Private: Health Blog

Hashimoto’s

March 9, 2018 by Caleb Greer, RN

(Caleb Greer, RN)

The American Thyroid Association estimates that 20 million Americans have some kind of thyroid disease, but due to the ambiguity of many of the symptoms, who knows how many are, undiagnosed or unaware of their ailment. Within the category of thyroid disorders lies Hashimoto’s disease, an autoimmune condition that can result in a wide array of symptoms. Historically, the disease was characterized by an infiltration of white blood cells into the thyroid tissue. Now, with more advanced techniques, diagnosis is dependent on the presence of antibodies to the thyroid tissues.

Hypothyroidism is one of the most frequent metabolic disorders we see in the clinic, and a majority of them have antibodies to their actual thyroid gland, which is definitive for Hashimoto’s disease. In these cases, there are a few components that we really dig into – genetic background, gut health, and pathogen load. While the major contributor to the development of this disease is inflammation, the source of the inflammation can come from many different places and will require different interventions to reach a solution. For antibodies to the thyroid to be made, the cells of the thyroid must first present the specific part, known as the antigen. There are two antigens that the immune system incorrectly recognizes as foreign in Hashimoto’s, thyroid peroxidase (TPO) and thyroglobulin (Tg). Why these proteins are tagged as foreign in the first place is not known; however, the literature suggests multiple different theories that revolve around the three components mentioned earlier.

Genetics

In the immune system, there are many fail-safes to prevent autoimmunity, and it starts in an organ called the thymus. Without getting too deep into immunology, the thymus is the factory that makes a majority of antigen-presenting immune cells. When these cells are made there is a process by which their ability to recognize self versus foreign body is assessed – those who fail are destroyed and not allowed in circulation. Certain differences in some of the genes that encode antigen responsiveness and sensitivity lead to a greater susceptibility or even predisposition to autoimmune diseases like Hashimoto’s. Other under-functioning genetic variants that play a role in the development of Hashimoto’s are the vitamin D receptor and white blood cell receptors that regulate expansion. The (VDR) is involved pathways that regulate cell survival, pathogenic responses (including promotion of self-tolerance), membranous transport, and epigenetic modifications to DNA. When there is poor VDR function, all downstream signaling takes a hit, which results from problems in the aforementioned pathways – and just supplementing vitamin D won’t help. As for the latter variant, many of the immune cells have receptors that reduce further immune activation and can help control the responses, like a negative feedback loop. Unfortunately, some individuals have a genetic profile that under-expresses these receptors, which leads to an unbridled inflammatory cascade that can increase the likelihood of autoimmunity.

Gut Health

There has been a large buzz around the gut’s influence on the entirety of the body, and this has lead to an increased interest among clinicians and researchers alike. The link between intestinal health and integrity with autoimmunity is well established in the scientific literature and a majority of the conclusions regarding the ‘why’ establish inflammation as the cause. Inflammation in the gut can arise from a large number of things, from the food we eat to the medications we take, but an in-depth review is beyond the scope of this paper. Inflammation leads to intestinal permeability, often called leaky gut, which results in larger-than-normal molecules passing the gut immune system and getting tagged as foreign objects. Our body’s immune system is like the most strict immigration policy imaginable, meaning that any foreign body detected is tagged for removal. Pertaining to Hashimoto’s, many commonly consumed foods have proteins that have very similar sequences to TPO and Tg. So, if said foods or proteins get tagged for removal and antibodies are made for them, tissue cross-reactivity can occur, thus leading to tissue destruction and a perpetuated immune response. Gut issues can also lead to the manifestation of autoimmune-predisposing factors discussed in the previous section.

