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For individuals looking to slow the signs of aging, stop the signs of aging and even reverse the signs of aging, optimizing the body’s function by optimizing cellular, endocrine, and immune function IS the answer. We lead people to encountering health and vitality starting from within with hormonal therapy and nutritional health with BHRT, high-grade supplements (nutriceuticals), chemical-free cosmetics and LipoSelection to treat the effects of aging. chronic fatigue, fibromyalgia, chronic infections, hormone imbalance, and immune dysfunction.

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Guide To Good Health (Spring 2011)

Read about the benefits of living a healthy lifestyle and take advantage of this great magazine to help make better healthcare decisions for yourself and your family.

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AALC In The News at WTAE

“I honestly feel better than I have in 20 years,” Susan Talbott said.

“It has changed my life. It’s given me my life back,” Daniel Werry said.

“I feel like a million bucks. At 48, I probably feel as good now as I did in my late 20s or 30s,” Scott Peters said.

They didn’t accept that their sluggish health and weight struggles were just a result of getting old, and they went to see Dr. Aldino Pierotti at the Anti-Aging and Vitality Center of Pittsburgh.

Pierotti prescribed bioidentical hormone therapy — something that his patients call a fountain of youth.

You can read more of this great article at WTAE.com!

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AALC on I Speak You Speak Pittsburgh

Listen to Anti-Aging & Longevity Center on I Speak You Speak Pittsburgh.

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Hormones, Metabolism, and Obesity

Obesity has become a major health epidemic and has dramatically increased over the last decades. Studies show that now approximately one-third of the U.S. population is classified as obese and over two-thirds are significantly overweight. While the cause is multifactorial, studies are clear that almost all overweight individuals have metabolic and endocrinological dysfunction that is causing or contributing to their inability to lose weight. It is not simply a problem that individuals are taking in more calories than they are consuming, but rather it is a complex vicious-cycle of endocrinological and metabolic dysfunction. Contemporary medicine has failed to address these dysfunctions in overweight individuals and doctors and patients continue to believe that all cases are a matter of will-power and lifestyle. Thus, it is no surprise that obesity is reaching epidemic proportions.

Leptin

The hormone leptin has been found to be a major regulator of body weight and metabolism and dysfunctional leptin signaling results in one of many vicious-cycles that prevent individuals from losing weight. Leptin is secreted by fat cells and the levels increase with the accumulation of fat. This leptin should then feed-back to the hypothalamus as a signal that there are adequate energy (fat) stores, and this should signal the body to burn fat rather than continue to store excess energy.

Studies are finding, however, that the majority of overweight individuals that are having difficulty losing weight have varying degrees of leptin resistance. The leptin is unable to produce its normal effects of weight loss, with the severity correlating with the degree of obesity (1-5). This leptin resistance results in a leptin deficiency in the hypothalamus, which in sensed as starvation, so multiple mechanisms are activated to increase fat stores, as the body perceives a state of starvation (1-30). Baseline leptin levels and the degree of leptin resistance is shown to be a good predictor of a person’s likelihood of achieving successful weight loss with dieting (68-70).

The metabolic effects of leptin resistance include a diminished TSH secretion, a suppressed T4 to T3 conversion, an increase in reverse T3, an increase in appetite, an increase in insulin resistance and an inhibition of lipolysis (fat breakdown)( 1-29,31). These effects of leptin resistance on thyroid hormones contribute to the drop in TSH and T3 levels that occur with dieting and results in decreased tissue thyroid action and a depressed metabolic rate that inhibits weight loss and promotes weight gain (1,6,10,14,18-23,29,30-37). Unfortunately, standard thyroid function tests miss over 80% of this type of hypothyroidism, as the TSH, free T4 and free T3 levels are typically in the normal range (1,6,10,14,31,38-46). In primary hypothyroidism, diminished thyroid hormones stimulate the hypothalamus to increase TRH secretion, which in-turn stimulates the pituitary to secrete TSH. Thus, the TSH serves as the basis for the diagnosis of primary hypothyroidism, but with the suppression of TSH that occurs with leptin resistance, this feed back is interrupted and a normal TSH level cannot be used to rule out a significant thyroid deficiency (1,6,10,14,31,38-46).

