Adrenal Fatigue, also known as adrenal insufficiency or adrenal dysfunction is a broad and heated topic.  There are many theories and opinions concerning adrenal fatigue, which makes it a controversial issue in healthcare community today.    The majority of the conventional medical community does not recognize Adrenal Fatigue as a real diagnosis. However, some experts say everybody has adrenal fatigue to some extent.  Others say nobody has it. As I said, there is a lot of varying perspectives about the adrenal glands. For this post, I am not going to argue whether adrenal fatigue exists or not.  From my 14 years of experience, I know it does. Over the last decade, I have observed three common types of adrenal fatigue.   I call these types, The Vampire, The Ghost and The Zombie.  There are more types/categories of adrenal fatigue, but these three are the most common I consistently see and treat.  You might find that you can relate to one of the three types. Quick Info on Cortisol: Many people are familiar with cortisol as the stress hormone. Cortisol is released from the adrenal cortex and is a glucocorticoid due to its effect on blood sugar. You can’t live without cortisol; it is essential to maintaining life. When cortisol is disrupted or being secreted dysfunctionally, it can cause many symptoms.  There is a lot of information about high cortisol or low cortisol, but the critical distinction is the daily levels of cortisol secreted are out of sync.    The adrenal glands secrete cortisol in a diurnal fashion, which helps to establish our typically circadian rhythm. Meaning it is supposed to be high in the morning, so we wake up bright eyed and bushy tailed.  Then cortisol lowers toward later afternoon and dives at night so that we can get a good night’s sleep. Normal Cortisol Levels: High in morning Moderate afternoon Low night Types of Adrenal Fatigue: There are many “types” of adrenal fatigue or adrenal insufficiency.  People with high cortisol, people with low cortisol and everyone in between.  I am sure many of you have read about the various types and subtypes of adrenal fatigue.  From my own experience treating patients, I am going to break it down into three simple profiles. These are the three common profiles I have seen in practice: The Vampire, The Ghost, and The Zombie. The Vampire: (up all night, sleep all day) High cortisol at night Low cortisol in morning and afternoon Vampires love to stay up at night.  Soon after 8 pm, their senses come alive and report they are more productive at night. They interact with others, work on the computer and even get household activities done at night.  This is also a time they report being hungry. Not for your blood, but worse. It’s a craving for junk food because they feel so much better at night, they tend to stay up late. Vampires report they couldn’t fall asleep early if they tried. However, this comes at a price, because they are always extremely tired the following morning.    Vampires are exhausted in the morning and would love to sleep in as late as possible. Unfortunately, life starts early. Vampires reluctantly get moving in the morning and depend on lots of coffee or caffeine to function. Vampires start to become moderately functional around noon. They optimistically think they are going to bed early and get a good night’s sleep.  No surprise, it’s groundhog’s day! Different night, same cycle. Vampire Daily Cycle:  The alarm goes off, they press snooze multiple times Finally, drag themselves out of bed in the morning Need coffee to function Start feeling good after 8:00 pm. Cravings for salt or sugar (CARBS!!!) Sleep after midnight (usually much later) A classic Vampire case is a patient of mine “Brandy.”  She is 37 years old and a SAHM (stay at home mom). She has a 7-year-old daughter and a 5-year-old son.  Her alarm clock goes off at 6:45 am and again at 7:15 am, and she barely makes it out of bed by 8:00 am. Her husband gets mad at her because she can never get the kids to school on time, which has been a creating a strain on their relationship as well.  She drags herself through the day with the best intentions of going to bed and waking up early. By the time 9 pm comes around, she feels like a “normal person.” She gets all her emails and housework done.  Then she watches Netflix/Amazon/Hulu while munching on chips and chocolate. Brandy reports this is the only time of the day that she has an appetite.  She tries to talk to her husband, but he is already asleep.  Brandy says when she tries to lie down at 10:30 pm she cannot fall asleep and feels wide awake. Wisely she does not take sleeping pills because they are habit forming and have too many side effects.  Besides, she doesn’t want to be in a coma in case her kids need her in the middle of the night. Brandy usually falls asleep between 1-2am and sleeps the entire night till the alarm at 6:15 am. No matter what she cannot get out of bed and kids are always late to school. Vampire Characteristics: Set multiple alarms Place alarms around the room Sleep through all alarms Have family members literally shake them to wake them up Do not remember the family members shaking them Get up, turn off the alarm and don’t remember doing this It is hard being a Vampire.  Life starts early, and they often end up getting left behind. And no, moving to Washington state is not going to get Vampires to enjoy the day.  This is not Twilight. The Ghost: (early to rise, early to bed – sort of) High cortisol in the morning Low cortisol in the afternoon Cortisol spikes in during the night Unlike Vampires, Ghosts have no problem going to sleep.  They fall asleep easy. In fact, they often fall asleep too early in

