoto´s about a year ago, and essentially has been going up and down emotionally with an early menopause, which may be from her stress, or may be from a combination of things including her disease. I had her hormones tested in addition to her thyroid levels and antibodies and they were somewhat unstable, as far as estrogen levels. Her thyroid was rather badly hit, with a goiter and elevation of antibodies in the 13,000 range. Not as bad as 30,000, like the last patient, but nothing to take for granted. Do your remember how I said one had to always see if any other autoimmune diseases were lurking in the background with Hashimoto´s ? Well, what we found were her cortisol levels were low, and she responded even worse to stress than normal. Her father had Rheumatoid arthritis and her sister had Hashimoto´s with diabetes mellitus. Often times one sees this in family members, but not always. I recommended the usual complicated mixture of nutrients, which sometimes looks like witchcraft when one has no idea what this all does. She began immediately to take the substances. I wish all my patients were this reliable. Some only take half, or decide they don´t have time etc. and wonder why they are not getting better. It doesn´t work if you don´t take it. She did however. She said it took a while to know when she could take the fish oil, and mainly that was right after her meals in divided dosages. Then I asked her to let me know as soon as she had her new lab data. I didn´t hear anything for some time and was concerned that the stress of her mothers condition etc would make her even worse off before the treatment had a chance to start working. It usually takes about 7-10 days before any results are noticed. I finally phoned her after several weeks and she told me she didn´t want to bother me. She is a very considerate person. As if she would bother me, when she only knew how I was waiting with bated breath to find out how fast and how well this could reduce her antibodies. Well, good news. They had already sunk 6,500 down to 2,500 in three weeks. I was delighted, but of course her other situation with her mother made me hold back my excitement and tell her in a rather conservative manner that her treatment was working. Then I asked about her mother. At that point, poor Marie Louise just burst into tears. Sometimes medicine means not only stopping a disease; quite often it is also just being there to comfort someone when they need it. We are watching her metabolism, and the T3, T4 hormone blood levels to adjust them when necessary, but the symptoms in general seem to be decreasing, and the tiredness that was not altered by merely replacing the hormones seems to be improving, as does her general condition. As with all patients on new treatments, they need to be monitored regularly and any changes they might notice should be recorded and taken care of immediately, when necessary. I wish it were all as easy as it seems, the patients have to adjust to taking a handful of different pills a day, and they divide them up, for convenience, and not all have such great responses. Some that have had diseases for longer periods of time may be slower to adjust to the treatment than others. The Grave´s diseases patients, who have had eye problems over a longer period of time than a year, may not always reverse to normal after months. Unfortunately some then expose other problems that must be dealt with in other areas of health, eg.can they get pregnant, will the eye problems have to be operated on, does the T3, T4 level suffice that they are receiving, ? etc. etc. Thank God, however, most patients improve, regulate their thyroid levels accordingly, and those with eye problems adjust back to normal in 6 months to a year. I am very pleased that the results for most have been so successful, and we shall continue to look at ways of helping the patients return to normal life. Conventional Treatment for Grave´s Disease (Thyrotoxicosis must be treated by a physician utilizing the designated emergency measures.) Antithyroid therapy: Inhibits the Production of Thyroid Hormone Thioamides: carbimazole and its’ metabolite Methimazole or Propylthiouracil (also blocks T4 to T3) Surgery Radioactive iodine therapy (for elderly patients, inoperable patients) All of the above treatments may cause hypothyroidism and the patients must be regularly monitored for this complication. Half of the patients on antithyroid medications show a prolonged remission period or remain in remission indefinitely. The usual course of treatment is 12 to 24 months. Side Effects of Antithyroid Medications: Thrombo and Leucopenia, agranulocytosis (rare), Hepatitis, drug fever and arthralgias (muscle pains) exanthema (rashes), and cholestase (gall bladder fluid retention). Conventional Treatment for Hashimoto´s disease: Thyroid hormone replacement/Thyroxin Nutritional supplements for Grave´s and Hashimoto´s disease: Fish oil 7 grams/day After two weeks, 6 grams Vitamin E 600-800 Units/day Selenium (Sodium Selenite) 200 micrograms/day Nicotinamide 400-500 mg/day Vitamin C 2 grams/day Beta carotene (no smoking) 2500 IU/day No Red meat, ocean fish, no cigarettes. Avoid cold cuts preserved with nitrites and any iodine containing foods, salts etc. Whenever patients do not eat meat at all, they need a vitamin B complex, particular for B12 and when they can they should eat more fish. We recommend organic foods. It is obviously easier