Radioactive Iodine Uptake Test

Why have a radioiodine uptake scan (RAI-U)

In a radioiodine uptake scan (abbreviated RAI-U) the patient swallows radioiodine. The thyroid gland absorbs the iodine. A scan then shows how much and where the iodine was absorbed.

Radioiodine uptake tests can help to show what the cause of hyperthyroidism. If the results are diffuse (meaning spread evenly through the whole gland) this shows graves diseases. Other causes such as a thyroid secreting nodule will show iodine concentrated in small areas.

Is a radioiodine uptake scan safe?

In conventional medicine they consider this test safe. They tell patients there are no side effects. Short-term studies show no clear side effects. I could not find any long-term studies. The only source I have found which discusses side effect of RAI-U test is the excellent book from Elaine Moore and Lisa Moore: Advances in Graves Disease and Other Hyperthyroid Disorders

These are the key points made about safety:

Radiation may take years or decades to manifest as symptoms.
They have done no long term population studies on those who have had the RAI-U test.

Who should get a radioiodine uptake test?

Whether to have a RAI-U test depends on the specifics of each case. I’m am not against it as it helps to diagnose the cause of hyperthyroidism. I do however believe they should run the test when it needs to be.

When a radioiodine test is recommended patients may consider if it is needed in addition to blood work. At times I have had client’s who reported that RAI-U test was ordered before a full set of thyroid blood tests. Go to this link for for more information on blood tests for hyperthyroidism.

One argument against the test is the fact that Graves disease is the most common cause of hyperthyroidism. So a RAI-U test may not be needed to make a diagnosis. On the hand thyroid secreting nodules and cancer are serious enough that the scan may be needed to rule out. In Graves disease there is an elevation of the TSI (thyroid stimulating immunoglobulin) antibody. However, this marker may also be elevated with other triggers of hyperthyroidism, so it’s not always sufficient to get a correct diagnosis.

Radioiodine uptake test and holistic health

Just because I’m a naturopathic doctor and work to give clients an alternative to conventional treatment, I am not against RAI-U scan. The radiation is a concern. Regardless, knowing if someone has Graves disease or something else causing hyperthyroidism will change the recommended natural treatment. Please see my main hyperthyroidism page for more information on natural treatment. The risk factor of the test is low compared to the cost of getting the wrong diagnosis.

July 16, 2018February 23, 2019

Naturopathic Treatment of Adrenal Fatigue

What Is Adrenal Fatigue?

The adrenals are small glands about the size of an almond that sit on top of each kidney. They produce the stress hormone cortisol. Cortisol is our body’s major stress hormone. It greatly affects how we feel and how much energy we have. Adrenal fatigue is the concept that long-term stress lowers the adrenals gland’s ability to make cortisol. Low cortisol then causes people to feel tired.

The General Adaptation Syndrome

In 1956 Hans Selye’s book “The Stress of Life” was first published. He based this on animal research of cortisol and adrenal function in animals. Experiments where done such as putting rats under stress, then testing then for changes in cortisol and size of the adrenal glands. He found that stress caused profound changes to the adrenal glands in three stages. He called this the general adaptation syndrome.

Phase 1: Alarm

This is the fight-or-flight response. It’s designed to help us survive immediate danger. Cortisol surges to move more blood and oxygen to the lungs and muscle. Other systems not needed at the moment slow down.

Functions stimulated

Increased blood pressure
Strengthens heart contractions
increases blood sugar
Excites mood and focuses mental clarity.

Functions supressed

Decreased digestion
Decreased detoxification
Lowers immune system function
Protein catabolism. The body breaks down its own proteins for fast, emergency energy.

Phase 2: Resistance

If the acute stress does not go away, then cortisol can remain elevated. This lead to illness of high stress such as hypertension, and cardiovascular disease.