Pathogen Load

To piggyback on the previous section, all pathogens will, or rather should induce an inflammatory response from the immune system – it’s supposed to happen. Inflammation has been given a bad connotation, but in reality, it is a necessary tool that our body utilizes to maintain homeostasis. That being said, unresolved inflammation is the real enemy. Sustained inflammation has the nasty habit of reducing liver detoxification pathways, damaging the blood-brain and intestinal barriers, and disrupting normal signaling pathways. Everyone is exposed to various bacteria, viruses, molds, parasites, and other agents of infection throughout their lives, and very seldom are they ever truly eliminated. Viruses hang out inside cells, bacteria and mold hide behind biofilms, and other pathogens can even change forms to survive until more favorable host circumstances are had, i.e. stress, sleep deprivation, fatigue, nutrient deficiency, etc. All that being said, these passengers are continually eliciting a low-grade inflammatory signal that can take its toll when other environmental stressors weigh in as well. Aside from their contribution to cellular distress and inflammation, the evidence is being brought against viruses in the case of molecular mimicry – similar to how food derivatives become immunological agents of doom. Viruses have the daunting ability to change the expression of immune cell receptors and thyroid cells alike, which allows for increased susceptibility to destruction by the immune system. Increased tissue destruction results in more intracellular antigens being released into the surrounding areas, leading to a heightened chance for autoantigen binding and processing.

Wrap-Up

There are many pieces to this clinical puzzle – thyroid markers, viral and bacterial loads, genetic work up, and many more. Having one marker determine your path is as efficient as sailing with a broken compass. Your condition may fit the typical mold and it may not, it may be autoimmune, or it may be unfortunate tissue destruction at the hands of some other inflammatory activity. Hashimoto’s thyroiditis is a complicated disease process with many contributing factors, but the primary takeaway is that it all begins with inflammation. Inflammation from what? That is where your clinician comes in – that is where a journey to understanding your body starts, and that is a road that will lead you to optimal health.

22 a Day

February 10, 2018 by Dr Joshua Flowers DC, DACNB

22 a Day

When I woke up the other morning, I received a text from a dear friend. The message I read made my heart sink and my stomach rise due to the awful news that we hear all too often. The death of a friend, a veteran, a hero to suicide.
Our military risks their lives to protect our freedom and our rights. 22 veterans take their own lives every day. It’s time the nation wakes up and addresses real concerns in our communities. These statistics are horrific and growing. We must not forget their sacrifice and dedication to our country and our freedom.
When the wounded return to our country, they are given access to some of the lowest forms of healthcare. They then have the challenge of navigating through the VA system. In my time as a doctor who works with veterans, I have seen and heard things that should never be acceptable: Patients that have been denied disability after stepping on an IED, amputee who was denied prosthetics because their doctor stated they broke the prosthetics that were actually never received, hundreds of veterans have had every drug imaginable thrown at them resulting in no change to their symptoms, additional health issues due to the overuse, and many times ending in suicide.
As a society, we sit on the sidelines and complain about taxes, sexual harassment in Hollywood, welfare, or what shoes the First Lady is wearing. We have lost our focus on the heroes who have fought to secure the freedom we are sitting in daily in the United States of America. When our heroes return from combat, they are expected to walk right back into civilian life as if they never experienced anything traumatic and life-changing. These events, especially when there are multiple tours of duty, accumulate and play in their minds like a nonstop movie reel.
The Label of Combat PTS (aka PTSD) as a mental health issue is hardly an identity these brave, and fierce men and women can bear to hear. The treatment options they are given are counseling and drugs. Combat PTS is much different and should be viewed as such. These traumatic events are ingrained with an emotional response that feeds a physical stress response. Combat PTS is often associated with brain injury and imbalances in the brain’s ability to produce and regulate hormones and neurochemicals. In our military personnel, that have had blast injuries, concussions, adrenal fatigue, high levels of stress and much more that underlay the diagnosis of PTS. I refuse to use the term PTSD in our veteran population because this is not a disorder, but a physiological response is happening in the brain from training and reacting to events experienced in war.
Anyone that sleeps 3-4 hours a day, fires heavy artillery (.50 Cal or larger), or has been in multiple firefights is at significant risk for Combat PTS. The innate reactions that are needed to survive such events are ingrained in areas of the brain called the limbic system. These reactions are in place to help us survive when we sense danger. These areas are not meant to be engaged all of the time.
When our Veterans return home, we as a nation do not understand why they can’t just shut it off or forget about it. It’s just not that simple. Imagine you have been through intense reaction training, “runnin’ and gunnin’” 24/7 and have been skillfully trained to react in very specific ways in order to stay alive. When you finish your enlistment and are now home with your family and friends, the programming does not change back to the life before enlistment like a light switch. Their brains have been reprogrammed, and many times damaged, so they are no longer functioning in a capacity where they can regulate emotions, responses, and triggers that are non-threatening – but perceived as a major threat due to their combat experiences. Their limbic system is stuck in “fight or flight” mode.
We must stop looking at this as a government or VA problem and realize this is a community and a social problem. Counseling is needed, not just for our veterans, but for our society. We can’t give veterans drugs and counseling and expect their reactions and feelings to disappear. It takes understanding, care, compassion, and outreach to help our heroes. Combat PTS is not a disease or a disorder nor is it solely a mental health issue. Combat PTS is a trained response that is difficult to control because of many other underlying factors such as sleep deprivation, concussions and changes in hormones to name a few. To truly help our veterans we need to educate society, provide real healthcare, and look at all the factors affecting their health. 22 a day is 22 too many, and it’s our responsibility as a society to help put an end to this.

