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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9 Body Hacks to Naturally Increase Testosterone

post-workout feast (Photo credit: kidmissile)

By Dr. Mercola

Testosterone, a hormone produced primarily by the testicles, is often associated with the epitome of "manhood" (although women have testosterone, too).

Indeed, it does play a large role in male sexuality and reproduction, impacting such factors as sexual and reproductive function, muscle mass, and hair growth, but also has some less "flashy," albeit equally important, roles like maintaining bone density, levels of red blood cells and a sense of well-being.

Beginning around age 30, a man's testosterone levels begin to decline, and continue to do so as he ages.

A wide range of chemical exposures included prescribed drugs like statins, adversely impact testosterone production in men. At the same time, estrogen levels typically increase due to widespread exposures to estrogen-mimicking compounds in food, water and environmental pollutants.

What are Your Options for Replacement?

If you're a man who's experiencing symptoms such as decreased sex drive, erectile dysfunction, depressed mood, and difficulties with concentration and memory, and you think low testosterone may be to blame, you can have your levels tested. Since testosterone levels fluctuate throughout the day, you'll probably need more than a blood test to get a true picture of your levels.

If your levels are indeed low, there are a number of synthetic and bioidentical testosterone products on the market, as well as DHEA, which is the most abundant androgen precursor prohormone in the human body, meaning that it is the largest raw material your body uses to produce other vital hormones, including testosterone in men and estrogen in women.

I only recommend using bioidentical hormones, and only then under the guidance of a holistic doctor who can monitor your hormone levels to ensure you need supplementation.

But, before you opt for this route, there are numerous strategies you can try to boost your testosterone levels naturally. These are appropriate for virtually anyone, as they carry only beneficial "side effects."

9 Ways to Naturally Increase Testosterone Levels

1.   Lose Weight

If you're overweight, shedding the excess pounds may increase your testosterone levels, according to research presented at the Endocrine Society's 2012 meeting. Overweight men are more likely to have low testosterone levels to begin with, so this is an important trick to increase your body's testosterone production when you need it most.

If you are serious about losing weight, you have got to strictly limit the amount of processed sugar in your diet, as evidence is mounting that excess sugar, and fructose in particular, is the primary driving factor in the obesity epidemic. So cutting soda from your diet is essential, as is limiting fructose found in processed foods, fruit juice, excessive fruit and so-called "healthy" sweeteners like agave.

Ideally you should keep your total fructose consumption below 25 grams per day and this includes fruits. This is especially true if you have insulin resistance and are overweight, have high blood pressure, diabetes or high cholesterol.

In addition to eliminating or severely limiting fructose, it will be vital to eliminate all grains and milk (even raw) in your diet. Milk has a sugar called lactose, which has been shown to increase insulin resistance so it will be wise to avoid it if you are seeking to lose weight.

Refined carbohydrates like breakfast cereals, bagels, waffles, pretzels, and most other processed foods also quickly break down to sugar, increase your insulin levels, and cause insulin resistance, which is the number one underlying factor of nearly every chronic disease and condition known to man, including weight gain.

As you cut these dietary troublemakers from your meals, you need to replace them with healthy substitutes like vegetables and healthy fats (including natural saturated fats!). Your body prefers the carbohydrates in micronutrient-dense vegetables rather than grains and sugars because it slows the conversion to simple sugars like glucose, and decreases your insulin level. When you cut grains and sugar from your meals, you typically will need to radically increase the amount of vegetables you eat, as well as make sure you are also consuming protein and healthy fats regularly.

I've detailed a step-by-step guide to this type of healthy eating program in my comprehensive nutrition plan, and I urge you to consult this guide if you are trying to lose weight.

The foods you choose to eat will be the driving force behind successfully achieving your weight loss goals -- high-intensity, short-burst-type exercises, such as my Peak Fitness Program, two to three times per week, combined with a comprehensive fitness plan, is important too, and has an additional benefit as well (see below)!