Phase 3: Exhaustion

If the adrenals glands can’t keep up and cortisol production drops. Too much cortisol is bad, but so is too little. We need to have enough cortisol for the following processes:

Maintain blood sugar
Maintain blood pressure
Regulate inflammation
Proper fluid and electrolyte regulation

Symptoms of adrenal fatigue include:

Low blood sugar (may cause hypoglycemia)
Inflammation (arthritis, aches, pains, worsens inflammatory conditions>
Insomnia (especially people who wake 2 – 3AM)
Decreased immune function – may often get sick with colds/flu/viral infections and takes longer to recover
Low blood pressure – may feel faint when standing up quickly
Cravings for salty food
Depressed mood
Frequent urination

Saliva Cortisol Tests

Cortisol is normally about 10 times higher in the morning than at night. It varies much during the day. Stress of eating sugar raises it. Reducing stress lowers it. A single blood test is typically not going to be very helpful.

When saliva cortisol tests came out, practitioners finally had a tool to measure cortisol through the whole day. Too high or low cortisol could now much more easily be found. Some people also have deregulated rhythms, such as cortisol low in the morning and high at night. At times knowing the pattern of adrenal function can help treatment.

For more on cortisol tests go to the functional medicine page.

What Is Stress?

Selye defined stress as “the body’s nonspecific response to any additional demand.” Any is the key word. It doesn’t matter if the stress is long hours at work, a poor diet, or physical illness. The body has only one stress response. It tells the adrenals to make more cortisol.

The society we live in puts great stress on people. This can be from working too many hours, emotional stress, or eating a bad diet. Lifestyle changes help. This includes meditation, exercise, calming music or anything else which relaxes the nervous system.

We can’t easily escape from our stress. But supplements for adrenal fatigue can help us handle it better.

Herbal adaptogens
Calming herbs
B vitamins
Pregnenolone and DHEA
Glandulars

For more information, go to the page on adrenal supplements.

Adrenal Fatigue versus Chronic Fatigue Syndrome

Adrenal fatigue referrers to a state of diminished cortisol brought on by any prolonged stress.

Chronic Fatigue Syndrome is a condition of debilitating fatigue. It is typically associated with a weakened immune system. Someone with CFS may have adrenal fatigue, however the two are not the same.

For more information on Chronic Fatigue Syndrome go to this page.

Adrenal fatigue is one cause of fatigue. Is is not the only cause. The concept of adrenal fatigue is only useful within a holistic framework. Many different things can make someone feels tired.

Some of the more common triggers of fatigue include:

Infection
Heavy metals
Environmental toxicity
Candida and yeast
Viral infections
Lyme and confections
Poor immunity
Poor digestion
Anemia
Other hormonal issues
Structural / physical injury

Often several of these factors are working together to cause fatigue. It is important to support the adrenal glands, but this is often just one part of a larger picture.

July 13, 2018March 7, 2019

San Pharma Isopathic Immune Metabolic Remedies

What are Isopathics?

Isopathics are not very well known in the United States, even among natural health care practitioners. This is unfortunate, as Isopathics offer an incredibly powerful to regulate the immune system and stimulate detoxification. Isopathics are made from cytoplasmic material of specific fungal and bacterial organisms. However, isopathics contain no living organisms. They work by presenting something inert to the immune system. The agent itself does nothing. However the response it triggers from the immune system can be quite profound. Isopathics are given in very minute dilutions. Isopathics do not simply stimulate the immune system. Rather, the effect is much more balancing. Overall, they help to re-education the immune system, down-regulate inappropriate inflammation, but also provoke the immune system to go after pathogens. They are “adaptogenic” for the immune system (in natural health, and adaptogen is a substance that will either increase or decrease the function of a system depending on what the body needs to do to restore health).

Some conditions where isopathics may be helpful

Auto-immune disease

In auto-immune disease it’s important to lower overall inflammation, yet there is often some immune system challenge that the body is not able to overcome. Therefore, in some ways the immune system is over active, and in other ways it’s under active. The immune system could be said to be in a state of “anergy.” Another way to explain it, is the immune system looses the ability to tell self, from non-self and thus acts in a confused manner. Although in certain ways the immune system is suppressed, it may be wrong to treat with many supplements that only stimulate immune system activity. This is because, that may also stimulate the auto-immune response. Isopathics from San Pharma on the other hand actually stimulate the immune system where needed, without potentiating the auto-immune response. In fact, isopathics can actually lower unwanted immune system activity.

