Tuesday, January 26, 2016

Fluoride and Hypothyroidism

One of the things I remember about my grandmother was her crusading against water fluoridation. Her activism seemed rather extreme and based on fear, not facts.

Now, decades later, as I'm looking up recent scientific study reports about hypothyroidism after being asked about it by a sister with a slightly elevated level of thyroid stimulating hormone (TSH), I've come across evidence pointing to a negative effect of public water flouridation. First, there's an observational study out of the United Kingdom, which found evidence indicating a correlation between flouridated water and hypothyroidism.
 2015 Jul;69(7):619-24. doi: 10.1136/jech-2014-204971. Epub 2015 Feb 24.
Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water.
Peckham S1Lowery D1Spencer S1.Author information
  • 1Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK.
Abstract
BACKGROUND:
While previous research has suggested that there is an association between fluorideingestion and the incidence of hypothyroidism, few population level studies have been undertaken. In England, approximately 10% of the population live in areas with community fluoridation schemes andhypothyroidism prevalence can be assessed from general practice data. This observational study examines the association between levels of fluoride in water supplies with practice level hypothyroidism prevalence.METHODS:
We used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data onfluoride levels in drinking water, 2012/2013 Quality and Outcomes Framework (QOF) diagnosedhypothyroidism prevalence data, 2013 General Practitioner registered patient numbers and 2012 practice level Index of Multiple Deprivation scores.FINDINGS:
We found that higher levels of fluoride in drinking water provide a useful contribution for predicting prevalence of hypothyroidism. We found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area).INTERPRETATION:
In many areas of the world, hypothyroidism is a major health concern and in addition to other factors-such as iodine deficiency-fluoride exposure should be considered as a contributing factor. The findings of the study raise particular concerns about the validity of community fluoridation as a safe public health measure.
This is far from a denunciation of flouride, but it indicates it could be a factor. Then, while looking up "hypothyroid" and "flouride," I found out that one of the ways scientists induce hypothyroidism in lab rats is by giving them flouride (and GABA--go, sprouts!--appears to help heal the thyroid afterward, interestingly). Further reading revealed that since 1979 it has been apparent that too much flouride in cattle can cause hypothyroidism and anemia.

Several of my female friends and relatives--plus myself for a short time after moving to Colorado from a place where I was drinking distilled water--have been told that they are hypothyroid due to elevated TSH levels and will have to go on synthetic thyroid hormones for the rest of their lives. This is not OK, especially if it is avoidable, for the proper amount of such hormone supplementation can change over time and taking the wrong dosage causes all kinds of serious side effects. Also, it's important that women, who are much more likely to be diagnosed with hypothyroidism, know that hypothyroidism can be transitory and elevated TSH levels don't necessarily require medication when there are no other symptoms:
 2015 Oct;24(164):241-4, 246.
Hypothyroidism in adults. Levothyroxine if warranted by clinical and laboratory findings, not for simple TSH elevation.
[No authors listed]
Abstract
Hypothyroidism is a common disorder due to inadequate thyroid hormone secretion. When a patient has signs and symptoms suggestive of hypothyroidism, how is it determined whether thyroid hormone replacement therapy will have a favourable harm-benefit balance? How should treatment be managed? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. The symptoms of hypothyroidism are due to slow metabolism (constipation, fatigue, sensitivity to cold, weight gain, etc.) and to polysaccharide accumulation in certain tissues, leading to hoarseness, eyelid swelling, etc. A blood TSH concentration of less than 4 or 5 mlU/L rules out peripheral hypothyroidism. TSH levels increase with age. Between 30% and 60% of high TSH levels are not confirmed on a second blood test. In overt hypothyroidism, the TSH level is high and the free T4 (thyroxine) level is low. Most of these patients are symptomatic. So-called subclinical hypothyroidism, which is rarely symptomatic, is characterised by high blood TSH levels and normal free T4 levels. The natural history of hypothyroidism depends on its cause. In chronic autoimmune thyroiditis, the most common form seen in rich countries, hypothyroidism generally worsens over time. However, other situations can lead to transient hypothyroidism that may last several weeks or months. Subclinical hypothyroidism, as the name implies, is usually asymptomatic. The risk of progression to overt hypothyroidism is about 3% to 4% per year overall but increases with the initial TSH level. Treatment guidelines are mainly based on physiological and pharmacological considerations and generally recommend levothyroxine therapy. The adverse effects of levothyroxine are signs of thyrotoxicosis in case of overdose (tachycardia, tremor, sweating, etc.). Even a slight overdose carries a risk of osteoporotic fractures and atrial fibrillation, especially in the elderly. In young adults, levothyroxine is usually started at a dose of about 1.5 microg/kg per day, taken on an empty stomach. Elderly patients and those with coronary artery disease should start at a lower dose: 12.5 to 50 microg per day. Treatment monitoring is based mainly on blood TSH assay. Dose adjustment should only be considered after 6 to 12 weeks, given the long half-life of levothyroxine. Certain drugs, such as iron and calcium, reduce the gastrointestinal absorption of levothyroxine. Enzyme inducers reduce its efficacy. In 2015, there is no robust evidence that levothyroxine therapy has any tangible benefit in patients with subclinical hypothyroidism. Some practice guidelines recommend treatment when the TSH level is above 10 mIU/L, or sometimes trial treatment for a few months for patients with symptoms suggestive of hypothyroidism. In practice, replacement therapy is needed for patients with overt hypothyroidism and a blood TSH concentration above 10 mIU/L. The main challenge is to recognise transient hypothyroidism, which does not require life-long treatment. When the TSH is only slightly elevated, there is a risk of attributing non-specific symptoms to an abnormal laboratory result and prescribing unnecessary treatment. Watchful waiting is an alternative to routine levothyroxine prescription in case of TSH elevation.

