My Cholesterol Experiment: Case Study, Preliminary Results

 

(cross-posted at Journey to Badwater)

 

I seem to have survived running hard yesterday at the Houska Houska without any ill effects. So far...

This morning I had to forego my morning coffee and go over to the lab to get my blood drawn after a 12 hour fast. I was getting my lipids re-checked, and my TSH too. I went into the Express lab at 6:40 am and it was hopping in there. Everyone must have waited until after the holiday.

After that I went back home and had my coffee, and felt much happier. I took Iris for a brief run, and then went up to Horsetooth. It was my first hill workout in way too long. Can't even remember the last time I purposely ran hills. I'm slower than a snail, but at least I got up there and did it.

On my way home my phone rang and I didn't recognize the number, so I just let it ring. Plus I don't talk on the phone and drive, I have a hard enough time just talking on a cell phone...add driving to that and it would be a disaster.

When I got home I listened to the voicemail, it was my doctor's office calling with my lab results. Only 4 hours went by since I got the blood drawn. I was amazed, I thought I'd be able to see my results at work tomorrow before they'd ever call me. Then I thought, must be something really off, to call me back that fast.

But when I talked to the nurse who works with my physician, she told me my cholesterol was in the normal range now. I couldn't believe my ears. I asked her what it was. She said, "192." And that my triglycerides, LDL, and HDL had also dropped. The HDL I can understand because I haven't been running much, and that is very sensitive to exercise, but it's still 70.

When I had my labs drawn in March, my total cholesterol was something like 257. I remember the triglycerides were normal and the LDL was high-normal at that time. My TSH has actually dropped slightly, I thought maybe it went up because of the way I've been tired in the afternoons and gained weight so easily. Having a lower TSH might have something to do with the lowered cholesterol, but I sort of doubt it because I've been more on the hyper end of things before and never had my cholesterol anywhere near that low. So I'm pretty convinced it's dietary.

When I got my lab results back in March, my doctor mentioned that going gluten free had produced some dramatic results for other patients, and she knew I didn't have much room for improvements in my diet in general. I really do eat well, and I allow myself to indulge in bad things occasionally, but not regularly. Over the past 5 weeks I've been off the wagon somewhat, and over the last week I was extra bad with the sweets and ice cream, so I was a little surprised when today's labs showed what they did.

As we talked on the phone, I told her that I had only made two dietary modifications over the past 3 months: one was no longer putting half and half in my coffee and switching to soy creamer, and the other thing is that I've been avoiding gluten. I haven't been completely gluten-free, but I have been mostly avoiding wheat and sticking to corn and rice for the majority of my carbohydrates.

What I've done is avoid eating wheat. I'm not so strict about it that I scan labels of things like soy sauce, which I know has wheat in it, and I drink beer, which is not gluten-free either. I just avoid things that are made with wheat flour and have wheat as a major ingredient.

By avoiding things made with wheat I've found that helps me avoid the bloated feeling I get when I eat things like bread and pasta, and it also helps me eliminate a lot of bad foods from my diet: baked things, cookies, and other crap that I shouldn't be eating anyway.

I do eat dairy products, but not very much. I eat cheese and yogurt occasionally, and I do eat lean red meat more often than dairy. I eat a good amount of fat, but other than the infrequent red meat and dairy sources, almost all of my dietary fat comes from olive oil, avocados, and fish. Salads and fish are probably the most frequent things you'll find on our dinner table.

This is all really interesting. I'm curious to see what happens by next year when I get my annual labs drawn again.

It has never been my intention to promote a gluten-free diet, because if you're not celiac, and not gluten-sensitive, it can be an awfully inconvenient and expensive way to feed yourself. I think I might be a little sensitive to gluten, because I've noticed that when I eat certain things I get bloated.

Pizza and bagels are the worst offenders for me. I think they are often made with high gluten flour products. I don't know if it's wheat itself that's the problem, I haven't tried a lot of the other grains simply because I'm not a big fan of flour and baked things anymore.

I also have never been one to jump on the bandwagon with the latest dietary trends like Paleo or Atkins or whatever. I do like the concept of Paleo, and there are a lot of things wrong with the commercially prepared, processed foods abundant in the American food landscape. I probably eat closer to Paleo than anything, but I'm not strict about that, either.

One thing I want to avoid is going on medications for anything unless I absolutely need them. I already take two thyroid meds and I don't buy into the statin thing, being an athlete I don't want to cause muscular problems. Some drugs, for some people, are worth taking, but I'm not into tithing for Big Pharma when I don't need to.