Yes, cortisol can affect your sleep.  It can cause: Insomnia Waking in the night Falling asleep before the sun sets Cannot get up in the morning Exhaustion during the day Not to mention, poor sleep over time can negatively affect your waistline, immune function, and mood. I am going to explain further why cortisol levels affect sleep.  First, I need to take a moment to explain a little about the magic of cortisol.  Bear with me, and I promise I’ll try not to bore you with the anatomy and physiology. Cortisol comes from the adrenal cortex and is a glucocorticoid.  Your adrenal glands sit right above your kidneys and secrete a lot of hormones, cortisol being one of them.  Cortisol is necessary for life, and we cannot live without it. One of the primary functions of cortisol is to help us get from meal to meal.   Cortisol raises your blood sugar to prevent hypoglycemia if we go through a prolonged amount of time without food.  Cortisol is also released along with adrenaline (norepinephrine/epinephrine) in times of stress. This helps us ‘fight or flight’ from whatever predator is attacking us.   Now in our society, we are not going to be attacked by a tiger.  Unless you have an Asian tiger-mom as I do, then I suggest flight. Most definitely, flight would be the best option.  Also in our society, we are not going to starve. Food is plentiful. We do not need to go and hunt and gather our food.  I can sit on my butt and have someone deliver it so I can binge out on chicken korma and Handmaid’s Tale. But while we are not running from The Predator and not living a version of Naked and Afraid, we still live in a state of perpetual stress.  The news, family crisis (aka drama), work, neverending emails and voicemails, traffic, time management, internet trolls. Our adrenals cannot differentiate between Michael Myers brandishing a butcher knife and your critical bullish boss.  Now your boss is not going to kill you like Michael Myers, but your adrenals still respond the same way. Your adrenals secrete a load of adrenaline and cortisol when you have to deal with everyday crazy-deadlines and crazy-clients.  The same way it would if you saw your child’s American-Girl-Doll, Samantha’s head spin around on its own in the middle of the night. Our chronic everyday stressors are what triggers cortisol to become released in a dysfunctional manner creating sleep issues. Okay, a little more physiology here.  Cortisol gets released from the adrenal glands in a diurnal fashion. In a perfect world, cortisol is secreted highest in the morning, so we wake fresh and bright-eyed.  It starts to reduce in the afternoon and drops significantly in the evening so we can fall asleep quickly and get a good night’s rest. As mentioned above, stress from our life can cause this diurnal curve to get altered.  This change in cortisol secretion can dramatically affect our sleep, consequently disrupting how we feel in the day. Dysfunctional secretion of cortisol from the adrenals is what affects our sleep.  In practice, I have seen three major patterns emerge. I refer to these three types, or patterns as The Vampire, The Ghost, and The Zombie.  I will reference these types often in other blogs. Because these types of adrenal fatigue have lots of symptoms ranging from sleep to weight gain, brain fog, hormonal imbalances, fatigue and more.  But for this blog, I am going to try and stick to how cortisol affects our sleep. The Vampire: The vampire had high cortisol in the evening and low cortisol in the morning and evening.  This is often referred to as a “Reverse Diurnal Curve.” As mentioned above, in a perfect world our cortisol is elevated in the morning and comes down at night.  In the case of the Vampire, they are the opposite of bright eyed and bushy tailed in the morning. Vampires are exhausted in the morning. They have to drag themselves to get up and get going for the day.  But come nighttime, they are awake and lively. Vampires cannot fall asleep at night and can stay up past midnight. Vampires can get stuck in the rut of taking sleeping pills and lots of coffee/soda/caffeine in the morning. A vampire’s cortisol is elevated at night, which is why they cannot fall asleep.  And their cortisol is low in the morning, which is why they have a hard time waking up.  And feel tired all morning and afternoon. The Ghost: Ghosts are the people that have trouble staying asleep.  Ghosts report they have not problem falling asleep but cannot stay asleep. That is because their cortisol is high in the middle of the night and early morning.  This makes them have trouble staying asleep or wake up too early in the morning. Their cortisol plummets come early afternoon.  Once 1-3pm hits, Ghosts disappear because they are so tired. There are two variants of The Ghost: Ghoul: The Ghoul falls asleep easily for about 3-4 hours.  Then they wake up like it is morning. But it is only 2 am.  Ghouls will stay up for 1-3 hours in the middle of the night.  At 2 am you will find them roaming into the kitchen for a snack, reading, watching TV, looking at their phones, writing their thoughts on a piece of paper.  I call them Ghouls because of the scary, ghoulish dark thoughts that chatter in their brains in the middle of the night. The dark thoughts are random and uncontrollable, ‘did I pay that bill? Is that deadline coming up?, are my kids alright?, should I text them right now? Don’t forget about A-Z’.  Come morning, and those thoughts are not anywhere nearly as scary as they were in the middle of the night. For Ghoul, their cortisol levels will rise in the middle of the night. For some, it raises at 1 am, and then they are up for hours. Others it increases

Adrenal fatigue can have a significant impact on sleep.  The main cause being that in adrenal fatigue the adrenal glands release cortisol in a dysfunctional manner.  The adrenal glands release cortisol in a 24-hour diurnal curve. In a perfect scenario: Cortisol is highest in the morning and will slowly decrease over the afternoon. At night cortisol is supposed to be low that way we fall asleep.   In adrenal fatigue, the cortisol is not secreted correctly causing trouble sleeping. As you might have read in my other posts on adrenal fatigue, there are several types of sleep disruption.  I call them the Vampire, the Ghoul, and the Poltergeist. I do not mean to make light of adrenal fatigue, as it can compromise a person’s life dramatically. But I find it easier to remember the concepts when I can create easily relatable themes. In this post, I am going to describe the three common disrupted sleep patterns and give you 11 tips to improve sleep with adrenal fatigue. Three common patterns of sleep disruption in adrenal fatigue: The Vampire: Trouble Falling Asleep:  This is the most common pattern seen in adrenal fatigue.  The cortisol is too high at night, making it difficult to fall asleep. Consequently, the cortisol is low in the morning.  This causes trouble waking up and fatigue in the morning. You might be a Vampire, or I am sure you know several.  These are the people that come alive at night but are exhausted in the mornings.  They can stay up and burn the midnight oil. But forget morning meetings, they are either still in bed or cognitively incoherent. The Ghoul: Waking up in the middle of the night:  These people have no trouble falling asleep. But they cannot stay asleep.  They will sleep hard to 2-4 hours and then will be wide awake in the middle of the night.  