Starvation dieting can decrease resting metabolic rate by as much as 40% and food restriction at a level to maintain just a 10% reduction in body weight results in significantly decreased intracellular thyroid hormone levels and a diminished metabolic rate that does not return to normal even after a normal diet is resumed (10,18-23,29,30,32,33-37). When combined with the effect of leptin resistance, this accounts for the majority of regained weight in weight reduced subjects (17-22,25,26,31,35,36,47). Low intracellular leptin levels are inversely correlated with reverse T3 (rT3), which may currently be the best marker, along with the T3/rT3 ratio, for diminished T4 to T3 conversion and cellular hypothyroidism in chronic illness (18,48-59). Reverse T3 has been thought to be an inactive metabolite, but it has been shown to be a competitive inhibitor of T3 (blocks T3 activity), directly decreasing cellular energy production, and to directly suppresses T4 to T3 conversion (47,56-59). In fact it is shown to be a more potent inhibitor of T4 to T3 conversion than PTU (56), a medication used to decrease thyroid hormone levels in hyperthyroidism.

In addition, increased adipose tissue results in a maladaptive stimulation of inflammatory cytokines, including TNF-alpha, IL-6 and CRP, which further suppress TSH secretion and the conversion of T4 into T3, as well as increasing the conversion of T3 into rT3 (60-64).

Diagnosis:

If individuals are having difficulty losing weight, we recommend obtaining a metabolic panel that consists of a leptin level, TSH , free T4, free T3, reverse T3, TPO antibody, antithyroglobulin antibody, glucose, insulin, HgA1c, IGF-1, testosterone, CRP, TNF-alpha (highly sensitive), IL-6 (highly sensitive), CRP, homocystine, SHBG and lipids. In addition, the relaxation phase of the ankle or brachioradialis muscle can be measured. This has been shown to correlate with the degree of hypothyroidism and to be a better indicator of tissue levels of thyroid than standard thyroid function tests (50,65,66).

While a complete review of the interpretation of these labs is beyond the scope of this article, as it not as simple as looking at what is normal or abnormal and ratios typically need to be evaluated. In general, however, a leptin level greater than 10 is associated with leptin resistance. Thus, if the leptin level is above 10, the TSH is unreliable (artificially decreased) and a normal TSH cannot be used to rule-out significant cellular hypothyroidism. Likewise, if the inflammatory markers CRP, TNF-alpha or IL-6 are relatively (high normal) or overtly elevated, which is often the case with numerous conditions including insulin resistance, diabetes, obesity, lupus, rheumatoid arthritis, stress, sleep apnea, depression, chronic fatigue syndrome, fibromyalgia, heart disease and insomnia, the TSH is not a reliable indicator of tissue levels of active thyroid hormone. The T3/rT3 ratio is typically the best marker for tissue hypothyroidism in these conditions, as again, the TSH is not reliable if leptin resistance or inflammation is present. Insulin levels along with the HgA1c, glucose and lipids are used to evaluate insulin resistance, another reason for problems with weight gain. A muscle reflex relaxation phase of greater than 110 msec also demonstrates low tissue levels of thyroid.

Treatment:

There are new medications, Byetta and Symlin, that decrease leptin resistance. These can be very beneficial treatments and can produce dramatic weight loss if given in conjunction with other metabolic treatments. While these medications are approved for type II diabetes and are showing significant weight loss in this patient population, they are showing promise in the non-diabetic population as well. The amount of weight loss varies according to the study design, but a significant percent of patients are having dramatic weight loss, despite little or no change in diet. Again, this demonstrates that many overweight patients have a metabolic problem rather than a problem of will-power. While these medications, by themselves, typically result in modest weight loss, combining these medications with metabolic treatments and a healthy lifestyle can allow for significant sustained weight loss.