Isopathics for digestive system disorders such as IBS and IBD

Within our digestive tract is a complex eco-system which has 10 time more microbes than we have cells in our body. Ideally, what should keep this eco-system in proper balance is our body’s own immune system. When the types of bacteria and fungus living in the digestive tract get out of balance, this is called gut dysbiosis. This leads to many problems such as IBS, IBD, Candidiasis, “leaky gut,” food allergies and fatigue just to name a few. Ultimately, it’s the patients own immune system that is going to have to maintain a healthy gut flora. Isopathics can help to stimulate the immune system to balance this complex ecosystem.

Isopathics for chronic infections

Many people have infections that don’t clear. This can be recurrant sinus infetions (or elsewhere in upper respiratory area), urinary tract infections, Epstein Barr virus, or others. Isopathics stimulate the immune system to fight off either active or latent infections. Sometimes it’s the people who never get sick whose immune systems need the most help. Never getting sick can be a sign that rather than being strong, the immune system is so weak it rarely makes an attempt to mount a response.

List of San Pharma Remedies

The following are short descriptions of San Pharma brand isopathics.

Notatum

This is made from metabolic products of Penicillium notatum. It’s main action is to down-regulated inflammation, but it also boosts immune system response against infection. Because of this duel action it’s often useful in autoimmune disease, inflammation and chronic infection.

Quentans

Made from metabolic products of Penicillium frequentans. Main action is boosting immune system function in active or chronic infection. Chronic illness may be triggered by a latent or sub clinical infection. In a subclinical infection, such as certain cases of EBV (Epstein Barr Virus) the body may seem to get over the initial infection, yet long term sytems remain such as fatigue, cold sweats, brain fog, muscle pain, occaional fever, poor sleep, headaches, and poor digestion. A remedy such as Quentens helps the body fight off chronic infection. This is similar inaction to Notatum, but more specific to viral infections.

Roqeuforti

Made from Penicillium roqueforti. Its main action is to regulate the terrain of the digestive system. We have more than 10 times more organisms living in our digestive system than cells in our body. This balance of this microbiological ecosystem is essential to health. Probiotics do help to keep this ecosystem in balance, however they are just one of numerous ways to bring balance back to the digestive track. Ideally a functional immune system will keep the intestinal terrain healthy. By actually restoring function to the immune system, it’s possible to get better long term, and deeper results then simply taking a lot of probiotics for years on end. This isn’t to imply that probiotics don’t help, or are not needed, but rather that other therapies can work synergistically with probiotics to promote healing on an even deeper level.

Mucor

Made from Mucor racemosus. Used from blood stagnation, vascular congestion and hypercoagulability. Can also be used for detoxification, in cases where other protocols don’t seem to be giving expected success.

Aspergillus

Useful for metabolic dis-regulation, and as part of protocol for many chronic degenerative diseases.

Candida

This is made from Candida parapsilosis, not Candida albicans. Will stimulate immune system to overcome candidiasis, but that is only part of it’s function. It stimulates the body to fight many viral and bacterial infections. Often combined with Roqueforti (discussed above) or other remedies, as they act synergistically together.

Subtilis and Mycobactin

Subtilis great for infections, inflammation, and allergies. Mycobactin S is similar, but generally more specific for the lungs. Subtilis is similar to Notatum (listed above) but stronger inaction.

Firmus

The strongest remedy available from San Pharma. Useful for chronic inflammation such as in the digestive system, lungs, joints and sinuses.

How are the San Pharma remedies used in a protocol?

