Bad news

At the ER last night, the ultrasound scan and the HCG levels were appropriate for a five-week pregnancy. I was over 8 weeks. I think it was likely another blighted ovum miscarriage, the second of my life. Sad, to be sure. But not as tragic as my sister's loss last year. Reproduction is not a sure thing. And now with Zika virus threatening, I'm not sure I even want to try again in a few months. I have five wonderful children, and I count my little blessings every day (especially when going somewhere in the car...I don't want to leave one behind :) ).

First an up, then a down

Last time I posted good news. Now I get to post worrisome news. Life is just like that, and it's best to expect it rather than run around screaming about unfairness.

I started bleeding this evening. I'm 8 weeks, 1 day pregnant. Bleeding is how my first pregnancy ended around 13 years ago. Such experiences give me so much new vocabulary. For example, tonight I learned what a "subchorionic hemorrhage" is. Hopefully, it's the cause for my present bleeding. I did play on the slides at the park with dd4 this evening, so I might have done something to cause a hemorrhage. I'll call the OB's office in the morning.

Test results

Is it OK if I brag just a teensy weensy bit? Dd9's test scores came in today, and she's apparently bright: 99th percentile in several areas, as well as her composite score. I don't think she's a genius; I've seen geniuses, and my children aren't. But she has a solid ability to reason that helps me be optimistic for her future. As with her older sister at this age, the listening comprehension score wasn't all that high, but members of this family tend to be very busy in their own heads and so not particularly good at listening.

The test scores reflected my daughter's abilities fairly accurately, and I think the ITBS is a good evaluation tool.

Driving all day

Yesterday I drove all day to get myself and my children home from a wedding. My morning sickness has been pretty easy to deal with, thanks to the nausea cure. I'm seven weeks along now. My sister, who has gone from "never again" to "maybe I'll have one more child if this really works" says she wants to see what I'm like at eight weeks. I guess that's when I'm supposed to be really sick.

However, I should not have eaten frozen-then-reheated pizza and chimichanga for dinner last night. Especially after eating pistachios to stay alert while driving for 10 hours. Yes, the junk food was easy to make, and I didn't want to say "no" to yummy food prepared by someone else. But do you know how long that stuff takes to digest? Add in the slow digestive tract of early pregnancy, and I nearly vomited last night. I wasn't nauseated, just gagging a lot.

Must. Respect. The. Slow. Stomach.

Correction on the NVP post below

I didn't discover how to get rid of all first trimester symptoms, just nausea. And apparently the remedy even works to knock out nausea caused by a gastrointestinal bug. My sister and her friend were able to get rid of nausea in connection with a stomach bug, although they still had other GI illness symptoms. I'll have to try the nausea cure on my kids during our spring break trip, which involves a lot of driving in the mountains. It is so gross when someone vomits during a car trip.

It makes sense that we wouldn't want to get rid of the slow digestion (gastroparesis) that goes along with early pregnancy. It's a result of all kinds of contracting tissue being prevented from contracting, and contraction of the uterus is exactly what we don't want when the placenta is being formed right across the uterine wall. Allowing the uterus to contract would make it hard to get the placenta properly attached, sort of like drilling pilings during an earthquake, I'd imagine.

So, I'm six weeks pregnant as of tomorrow. I need naps sometimes (I took the first one of this pregnancy today, actually), and I have to be careful not to eat too much or too little. But I'm not curled up in a nauseated ball of misery. I ate three corn dogs today (it was National Corn Dog Day). Basically, I'm trying to follow the eating guidelines they give for mild gastroparesis, and they help. Warm milk with malted milk powder is soothing to my backed-up tummy, too. (Yeah, I'm drinking milk during the first trimester. This is my favorite pregnancy yet. Pity I didn't figure this all out a long time ago....)

Now that my almost-MD brother is past Match Day, I'm going to bother him to help me get a letter to a journal out about this nausea cure. It's killing me that it is cheap and effective, yet I can't just post it here. No one will take it seriously if I don't get it published in an official journal, and you can't get something published in an official journal if you've already published it online.

Testing time

I just administered the ITBS test to two homeschooled third-graders today. They were quite intelligent children who worked speedily and finished the whole test easily by early afternoon even with breaks.