It will take 1-3 hours to fall back asleep. And during that 1-3 hours, you can find them roaming the house, looking at their phones and pondering every possible stressor in their and their family’s lives.   And by the time they do fall asleep, their morning alarm rings shortly after that. Their cortisol pattern is low in the evening. But the middle of the night the cortisol spikes causing them to wake up for 1-3 hours in the middle of the night. The Poltergeist: Waking up multiple times in the night:  These people fall asleep fine. But they find themselves waking up 3-6 times a night.  It is irritating and even anxiety provoking to wake up so many times in the night. The second you fall asleep, disturbingly only to wake up 45 min to an hour later for no reason.  It not like the dog woke you up, or there was some loud party next door. The Poltergeist is just annoyingly being woken all night long for no good reason. Then come morning they are exhausted and feel like they did not get restful sleep.  This disrupted sleep pattern is because the cortisol is bouncing up and down all night. The goal here is to re-establish the proper diurnal curve of cortisol.  Bringing the cortisol down at night and keeping it low all night so you can get a good night’s sleep. 11 Tips on How to Improve Sleep with Adrenal Fatigue To start I have to state the “disclaimer”…this is not meant for medical advice, please ask your doctor and if your doctor doesn’t know, get a new doctor, and this information is intended for educational purposes only, etc. 1. Balance blood sugar at night: Cortisol helps to raise blood sugar.  If our blood sugar drops while we are sleeping, your adrenal glands naturally release cortisol.  This increase of cortisol will cause you to wake up in the middle of the night. A lot of people eat dinner early, at 5:30-630 pm.  If your last meal was at 6 pm, by the time 2 am hits your blood sugar can drop causing the cortisol to rise to keep your blood sugar from getting too low.  Having a small bedtime snack of protein can maintain your blood sugar level all night. Protein sources such as nuts, hard boiled egg, small protein shake are great ways to balance your blood sugar at night.  You want something small (about 100 calories) and consisting mainly of a protein source. 2. No intense exercise after 12 pm:  Exercise, especially cardiovascular exercise raises cortisol.  If you exercise after 12 pm noon, your cortisol will rise causing elevated levels at night.  Exercise is very healthy for adrenal fatigue and health. But keep your workout to the morning.  Walking is one of the best activities for adrenal fatigue. It is not stressful to the body and will not raise cortisol like intense cardiovascular exercise.  Doing intense metabolic conditioning can be detrimental to adrenal fatigue. Hardcore cardio will rapidly spike cortisol. This not only disrupts sleep but also causes an imbalance in insulin and glucose.  ‘Shelley’ a patient of mine is a perfect example. Every night after work, Shelley would go to the gym to do a spin or boot camp class.  She complained that not only did she have trouble sleeping at night, she also couldn’t lose weight. In fact, she kept gaining weight, especially in the belly.  Shelley complained that she was tired all the time. And she was always late for work in the morning because she kept pressing snooze on her alarm. Even though Shelley tried to eat healthily, the carb cravings were insatiable.  I convinced Shelley to stop exercising altogether. This was to help get the cortisol levels regulated. Between the cessation of the intense cardio, hormone balancing and adrenal supplementation Shelley started to feel better. She slept better and started waking up earlier.  She began walking in the morning before work. The cravings decreased, and she lost weight. 3. Raising Phosphatidylserine levels at night: Phosphatidylserine helps to reduced cortisol levels.  When taken at night phosphorylated serine can help you fall asleep

One of the most common issues we hear from our patients is trouble sleeping. People often have trouble falling asleep and also trouble staying asleep. Both are related the adrenal hormone cortisol. We have been getting a lot of questions about sleep, so below are two questions from a couple of readers. Question from Norma, 53 yo female:  Hi, I’m between the ghoul and the poltergeist. I use to sleep all night now I’m lucky to sleep from 9pm/12am to 1/2 am Or 1/3am or 2/5am.  Sometimes I’m up 4/5x night. I’m 53 and take hormones. Sometimes I’m so tired from not sleeping through the night… Dr. Davidson’s Reponse:  This question is in reference to an article we wrote on cortisol and how it affects sleep and daytime energy.  Cortisol is released from your adrenal glands in a diurnal fashion. In a perfect world, the cortisol secretion is highest in the morning and will wan through the day and drop dramatically at night. This pattern follows the sun. As the sun rises, our cortisol goes up and as the sun sets, our cortisol is supposed to go down. This reflects our energy levels in that high cortisol in the morning helps us wake up and get going for the day.  The cortisol will stay elevated in the day for daytime productivity. Then will drop at night so that it is easy to fall asleep and stay asleep all night.   In our article, we mention three profiles that reflect when cortisol secretion has gone wrong.  We are not making light of adrenal fatigue and the havoc it can wreak in our lives. But these three profiles are easily learnable and understandable.   The three profiles are the Vampire, the Ghost, and Zombie  The Ghost is broken up into two distinctions: the Ghoul and the Poltergeist.  Real quick to explain, the vampire is the person that has high cortisol at night and low cortisol in the morning.  The Vampire will stay up late, having a tough time falling asleep at night. And will have a terrible time waking up in the morning and will be tired all morning if not the afternoon as well.  The Zombie has low cortisol levels all day and night long. Meaning Zombies are tired all day and night long. They can sleep for hours and still say they are “soooooo tired.”  Ghosts are the people that have no trouble falling asleep but will wake up in the middle of the night. There are two variants of the Ghost.  There is the Ghoul, that wakes up after 4 hours and cannot go back to sleep.  Ghouls roam the halls, play on their phone, get some household work done, might have a small meal, watch TV.  Ghouls can be up from 1-3 hours in the middle of the night. And by the time a Ghoul is tired and fall asleep they have to wake up soon after to start the day.  