Author: Dr. Joshua Flowers DC DACNB

Winter sports TBIs awareness

January 10, 2018 by Dr Joshua Flowers DC, DACNB

(Dr Joshua Flowers DC DACNB)

January is National Winter Sports TBI Awareness Month…

Here in Colorado we are in the peak of winter. With Skiing, snowboarding, snowmobiles, and hockey leagues in full throttle, Colorado has one of the highest rates of TBI’s in the nation. With extreme sports comes extreme risk of head injury. Concussions and TBI’s are not “walk it off” injuries. Many people try to push themselves to get back to normal life after injury. After a fresh concussion, the brain needs time to heal. Decreasing stimulation is a significant factor in treating a brain injury. We recommend fasting, rest, and limited to no screen time for the first week to two weeks depending on the severity.

The goal is to decrease neuro-inflammation, stress (both physical and emotional), and increase healing. Other factors like gut motility, gut absorption, hormone production, and medications can affect the healing process. If a patient is having changes in gut motility, then there is a high likelihood that the patient is suffering from malabsorption. Malabsorption can affect the absorption of B vitamins, essential fatty acids, fats, and much more. The brain needs B vitamins, fats and EFAs for development, healthy brain function, and healing. If a patient has malabsorption, then they have a higher likelihood of struggling to recover from concussions and TBI’s

Another commonly overlooked complicating factor in head injuries is pituitary hypofunction. The pituitary gland is frequently injured in TBI patients. The anterior pituitary makes seven different hormones that affect a wide range of functions throughout the entire body. If the stalk of the pituitary is damaged, we can see a decrease in production of any or all of these hormones. We will be discussing the affect of dysfunction in a few of these hormones.

Growth hormone (GH) has a huge factor in healing the brain and increasing synaptogenesis (growth of new synapsis).
Follicle-stimulating hormone (FSH) and Luteinising hormone (LH) also known as gonadotrophins. FSH and LH act on the ovaries or testes to stimulate the production of sex hormones, like testosterone and estrogen, and egg/sperm maturity. Sex hormones play a significant role in mood and brain function as well as healing.
Prolactin (PRL) stimulates milk production.
Melanocyte-stimulating hormone’s (MSH) is also produced by the anterior pituitary, however, the exact role in humans is unknown.
Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands to secrete steroid hormones, particularly cortisol.
Thyroid-stimulating hormone (TSH) is a hormone that controls the production of thyroid hormones. Thyroid hormones help to regulate energy throughout the body and have a strong influence on brain function.

As you can see, there are many factors that play into the healing and recovery of concussions and TBIs. When the brain has an injury the influence of this injury affects the entire body. It is important to support all of the systems which lead to good brain health. If you or a loved one are struggling to recover from a brain injury or has had a recent concussion and would like to better explore your options, please contact us.