I'm never sure what to say to homeschoolers who voice complaints about the requirement to have their children tested or evaluated every other year here in Colorado. It's really not that big a deal. The tests cost $29 each plus postage to return them. And I like the information I receive about my children's strengths and weaknesses.

Perhaps it takes a naivete I no longer possess to hold the opinion that parents will always do what's best for their children. People--including parents and teachers--vary widely in their abilities and knowledge. And, like it's written under the shark picture in the sidebar, ignorance is no protection. Loving, diligent parents might be misteaching their children inadvertently. Testing and evaluation are there to to protect children, not to exert state control. When adequate education is occurring, the state leaves us alone; when adequate education is not occurring, surely we want that discovered and addressed. Children need a minimum level of protection from educational neglect. (Some of these arguments apply to the people who hate any form of testing in regular schools, by the way.)

(Did you already guess that I'm not a social libertarian?)

Eureka! Good-bye morning sickness (NVP)! (Well, partly)

I believe I have found a reason for and partial cure for morning sickness. I have no reason to question its safety or efficacy. I've been testing it on myself (five weeks pregnant!), and it stops the morning sickness cold. It's also very inexpensive and accessible. Now I believe those women who say they were never sick when they were pregnant.

I have a brother who is nearly done with his MD. I'm hoping to convince him to assist me in co-authoring a letter to the editor to get this out via the respectable scientific journal system. But if for some reason, I can't find someone to publish it, I promise to put the cure out on the internet everywhere I possibly can. Too many women have suffered for too long.

[Update 4/15/2020: I miscarried the pregnancy mentioned above early on. Yes, I was 41 years old and blighted ovums miscarriages and I already had a history, but I am very cautious about recommending pregnancy usage of the mentioned "cure" as an isolated supplement until some testing has been done on it. The supplement did turn out very helpful with other kinds of nausea, though, so read later entries in this blog to find out more.]

Foods and Dementia

Who wants dementia? I think nearly everyone would rather have their mental faculties mostly intact than muddle about in an impaired state. The prospect of the golden years seems less wonderful if you won't be able to find your shoes or remember your children's names once you attain them.

As a result, the news outlets are quick to tell us about the new superfoods that are linked with lower risk of cognitive decline. Because we really want to know!

What are the frequently-mentioned foods at present that are purported to be good for our brain health?
- Leafy green vegetables
- Apples
- Colorful fruits and vegetables overall
- Nuts (even peanuts)
- Salmon and other cold-water fish
- Berries and dark-skinned fruits
- Coffee & tea
- A low-to-moderate amount of red wine
- Chocolate
- Virgin olive and coconut oils
- Many spices, including chile peppers, turmeric, cumin, coriander, and cinnamon
- And, of course, though it's not diet advice, exercise regularly and don't smoke.

Pretty basic, except for the tea, coffee, and red wine. What are they doing on that list, asks the typical Latter-day Saint. We're supposed to avoid them under the LDS Word of Wisdom, a revelation given to Joseph Smith on how to keep ourselves healthy. Even a couple glasses of wine can impair a smaller driver, and all sorts of personal problems result from alcohol abuse; moreover, frequent alcohol consumption is clearly correlated with an increased risk of dementia while abstaining from alcohol does not carry a significant greater risk of dementia over the long run. Coffee and tea are fairly obvious for Mormons, in that the constant sipping of beverages with a lot of caffeine can deaden us to quiet inspiration, and habituation to substances just seems like a bad idea in general. Why would drinks that we're supposed to avoid have important health benefits correlated with them?

My opinion is that there are other ways to get those benefits, and we just need to wait for the scientific research to get to the point where it can tell us for certain how to do so. After all, it took a long while for scientists to conclude that tobacco really was causing an increase in lung cancer.

I was quite interested to come across a theory out of Italy recently. Surely, as the home of the Mediterranean diet, they'd be likely to come up first with an explanation as to why their food keeps them so healthy! The gist of it is that DHA (an omega-3 fatty acid found in fatty, cold-water fish) and salicylic acid (acetyl salicylic acid is aspirin) work together to protect the brain cells and synapses. Salicylic acid, or salicylates, are high in almost every specific food and drink* listed above. Many of these foods are also known for containing polyphenols, but that's been a hard category of substances to nail down as to concrete health benefits. Willow bark--which contains a precursor to aspirin--has been in use for treating aches and fever since the time of ancient Mesopotamia and ancient Egypt, so we've been learning about its benefits and drawbacks for a long time. What if, instead of taking baby aspirin, we should just be eating and drinking a high salicylate diet (well, except for those that are sensitive to it)? In that case, I can drink fruit juices like apple cider and orange juice and sip herbal teas, and I'll still drink plenty of salicylates. If I add in some fish, then I'm protecting my brain!