Individual remedies are never used as a mono-therapy. Since all the San Pharma isopathics stimulate detoxification, they generally given with some support for detoxification. Additionally, other supplements and homeopathics will be used to focus action of San Pharma’s onto a specific area. Which remedies are best depends upon the individual, and not the disease. Therefore it’s best to have a holistic assessment from a trained practitioner rather than trying to match a specific remedy to a disease.

July 13, 2018January 16, 2019

Selenium For Graves Disease

Review of research studies which show use of selenium for Graves disease and other thyroid conditions.

Selenium Supplementation in Patients with Autoimmune Thyroiditis Decreases Thyroid Peroxidase Antibodies Concentrations [1]

Study was done on 70 women with either thyroid peroxidase or thyroglobulin antibodies elevated. 36 patients were given 200 mcg of selenium a day. The other 34 given a placebo. They found a significant drop in thyroid peroxidase in the selenium group, compared to placebo. “We conclude that selenium substitution may improve the inflammatory activity in patients with autoimmune thyroiditis, especially in those with high activity.”

Selenium and the Course of Mild Graves’ Orbitopathy

This study is interesting because it doesn’t just show selenium helping they thyroid, but also mild cases of orbitopathy (Graves ophthalmopathy). “Selenium administration significantly improved quality of life, reduced ocular involvement, and slowed progression of the disease in patients with mild Graves’ orbitopathy.”

Concentration of selenium in the whole blood and the thyroid tissue of patients with various thyroid disease [3]

Study of 41 women, with thyroiditis, Graves disease, thyroid nodules or cancer. Found less selenium in women with thyroid disease. “The lowest mean selenium level was achieved in the whole blood of women with Graves’ disease and the highest in the whole blood of healthy people. In the thyroid cancer tissue, we found the lowest concentration of selenium and the highest in the thyroid gland of women with nodular goiter and Graves’ disease. The low selenium levels in the thyroid tissue may increase thyroid cancer risk.”

Serum Selenium Levels in Patients with Remission and Relapse of Graves’ Disease [4]

This study found a relationship between blood levels of selenium and auto-antibodies. “Conclusion: Our data indicate that high serum Se levels (>120 ug/l) may influence the outcome of GD. This is important, as Selenium administration trials in GD, which are under discussion need to be performed with Selenium supplementation at higher dosages than used in autoimmune thyroiditis.”

Supplementation with antioxidants in the treatment of Graves’ disease; the effect on glutathione peroxidase activity and concentration of selenium [5]

Another study improvement in Graves Disease with selenium and other anti-oxidants. “Conclusion: The results of the study clearly indicate that supplementation with antioxidants in the treatment of Graves’ disease is justified, particularly those containing selenium.”

The Role of Selenium in Thyroid Autoimmunity and Cancer [6]

“There is evidence supporting considerable oxidative stress in Graves’ disease where Se supplementation, because of its free radical scavenging properties, may increase the enzymatic antioxidant activity… Low Se serum levels have also been associated with increased risk of thyroid cancer and may play a role in carcinogenesis. It is noteworthy, that the Food and Drug Administration has recently determined that there is sufficient evidence to warrant a qualified health claim for Se and cancer.”

The Evolving Role of Selenium in the Treatment of Graves’ Disease and Ophthalmopathy [7]

Another article citing the use of selenium in both hyperthyroidism from Graves Disease and Graves ophthalmopathy.

“Selenium as selenocysteine is incorporated in selenoproteins, such as glutathione peroxidase which catalyzes the degradation of hydrogen peroxide and lipid hydroperoxide that are increasingly produced in hyperthyroidism. Moreover, selenium decreases the formation of pro inflammatory cytokines, while it contributes, in synergy with antithyroid drugs, to stabilization of the autoimmune process in GD (Graves Disease) and alleviation of GO (Graves ophthalmopathy).”

Selenium may be lower in people with Graves orbitopathy, compared to those who just have Grave’s disease of thyroid. [8]

Summation – the use of selenium in Graves disease

There is an abundance of medical lititure that cites the use of selenium in Graves disease. This even includes its use as an adjunction to conventional treatments. Considering this, and the fact that selenium is a very inexpensive common supplement you would expect that every doctor treating Graves disease patients would recommend the use of selenium. However, this is not common practice at all.