Poltergeists wake up all night long. It is really irritating to fall asleep only to wake up 30 min to one hour later. And they do this over and over again. Poltergeists only get a series of small naps all night. Therefore they are so very tired in the day. Back to Norma and her question about whether she is a ghoul or a poltergeist.  There are so many variants of the Vampire, ghost(s) and Zombies as we are all unique individuals.  But Norma is a Ghost. Norma is a hybrid of Ghost: a PolterGhoul. Once a vampire falls asleep, they generally stay asleep all night, if not all morning long.  But Norma is waking up too frequently in the night for extended amounts of time. This means her cortisol is spiking in the middle of the night, multiple times.   So basically Norma is getting a series of small naps all night long.  That is because her cortisol is bouncing up and down all night long. Why is this happening? Well, most often it is from stress. If there is a lot of stress going on (whether that is good-stress or bad-stress, it is still stress.   Chronic stress will raise cortisol at night.  Now I am sure Norma cannot make the stress go away because we all have “life” to deal with.  But she can reduce the cortisol at night to help her sleep better. Balancing her blood sugar is the first start.  Having a bedtime snack before bed will balance her blood sugar, keeping her cortisol from spiking in the night. To put this another way, if you eat dinner at say 6 pm.  But you have nothing after dinner. Come 2 am, you have not eaten in 8 hours.  This can cause your blood sugar to drop. When your blood sugar drops, your adrenal glands will secrete cortisol to tell your liver to do a process called gluconeogenesis.   Gluconeogenesis is a process that your liver can do to make blood sugar/glucose without even have eaten anything.  But in this process, the rise in cortisol will wake you up in the middle of the night. One easy thing that Norma can do is have a bedtime snack of protein and carbohydrates.  Also taking supplements that reduce cortisol at night would be helpful for Norma/Ghost. I have to say this, or my attorney will give me a verbal flogging: this is for educational purposes and not medical advice, etc… So these are my suggestion for reducing the cortisol: Supplementation:  Cortisol Manager: this is a great blend of herbs and minerals to lower cortisol at night.  This is a nice supplement to take if you have a lot of stress on your plate or there a lot on your mind.  It is not a sleeping pill but helps to reduce cortisol for better sleeping. Kavinace: this is a great amino acid supplement that is a precursor to GABA.  GABA is a huge molecule that is hard to digest. By taking the precursor to GABA can

Kavinace is off the market. Where did Kavinace go? And What Do I Do Now? Kavinace by Neuroscience is no longer available for sale as a dietary supplement.  In mid-April 2019 Neuroscience and several other companies received warning letters from the FDA saying that they cannot make products containing 4-amino-3phenylbutyric acid anymore. Reason being, the FDA says that 4-amino-3phenylbutyric acid is not technically qualified as a dietary supplement.   Kavinace has been a great product that my patients and myself have used for many years.  I’ve found that it really helps you to “stay asleep.” For many of us, we have no problem falling asleep, but a terrible time staying asleep through the night.  Either you would wake up after 3-4 hours for at least an hour. Or you would wake up multiple times a night. Needless to say, resulting in an unrestful night of sleep.  Kavinace worked great to help stay asleep. It is not a sleeping pill.  So you would never wake up feeling groggy. And if for some reason, if you had to wake up in the middle of the night, you could easily have a coherent conversation or drive a car.  That was what made Kavinace so great. If you are reading this, you are well aware that Kavinace is not available.  So what next? What can you do if you cannot take Kavinace anymore? Do I need to wean off of Kavinace? Am I going to go through withdrawals? Am I ever going to get rested sleep ever again? To answer these questions we have to answer, why did Kavinace work in the first place?  It contains a small, yet effective amount of 4-amino-3phenylbutyric acid. This is a derivative of the neurotransmitter GABA, which can cross the blood-brain barrier. In doing so, this can help with calming and reducing cortisol.  So if you wake up in the middle of the night, your mind doesn’t go too all the places and things and stressors that you have in your life.  It also contains Taurine, is a great amino acid that is also considered to have a positive impact on GABA. Is Kavinace like those bizarre google internet searches I saw about Phenibut? No, Kavinace is not like the high doses that people take of Phenibut for “recreational” purposes.   Do I need to wean off of Kavinace since I cannot take it anymore? Am I going to have withdrawals because I can no longer take it? I have not found Kavinace to be habit forming.  If you were to stop taking it, after a few days your sleep patterns may go back to what they were initially.  You will not go through any “withdrawal” process. But your sleep will not be any worse than it was previously to taking Kavinace. What can I take in replacement of Kavinace that is actually going to work? Kavinace was a very helpful dietary supplement for helping support sleeping through the night.  It is unfortunate that we cannot obtain it anymore. But here are some options to replace Kavinace for staying asleep.   These products contain specifically, PharmaGABA, which is a unique form of GABA that can be absorbed in the GI tract and cross the Blood-brain barrier.   I am going to explain these products that I use in replacement of Kavinace to see what might fit your situation.  Now I have to reiterate the “disclaimer”…this is not meant for medical advice, please ask your doctor and if your doctor doesn’t know, get a new doctor, and this information is intended for educational purposes only, etc.         CereVive by Ortho Molecular Products: This dietary supplement is easily replaceable to Kavinace.  CereVive contains the PharmaGaba which as mentioned above is an absorbable form of GABA.  It will support GABA like Kavinace to help you stay asleep. It also has Mucuna Pruriens Extract that is standardized to contain 10% of L-Dopa, which is a precursor to the neurotransmitter Dopamine. Dopamine is an amazing neurotransmitter.  It helps with focus, concentration, and motivation.  