The Oft-Ignored Link Between Mental Illness and Hypothyroid Disease

Overview of the thyroid system (See Wikipedia:Thyroid). To discuss image, please see Talk:Human body diagrams (Photo credit: Wikipedia)

By Kelly Brogan, M.D.

Meet your mitochondria.1 With a laundry list of responsibilities ranging from creating energy to determining the time of a cell's death, mitochondria have increasingly become the focus of chronic disease research.2

The keeper of our mitochondria is our thyroid hormone.3 This is why, when thyroid hormone is deficient or poorly functioning, patients experience an array of symptoms, including fatigue, constipation, hair loss, depression, foggy thinking, cold body temperature, low metabolism, and muscle aches.

How much of what we call "mental illness" is actually thyroid-driven? In my experience, a vast majority, and certainly enough of a subset to warrant a more sophisticated appreciation for proper diagnosis and treatment in these patients.

To Reverse Pathology, You Need a Whole Mind-Body Approach

Thyroid health is so much more than pumping out a hormonal product – it is a sophisticated conversation between the brain, gland, hormones, and the receiving cells and tissues.

This circuitry is at the mercy of yet another hormone, cortisol,4 produced by your adrenal glands, signaled by your brain.

This is why hypothyroidism can also look like anxiety, palpitations, insomnia, and sweating, and why one person may feel restored on thyroid hormone and another decimated.

Once we ask about the state of adrenal function, we have to dig a step deeper and ask what is taxing the adrenals. From this point of inquiry, we are typically talking about gut, diet, and environmental immune provocation.

This is the model of medicine that prizes root-causes, considerations like gluten enteropathy, sugar imbalance, fluoride toxicity, and iodine deficiency as potential drivers of thyroid hypofunction. The many lifestyle and environmental factors that can influence this relationship are prime examples of the web-like, whole mind-body approach that medicine must take in an effort to truly reverse pathology.

Underdiagnoses and Mistreatment

When patients are tested for thyroid pathology, typically at their own request, they are often confronted with "reference range" rejection – physicians staring at numbers instead of the suffering humans before them.

Reference ranges that bracket your lab results are based on unscreened and clinically unassessed populations (many were active hypothyroid patients), never calibrated for diagnostic practice. Doctors are trained to look at a brain hormone – TSH – as an absolute indicator of whether or not a patient is living in a glandular hormonal deficiency state.

Dysfunction of the endocrine system at large is totally ignored by this metric that "diagnoses" only the lowest 2.5 percent of those in a given reference range, as hypothyroid, without looking at the whole picture of their hormone activity. There is also neglect for the significance of antibodies as a relevant indicator of endocrine/immune dynamics, and consideration of autoimmune drivers.

For those who do receive the label of hypothyroid, they remain obliquely objectified by their lab work as their doctors use synthetic T4 – Synthroid – to attempt to move their TSH within range, more often leaving them symptomatic but "treated" because of poor conversion to active thyroid hormone (T3) and suppression of natural T3 production because of their now lower TSH.

When patients are denied appropriate hormonal treatment, it can be a slippery slope to medications for their remaining symptoms, and one category of medications in particular – psychiatric.

The Psychiatric Slide

Psychiatry is often positioned to slap Band-Aids on the festering unwashed wounds of the population. When these patients are told that they are "fine" or "treated" but they continue to feel unwell, they are sent to a psychiatrist, or started on psychotropics by a nonspecialist. Are many psych patients actual thyroid patients?

The literature seems to suggest as much, particularly in pregnant women. An important premise, however, is that there is likely gross underdiagnosis taking place in the literature secondary to use of a single metric TSH. We will see the significance of thyroid autoantibodies in various psychiatric diagnosis.

This reflects what functional medicine and naturopathy have claimed for years – that immune dysregulation is the key factor in thyroid hypofunction, and may predate actual change in hormone production by up to seven years.5 The role of thyroid in brain health has been the subject of speculation for over a century. As noted in a 1949 paper in the British Medical Journal:6

"[Since] 1888 the Committee of the Clinical society of London reported on the mental changes observed in over 100 cases of Myxoedema and noted the general retardation, sluggishness and slowness of apprehension, which was associated with insanity in the form of melancholia, chronic mania and dementia."