True, there is no single, huge, multi-million dollar study “proving” the efficacy of selenium. That is not likely to happen, as there is very little profit to be made from a cheap, non-patentable supplement. Nonetheless, does this mean that the abundance of evidence for selenium’s use in Graves disease should be ignored?

References

[1] http://jcem.endojournals.org/content/87/4/1687.short

Selenium Supplementation in Patients with Autoimmune Thyroiditis Decreases Thyroid Peroxidase Antibodies Concentrations

The Journal of Clinical Endocrinology & Metabolism April 1, 2002 vol. 87 no. 4 1687-1691

[2] http://www.nejm.org/doi/full/10.1056/nejmoa1012985

Selenium and the Course of Mild Graves’ Orbitopathy

N Engl J Med 2011; 364:1920-1931May 19, 2011DOI: 10.1056/NEJMoa1012985

[3] http://link.springer.com/article/10.1385/BTER:88:1:25

Concentration of selenium in the whole blood and the thyroid tissue of patients with various thyroid diseases

[4] Serum Selenium Levels in Patients with Remission and Relapse of Graves’ Disease

http://www.ingentaconnect.com/content/ben/mc/2007/00000003/00000003/art00009

[5] http://www.sciencedirect.com/science/article/pii/S0009898103005321

Supplementation with antioxidants in the treatment of Graves’ disease; the effect on glutathione peroxidase activity and concentration of selenium

[6] http://online.liebertpub.com/doi/abs/10.1089/thy.2006.16.455

The Role of Selenium in Thyroid Autoimmunity and Cancer
Leonidas H. Duntas. Thyroid. May 2006, 16(5): 455-460. doi:10.1089/thy.2006.16.455. Volume: 16 Issue 5: June 6, 2006

[7] http://www.hindawi.com/journals/jtr/2012/736161/

Leonidas H. Duntas, “The Evolving Role of Selenium in the Treatment of Graves’ Disease and Ophthalmopathy,” Journal of Thyroid Research, vol. 2012, Article ID 736161, 6 pages, 2012. doi:10.1155/2012/736161

[8] Khong, J. J., Goldstein, R. F., Sanders, K. M., Schneider, H., Pope, J., Burdon, K. P., Craig, J. E. and Ebeling, P. R. (2014), Serum selenium status in Graves’ disease with and without orbitopathy: a case–control study. Clinical Endocrinology, 80: 905–910. doi: 10.1111/cen.12392

July 1, 2018October 10, 2019

Kratom: Asian Herb For Addiction and Pain

This is the first post I made about kratom. Since writing this short article I have done much more research on kratom and seen it help people in practice. Because of the ways I have seen this herb help people, and additional information about it’s history and safety, I have expanded my practice to include kratom consultations and sales. I am leaving this first post up unchanged, but will be adding many more pages with detailed and updated information on this amazing herb.

Kratom (Mitragyna speciosa) is an herb from southeast Asia with a long history of being used for pain. The past few years it has gained notoriety as a substitute for opioids.

Safety concerns and proper use of Kratom

While it is true that most medicinal herbs are relatively safe compared to drugs, herbs are complex medicinals that should not assumed to be safe just because it’s natural.

With most medicinal herbs form Europe and North America we have knowledge to draw on from hundreds (if not thousands) of years. This allows us to understand the safety of such herbs, and how best to use them medicinally.

From an herbalist perspective, this information is invaluable. For example agrimony isn’t simply an herb that can used for PMS, it’s for people with tension who hide their stress. Lady’s Mantle is another Western herb that may be used in similar cases, but has a specific indication “prominent blue veins” and also may seen anxiety and insomnia. both of these herbs may be used in similar cases, but have specific descriptions based on hundreds of years of observation. As as herbalist this means the right herb can be selected for the right person (as supposed to simply giving every woman the same thing for PMS).