Time will tell what science finds out. In the meantime, I'm more than comfortable following the Word of Wisdom. It has a lot of good counsel about what to eat and drink (it's not just a list of prohibitions), the specifics of which are finding wide support from nutritional science.

* Sorry, chocolate, you're not on the salicylate list. But you definitely help with cognitive function, at least short-term.

Vitamin D oversupplementation-to-Colitis connection

Since posting my last bit about vitamin oversupplementation in general, I came across this 2009 study from India:

J Clin Immunol. 2009 Jul;29(4):470-8. doi: 10.1007/s10875-009-9277-9. Epub 2009 Feb 14.

Plasma 1,25 dihydroxy vitamin D3 level and expression of vitamin d receptor and cathelicidin in pulmonary tuberculosis.

Selvaraj P1, Prabhu Anand S, Harishankar M, Alagarasu K.

Author information

Abstract

INTRODUCTION:

Vitamin D(3), which exerts its effect through vitamin D receptor (VDR), is known for its potent immunomodulatory activities. Associations between low serum vitamin D(3) levels and increased risk of tuberculosis have been reported.

STUDY SUBJECTS AND METHODS:

Plasma 1,25 dihydroxy vitamin D(3) levels (1,25(OH)(2) D(3)) and ex vivo levels of VDR protein from peripheral blood mononuclear cells were studied in 65 pulmonary tuberculosis (PTB) patients and 60 normal healthy subjects (NHS) using enzyme-linked immunosorbent assay-based methods. Using real-time polymerase chain reaction (PCR), induction of VDR, cathelicidin, and CYP27B1 mRNA were studied in live Mycobacterium tuberculosis-stimulated macrophage cultures treated with or without 1,25 dihydroxy vitamin D(3). VDR and CYP27B1 (-1077 A/T) gene polymorphisms were studied using PCR-based methods.

RESULTS:

1,25(OH)(2) D(3) were significantly increased (p = 0.0004), while ex vivo levels of VDR protein were significantly decreased in PTB patients (p = 0.017) as compared to NHS. 1,25(OH)(2) D(3) levels were not different between variant genotypes of CYP27B1. A trend towards decreased levels of VDR protein was observed among NHS with BsmI BB and TaqI tt genotypes compared to NHS with other genotypes. Relative quantification of mRNA using real-time PCR revealed increased VDR mRNA expression in live M. tuberculosis-stimulated culture in PTB patients (p < 0.01) than normal healthy subjects. Cathelicidin mRNA expression was significantly increased in vitamin D(3)-treated cultures compared to unstimulated and M. tuberculosis-stimulated culture in both patients (p < 0.001) and NHS (p < 0.05).

CONCLUSIONS:

The present study suggests that PTB patients may have increased 1,25(OH)(2) D(3) levels, and this might lead to downregulation of VDR expression. Decreased VDR levels could result in defective VDR signaling. Moreover, addition of 1,25(OH)(2) D(3) might lead to increased expression of cathelicidin which could enhance the immunity against tuberculosis.

In combination with the information I posted about below--Vitamin D receptors are essential to avoiding colitis (inflammation and soreness in the intestines)--I think there's a very solid basis to suspect a connection between Vitamin D supplementation and the uptick in people suffering with intestinal problems in the USA.

It takes only 4 cups of milk to get all the Vitamin D you need. For adults. A tablespoon of cod liver oil has more than three times the RDA of Vitamin D. Again, that's for adults. Unless you have reason to think you need supplemental vitamin D, I recommend you don't take it. And be even more cautious when dosing a child.

Vitamin Oversupplementation - Don't do it!

I once had a dentist tell me that I could flush my multivitamins down the toilet for all the good they were doing me. I smiled and thought he was a bit extreme. I now join him in that advice.

Guess what happens if we oversupplement with folic acid for a long time? Our bodies downregulate (make less of) folic acid receptors in our intestines and other folate-related activity gets altered.