Dopamine is also part of the reward pathway, which in essence is the pleasure neurotransmitter.  Sounds good? Not for everyone, because if you are a type-A personality, that is already hyper-focused and task-oriented and maybe a bit of an anxious nature (yes, that is me), then taking mucuna is a no-no.  CereVive also has 5HTP (5-hydroxytryptophan), which is a precursor to serotonin. Serotonin is the happy-neurohormone. It’s important for sleep, appetite craving control, happiness/mood control. Which not to complicate everything, dopamine has a hand in this as well.   So it is important to have a balance of these neurohormones.  Both mucuna and 5HTP are contraindicated with certain medications, particularly antidepressants meds. This may not be an option for you depending on your meds and situation.   CereVive also has taurine in it as well, just like Kavinace.  While CereVive can help you stay asleep, just like Kavinace did, it is also helpful for stress and mood.   Again the “disclaimer,” but let’s say you are a good candidate for CereVive.  Then taking 2-4 capsules before bed would replace Kavinace. PharmaGABA by Designs for Health:   This dietary supplement has 100mg of chewable PharmaGABA per tablet.  Perhaps you are not a good candidate for CereVive. Or perhaps you don’t need something as complex as CereVive.  Then PharmaGABA is a great option for staying asleep through the night. Again, as mentioned PharmaGABA is absorbed easily.  It is made with the amino acid, glutamic acid and fermented with beneficial bacteria Lactobacillus hilgardii.  Because it is chewable, means it is absorbed quickly. This easily absorbed chewable tablets also make it easier to fall asleep. If you have no trouble falling asleep, make sure to take this right before you go to bed.  If you feel that PharmaGABA fits for you …. Again, “disclaimer,” chew one to two tablets before bed. Let’s say, you are a real ‘tough sleeper.’ Or you’re really worried about not having your Kavinace and feel you really need

Hashimoto’s Disease also known as Hashimoto’s Thyroiditis is an autoimmune disorder in which the immune system attacks the thyroid gland, eventually leading to hypothyroidism.  Hashimoto’s does run in families as a genetic trait and seems to be more predominant in females.  Proper Hashimotos testing is important for a diagnosis and will help in determining effecitve treatment options.   Blood tests to diagnos Hashimoto’s Disease:  TPO: Thyroid peroxidase antibody TGab: Thyroglobulin antibody TSH: thyroid stimulating hormone Free T4 Free T3 Reverse T3 Iron TIBC: Total iron binding capacity Ferritin   Thyroid Peroxidase Antibody (TPO) and Thyroglobulin Antibody (TGab) The TPO and TGab are antibodies present in Hashimoto’ s.  In about 70-80% of people with Hashimoto’s, the TPO antibodies are present.  In about 15-20% of patients with Hashimoto’s disease the TG antibodies only are present. The presence of TPO and TG antibodies together is much less common at about 5%.   It is important to not only to test for TPO but also the TGab because a portion of the population with Hashimoto’s could be missed.  Also the higher the level of circulating antibodies can contribute to more symptoms in Hashimoto’s, meaning that monitoring the antibody levels is helpful for treatment. Reference Ranges: TPO < 9 iu/mL TGab < 1 iu/mL   Thyroid Stimulating Hormone (TSH) The TSH is a signal from the brain to the thyroid in order to get the thyroid to produce or not produce thyroid hormone.  If the thyroid gland is under producing thyroid hormone then the TSH increases.  If the thyroid gland is overproducing then the TSH decreases.   Reference Range: TSH .45-4.5 uIU/mL The reference range for TSH is misleading as many people can fall into range and have hypothyroid.  If a person’s TSH is 2.0uIU/mL or higher, it is important to further investigate as this indicates hypothyroid, Hashimoto’s or decreased thyroid function.   Free T4 (FT4) Free T4 is mainly made from the thyroid gland and it is a very stable molecule.  It has a long half life, close to 7days and really has very little activity.  Free T4 is needed to convert to Free T3, which is the most active of the thyroid hormones. Reference Range: Free T4 .8-1.8 ng/dL   Free T3 (FT3) Free T3 is the active form of thyroid hormone, so it is important to make sure it is in the proper range.  A person with a good level of T4 but with a low T3 will still have hypothyroid symptoms. Reference Range: Free T3 2.0-4.4 ng/dL This reference range for free T3 is very vast.  Any free T3 under 3.0ng/dL is going to have hypothyroid symptoms.  Having the free T3 at 3.8-4.4ng/dL is ideal for thyroid function.   Reverse T3 (RT3) Reverse T3 is a inert, inactive thyroid hormone.  In cases such as Hashimoto’s, T4 mono-therapy, starvation/caloric restriction diets to name a few, the FT4 will not convert to FT3 and instead to RT3 thus, causing the person to have more hypothyroid symptoms. Reference Range: Reverse T3 8-25 ng/dL Optimal: RT3 less than < 20 ng/dL Iron Often in Hashimoto’s disease the hemoglobin and hematocrit (the iron that is available for use right now) is normal but the total serum iron is low.  When the total serum iron is low that can cause fatigue and symptoms associated with iron deficiency anemia (IDA).  But as stated above, the hemoglobin and hematocrit are normal, which is what most doctors test for when looking for IDA. Reference Range: Adult female 40-190 mcg/dL (optimal 75-150 mcg/dL) Adult male 50-180 mcg/dL (optimal 75-150 mcg/dL)   Total Iron Binding Capacity (TIBC) The TIBC tends to be elevated in Hashimoto’s disease.  The TIBC is the ability for the body to bind/absorb iron.  If the total serum iron levels are low then the TIBC would be elevated because the body is desperately trying to locate and bind iron. Reference Range:  Optimal TIBC is 250-350 mcg/dL Ferritin Ferritin is a protein that binds to iron and can often be low in Hashimoto’s disease. Ferritin, like the serum iron is important in our iron-stores.  If we do not have good iron-stores independent of hemoglobin/hematocrit then symptoms of iron deficiency anemia manifests.  Also making sure your iron-stores are adequate is important should an accident occur where there is a lot of blood loss.  Acute blood loss can be a serious disaster if one does not have enough iron-stores like ferritin and serum total iron. Reference range: Ferritin adult female 10-154 ng/dL (optimal 75) Ferritin adult male 20-345 ng/dL (optimal 100-250)   The blood tests listed above is a comprehensive list in order to properly diagnose and treat Hashimotos disease.  Let us know if you have any questions.  