to merely take an antithyroid medication for Grave´s disease when possible, but since the side effects render this difficult for some patients, this alternative has proven time and again to lower the antibody levels in autoimmune diseases such as Grave´s and Hashimoto´s disease to balance out the patients hormone levels where they can be regulated for a normal metabolism. It needs to be emphasized that there are many other causes of thyroid disorders, and a thorough laboratory and physical examination is imperative in every case to insure a safe, balanced treatment from a proper diagnosis. Diet with Treatments The importance of diet in any disease has to do with the mechanism of toxicity in infections and in autoimmune diseases. Do you remember the old saying “feed a cold, starve a fever“? Well, that is not so far from the truth, in that by eating red meat for example, one increases the toxic cytokines which also increase the fever. This is why I recommend not to eat red meat (beef or pork) in any of these diseases, except upon occasion, for example, every 10 to 12 days, a little bit, if it is really needed, or missed in the diet. Most of my patients have no difficulty with this, as one can always eat fish, chicken, turkey, sometimes a little lamb, and many, many vegetarian dishes, including quiche, pizza, spinach lasagna, etc. I try to keep down the consumption of animal fats as much as possible, including cheeses but most of my patients eat a little every day, without any major changes in the metabolism. The fish oil in all of these inflammatory diseases is imperative, as it shifts the toxic cytokines in both autoimmune diseases as well as viral diseases. As far as foods that prevent further toxicity, the following are recommended: fresh fruits, vegetables, red and black berry juices, green tea, garlic, onions, and whole grains of all sorts, seeds and fish products. The berry juices contain natural antioxidants called flavinoids, which block the oxygen radicals and prevent their toxicity. Garlic has thiol groups which also protect the immune system and garlic inhibits xanthine oxidase, an oxygen radical generating enzyme in inflammation. Garbanzo beans, wheat germ and parsley have high levels of folic acid. I had never thought that diet could play such an important role in preventing diseases as well as keeping down the toxicity in diseases, but I was wrong. It does indeed play a major role. Seeds have not only many antioxidants including vitamin E, but they have natural inhibitors of proteases, and many nuts also have magnesium. Staying away from coffee, colas, and alcohol is important in decreasing the substrates for the oxygen radical generating enzymes. A glass of wine, however, or an occasional beer is allowed, but not every day. The alcohol alters the immune system and generates oxygen radicals. This is especially a problem in liver toxicities as seen in viral hepatitis. One very important substance to stay away from, especially in inflammations of the brain as in multiple sclerosis, is monosodium glutamate (MSG). MSG enhances toxicity in inflammatory situations in the brain. One of my patients told me that she had double vision after eating Chinese food. This was when I began to read more and more about the toxicity of MSG in the brain. It seems that in healthy individuals this is not a problem, but in inflammatory diseases this is indeed a problem. Sufficient amounts of zinc, magnesium, folic acid and vitamin C are all very important to increase the synthesis of biopterin responsible for antiviral as well as anti-inflammatory activities from the nitric oxide synthase enzymes in the body. Selenium is important in reducing peroxide products to non toxic substances. It is part of a very important enzyme called glutathione peroxidase. This enzyme requires cysteine from garlic and green leafy vegetables, as well as flavinoids, found in berry juices and many vegetables, including root plants. Selenium is found in grain products from Scandinavian countries, especially high in the fall and spring, when more rains wash the selenium into the soil for the plants to take up. Unfortunately, many of these natural protective substances are robbed from the soil in our modern agriculture methods. When organic foods cannot be obtained, it is often necessary to take these substances as extra supplements in the daily diet. This is why I recommend the higher dosages of these supplements, as many patients cannot find these natural foods, or they do not have the time, or interest to go out of their way and look for them. Vegetarian diets, in general are healthier, as long as they are not soaked with pesticides, but all people cannot adjust to such a change if they are not used to it. Often this needs to be a slow change, which over time can indeed open up a whole new world of tastes and pleasant eating experiences. The lowest incidences of cancer are in vegetarians. This alone certainly shows us how much diet plays a role in diseases. My patients tell me they feel much better eating more vegetables and more fruits. Some of them had discovered this on their own, before they ever came to me. Others discovered this after being on a healthier diet that it enhanced the efficacy of the nutritional supplements. All in all, a healthy diet prevents disease, toxicities, and cancer. It does not change the predisposition to diseases, but it drastically changes their development.