Another study published in the journal Encephale7 in 2004 notes several actions of thyroid hormone on your brain:

"Thyroid hormones receptors are predominantly present in cerebral cortex, amygdala, plexus choroideus and structures of adult neurogenesis: hippocampus and olfactory bulb. Thyroid hormones modify expression of genes encoding myelin, neurotrophins, and proteins involved in intracellular signaling pathways. They have also neuroprotective and vasodilatory effects."

Dipping Hormones and Depression

In the case of depression, there is much dispute as to the significance of hypothyroidism in presentations of classical and treatment resistant cases. Estimates of "subclinical hypothyroidism" (where free hormones are low, but TSH is normal) are up to 52 percent in the resistant population,8 which is demonstrative of the importance of looking beyond TSH.

The specific suppression of free T3 levels in depressed patients has been evaluated in several studies including those which specifically identified poor conversion of T4 to T3 in depressed women who were less likely to improve with standard medication treatments.9, 10 In 10 years after initial hospital admission, those with evidence of thyroid dysfunction through a stimulation test (TRH) were significantly more likely to relapse.11 Antibodies to thyroid tissue are also present in 20 percent of depressed patients,12 as compared to 5-10 percent of the general population.

If All Else Fails, Add Some Thyroid

In both bipolar and unipolar depression, there have been six randomized, placebo-controlled trials conducted wherein thyroid hormone was used as an augmentation to an incompletely effective antidepressant (tricyclic) and found to be effective, particularly in women. In the STAR*D report,13 the largest and most expensive trial ever conducted on antidepressant treatments, T3 was found to result in remission in 24.7 percent of patients.

Predicting Postpartum?

Perhaps the best studied population when it comes to the predictive role of thyroid abnormalities, pregnant and postpartum women deserve the most vigilant screening. Of 31 inpatient women with a diagnosis of postpartum psychosis,14 19 percent had detectable thyroid autoantibodies and 67 percent of these women developed thyroid dysfunction by six months as compared to 20 percent in the controls.  TSH at delivery has been shown to be a predictor of postpartum depression at six months postpartum.15, 16, 17 Even in the setting of "normal" TSH levels, thyroid autoantibodies are predictive of postpartum depression and anger18, 19 including in prospective trials.20, 21

Risks of hypothyroidism include adverse pregnancy outcomes such as hemorrhage, preeclampsia, fetal cardiac rhythm anomalies, and labor abnormalities.22 Thyroid antibodies, once again, represent a significant risk factor, not just for psychiatric pathology but for tripled odds of miscarriage and double of preterm birth.23 Importantly, in one randomized, placebo-controlled trial,24 supplementation with 200 micrograms (mcg) of selenium during pregnancy reduced antibody activity and improved hormone parameters likely owing to selenium's antioxidant properties in thyroid tissue.

Hypermania Hyperthyroid

In a recent review entitled "Gender differences in thyroid system function: relevance to bipolar disorder and its treatment,"25 the authors discuss high prevalence of subclinical hypothyroidism in female bipolar patients with a focus on rapid cycling illness, resistant to treatment. Lithium, considered a gold-standard mood-stabilizer, interferes with thyroid hormone secretion, and may induce or unmask underlying pathology.

A randomized, placebo controlled trial26 of T4 treatment in bipolar depression showed improvement that was limited, statistically, by high rates of placebo response, and likely the same conversion limitations of using T4 as opposed to a T3 containing preparation. A rational extension of this finding was demonstrated in two studies that found elevated T3 in manic bipolar patients, one noting that patients with bipolar mania relative to controls were 2.55 times as likely to have abnormal free hormone levels.27,28

Feeling like a mental patient? Look out for these offenders. The establishment of a relationship between suboptimal thyroid function and symptoms of mental illness tells us that appropriate and comprehensive screening is vital in this population. It also leads us to ask, why is the thyroid flagging, and what can we do about it. High on my list of causative offenders are:

• Birth control pills:29 The synthetic hormones in this pharmaceutical product increase thyroid hormone binding globulin, effectively lowering available thyroid hormone even without perturbing lab values.
• Gluten:30 In addition to its direct effects on the brain through opioid compounds, indirect effects through autoimmune and cytokine stimulation, gluten drives at least two pathologies – celiac and Hashimoto's – that are significantly associated with depression and other mental illnesses. The prevalence and causative role of gluten in Hashimoto's Disease (thyroid autoimmunity) has been established.31 The role of gluten in brain health is of increasing interest, and in celiac patients with thyroid autoantibodies, depression and panic disorder risk is greatly increased.32
• Fluoride:33 Historically, fluoride was used, even in the milligram range, to suppress thyroid function in hyperthyroid patients. It interferes with multiple aspects of thyroid tissue integrity, hormone activation, and displacement of iodine, a critical and essential mineral for thyroid function.
• Endocrine disruptors:34 From exposure in utero, 35 industrial and agricultural chemicals such as phthalates, flame retardants, and PCBs are pervasive toxicants that interfere with the hypothalamic pituitary adrenal signaling, stimulating the immune system and derailing hormones.

Summary of Recommendations

For all of the reasons listed above, my top recommendations for anyone experiencing symptoms of mood disturbance are to:

• Clean up your local environment: from personal care products to cleaning agents, water, air, and electromagnetic fields
• Clean up your diet: eliminate gluten, dairy, GMOs (soy, corn, and vegetable oils), and sugar
• Clean up your mind: initiate a meditation practice to heal your adrenals and promote anti-inflammatory signaling.

In my article, "Thyroid Dysfunction and Treatment," I explore these interventions a bit further. The thyroid is a canary in the coalmine. In our fast-paced, technology-smothered, nutrient-depleted, and toxicant-replete lifestyles, your thyroid gland may be the first to come under siege. Recognize the profound significance of treating a thyroid condition with psychotropic medications, and choose to go to the root of the problem, first.

About the Author

Dr. Brogan is boarded in Psychiatry/Psychosomatic Medicine/Reproductive Psychiatry and Integrative Holistic Medicine, and practices Functional Medicine, a root-cause approach to illness as a manifestation of multiple-interrelated systems. After studying Cognitive Neuroscience at M.I.T., and receiving her M.D. from Cornell University, she completed her residency and fellowship at Bellevue/NYU.

She is one of the only physicians with perinatal psychiatric training who takes a holistic evidence-based approach in the care of patients with a focus on environmental medicine and nutrition. She is also a mom of two, and an active supporter of women's birth experience, rights to birth empowerment, and limiting of unnecessary interventions which is a natural extension of her experience analyzing safety data and true informed consent around medical practice. She is the Medical Director for Fearless Parent, and an advisory board member for GreenMedInfo.com and Pathways to Family Wellness. She practices in NYC and is on faculty at NYU/Bellevue.

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Mass Obesity No Cause for Celebration

Picture of an Obese Teenager (146kg/322lb) with Central Obesity, side view.Self Made Picture of an Obese Teenager (Myself) (146kg/322lb) with Central Obesity, Front View. Feel Free to use. (Photo credit: Wikipedia)

By Dr. Mercola

America is as obese as it possibly can be, yet the government and media refuse to take responsibility for this tragic problem.  Although obesity rates among American preschoolers declined by 43 percent in the past decade, teenage and adult obesity are deplorable and show no signs of improvement.1

These findings were broadcast on all of the nation's major news stations and in most major newspapers2, 3, 4 with many claiming "victory" in the fight against childhood obesity. While this all sounds like good news, I disagree with such proclamations.

The study, published in JAMA,5 found that obesity rates among two- to five-year olds dropped from 14 percent in 2003 to eight percent in 2012. The researchers suggest that decreased consumption of high-calorie drinks and higher rates of breast feeding might account for the decline.

No reduction in obesity rates was found among any other age group, however. And obesity rates for women over the age of 60 actually rose by about 21 percent. Eventually, nearly all Americans end up obese which contributes to a lifetime of chronic disease.