Hashimoto’s Thyroiditis has been around for a long time, but not entirely recognized until recently.  Archaic dogma assumes if you have hypothyroid you have Hashimoto’s disease. And the treatment is singular, Synthroid/levothyroxine; however, Hashimoto’s is so much more than hypothyroid.  Hashimoto’s disease is an autoimmune disorder in which the immune system attacks the thyroid, which results in hypothyroid and a multitude of autoimmune symptoms throughout the entire body.   Recently brave celebrities are coming forward talking about their battle with Hashimoto’s.  The public is creating forums to discuss their Hashimoto’s. People are writing blogs and books about their Hashimoto’s disease.  Finally, functional medicine and progressive doctors are treating Hashimoto’s as an entity itself. I cannot tell you how many times I have had a new patient see me for Hashimoto’s disease, and they cannot answer how they got diagnosed.  Or ask me, “how do I get tested for Hashimoto’s disease?”. The proper tests for a Hashimoto’s diagnosis is a blood test for antibodies.  The antibodies tested to diagnose Hashimoto’s disease are: Thyroid Peroxidase Antibodies (TPO) Thyroglobulin Antibodies (TGab) Thyroid Peroxidase Antibodies (TPO): The TPO is the most common antibody to be seen elevated in Hashimoto’s.  About 75% of Hashimoto’s patients have elevated levels of TPO. The standard reference for TPO is anything less than 9iu/mL.    Thyroglobulin Antibodies (TGab): About 5-10% of people diagnosed with Hashimoto’s disease have only TGab elevated.  The reference for TGab is less than or equal to 1 IU/mL. Because having just your thyroglobulin antibodies elevated is not as common, many people with Hashimoto’s are missed.  I have had many patients who have been told they do not have Hashimoto’s, but they have so many symptoms related to it. Eventually, we find out their thyroglobulin antibodies were never tested. For example, “Michele” came to see me because she was at her wit’s end.  She had been to her internist and multiple endocrinologists. Michele was taking Synthroid prescribed for her by an endocrinologist.  But she kept feeling worse and worse and was upset because she wasn’t getting any answers. The latest endocrinologist told her that she didn’t have Hashimoto’s Disease and was not even hypothyroid.  He kept lowering her Synthroid because her TSH was in normal range. And he wanted to take her off her thyroid medication for eight weeks and retest her thyroid. Michele already felt so bad she was afraid to stop the thyroid medication.  Her family was confused and frustrated with her. Her husband thought she must be going through hormone problems or early menopause at 43 years old. And her internist, while doing his best to help her, finally said that maybe she should see a psychiatrist.   I have had many patients tell me they have been told their symptoms are in their head and recommended to see a therapist, psychologists, and psychiatrist.  I do believe in the power of therapy, and everyone can use a good therapist. But it is very frustrating and disempowering to be told your physical symptoms are psychosomatic.  Michele was experiencing a lot of joint pain and fatigue. Her hair was half the amount it used to be. She has no libido, menstrual problems, heart palpitations, migraines, digestive and short-term memory issues.   I ran a blood test for her thyroglobulin antibodies, and they were elevated at >900.  Because thyroglobulin antibodies are not as common in Hashimoto’s, Michele’s diagnosis was missed.  It did take time to work on reducing Michele’s antibodies and Hashimoto’s symptoms. But it gave her a sense of strength and hope to know, that her symptomatology was not “all in her head.” Quick side note: Do not confuse the thyroglobulin antibodies with total thyroglobulin levels.  For Hashimoto’s disease, you want the thyroglobulin antibodies. The total thyroglobulin levels are for testing patients that have had their thyroid gland removed due to cancer.  Total thyroglobulin levels are used to see if part or any of the thyroid gland is growing back after thyroid removal from cancer. I consider there are three types of Hashimoto’s disease.   TPO-only: These are the people that have only the thyroid peroxidase antibodies elevated: about 75% of Hashimoto’s patients. TGab-only: The people that have only the thyroglobulin antibodies elevated: about 5-10% of Hashimoto’s patients. Mixed TPO/TGab: The people that have BOTH thyroid peroxidase antibodies and thyroglobulin antibodies elevated: about 15% of Hashimoto’s patients. From working with Hashimoto’s patients for over a decade, patients with the mixed (both TPO and TGab) seem to have more symptomatology than those with TPO or TGab only.  Hashimoto’s disease is an autoimmune disease where the immune system is attacking healthy thyroid tissue. I feel if you have both TPO and TGab it’s like having “two-armies” attacking your thyroid instead of one. What does the Hashimoto’s antibody level mean? The goal with Hashimoto’s antibodies is to try to get the levels to reduce as much as you can.  I have had some patients with antibodies so high, and the blood test cannot get an accurate value.  I have seen TPO antibodies >2000 and TGab >900. The lower the antibodies, the lower the autoimmune reaction against the body.   I do find a correlation between symptoms of Hashimoto’s and the level of antibodies in the bloodstream. “Michele” from above, her thyroglobulin antibodies were so high (>900), that the blood test could not get an accurate value.  We got right to work utilizing a multifactorial plan implementing medication, supplementation, dietary and lifestyle management. After three months her TGab was still >900, but Michele only felt slightly better. Another three months later her TGab was 755, she felt much better, and we were on our way. Another example, “Debe” came to see me for her Hashimoto’s hypothyroid symptoms.  I asked her, “Do you know which antibodies you have and what their levels are?”. Debe did not, but that is understandable as most people don’t.  I think it is important to educate patients about what Hashimoto’s is and what the antibodies are. And we are not only going to work