Wednesday, January 13, 2016

Choline

A week ago, I came across a recent report of a study done on 15-year-olds that found a significant association between blood plasma levels of choline and academic achievement. Considering that around 90% of the US population is thought to be deficient in choline intake, that is a very important finding.

Here's the abstract of the paper, published ahead of the paper's printing:

Plasma 1-carbon metabolites and academic achievement in 15-yr-old adolescents.
Nilsson TK1Hurtig-Wennlöf A2Sjöström M2Herrmann W2Obeid R2Owen JR2Zeisel S2.Abstract
Academic achievement in adolescents is correlated with 1-carbon metabolism (1-CM), as folate intake is positively related and total plasma homocysteine (tHcy) negatively related to academic success. Because another 1-CM nutrient, choline is essential for fetal neurocognitive development, we hypothesized that choline and betaine could also be positively related to academic achievement in adolescents. In a sample of 15-yr-old children (n = 324), we measured plasma concentrations of homocysteine, choline, and betaine and genotyped them for 2 polymorphisms with effects on 1-CM, methylenetetrahydrofolate reductase (MTHFR) 677C>T, rs1801133, and phosphatidylethanolamine N-methyltransferase (PEMT), rs12325817 (G>C). The sum of school grades in 17 major subjects was used as an outcome measure for academic achievement. Lifestyle and family socioeconomic status (SES) data were obtained from questionnaires. Plasma choline was significantly and positively associated with academic achievement independent of SES factors (paternal education and income, maternal education and income, smoking, school) and of folate intake (P = 0.009, R2 = 0.285). With the addition of the PEMT rs12325817 polymorphism, the association value was only marginally changed. Plasma betaine concentration, tHcy, and the MTHFR 677C>T polymorphism did not affect academic achievement in any tested model involving choline. Dietary intake of choline is marginal in many adolescents and may be a public health concern.-Nilsson, T. K., Hurtig-Wennlöf, A., Sjöström, M., Herrmann, W., Obeid, R., Owen, J. R., Zeisel, S. Plasma 1-carbon metabolites and academic achievement in 15-yr-old adolescents.

From the studies I've looked at, choline is dangerous to just one group of people: men with prostate cancer. Prostate cancer cells apparently just love choline.

But for everyone else, choline is a vital nutrient for brain function, especially for children. It's so important that women have choline to give to their babies that estrogen helps females' pre-menopausal bodies make more choline. If you have a teenager, especially a boy, make sure they get enough choline!

Guess what one of the very best sources of choline is? The humble egg, until recently demonized in US nutrition and medicine. The people who make dietary recommendations have been swinging back from that stance, now grudgingly saying that one egg per day is probably OK. But a growing teenage boy needs at minimum around 2 eggs worth of choline per day. One can also get choline from beef, but there are many correlations between red meat (see recent discoveries about carnitine--which is found at very high levels in beef--and heart disease) and various diseases, so I prefer to keep our family's beef intake low. Eggs are a terrific source of nutrients for a developing body; just ask a baby chicken.

Tuesday, January 5, 2016

ADHD and fish oil supplements

Generally, I'm very skeptical of supplements, essential oils, and anything without serious research and studies behind it. Even when there are supporting studies, I'm very slow to be convinced.

However, I'm convinced on the efficacy of fish oil, at least for some young people, in helping with attention problems.

From a 2015 report of a study done of Dutch boys:

Those who regularly ate an omega-3-loaded margarine experienced an improvement in their ability to pay attention, compared with boys who did not, researchers report in the March 19 issue of Neuropsychopharmacology.

And from a 2005 report of a study done on children with developmental coordination disorder:
 2005 May;115(5):1360-6.

The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder.