But I was absolutely shocked and amazed at the results of my labs this morning. Time will tell if this is a lasting change, I probably won't have another lipid panel drawn until next spring. If this is a lasting change for me, worrying about cholesterol-lowering medications is not going to be an issue.

Time will tell and this case study will go on. I intend to stick to the dietary changes I've made, and see where that goes. Dropping my cholesterol by 65 points in 3 months without drugs, hell I should write a book...

Obesity, A Rant

I found this fascinating.

Yesterday we saw a young family, the parents and two little girls probably 8 to 10 years old. The parents were noticeably overweight but not what I'd call obviously obese. I'd say average based on the majority of people I see these days. But the little girls were both fat, in my opinion, at least working on obese.

I wonder, what are these kids eating, how much are they eating and what, and what are they doing all the time?

Allow me to rant for a while.

Obesity is one of the most pressing issues we have to deal with not only here in this country but worldwide, as it's spreading. Pun not intended.

It caught my eye not only because I'm interested in the topic, but I used to work for this organization, Scottsdale Healthcare, it's a good hospital system and good place to work, doing some cutting edge work in certain areas like bariatrics. 

I first saw this in one of the e-mail medical newsletters I read daily.

Diabetes is an extremely costly disease. The complications: cardiovascular disease, neuropathies, infections, organ dysfunction especially of the kidneys and eyes. Limb loss. Sepsis. Dialysis. Premature death.

We also need to attempt to stop it before it happens, like not letting people get to a BMI of 30 in the first place, even though some people are more likely to go there due to genetic influences. The video doesn't talk about changing behavior early on, intervening before a person starts to become obese and the metabolic signaling results in diabetes.

Years ago people were not so fat. They were more active. They didn't have the range of sedentary activities to keep them mesmerized. There wasn't the range of bad food, and the ingredients, and the portion sizes.

There is a huge genetic influence on obesity. But that doesn't mean we throw up our hands and say, wait until the person is diabetic then give them a sleeve gastrectomy.

We need thinkers like Dr. Blackstone to manage the medical approach to managing this disease, but we also need more action on the prevention end of things. We certainly aren't doing enough lifestyle interventions to help solve the problem.

Workplace habits, city planning, commuting time, work schedules, stress, availability of healthy foods, lack of leisure time, leisure time choices, lack of physical education that truly teaches kids how to develop healthy lifestyles, all of these things and more add up to what? Sleeve gastrectomies?

No!

Exercise and nutritional screening, behavioral screening for tobacco and alcohol consumption, electronics use and TV watching. Simple things! Doctors aren't necessarily good examples at all.

I'd like to see total screening in preventive care as an ongoing intervention, education and practice throughout the lifespan. It doesn't belong primarily in the domain of preventive health care in a doctors' offices. The schools could play a huge role, along with the community organizations that sponsor youth activities. What to eat, how to cook, what to buy, what to avoid. How to increase activity, emphasizing less sedentary time.

As people get older, include thyroid screening. You wouldn't believe how many patients I see, when I look at their labs, I see elevated TSH and they're not on thyroid meds. When I ask about it, they look perplexed. Many cancer treatments can affect thyroid function but many of these patients are not getting treatment for cancer. They say they are tired.

The thing is, we already know all this stuff. We know what would work. But there's a lack of organized, coordinated societal effort. In the video, Dr. Blackstone acknowledges that some of the other medical disciplines such as oncology and cardiology have had a lot of success with combination therapies, including behavioral interventions and medications, in addition to surgery. It is a multifaceted problem and needs to be treated accordingly.

But when I see little kids who are well on their way to becoming obese adults, it makes me cringe, and I know we are setting them up for failure early on, before they ever get a chance to learn to make healthy choices for themselves.

And I think that's a major failure on the part of the adults in this country. We know better, and it's outright negligence to continue to allow this to happen.

end of rant, for now.

(cross posted at Journey to Badwater )

Seeing through the (Brain) Fog

One of the most frustrating things about hypothyroidism, when it isn't adequately treated, is the brain fog that goes along with it. At least it's that way for me. I don't feel good when I can't think clearly. I am a high functioning person and I use and expect a lot of my brain all the time. When it's not working, I feel like I've shut down. My quality of life is so diminished when I can't concentrate that it depresses me.

When this goes on for a period of time, it can make you question the meaning of your existence, and not in the philosophical sense. I've heard people say it feels pointless to go on living like this. That's another reason why we need to be vigilant about our physicians' handling of our treatment. They might not have ever experienced brain fog, but I bet if a doctor had to deal with their own brain fog, they would understand. Completely.
 