2.   High-Intensity Exercise like Peak Fitness (Especially Combined with Intermittent Fasting)

Both intermittent fasting and short intense exercise have been shown to boost testosterone. Short intense exercise has a proven positive effect on increasing testosterone levels and preventing its decline. That's unlike aerobics or prolonged moderate exercise, which have shown to have negative or no effect on testosterone levels.

Intermittent fasting boosts testosterone by increasing the expression of satiety hormones including insulin, leptin, adiponectin, glucagon-like peptide-1 (GLP-1), colecystokinin (CKK) and melanocortins, all of which are known to potentiate healthy testosterone actions, increase libido and prevent age-related testosterone decline.

Having a whey protein meal after exercise can further enhance the satiety/testosterone-boosting impact (hunger hormones cause the opposite effect on your testosterone and libido). Here's a summary of what a typical high-intensity Peak Fitness routine might look like:

• Warm up for three minutes
• Exercise as hard and fast as you can for 30 seconds. You should feel like you couldn't possibly go on another few seconds
• Recover at a slow to moderate pace for 90 seconds
• Repeat the high intensity exercise and recovery 7 more times

As you can see, the entire workout is only 20 minutes. Twenty minutes! That really is a beautiful thing. And within those 20 minutes, 75 percent of that time is warming up, recovering or cooling down. You're really only working out intensely for four minutes. It's hard to believe if you have never done this that you can actually get that much benefit from four minutes of exercise. That's all it is.

Keep in mind that you can use virtually any type of equipment you want for this – an elliptical machine, a treadmill, swimming, even sprinting outdoors (although you will need to do this very carefully to avoid injury) -- as long as you're pushing yourself as hard as you can for 30 seconds. But do be sure to stretch properly and start slowly to avoid injury. Start with two or three repetitions and work your way up, don't expect to do all eight repetitions the first time you try this, especially if you are out of shape.

You can find more information about this in an article previously written on intermittent fasting.

3.   Consume Plenty of Zinc

The mineral zinc is important for testosterone production, and supplementing your diet for as little as six weeks has been shown to cause a marked improvement in testosterone among men with low levels.1 Likewise, research has shown that restricting dietary sources of zinc leads to a significant decrease in testosterone, while zinc supplementation increases it2 -- and even protects men from exercised-induced reductions in testosterone levels.3

It's estimated that up to 45 percent of adults over the age of 60 may have lower than recommended zinc intakes; even when dietary supplements were added in, an estimated 20-25 percent of older adults still had inadequate zinc intakes, according to a National Health and Nutrition Examination Survey.4

Your diet is the best source of zinc; along with protein-rich foods like meats and fish, other good dietary sources of zinc include raw milk, raw cheese, beans, and yogurt or kefir made from raw milk. It can be difficult to obtain enough dietary zinc if you’re a vegetarian, and also for meat-eaters as well, largely because of conventional farming methods that rely heavily on chemical fertilizers and pesticides. These chemicals deplete the soil of nutrients ... nutrients like zinc that must be absorbed by plants in order to be passed on to you.

In many cases, you may further deplete the nutrients in your food by the way you prepare it. For most food, cooking it will drastically reduce its levels of nutrients like zinc … particularly over-cooking, which many people do.

If you decide to use a zinc supplement, stick to a dosage of less than 40 mg a day, as this is the recommended adult upper limit. Taking too much zinc can interfere with your body's ability to absorb other minerals, especially copper, and may cause nausea as a side effect.

4.   Strength Training

In addition to Peak Fitness, strength training is also known to boost testosterone levels, provided you are doing so intensely enough. When strength training to boost testosterone, you’ll want to increase the weight and lower your number of reps, and then focus on exercises that work a large number of muscles, such as dead lifts or squats.

You can “turbo-charge” your weight training by going slower. By slowing down your movement, you’re actually turning it into a high-intensity exercise. Super Slow movement allows your muscle, at the microscopic level, to access the maximum number of cross-bridges between the protein filaments that produce movement in the muscle.