A thorough analysis and work up will find that many overweight patients have, in addition to leptin resistance, dysfunction of the hypothalamus-pituitary-thyroid axis as well as dysfunction of the peripheral (cellular) thyroid metabolism and utilization. Correction of these dysfunctions can result in dramatic long term successful weight loss. If high reverse T3 is found, T4 preparations such as Synthroid or Levoxyl are shown to be ineffective in restoring tissue thyroid levels (67). T4/T3 preparations such as Armour thyroid are better but timed released T3 preparations are the most effective at restoring tissue T3 levels and often effective when Armour thyroid, Synthroid and Levoxyl fail to restore normal tissue levels of thyroid.

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Standard Blood Tests Missing The Majority of Hypothyroid Patients

Many common problems such as fatigue, depression and difficulty losing weight can be due to low thyroid, however, many people, especially women, are not getting the treatment that would be of great benefit. This is because severely low thyroid levels are often not picked up by the standard TSH, T4, and T3 testing, which is the only testing done about 90% of the time.

New studies indicate, however, that the ratio of active thyroid hormone, T3, to the T3 blocking hormone, reverse T3, must be determined to accurately determine an individual’s true thyroid levels. This can often reveal a problem of hypothyroidism even though the standard tests are normal. This test is rarely done, however, even though this is the most important determinate of thyroid function. Individuals on thyroid hormone also often receive improper doses, usually too low, when the TSH is used for dosing.

There is mounting evidence that hypothyroidism is present in the majority of and possibly all fatigued patients. The problem is that standard blood testing that consists of TSH, T4 and T3 does not detect it. Thus, many patients are erroneously told over and over that their thyroid levels are fine. TSH is secreted by the pituitary in the brain, telling the thyroid to secrete T4, which is not the active thyroid hormone. T4 must then be converted in the body to the active thyroid hormone T3. When T4 and T3 levels drop, the TSH should increase indicating hypothyroidism. This is the standard way to diagnose hypothyroidism. There are, however, many things that result in hypothyroidism but are not diagnosed using the standard TSH and T4 and T3 testing. This method misses thyroid problems with  patients 90% of the time.

First of all, there is clearly pituitary dysfunction from a variety of causes, including viruses, bacteria, stress, yeast, inflammation, toxins, pesticides, plastics and mitochondria dysfunction. This results in low normal TSH levels along with low normal T4 and T3 levels. Very few doctors understand the significance of this and incorrectly state that the thyroid is fine.

In addition, many patients do not adequately convert T4 to the active T3, resulting in low levels of active thyroid hormone and suffer from low thyroid despite having a normal TSH. Also, there is another problem in that T4 cannot only be converted to T3, but it can also be converted to reverse T3, which is inactive and blocks the thyroid receptor. Very few practicing physicians consider this, but it is a major problem. There is an evolutionary enzyme that increases the T4 to reverse T3 in times of stress and illness. This worked well for our ancestors because in times of famine it allowed those who had this enzyme to survive. But in our modern society, reverse T3 works against us causing fatigue, difficulty losing weight, brain fog, muscle aches and all the other symptoms of hypothyroidism. Reverse T3 can be increased with chronic illnesses such as Chronic Fatigue, Fibromyalgia, yo-yo dieting (often responsible for the quick weight gain after losing weight), stress, heavy metals and infections commonly present in chronically ill and immune deficient patients. Low thyroid not only results in undesirable symptoms, but it also increases the risk of heart disease and cancer. When more extensive testing is done, these patients are so relieved to be shown on paper that their thyroid is truly low and that they can expect to be feeling better soon. There are only a few labs that can accurately measure reverse T3. It is difficult for labs to do and many labs will erroneously indicate normal or low levels of reverse T3. Some doctors that have ordered reverse T3 on patients have found it not to be useful because they are not getting accurate results or they don’t know how to interpret the results.

In addition, there is also a thyroid resistance syndrome found in these patients, meaning that there may be thyroid in the blood but there is no thyroid effect. This has been discounted in the past, but more and more evidence is surfacing proving that this is indeed a significant problem with these conditions.