Share Share on Facebook Tweet Tweet this Pin Pin this Share Share on LinkedIn There are a couple of ways to answer this question, but first, let’s run through an all too common scenario. You are tired all the time, you have gained 30 lbs, your hair is falling out, and have struggled with constipation for years. Of course, you Googled your symptoms and are pretty sure that you have a thyroid problem. You decide to make an appointment with your doctor to get a blood test to find out once and for all if you have hypothyroidism. Below is a list some of the common and not so common hypothyroid related symptoms. Common Hypothyroid Symptoms: Low energy / Fatigue / Drowsiness Weight gain Constipation PMS / Heavy periods Infertility Low mood / depressed Anxiety Enlarged thyroid (Goiter) Puffy eyes/face Swollen hands and feet Dry skin Brittle nails Hair loss Loss of eyebrow hair (lateral ⅓ = Queen Anne’s Sign) Cold feeling  Going into the appointment, you feel optimistic that you might get some answers as to how you have been feeling and excited to feel better.  You tell your doctor the situation, and he draws some blood to run a few tests. About a week later, you get a call from his office saying you that your tests were “normal” and your thyroid is fine.   You are disappointed. How can you feel this lousy and your thyroid tests be normal? You feel lost, a bit hopeless and not sure what to do next.   This is an all too common situation that many of our patients have gone through. So, do you have hypothyroidism? You seem to have all of the classic symptoms of hypothyroidism, but your doctor says your fine.   From a conventional perspective, If your Thyroid Stimulating Hormone Level (TSH) is above the reference range, then your doctor will diagnose you with Hypothyroidism. If your TSH is within the reference range, your doctor will not diagnose you with Hypothyroidism. This seems very simple and straightforward; however, we have had many patients over the years go to their doctor, suspecting they have a thyroid issue only to be told they don’t.  You might have had a similar experience. How can so many people, especially women be wrong about how they feel and the symptoms they have on a daily basis. Why is a hypothyroidism diagnosis contingent only on a single TSH level? Why are a  patient’s symptoms routinely ignored during the evaluation process? TSH Test: The Thyroid Stimulating Hormone test is a screening assessment of the hormonal communication between the brain and the thyroid gland. The anterior pituitary gland in the brain releases TSH, which then enters the bloodstream and ends at the thyroid gland. The TSH hormones then “stimulates” the thyroid gland to produce T4 (Thyroxine). Once an adequate amount of T4 is in the bloodstream, it signals the pituitary to stop producing TSH.   In physiology, this is referred to as a Negative Feedback Loop. Many factors influence the thyroid feedback loop. Genetics, nutrition, sleep quality, stress, and environmental toxins are some of the factors that affect thyroid function.   If your thyroid is low or underactive, the TSH tends to be high normal, which we consider anything higher then 2.0 ng/dL to 2.5 ng/dL. If the TSH is greater than 4.5 ng/dL, this is diagnostic for Hypothyroidism. TSH Reference Range: 0.45 ng/dL to 4.5 ng/dL The TSH test is often the only “screening” test that will be done to assess thyroid function. Conventionally, it is black and white, either you are Hypothyroid, or you are not. If your TSH test is greater than 4.5 ng/dL, then you are hypothyroid and if it below 4.5 ng/dL you are not considered to be hypothyroid regardless of your symptom picture.   Obviously, this begs the question, is a TSH test really that reliable to be the only criteria to diagnose someone with Hypothyroidism? We feel the TSH should not be the only test used to diagnose a patient accurately. Many people have a TSH level below 4.5 ng/dL that could easily be considered to have hypothyroidism based on symptoms alone. We think the TSH only approach is severely inadequate to assess and diagnose someone with Hypothyroidism. Thyroid issues are much more complicated and should not be reduced down to a single test. Some Endocrinology Associations have proposed that the TSH reference range should be reduced from 4.5 ng/dL down to 2.5 ng/dL. This certainly narrows the reference range so that fewer people would go undiagnosed. Even still, this puts too much of an emphasis on just the TSH level alone. The tests we routinely run for our patients are listed below. We never just run a TSH alone, but we do include it in our panel as it does help to make decisions about medication dosage adjustments. We prefer to run a Free T3 and Free T4, as opposed to Total T3 and Total T3. We find that most everyone typically falls within the reference range as well. In our opinion, a Free T3 level is the most clinically relevant test. We also include both the Anti-TPO and Antithyroglobulin antibody tests as well because we want to know if the patient has Hashimoto’s Thyroiditis or not.   Ideal Hypothyroidism Testing: TSH Free T3 Free T4 Anti-TPO Anti-Thyroglobulin Reverse T3 (if currently on medication)  If you are interested in getting testing done, you can purchase labs directly from our online store. Use the discount code: THYROID to get 25% off your order. It is estimated that about 70% of all hypothyroid cases are of the Hashimoto’s type. Plus, it helps formulate a comprehensive treatment plan, beyond just medication. We consider many other factors. Factors that Influence Thyroid Function: Genetics Diet (sugar / gluten) Stress Sleep (lack of) Liver function (caffeine & alcohol) Environmental toxins  Is Subclinical Hypothyroidism Treated? One rule we have always stuck by is to treat the patient, not a blood test. Unfortunately, there is