CONCLUSIONS:
Long-term oversupplementation with folate leads to a specific and significant down-regulation in intestinal and renal folate uptake, which is associated with a decrease in message levels of hRFC, PCFT/HCP1, and FR. This regulation appears to be mediated via a transcriptional mechanism, at least for the hRFC system.
PMID:

And what happens if we oversupplement with Vitamin D for a long time? Do the vitamin D receptors in our intestines also get messed up? If so, that would be a very bad thing. The presence of Vitamin D receptors is essential to not getting colitis, per this study:

Abstract The inhibitory effects of vitamin D on colitis have been previously documented. Global vitamin D receptor (VDR) deletion exaggerates colitis, but the relative anticolitic contribution of epithelial and nonepithelial VDR signaling is unknown. Here, we showed that colonic epithelial VDR expression was substantially reduced in patients with Crohn’s disease or ulcerative colitis. Moreover, targeted expression of human VDR (hVDR) in intestinal epithelial cells (IECs) protected mice from developing colitis. In experimental colitis models induced by 2,4,6-trinitrobenzenesulfonic acid, dextran sulfate sodium, or CD4+CD45RBhi T cell transfer, transgenic mice expressing hVDR in IECs were highly resistant to colitis, as manifested by marked reductions in clinical colitis scores, colonic histological damage, and colonic inflammation compared with WT mice. Reconstitution of Vdr-deficient IECs with the hVDR transgene completely rescued Vdr-null mice from severe colitis and death, even though the mice still maintained a hyperresponsive Vdr-deficient immune system. Mechanistically, VDR signaling attenuated PUMA induction in IECs by blocking NF-κB activation, leading to a reduction in IEC apoptosis. Together, these results demonstrate that gut epithelial VDR signaling inhibits colitis by protecting the mucosal epithelial barrier, and this anticolitic activity is independent of nonepithelial immune VDR actions.

What if all that Vitamin D in our milk, in our multivitamins, and Vitamin D drops is decreasing our intestinal Vitamin D receptor activity and depriving us of protection to our intestinal lining? Would that help explain the mysterious rise of leaky guts and gluten intolerances?

Is it too much for me to ask that the government keeps its meddling hands off of my food? I'll eat tuna and eggs and go get some sunlight on my fair skin. I don't need supplements!

Hiking

I love hiking. But I don't love hiking with toddlers and small children. Sure, it's sweet fun for the first few minutes, then one hears "I need to go to the bathroom." "Will you carry my bag full of stuff that you told me not to bring but I brought anyway?" "I'm tired. Can we stop and rest?" "May I have my snack now?"

And if the hike has any dangerous dropoffs, I sound like this: "Stay away from the edges." "Don't climb that!" "Stay right by me." "Don't drag me! You're pulling me off balance!!!" I'm very acrophobic. Combine a fear of heights with a mother's constant concern for her offspring, and the result is an oddly-pitched, cringing sound for someone who's supposed to be enjoying a fun family outing.

Then the children hit an age where they can find their own footing on a rocky trail without holding onto my hand. Where they carry their own water and remember to grab their own hats on the way out of the house. When they climb heights bravely and make it higher than their shaky mother. When they say that a Saturday hike was the best part of their birthday.

That makes the early outings--made with the hope of teaching a love of nature and the outdoors--all worth it.

More on MTHFR mutation (see last post)

A year ago, a study was published finding that high doses of folic acid can apparently make rats develop pseudo-MTHFR deficiency. Lovely.

Here's the abstract:

Am J Clin Nutr. 2015 Mar;101(3):646-58. doi: 10.3945/ajcn.114.086603. Epub 2015 Jan 7.
High folic acid consumption leads to pseudo-MTHFR deficiency, altered lipid metabolism, and liver injury in mice.
Christensen KE1, Mikael LG1, Leung KY1, Lévesque N1, Deng L1, Wu Q1, Malysheva OV1, Best A1, Caudill MA1, Greene ND1, Rozen R1

OBJECTIVE:
Our goal was to investigate the impact of high folic acid intake on liver disease and methyl metabolism. 

DESIGN:
Folic acid-supplemented diet (FASD, 10-fold higher than recommended) and control diet were fed to male Mthfr(+/+) and Mthfr(+/-) mice for 6 mo to assess gene-nutrient interactions. Liver pathology, folate and choline metabolites, and gene expression in folate and lipid pathways were examined. 