The combination of factors, including pituitary dysfunction, high reverse T3, and thyroid resistance, results in many patients having inadequate thyroid effect. T4 preparations such as Synthroid and Levoxyl rarely work and Armour thyroid, a pig glandular product, is somewhat better, but definitely not adequate for most patients. The treating physician must know when to use a T4/T3 combination or straight T3. T3 works the best for many of these patients, but Cytomel, a very short acting T3 available at normal pharmacies, is also a poor choice because the varying blood levels cause problems. Compounded timed release T3 is usually the best treatment. However, to achieve significant improvement, the treating physician must be very knowledgeable about T3 and must realize that when on T3, standard bloods blood test will lead one to dose incorrectly and not obtain significant benefits. Many doctors who learn to use thyroid medication properly cannot believe how effective it is when used properly. This includes doctors who previously felt that they were thyroid experts and had been using traditional T4 thyroid preparations for a long time. Ultimately, it is the expertise and dosing of the T3 or T4/T3 combinations and the makeup of the medications that determines the patient outcome and success of treatment.

 


Reverse T3 is the Best Measurement of Tissue Thyroid Levels

The Journal of Clinical Endocrinology & Metabolism 2005; 90(12):6403–6409

Thyroid Hormone Concentrations, Disease, Physical Function and Mortality in Elderly Men

Annewieke W. van den Beld, Theo J. Visser, Richard A. Feelders, Diederick E. Grobbee, and Steven W. J. Lamberts Department of Internal Medicine , University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands

This study of 403 men investigated the association between TSH, T4, free T4, T3, TBG and reverse T3 (rT3) and parameters of physical functioning. This study demonstrates that TSH and/or T4 levels are poor indicators of tissue thyroid levels and thus, in a large percentage of patients, cannot be used to determine whether a person is euthyroid (normal thyroid levels) at the tissue level. In fact, T4 levels had a negative correlation with tissue thyroid levels (higher T4 levels were associ­ated with decreased peripheral conversion of T4, low T3 levels and high rT3). This study demonstrates that rT3 inversely correlates with physical performance scores and that the T3/rT3 ratio is currently the best indicator of tissue levels of thyroid.

This study showed that increased T4 and RT3 levels and decreased T3 levels are associated with hypothyroidism at the tissue level with diminished physicial func­tioning and the presence of a catabolic state (breakdown of the body). This study adds to the mounting evidence that giving T4 preparations such as Synthroid and Levoxyl are inadequate for restoring tissue euthyroidism and that a normal TSH cannot be relied upon as as an indication of euthyroidism, as it has a very low sensitivity and specificity for hypothyroidism. This poor sensitivity and specificity is further decreased with the presence of one or more systemic illnesses, including diabetes, heart disease, hypertension, systemic inflammation, asthma, CFS, fibro­myalgia, rheumatoid arthritis, lupus, insulin resistance, obesity, chronic stress and almost any other systemic illness.

Low T3 syndrome, with low T3 and high reverse T3, is almost always missed when using standard thyroid function tests, as the T3 level is often in the low normal range and reverse T3 is the high normal range, again making the T3/rT3 ratio the most useful marker for tissue hypothyroidism and as a marker of diminished cel­lular functioning. The authors of this study conclude, “Subjects with low T3 and high reverse T3 had the lowest PPS [PPS is a scoring system that takes into account normal activities of daily living and is a measure of physical and mental function­ing]…Furthermore, subjects with high reverse T3 concentrations had worse physical performance scores and lower grip strength. These high rT3 levels were accompanied by high FT4 levels (within the normal range)…These changes in thyroid hormone concentrations may be explained by a decrease in peripheral thyroid hormone me­tabolism… Increasing rT3 levels could then represent a catabolic state, eventually proceeding an overt low T3 syndrome.”

This study demonstrates that TSH and T4 levels are poor measures of tissue thyroid levels, TSH and T4 levels should not be relied upon to determine the tissue thyroid levels and that the best estimate of the tissue thyroid effect is the rT3 level and the T3/rT3 ratio.


Standard Thyroid Tests Lack The Accuracy To Determine The Proper Dose of Thyroid Replacement

The British Medical Journal 293:808-810

Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement?