Americans Have Far from Conquered Obesity

One-third of American children and teens (aged two to 19), and more than two-thirds of adults are still either overweight or obese. One out of eight preschoolers is still in the obese category, along with 18 percent of kids aged six to 11—up from seven percent in 1980.6

From my perspective, we're still FAR from being in a position to jump for joy or pat ourselves on the back. The study authors themselves concluded:

"Overall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. Obesity prevalence remains high and thus it is important to continue surveillance."

While it may sound promising that overall obesity rates have "stabilized," what that REALLY means is that we have maxed out, we are as fat as we can possibly be as a nation, and show no signs of improvement.

Other statistics clearly show that Americans, including children, are sicker than ever, and it's absolutely obvious that this is a direct result of corrupted federal policies and the junk food industry marketing to kids, getting them addicted to sugar as soon as possible with famous cartoon characters and flashy images.  Don't be fooled by this latest PR stunt to make you think they're finally getting something right.

The anti-obesity campaign is NOT working. And while some reporters have stated that the drop in obesity among toddlers is due to successful physical fitness programs, such as First Lady Michelle Obama's Let's Move! Campaign (which launched in 2010), I fail to see this connection. 

Improved breastfeeding rates are the most likely primary factor contributing to the decline seen in this age group (two- to five-year olds).  This is the one area I can appreciate, after decades of disastrous infant formula marketing to new moms, it appears we are finally acknowledging the critical value of breastfeeding.

According to the CDC,7 the percent of babies breastfeeding at six months increased from 35 percent in 2000 to 49 percent in 2010, and infants still breastfeeding at 12 months increased from 16 percent to 27 percent during that same time period.  While most infant formulas are about 50% carbohydrates, breast milk is naturally around 18%, which is the obvious problem that contributes to infant obesity.

Federal policies have not budged when it comes to issues that matter the most, or could have the greatest impact. Subsidizing the growing of genetically engineered (GE) corn, soy, and sugar beets continues to fuel the production of cheap, processed junk food that fatten us up and cause cascading health problems, courtesy of the insulin resistance such a diet brings. 

Subsidizing the growing of GE soy and corn for hydrogenated vegetable oils is the primary source of clogged arteries leading to countless unnecessary heart attacks.

The combination of junk food manufacturers, pesticide producers' agriculture lobbying, and the willingness of our federal politicians to be lobbied because of their greed for money and power has not changed one bit in the past decade. If anything, it's only gotten more insidious.

New USDA Rule May Stop Soda and Junk Food Advertising in Schools

As a general rule, the beverage industry also still denies or strongly downplays its role in the childhood obesity epidemic, despite the fact that beverage companies spend over $1 billion annually on youth-targeted marketing—especially in school settings—and sodas have been repeatedly shown to massively promote obesity in study after study.

Hopefully, we'll soon see a reduction in junk food advertising in schools at least. First Lady Michelle Obama recently announced a new US Department of Agriculture (USDA) rule that would phase out advertising of sugary drinks and junk food on school grounds.  Historically, the junk food industry always finds a way to buy their way back into schools as a desperately needed source of revenues. As reported by NBC News:8

"US Agriculture Secretary Tom Vilsack said the new rules would eliminate marketing for products that cannot be sold in schools. 'If you can't sell it, you ought not to be able to market it,' Vilsack said. He said companies spend $149 million a year on marketing food and drinks to kids in school...

The Federal Trade Commission says the heaviest marketers are candy and snack food manufacturers, beverage companies, and fast food restaurants, which make use of posters and scoreboards. They also give students coupons, for instance offering pizza as a prize for students who read a certain number of books, and they place advertisements in school television programs and other educational materials. California banned sodas and junk food from public schools in 2005 and Connecticut did in 2006, but most states don't have policies."

True Cost Accounting—Understanding the Real Cost of Cheap Food

I was in the Philippines last month and over there fresh fruits and vegetables are inexpensive and processed junk food is costly. So there are strong economic incentives for them to eat healthy. However, the converse is present in the US. For some families, access to fruits and vegetables is very limited, forcing them to rely on the heavily subsidized processed foods at their local markets. Others realize they can get a value meal at numerous fast-food restaurants for far less money than it takes to purchase foods to cook from scratch. But all this cheap food comes with a hidden price tag.