5.   Optimize Your Vitamin D Levels

Vitamin D, a steroid hormone, is essential for the healthy development of the nucleus of the sperm cell, and helps maintain semen quality and sperm count. Vitamin D also increases levels of testosterone, which may boost libido. In one study, overweight men who were given vitamin D supplements had a significant increase in testosterone levels after one year.5

Vitamin D deficiency is currently at epidemic proportions in the United States and many other regions around the world, largely because people do not spend enough time in the sun to facilitate this important process of vitamin D production.

So the first step to ensuring you are receiving all the benefits of vitamin D is to find out what your levels are using a 25(OH)D test, also called 25-hydroxyvitamin D.

A few years back, the recommended level was between 40 to 60 nanograms per milliliter (ng/ml), but more recently the optimal vitamin D level has been raised to 50-70 ng/ml.

To get your levels into the healthy range, sun exposure is the BEST way to optimize your vitamin D levels; exposing a large amount of your skin until it turns the lightest shade of pink, as near to solar noon as possible, is typically necessary to achieve adequate vitamin D production. If sun exposure is not an option, a safe tanning bed (with electronic ballasts rather than magnetic ballasts, to avoid unnecessary exposure to EMF fields) can be used.

As a last resort, a vitamin D3 supplement can be taken orally, but research suggests the average adult needs to take 8,000 IU's of vitamin D per day in order to elevate their levels above 40 ng/ml, which is the absolute minimum for disease prevention.

6.   Reduce Stress

When you’re under a lot of stress, your body releases high levels of the stress hormone cortisol. This hormone actuallyblocks the effects of testosterone,6 presumably because, from a biological standpoint, testosterone-associated behaviors (mating, competing, aggression) may have lowered your chances of survival in an emergency (hence, the “fight or flight” response is dominant, courtesy of cortisol).

In the modern world, chronic stress, and subsequently elevated levels of cortisol, could mean that testosterone’s effects are blocked in the long term, which is what you want to avoid.

My favorite overall tool to manage stress is EFT (Emotional Freedom Technique), which is like acupuncture without the needles. It's a handy, free tool for unloading emotional baggage quickly and painlessly, and so easy that even children can learn it. Other common stress-reduction tools with a high success rate include prayer, meditation, laughter and yoga, for example. Learning relaxation skills, such as deep breathing and positive visualization, which is the "language" of the subconscious.

When you create a visual image of how you'd like to feel, your subconscious will understand and begin to help you by making the needed biochemical and neurological changes.

7.   Limit or Eliminate Sugar from Your Diet

Testosterone levels decrease after you eat sugar, which is likely because the sugar leads to a high insulin level, another factor leading to low testosterone.7

Based on USDA estimates, the average American consumes 12 teaspoons of sugar a day, which equates to about TWO TONS of sugar during a lifetime. Why we eat this much sugar is not difficult to understand -- it tastes good, and it gives us pleasure by triggering an innate process in your brain via dopamine and opioid signals.

What it is doing to us on both a physical and emotional level is another story entirely, and most people stand to reap major improvements in their health by cutting back on, or eliminating, sugar altogether from their diets. Remember foods that contain added sugar and fructose, as well as grains like bread and pasta, should all be limited.

If you're struggling with sugar addiction and having trouble dealing with cravings, I highly recommend trying an energy psychology technique called Turbo Tapping, which has helped many "soda addicts" kick their sweet habit, and it should work for any type of sweet craving you may have.

8.   Eat Healthy Fats

By healthy, this means not only mon- and polyunsaturated fats, like that found in avocadoes and nuts, but also saturated, as these are essential for building testosterone. Research shows that a diet with less than 40 percent of energy as fat (and that mainly from animal sources, i.e. saturated) lead to a decrease in testosterone levels.8

My personal diet is about 60-70 percent healthy fat, and other experts agree that the ideal diet includes somewhere between 50-70 percent fat.

It's important to understand that your body requires saturated fats from animal and vegetable sources (such as meat, dairy, certain oils, and tropical plants like coconut) for optimal functioning, and if you neglect this important food group in favor of sugar, grains and other starchy carbs, your health and weight are almost guaranteed to suffer. 

 http://fitness.mercola.com/sites/fitness/archive/2012/07/27/increase-testosterone-levels.aspx  Link back to Mercola.com where the rest of this article is located.

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