Fraser WD, Biggart EM, OReilly DJ, Gray HW, McKillop JH

Most physicians, including endocrinologists, rely on standard thyroid tests to determine their patients’ “proper” dose of thyroid replacement. The evaluation of a patient’s signs and symptoms to determine the proper dose has been reduced to the point of being unimportant to most physicians. This study demonstrates that it is improper to rely on standard thyroid tests to determine a patient’s optimal dose of thyroid replace­ment and doing so will result in inadequate replacement for the majority of patients. Thus, it is of no surprise that a large percentage of patients continue to suffer with symptoms of hypothyroidism despite being on so-call “proper” doses of thyroid, which is compounded by the fact that T4 only preparations are most often used.

This prospective study of 148 hypothyroid patients investigated the role of monitoring thyroid replacement with standard thyroid tests and the accuracy of such tests to determine the proper dose of thyroid replace­ment. The authors measured TSH, free T4, free T3, total T4 and total T3 and used a battery of clinical param­eters and an exam by clinicians experienced in thyroid disease. This study found that the TSH is a poor measure for estimating the metabolic severity of primary thyroid failure and/or a proper thyroid dose.

The authors conclude, “Measurements of serum concentrations of total thyroxine, free thyroxine and TSH, made with sensitive immunoradiometric assay, did not, except in patients with gross abnormalities, distinguish euthyroid [normal thyroid] patients from those who were receiving inadequate or excessive replacement. These measurements are therefore of little, if any, value in monitoring patients receiving thyroxine replacement…The serum concentration of thyroid stimulation hormone is unsatisfactory as the thyrotrophs in the anterior pituitary are more sensitive to changes in the concentration of thyroxine in the circulation than other tissues…It is clear that serum thyroid hormone and thyroid stimulating hormone concentrations cannot be used with any degree of confidence to classify patients as receiving satisfactory, insufficient, or excessive amounts of thyroxine replace­ment…The poor diagnostic sensitivity and high false positive rates associated with such measurements render them virtually useless in clinical practice…Further adjustments to the dose should be made according to the patient’s clinical response…Our findings emphasize the need for laboratories to make their users aware that the reference ranges for thyroxine, free thyroxin, and thyroid stimulation hormone concentrations in patients receiving thyroxine replacement are considerably different from the conventional ranges; they should also point out limitations of these ranges.”

Most physicians, including endocrinologists, feel that a suppressed TSH is an indication that the dose of thyroid should be reduced (except with thyroid cancer). While a suppressed TSH may be an indication the patient is hyperthyroid, this study found that was the case only 20% of the time. In other words, doctors who make the assumption that a suppressed TSH means over-replacement and decrease the dose based on the suppressed TSH will be wrong 80% of the time because 80% of the time a suppressed TSH was shown not to be an indication that the patient was hyperthyroid or receiving too much thyroid replacement. Unfortunately, most physicians, including endocrinologists, lack of ability or confidence to clinically evaluate a patient’s thyroid status and lack understanding of the limitations of standard thyroid function tests, which has resulted in the majority of hypothyroid patients receiving inadequate doses of thyroid replacement.

 


Testosterone Decreases Heart Disease by 60 Percent

The Journal of Clinical Endocrinology & Metabolism. Aug 2002. Vol. 87, No. 8 3632-3639

Optimal testosterone levels in men have been shown to decrease the risk of coronary artery disease by 60%

Low Levels of Endogenous Androgens Increase the Risk of Atherosclerosis in Elderly Men: The Rotterdam Study

A. Elisabeth Hak, Jacqueline C. M. Witteman, Frank H. de Jong, Mirjam I. Geerlings, Albert Hofman and Huibert A. P. Pols

Abstract

In both men and women, circulating androgen levels decline with advancing age. Until now, results of several small studies on the relationship between endogenous androgen levels and atherosclerosis have been inconsistent.

In the population-based Rotterdam Study, we investigated the association of levels of dehydroepiandrosterone sulfate (DHEAS) and total and bioavailable testosterone with aortic atherosclerosis among 1,032 nonsmoking men and women aged 55 yr and over. Aortic atherosclerosis was assessed by radiographic detection of calcified deposits in the abdominal aorta, which have been shown to reflect intimal atherosclerosis.