The featured video discusses a number of principles associated with food, such as the principle of true cost accounting,9 which helps you understand the real cost of the food you buy. When you make purchasing decisions based solely on price, without asking why the food is so inexpensive, you're actually supporting a long list of social and environmental ills that, ultimately, you still end up paying for in one way or another.

While Americans pay less for their weekly grocery bill than people in most other nations, the true cost of all this cheap food is staggering. Declining health and rising health care costs are two of the most obvious considerations. Parents need to wake up and face the reality that processed foods have dramatically changed over the years. The level of processing and chemical additives has increased exponentially, and today's pre-packaged convenience foods have been processed and altered to the point of being virtually unrecognizable, nutritionally, from real food.

Processed food is typically NOT interchangeable with fresh whole food, no matter what it says on the bag. Unfortunately, many still do not know that the "natural" label is completely worthless, as foods bearing the "natural" label can still, legally, be chockfull of chemicals, additives, and genetically engineered ingredients. 

Children Are Highly Susceptible to GMO Side Effects

In the US, parents also have to contend with the fact that a vast majority of this cheap food is genetically engineered and heavily contaminated with the toxic herbicides like glyphosate, the active ingredient in Monsanto's Roundup. Experts like Dr. Don Huber strongly believe that glyphosate is actually more toxic than DDT.

Compelling evidence now suggests that glyphosate residues, found in most commonly consumed foods in the Western diet courtesy of GE sugar, corn, soy, and wheat, enhance the damaging effects of other food-borne chemical residues and toxins in the environment to disrupt normal body functions and induce disease. Glyphosate also severely disrupts your gut flora, thereby further exacerbating metabolic havoc and poor health. Children are clearly at greatest risk here. The sooner their gut flora becomes severely compromised, the sooner their health will begin to fail. If they're fed GE foods from infancy, they may be facing serious health issues by the time they're in their teens!

This is a valid concern, as genetically modified organisms (GMOs) can even be found in infant formulas, and no one really knows what the health risks of such ingredients might be, especially long-term. It's important to remember that pound for pound, infants experience greater exposure to chemicals than adults, and have immature and porous blood-brain barriers, which allow greater chemical exposures to reach their developing brains. Hence, an all-organic diet is really crucial for infants and young children.

Breastfeeding is clearly the best option. Besides lacking the full arsenal of critical nutrients obtained from breast milk, many infant formulas also contain far too much sugar (your baby doesn't need any). But it's not just a matter of vitamins, minerals, proteins, and fats that makes breast milk far superior to formula. Breast milk also contains substances that may significantly enhance your baby's gut and support the healthy development of her entire nervous system.

Teach Your Kids the Basic Tenets of Optimal Health

Do not make the mistake of underestimating the power of your influence as a parent when it comes to laying down potentially lifelong habits. Leading by example is one of the most effective teaching tools there is. Children will simply not know which foods are healthy unless you, as a parent, teach it to them.

Remember, wholesome food is "live" and typically raw food, and the hallmark of live food is the fact that it will wilt and decompose. The fact that fast food burgers, buns, and fries show no signs of decomposing, even after a decade, is a clear indication that it's not real food and serves no beneficial purpose as part of your child's diet.

If you're unsure about how to get your family on the right track, my optimized nutrition plan offers a step-by-step guide to feeding your family right. You can find even more help in the book I wrote on the subject, called Generation XL: Raising Healthy, Intelligent Kids in a High-Tech, Junk-Food World. As a quick overview, here are some of the most important lifestyle strategies you can teach your child that will serve him or her well for the rest of their life:

1. Proper food choices: For a comprehensive guide, see my free optimized nutrition plan. Generally speaking though, you'll want to focus your diet on whole, ideally organic, unprocessed or minimally processed foods. For the best nutrition and health benefits, you will want to eat a good portion of your food raw.
Avoid processed sugar, and refined fructose in particular. All forms of sugar have toxic effects when consumed in excess, and drive multiple disease processes in your body, not the least of which is insulin resistance, a major cause of chronic disease and accelerated aging. I believe the two primary keys for successful weight management are severely restricting carbohydrates (sugars, fructose, and grains) in your diet, and increasing healthy fat consumption. This will optimize insulin and leptin levels, which is key for maintaining a healthy weight and optimal health. Sources of healthy fats include:

Olives and olive oil	Coconuts and coconut oil	Butter made from raw grass-fed organic milk
Raw nuts, particularly macadamia	Organic pastured egg yolks	Avocados
Grass-fed meats	Palm oil	Unheated organic nut oils



2. Regular exercise: Even if you're eating the healthiest diet in the world, you still need to exercise to reach the highest levels of health, and you need to be exercising effectively, which means including high-intensity activities into your rotation. High-intensity interval-type training boosts human growth hormone (HGH) production, which is essential for optimal health, strength and vigor. HGH also helps boost weight loss.
So along with core-strengthening exercises, strength training, and stretching, I highly recommend that two to three times a week you do Peak Fitness exercises, which raise your heart rate up to your anaerobic threshold for 20 to 30 seconds, followed by a 90-second recovery period.
3. Stress reduction: Your emotional state plays a role in nearly every physical disease -- from heart disease and depression, to arthritis and cancer. Meditation, prayer, social support, and exercise are all viable options that can help you maintain emotional and mental equilibrium. I also strongly believe in using simple tools such as the Emotional Freedom Technique (EFT) to address deeper, oftentimes hidden, emotional problems.
4. Drink plenty of clean pure water.
5. Maintain a healthy gut: About 80 percent of your immune system resides in your gut, and research is stacking up showing that probiotics—beneficial bacteria—affect your health in a myriad of ways; it can even influence your ability to lose weight. A healthy diet is the ideal way to maintain a healthy gut, and regularly consuming traditionally fermented foods is the easiest, most cost effective way to ensure optimal gut flora.
6. Optimize your vitamin D levels: Research has shown that increasing your vitamin D levels can reduce your risk of death from ALL causes. Sun exposure is the best way to optimize your vitamin D levels as your body has built-in "fail-safe" mechanisms that prevent detrimental side effects from occurring. For more information on how to safely and effectively optimize your vitamin D levels, please see my previous article, "How Vitamin D Performance Testing Can Help You Optimize Your Health."
If you opt for oral vitamin D supplements, make sure you use D3, not prescription D2, as the latter may do more harm than good. Also, if you take supplemental vitamin D, you're creating an increased demand for K2—not K1 that is typically in vegetables as it will not work synergize with vitamin D. Vitamin K2 deficiency is actually what produces the symptoms of vitamin D toxicity, which includes inappropriate calcification that can lead to hardening of your arteries. Together, vitamin D and K2 help strengthen your bones and improve your heart health.
7. Avoid as many chemicals, toxins, and pollutants as possible: This includes tossing out your toxic household cleaners, soaps, personal hygiene products, air fresheners, bug sprays, lawn pesticides, and insecticides, just to name a few, and replacing them with non-toxic alternatives.
8. Get plenty of high-quality sleep: Regularly catching only a few hours of sleep can hinder metabolism and hormone production in a way that is similar to the effects of aging and the early stages of diabetes. Chronic sleep loss may speed the onset or increase the severity of age-related conditions such as type 2 diabetes, high blood pressure, obesity, and memory loss.

More Tips for Creating a Healthy Eating Environment for Kids

Ultimately, teaching your child the importance of healthy foods and exercise is the key to maintaining health. With that in mind, here are a few more tips to foster a healthy view of food and self-esteem in your child:

• Lead by example and seek to maintain optimal body weight for yourself and your spouse
• Refrain from making jokes about your child's weight, even if no harm is intended
• Explain the health risks of being overweight to your child, but avoid comparing your overweight child to other children, including thinner siblings
• Cook healthy meals for your family, and let your child be involved in making dinner, but avoid making your child eat different food than the rest of the family
• Encourage your child to make healthy food choices and praise them when they do instead of putting your child down about weight or eating habits
• Instead of using food as a reward or punishment, have healthy snacks available at all times, and explain to your child the benefits they'll get from eating these fresh, whole foods; use non-food items, such as stickers or special outings/activities as rewards instead

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