Kratom has not been historically used in Western herbalism (nor Ayurvedic or Chinese medicine as I can find in my research). When people me about herbs from other parts of the world I often just have to say I do not know as it’s not in my herbal medicine books so what we are left to go by is information from the Internet. Typically I dismiss such herbs because I’d rather go with herbs which I am familiar with and have a long track record, rather than something being promoted over the Internet with claims I am unable to verify.

Kratom is different for two reasons:

By now it’s been widely used enough in the West so we know it has a strong effect on pain
It has something to offer which other Western herbs do not

The information available about using Kratom is very general. Small amounts are stimulating. Larger doses can help with pain and sleep. Specific indications and actions beyond that are not very much known. There are some various strains which are supposed to vary in terms of opioid like and pain killing effect.

What I can say from cases I have seen personally is it may have a very strong pain killing effect, and help with insomnia as well. I have recommended it to clients (in select cases when I felt it could be far more useful than other herbs) with some good results.

As far as detailed information on safety and purported dangers I will refer readers to the following website:

For more information about Kratom go to the American Kratom Association

The following article from Huffington Post may also be enlightening about alleged dangers of Kratom:

FDA Releases Kratom Death Data, Undermines Its Own Claims About Drug’s Deadly Harms

July 1, 2018March 2, 2021

Eosinophils, Parasites and Allergies

White Blood Cell Count and Differential

There are two types of cells in our blood. Red blood cells which carry oxygen and white blood cells which are part of our immune system. There are five types of white blood cells:

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

On blood tests you will typically see the White Blood Cell count or WBC. This should be followed by the “differential.” The differential is a break down of what percent of the total WBC is each type of white blood cell. Seeing some kinds of white blood cells elevated or suppressed can give information about the state of your immune system.

Elevated eosinophils indicate parasites or allergies.

Convention ranges for eosinophils go up to about 7%. This reference range is in reality far to large. Optimally, eosinophils should be no more than 3%.

Why does it matter if eosinophils are above 3%?

When eosinophils go up this indicates a nonspecific inflammatory response by your immune system against something it does not like. Much more may be going on than just an elevated blood test markers. There may very well be other symptoms caused by whatever is triggering the elevation in eosinophils.

How elevated eosinophils are does not necessarily tell you how bad the problem is. For example intestinal parasites can raise eosinophils (or sometime there is no elevation whatsoever). There may be a very mild increase, perhaps from 2.0 to 4.0, yet this slight elevation can signal a problem which can lead to many other symptoms or diseases.

Regardless, very elevated eosinophils (10% or higher) may be best interpreted as positive for parasite unless proven otherwise.

Some conditions which may be associated with elevated eosinophils are:

Cancer
Polycythemia
Hyperthyroidism
Anterior pituitary dysfunction
Adrenal dysfunction
Phlebitis
Edema
Rhinitis
Gastroenteritis
Eosinophila myalgia syndrome

Won’t by doctor treat the problem if eosinophils are elevated?

Not necessarily. First you medical doctor may be using the very conservative conventional reference range, which misses everyone in the 3-7% range. Even if you are over 7% the labs may still be ignored.

If eosinophils are elevated then either allergies or parasites should be investigated. Often the conventional tests for these are not adequate. Typically some IgE and maybe IgG tests are run for environmental and food allergies. These tests are not perfect and allergenic reactions to foods are easily missed.

Then there are microscopic exams for parasites. Stool tests for parasites are very unreliable. Just because you submitted a stool sample and it came back negative for parasites that doesn’t mean you don’t have parasites. All it means is that they didn’t see any parasites in that particular sample. A comprehensive functional stool tests for a lab such as diagnostechs is much better and includes markers such as saliva antibodies to catch parasites that may otherwise be missed visually.

My eosinophils are optimally low – does that mean I don’t have allergies or parasites?

This is just one marker. Allergies and parasites do not always cause an increase in eosinophils. If other symptoms/labs indicate allergies or parasites the it’s best to pursue a course of treatment based on that. These problems can not be ruled out based on normal eosinophils.