Relative to men with levels of total and bioavailable testosterone in the lowest tertile, men with levels of these hormones in the highest tertile had age-adjusted relative risks of 0.4 (60% reduction) [95% confidence interval (CI), 0.2–0.9] and 0.2 (CI, 0.1–0.7), respectively, for the presence of severe aortic atherosclerosis. The corresponding relative risks for women were 3.7 (CI, 1.2–11.6) and 2.3 (CI, 0.7–7.8). Additional adjustment for cardiovascular disease risk factors did not materially affect the results in men, whereas in women the associations diluted. Men with levels of total and bioavailable testosterone in subsequent tertiles were also protected against progression of aortic atherosclerosis measured after 6.5 yr (SD ± 0.5 yr) of follow-up (P for trend = 0.02). No clear association between levels of DHEAS and presence of severe aortic atherosclerosis was found, either in men or in women. In men, a protective effect of higher levels of DHEAS against progression of aortic atherosclerosis was suggested, but the corresponding test for trend did not reach statistical significance.

In conclusion, we found an independent inverse association between levels of testosterone and aortic atherosclerosis in men.

 


Tissue and Pituitary Levels of T3 and T4 Only Preparations

Journal of Clinical Investigation 96:2828-2838

Replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues…

Escobar-Morreale HF, Obregon MJ, Escobar del Rey F, Morreale de Escobar G
Endocrinology 137(6):2490-2502

Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues…

Escobar-Morreale HF, Escobar del Rey F, Obregon MJ, Morreale de Escobar G

Levothyroxine (T4) only replacement with products such as Synthroid and Levoxyl are the most widely accepted forms of thyroid replacement. This is based on a widely held assumption that the body will convert what it needs to the biologically active form T3. Based on this assumption, most physicians and endocri­nologists believe that the normalization of TSH with a T4 preparation demonstrates adequate tissue levels of thyroid. This assumption, however, had never been directly tested until these studies were published. The first study investigated whether or not giving T4 only preparations will provide adequate T3 levels in varying tissues. Plasma TSH, T4 and T3 levels and 10 different tissue levels of T4 and T3 were measured after the infusion of 12-13 days of thyroxine. The second study compared the plasma TSH, T4 and T3 levels and 13 different tissues levels of T4 and T3 when T4 or T4/T3 preparations were utilized.

These studies demonstrate that the normalization of plasma TSH and T4 levels with T4 only preparations provide adequate tissue T3 levels to only a few tissues including the pituitary (hence the normal TSH) but almost every other tissue will be deficient. They show that it is impossible to achieve normal tissue levels of T3 by giving T4 only preparations unless supra-physiological levels of T4 are given. The authors conclude,“The current replacement therapy of hypothyroidism should no longer be considered adequate…”

The second study found that a combination of T4/T3 is required to normalize tissue levels of T3. The study found that the pituitary was able to maintain normal levels of T3 despite the rest of the body being hypothy­roid on T4 only preparations. Under normal conditions, it was shown that the pituitary will have 7 to 60 times the concentration of T3 of other tissues of the body and when thyroid levels drop, the pituitary was shown to have 40 to 650 times the concentration of T3 of other tissues. Thus, the pituitary is unique in its ability to concentrate T3 in the presence of diminished thyroid levels that is not present in other tissues. Consequently, the pituitary levels of T3 and the subsequent level of TSH is a poor measurement of tissue hypothyroidism as almost the entire body can be severely hypothyroid despite a normal TSH level.

These studies add to the large amount of studies that demonstrate that pituitary thyroid levels are not indica­tive of other tissues in the body and demonstrate why the TSH level is a poor indicator of a proper thyroid dose. They also demonstrate that it is impossible to achieve normal tissue thyroid levels with T4 preparations such as Synthroid and Levoxyl. It is no surprise that the majority of patients on T4 preparations will continue to suffer from symptoms of hypothyroidism despite being told their levels are “normal”. Patients on T4 only preparations should seek out a physician who is well-versed in the medical literature and understands the physiologic limitations and inadequacy of commonly used thyroid preparations.