RESULTS:
Liver and spleen weights were higher and hematologic profiles were altered in FASD-fed mice. Liver histology revealed unusually large, degenerating cells in FASD Mthfr(+/-) mice, consistent with nonalcoholic fatty liver disease. High folic acid inhibited MTHFR activity in vitro, and MTHFR protein was reduced in FASD-fed mice. 5-Methyltetrahydrofolate, SAM, and SAM/S-adenosylhomocysteine ratios were lower in FASD and Mthfr(+/-) livers. Choline metabolites, including phosphatidylcholine, were reduced due to genotype and/or diet in an attempt to restore methylation capacity through choline/betaine-dependent SAM synthesis. Expression changes in genes of one-carbon and lipid metabolism were particularly significant in FASD Mthfr(+/-) mice. The latter changes, which included higher nuclear sterol regulatory element-binding protein 1, higher Srepb2 messenger RNA (mRNA), lower farnesoid X receptor (Nr1h4) mRNA, and lower Cyp7a1 mRNA, would lead to greater lipogenesis and reduced cholesterol catabolism into bile.

CONCLUSIONS:
We suggest that high folic acid consumption reduces MTHFR protein and activity levels, creating a pseudo-MTHFR deficiency. This deficiency results in hepatocyte degeneration, suggesting a 2-hit mechanism whereby mutant hepatocytes cannot accommodate the lipid disturbances and altered membrane integrity arising from changes in phospholipid/lipid metabolism. These preliminary findings may have clinical implications for individuals consuming high-dose folic acid supplements, particularly those who are MTHFR deficient.

It seems long past time that we stop having everyone take folic acid, a molecule that our bodies hardly dealt with until around 60 years ago. There are better options out there.

More on folic acid

Around half the US population has a mutation in the gene that encodes MTHFR, which mutation limits their ability to turn folic acid into L-methylfolate, which is what the human body uses in nearly every cell for all sorts of purposes, including important functions of the immune and nervous systems. Intriguingly, one study of autistic kids found that all but 2% of them had at least one MTHFR mutation.

Folic acid supplementation has decreased neural tube defects in the USA and Canada by only about 35-45%, raising a suspicion in me that around half the population isn't able to fully utilize the folic acid that is now so plentiful in our food supply. To me, this, combined with our knowledge that half the population has difficulty turning folic acid into L-methylfolate, indicates that instead of folic acid, we should be consuming supplements of L-methylfolate. 

Fortunately, it is now possible to purchase L-methylfolate and take that instead of folic acid. Merck sells it as Metafolin, and no prescription is required. A search of PubMed shows that scientists are starting to promote L-methylfolate's use instead of folic acid for women who could get pregnant. I buy L-methylfolate from Solgar on Amazon.com, and it is also available from various marketers of natural supplements, for people are starting to realize how frequently the MTHFR mutations appear to be correlated with a wide variety of health problems.

Snow Days!

The glee in our home yesterday evening was hilarious right after the girls found out that a second snow day in a row had been called for the local schools. There was dancing, kicking, jumping, and many happy, loud sounds.

The exchange student really likes school, actually, but snow days happen perhaps one day every ten years in her home city, so this is quite the event to her.

And then my dear children...they love going to their charter school part-time, yet still...freedom to do whatever they want is so appealing! But since they're homeschoolers, they are doing their usual home learning today before being allowed to go play in the 12+ inches of fresh snow outside.

We aren't cruel parents. We did let them watch Groundhog Day with us (my husband also got off work due to the snow) while working on their studies.

When Chekhov saw the long winter, he saw a winter bleak and dark and bereft of hope. Yet we know that winter is just another step in the cycle of life. But standing here among the people of Punxsutawney and basking in the warmth of their hearths and hearts, I couldn't imagine a better fate than a long and lustrous winter.
- Phil, Groundhog Day

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.

J Epidemiol Community Health. 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 S1, Lowery D1, Spencer 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:

Prescrire Int. 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.

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 TK1, Hurtig-Wennlöf A2, Sjöström M2, Herrmann W2, Obeid R2, Owen JR2, Zeisel 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.

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:

Pediatrics. 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.

Richardson AJ1, Montgomery P.

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.