Being an oncology nurse, I am constantly hearing about chemobrain, a phenomenon that many people experience when going through chemotherapy, and for months to years after treatment, or even permanently. I have never experienced chemobrain but from the way patients describe it, it sounds just like hypothyroid brain.

One of the newsletters I subscribe to featured this article on concentration recently, intended to help people experiencing chemobrain to function better. When I read it, I found it perfectly applicable to hypothyroid brain.

I hope this helps. I'd like to hear your comments.

Do I always have to take my medication on an empty stomach?

I was just asked this question again today and I've been meaning to post about this, but then I always forget.

Doctors and pharmacists always say you need to take your thyroid medication on an empty stomach. Why? Because food, especially foods with calcium or iron in them, will interfere with thyroid hormone absorption from your stomach. Also, some medications, like antacids, can bind to the thyroid medication and prevent absorption. (Caution: If you do take other medications along with thyroid meds, check with your pharmacist to see if there might be any interactions between drugs or any reason that you absolutely need to take them separately from your thyroid meds.)

Here's the scenario: You're newly diagnosed with thyroid disease and need to start taking medication. Upon hearing that you need to take it on an empty stomach, you realize that means you won't be able to eat breakfast in the morning for an hour even if you tke the pill first thing when you wake up. That disrupts your whole morning routine. So you get this great idea: you'll wake up an hour early, take your pill, and go back to sleep. Sounds great, right?

WRONG! Not fun. Plus, how many times do you wake up out of a sound sleep and have to do something, and then can go right back into a sound sleep for another hour? (If you can, then you're either lucky, or not perimenopausal)

One of the biggest fallacies about taking thyroid meds is the waiting an hour until you eat. If you always do the same thing, and are always consistent, the absorption thing will work itself out in the testing and dosing. I take mine every morning with my coffee (which has milk in it) and I eat breakfast soon after. You need your sleep more than you need to be woken up every morning just to take a pill. I know so many people who think they have to do it that way and really, it makes no sense.

Here's what I learned from my old endocrinologist in Arizona. She had her thyroid removed and took thyroid meds every day. She took hers with her morning latte. She explained it like this:
If you always have the latte, then the test will be based on your thyroid med absorption with the latte. So whatever your TSH comes out to be based on thyroid meds with latte, you can be medicated based on thyroid meds with latte.

I never worry about it, and I've never had a problem. In races, like I said, just do it when it's the same time of day. One day doesn't make all that much difference in your overall TSH if it's done slightly differently due to a race. Especially considering you'll only be getting tested every few months at the most.

Enjoy your sleep! (And your coffee)

Medical News: Older Surgeons May Not Be Better Surgeons - in Surgery, General Surgery from MedPage Today

I just found this article. I'm not endorsing this as the way to go in all instances, and it's not specifically thyroid surgery-related, but it is something to consider if you ever find you need surgery or some procedure done on your thyroid, or anything in your body. Food for thought. Always remember to interview a doctor or surgeon before you decide to go with them. How long have they been doing the procedure/practice? How many of these surgeries have they done? You also might want to google on the doctor and see what sorts of reviews they have.
Medical News: Older Surgeons May Not Be Better Surgeons - in Surgery, General Surgery from MedPage Today

Follow-Up: An Experiment of One

If you read my October 2011 post, An Experiment of One, I said I would follow up with the post when I got my next thyroid labs drawn.

I got my results back two weeks ago. TSH 2.29, FT4 0.89, FT3 0.99. I've been symptomatic since around mid-November.

Afternoon fatigue that starts around 11 am. Feeling cold all the time. Difficulty concentrating and multitasking. Dry, dry skin, worse than usual for this time of year and our climate. Weight re-gain of 4 pounds, after I worked hard to lose it earlier this fall, despite no change in diet and increased running mileage. Total cholesterol 252, up from 199 last year at TSH of 1.0.

I'm adding back the skipped doses of Levoxyl and see where that takes me. I'll re-test in about 4 months if I do feel better, also recheck cholesterol. If I don't feel better within 12 weeks I won't wait, I will ask to re-check thyroid and see if a dose adjustment is necessary.

I did have another thyroid ultrasound and the nodule in question has shrunk further, which is good news. My thyroid appears shrunken too, without a lot of blood flow. It's not very functional, which is no surprise, this many years into Hashimoto's. I don't know if this means I am less likely to have flare-ups of thyroiditis now, but that would be a nice benefit of a non-functional thyroid.

I'd like to ask an endocrinologist these questions.

Another good source of information

Columbia University Medical Center has an excellent website with a variety of health resources.
http://www.cumc.columbia.edu/dept/thyroid/index.html