BACKGROUND:
Developmental coordination disorder (DCD) affects approximately 5% of school-aged children. In addition to the core deficits in motor function, this condition is associated commonly with difficulties in learning, behavior, and psychosocial adjustment that persist into adulthood. Mounting evidence suggests that a relative lack of certain polyunsaturated fatty acids may contribute to related neurodevelopmental and psychiatric disorders such as dyslexia and attention-deficit/hyperactivity disorder. Given the current lack of effective, evidence-based treatment options for DCD, the use of fatty acid supplements merits investigation.METHODS:
A randomized, controlled trial of dietary supplementation with omega-3 and omega-6 fatty acids, compared with placebo, was conducted with 117 children with DCD (5-12 years of age). Treatment for 3 months in parallel groups was followed by a 1-way crossover from placebo to active treatment for an additional 3 months.RESULTS:
No effect of treatment on motor skills was apparent, but significant improvements for active treatment versus placebo were found in reading, spelling, and behavior over 3 months of treatment in parallel groups. After the crossover, similar changes were seen in the placebo-active group, whereas children continuing with active treatment maintained or improved their progress.CONCLUSIONS:
Fatty acid supplementation may offer a safe efficacious treatment option for educational and behavioral problems among children with DCD. Additional work is needed to investigate whether our inability to detect any improvement in motor skills reflects the measures used and to assess the durability of treatment effects on behavior and academic progress.

The improvements in reading and spelling were very striking, as discussed at the end of the study paper (I can't link to it because the text is not available without going behind a paywall):
In this kind of population, delays in literacy development usually increase over time, indicating the value of early intervention. Children in the placebo group fell even more behind with spelling during the 0- to 3-month parallel-group phase, although they did show average progress in reading. In contrast, children receiving active treatment made 3 times the expected normal gain in reading age and twice the normal gain in spelling age, bringing their average scores toward normative values. In the follow-up phase, they continued to make improvements above what would be expected for chronologic age.

My conclusion: Eat more cold-water, fatty fish or consider supplementation with omega-3 fatty acids--especially DHA and EPA, for ALA doesn't seem to help (see http://www.ncbi.nlm.nih.gov/pubmed/25339885)--if you think your children have problems with attention. There doesn't appear to be any harm from moderate supplementation, at least in the young. Brains need specific kinds of lipids to form and utilize efficient neural pathways, and it appears that fish oil somehow helps them get/make the needed substances.*

* Here are some tantalizing studies about fish oil and cognitive function, particularly in the young: http://www.ncbi.nlm.nih.gov/pubmed/12725043, http://www.ncbi.nlm.nih.gov/pubmed/18492851, http://www.ncbi.nlm.nih.gov/pubmed/15718358, http://www.ncbi.nlm.nih.gov/pubmed/21514362, http://www.ncbi.nlm.nih.gov/pubmed/26200950, http://www.ncbi.nlm.nih.gov/pubmed/25713056, http://www.ncbi.nlm.nih.gov/pubmed/25542508, and http://www.ncbi.nlm.nih.gov/pubmed/25498892.

Friday, January 1, 2016

Increments

Happy New Year!

Like many people, you've probably heard people mention New Year's resolutions and groaned a bit to yourself recently. The 80s and 90s were quite a heyday for goal-setting, and the failure by pretty much everyone to meet all those goals brings feelings of failure and maybe guilt. Well, bah, humbug to that!

Set little goals! Baby steps to the changes you want to make. Here's what I mean:

No: Lose 20 pounds this year. Yes: Stop eating two desserts in a day.
No: Get a better job. Yes: Take concrete steps to increase my employability, starting with my performance at my present job.
No: Master the guitar. Yes: Practice the guitar five minutes every day and leave it in a place that makes that goal easy to accomplish.
No: Get 8 hours of sleep every night. Yes: Set the house wireless to turn off five minutes before your target bedtime.
No: Get a 4.0 GPA. Yes: Read my syllabus carefully at the beginning of the term and plan ahead to get important projects done with time to spare.
No: Run a marathon. Yes: Find an exercise that you enjoy and do it 2-3 times a week in a way that won't cause you to injure yourself (OK, for some people that might be jogging...I'm talking to everyone else).
No: Never have an impure thought again. Yes: Drop your Netflix subscription. (You'll save money and have time to read again, too.)
No: Have a wonderful relationship with that estranged family member. Yes: Don't say a single negative thing to anyone about that person this year.
No: Find a romantic partner worth staying with. Yes: Go do things that are worth doing and pay attention to who you meet while doing those things.
No: Keep my house in perfect order. Yes: Set up a cleaning system for yourself that maintains hygiene and allows you to go to bed each night with a feeling of having accomplished something on the cleanliness front. (Yes, it feels like trench warfare with little children in the home.)

As we learn from calculus, infinitely small increments still add up to a completed function. Even if it does sometimes feel like it takes infinity to do so....

Never give up on making an important change. Big goals aren't better than little goals if the big goals are unrealistic ones that we know we won't do.