A low functioning thyroid can cause many symptoms.  That is because the thyroid is involved in practically every aspect of your body.  In this post, I am going to talk about ways to help hair loss from thyroid and other hormonal imbalances. Hair loss from hypothyroid is from the root.  You will find full-length pieces of hair everywhere.  In hypothyroid you will find hair thinning all over but particularly the top and hairline.  Also, the eyebrows really take a beating in hypothyroid. There will be patches of hair missing throughout the eyebrows and the tail ends will disappear.  Even body hair will reduce in hypothyroid. I had a patient that hadn’t shaved in years. And once we treated her hypothyroidism, she had to start shaving her legs again. Other Common Symptoms of Hypothyroid: Fatigue Weight gain Dry skin and terrible nails Irregular periods / bad PMS Mood issues: Thyroid slows everything down, even your mood.  Many people report once their thyroid is treated their mood improves. Blood work out of range:  Hypothyroid can disrupt blood sugar, raise cholesterol and increase inflammatory markers. While having concerns over hair loss might seem superficial, it is not.  It is disturbing to be losing hair and worrying if it will ever stop. I’ve had patients who: Cry in my office because they don’t know how to stop the hair loss. Bring in hair that was lost in a little baggie or tissue.   Send me pictures of the hair they are losing.   Spend extraordinary amounts of money on special shampoos, conditioners, products for thinning hair. Spend money on low-level laser hats and steroid scalp injections Get their temples tattooed, so the hair loss is not so noticeable get blown off by their primary care or general provider because of their hair loss concerns. It is important to understand hair loss is not a “disease,” it is not going to kill you.  Unfortunately, many doctors are not interested in your hair loss concerns. Because they are jaded by dealing with people that have illnesses like diabetes, cancer, heart disease.  I have had patients tell me that their primary care doctors tell them there is nothing that can be done. One patient told me, her doctor told her to buy a wig.  They are told hair loss is a consequence of thyroid, hormones, getting old and to just deal with it.  But this is a very distressing concern, especially for women. For men, it is more socially acceptable to have thinning hair or baldness compared to women. With that said, I would like to provide you with some ideas to help with hair loss from hypothyroid and other hormonal imbalances.   Thyroid medication:  If your thyroid is underactive, taking thyroid medication will help improve the overall function.  If you are having symptoms of hypothyroid and excessive hair loss, have a blood test to check your thyroid. If you are interested in the different types of thyroid medication click on the link to listen to our podcast Episode 021.  Thyroid Testing: If you are interested in thyroid testing, click on the link to our podcast Episode 019 that is all about thyroid labs.   Raise T3:  Bear with me as I try not to bore you with the physiology of thyroid hormones. This is going to be short and sweet and will not include every detail of how the thyroid functions.  The brain releases TSH (thyroid stimulating hormone). The TSH monitors overall thyroid hormones. The thyroid releases mainly T4 (thyroxine). Thyroxine (T4) converts to T3 (triiodothyronine).  T4 has a long half-life and doesn’t have much activity other than converting to T3, which is the active form of thyroid. You can have all the T4 in your body, but if you do not have T3, then you will have symptoms of hypothyroid.  The goal here is to raise your T3 or raise the conversion of T4 to T3. The TSH is not an accurate measure of thyroid function. To accurately measure thyroid, you want to include a Free T4 and a Free T3. Ways to Raise T3: Reduce exercise: Excessive cardiovascular exercise will decrease your conversion of T4 to T3.  If you over exercise or do a high volume of intense cardiovascular exercise, you are putting a heavy burden on your thyroid and adrenal glands.  Intense cardio will dramatically increase your cortisol levels which impact your T3 levels. Liver function: Your liver is the main converter of T4 to T3.  If your liver is burdened or not functioning well, it cannot convert T4 to T3.  Thereby reducing your T3 levels in your bloodstream. A burdened liver can come from: Excessive caffeine intake Too much alcohol High intake of sugar especially fructose (high fructose corn syrup) Certain medications like statins (cholesterol-lowering medication) Taking a lot of medications Taking a lot of Tylenol or medicines with acetaminophen Fatty-liver disease (NAFLD)  Improve liver function by: Avoiding too much alcohol, sugar, fructose and restricting medications, especially meds with acetaminophen. Reduce coffee/caffeine consumption Take a liver supplement with herbs and vitamins to improve liver function Regular bowel movements, reduce constipation No starvation/caloric restriction (dieting):  Restricting your calories dramatically reduces your T3 levels.  Part of your T3’s function is to keep your metabolism moving at a healthy pace.  If your body thinks it is starving, it will do anything to try and preserve body mass.  Automatically your T3 levels drop to reduce metabolism. I remember a young teen patient that was referred to me by a colleague to address her thyroid levels. She came in with her mom and grandmother as they were concerned about her hypothyroid symptoms.  She was always tired and it was starting to affect her grades, family and social life. Her TSH was in range and even looked like she was HYPER-thyroid. Her T4 levels were normal. But she has very low levels of T3. I had seen her a couple years before and noticed that she had lost a considerable amount of weight.   In fact, she was incredibly thin.