Winter Break is Over

Ah, sigh. Farewell, fine break. It was fun to have family in town--I love my parents-in-law--and have time to enjoy some of the winter sports with the older children while my husband stayed home with the little ones.

We eased back into schoolwork today and yesterday with the older girls by letting them work on projects of their choosing. Poisons, medieval castles, and parakeet training (very hands-on for the last one) were the topics of study. Noses back to the grindstone tomorrow!

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.

Christmas Break

Merry Christmas! Like much of the world, we're wrapping presents, preparing holiday treats, and seeing family and friends more than usual. It's a good time of year.

I spent a couple of hours today wrapping the presents that I've accumulated for the past half year or so. With ten people scheduled to be around the Christmas tree on the morning of December 25th, our present unwrapping scene will last for a while. We insist on the presents being opened one at a time so that the gift and the giver can be properly acknowledged. Even if it is better to give than to receive, the giver should nevertheless hear a word or two of thanks!

We didn't spend a lot on presents, but then we never do. Christmas doesn't seem very fun if we overspend on it.

A little crow

Almost two months ago, I mentioned that I was starting to change my eating habits so that I could lose some weight.

I'm quite pleased. This is a healthy rate of weight loss, and I've still eaten dessert (just less of it). I snack less and in much smaller amounts, and I tend to not take seconds at dinner anymore. I'm also better at exercising some (20-30 minutes on a stationary recumbent bicycle) most days. I'm also slowly weaning my 18-month-old, which might affect things a bit, although I'm not sure which direction.

Nothing tastes as good as feeling comfortable in my clothes.

I highly recommend the book The Diet Trap Solution: Train Your Brain to Lose Weight and Keep It Off for Good by Dr. Judith Beck.

Autism Advance

Good news from the field of autism research today! For the first time, they've been able to link a neurotransmitter in the human brain to autistic behavior. Thank you, Harvard.

The neurotransmitter in question is GABA, an inhibitory transmitter. I bet some supplement makers are about to make a lot of money.

Life

Last week, Colorado was horrified when a lone, unstable-appearing man, who used marijuana and had other hints of less-than-prosocial behavior in his past, attacked a Planned Parenthood clinic.

Before I discuss this any further, I'm going to share a recent, raw tragedy. My younger sister, 19 weeks pregnant, went on vacation this week to another country. Yesterday, we found out that she was bleeding heavily. They had to give her several blood transfusions. The pregnancy ended. My sister is now physically recovering, but her emotional recovery will no doubt take a very long time.

I view the act of intentionally aborting unborn children for convenience to be heinous. I abhor Planned Parenthood's unique focus on providing that "service" to mothers who don't like the timing of when they got pregnant. (Please, get an IUD (females) or more permanent birth control (everyone) if you don't want children.)

All that said, I whole-heartedly condemn the shootings by Robert Dear in Colorado Springs. Pro-life means being against taking life in general. There are valid arguments for and against abortion, and those offering abortions (hopefully) typically don't consider themselves to be ending a life. (I think they're scientific illiterates for holding that belief, but I don't consider them intentional murderers.) Also, abortion is legal. Dear wasn't justified. At all. I reject any rhetoric that would claim he was.

Yesterday, we saw a jihadist couple leave their baby with grandma then go shoot up a holiday party, hoping to video-tape it for some repulsive purpose. They are part of a religion that claims to abhor taking innocent life, but apparently their working definition of "innocent" is much different than we in the USA are accustomed to viewing that word. I absolutely reject any rhetoric that defines as fair targets for violence those who are civilians on the ground that they reject Islamic supremacy. I applaud Muslims who also reject such rhetoric, and I wish there were more of them.

Snow Day!

Our exchange student is so excited that our part of Colorado is being hit by a blizzard right now because the schools have been closed for tomorrow. She literally danced for joy when she found out. She does like school and is a diligent, intelligent student. But snow days are just fun!

My children won't get a snow day from their usual homeschool studies, though. It will be too cold--high wind chill expected--for them to go outside during the morning, so they might as well be kept busy learning. They like to learn. For their recreational reading, they more often than not pick non-fiction books. At their age, I was a bookworm who read all kinds of historical fiction and fantasy. My home life was quite stressful, and I escaped into books, often wonderful books that taught me much and gave me a lot of hope. Nevertheless, I'm pleased that my children don't feel the need to escape their lives the way I did.