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THYROID HEALTH WWW.IHPMAGAZINE.COM

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Natural Options in Thyroid Disease CAM in Europe 2016-01-25 12:32 PM

contents

FEATURES 20

The 12th International Conference of the Society of Integrative Oncology: A Canadian perspective

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Evidence for novel, therapeutic, natural options in thyroid disease

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Emotional Effects of Thyroid Cancer and Patient Needs

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Complementary and Alternative Medicine in Europe

28 DEPARTMENTS 5

Publisher’s Letter

6

Editorial Board

8 22 24 38

Bits and Bites

Industry and Research News

Product Profiles Clinic Profile

Darou Wellness

Post Scriptum

find us on 4

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publisher’s letter

EXCITEMENT IN THE AIR

O

ver the years, I have always found

naturopathic medicine in Ontario acquired

that one of the best ways to meet

a new status. With the Naturopathy Act, 2007,

fellow industry members is at a

proclaimed in June, the naturopathic pro-

trade show or convention. I recently attended

fession became self-regulated, which brings

the 2016 Canadian College of Naturopathic

it to the next level in terms of integration.

Medicine (CCNM) student event, and I caught

New doctors, new clinics, new and inno-

up with some old friends—and met some

vative products, experienced—and very

new ones.

passionate—doctors are all ingredients of a

At the show itself, there was a sense of excitement in the air. It was a pleasure to

growing and vibrant industry. Now, that is something to be excited about.

meet graduating students and future naturopathic doctors who are stoked on starting

Please don’t forget to download

their own clinics. I met with many exhibitors

your IHP App to have access to

who were excited to showcase their new

exclusive content and full-length

and innovative products. I also liased with

reference material.

some old friends, who after years in the business, are still very passionate about homeopathic medicine. All this buzz and excitement made me proud to be part of this fantastic industry.

The ever-changing regulation also brings forth a sense of excitement. Last year,

Olivier Felicio Publisher/Editor-in-Chief

WINTER 2016 • Volume 9 Issue 1 Founder Sanjiv Jagota

Circulation

Publisher & Editor-in-Chief Olivier Felicio

IHP Magazine Inc. 1235 Bay St., Suite 700; Toronto, Ontario, M5R 3K4 Email: circulation@ihpmagazine.com

Senior Managing Editor Phill Feltham Managing Editor Inna Levchuk Art Director Scott Jordan

Advertising

Graphic Designer Kaitlin Yep

Olivier Felicio (416) 203-7900 x 6107 olivier@rivegauchemedia.com

Contributors

Rita Banach, Jason Boxtart, Julie Ennis, Rochelle Fernandes, Hannah Lemke, Ellen McDonell, Marie-Jasmine Parsi, Susanne Schunder-Tatzber

IHP Magazine Inc. President Olivier Felicio General Manager Melanie Seth General Customer Care Manager Lucy Holden Subscription Rates

Canada $80 (gst included) for six issues | International $120

Published by IHP Magazine Canada Post Canadian Publication Mail Agreement Number 4067800 The publisher does not assume any responsibility for the contents of any advertisement and any and all representations or warranties made in such advertising are those of the advertiser and not of the publisher. The publisher is not liable to any advertiser for any misprints in advertising not the fault of the publisher and in such an event the limit of the publisher’s liability shall not exceed the amount of the publisher’s charge for such advertising. No portion of this publication may be reproduced, in all or part, without the express written permission of the publisher. ihp magazine is pleased to review unsolicited submissions for editorial consideration under the following conditions: all material submitted for editorial consideration (photographs, illustrations, written text in electronic or hard copy format) may be used by ihp Media Inc. and their affiliates for editorial purposes in any media (whether printed, electronic, internet, disc, etc.) without the consent of, or the payment of compensation to, the party providing such material. Please direct submissions to the Editor, ihp magazine.

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Weng Ng (416) 203-7900 x 6128 weng@thergmgroup.net

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2016-01-25 1:23 PM

feature

Evidence for novel, therapeutic, natural options in thyroid disease

By Rochelle Fernandes (MSc., ND (cand)) Peer reviewed by Jason Boxtart (ND), Hannah Lemke (ND (cand)), Marie-Jasmine Parsi (ND (cand))

INTRODUCTION

and fish (Blaszczyk, 2013). Magnesium has been used in a

Thyroid disorders affect about 200 million people in the

wide array of diseases, such as arrhythmia, hypertension,

world (0.8-5% of the population), and are four to seven

high cholesterol, premenstrual syndrome, asthma, diabetes

times more common in women (Mircescu, 2010). These

and attention deficit hyperactivity disorder (ADHD), in

disorders are ubiquitous in the context that they are the

doses of 100-400mg on average taken with meals

root of many other diseases. Thyroid conditions include

(Micromedex, 2015). More recently, the relationship between

hyper/hypothyroidism, goiter, thyroid cancer, Graves’

Mg abnormalities and the development of thyroid disorders

disease (GD) and Hashimoto’s thyroiditis. Conventional

has been considered.

treatment option for nodules and cancer is surgery.

Medications are also used for many thyroid conditions.

EVIDENCE FOR MAGNESIUM

Pharmaceutical medications that are common for hypo-

A growing body of evidence has shown the role and pattern

thyroid status include Synthroid and Cytomel.

of magnesium levels in thyroid disorders, including thyroid

Hyperthyroidism is treated by radioactive iodine or anti-thy-

cancer and autoimmune thyroid disease. For example,

roid medications, such as Methimazole. There are several

after factoring out ethnicity, one meta-analysis showed a

natural options available to treat thyroid conditions that

significant association between serum Mg and thyroid

can be used in conjunction with these medications or on

cancer. This retrospective analysis found that individuals

their own, such as selenium (Se), kelp and zinc. However,

with thyroid cancer had lower serum levels of Se and Mg,

more recent attention has been drawn to other options,

but higher levels of copper (Cu) than the healthy controls

such as magnesium, vitamin D and carnitine. The following

(Shen, 2015). Further benefit from these findings in a future

is a summary of the current evidence on these natural

study would be to understand the results in the context of

treatment options.

ethnicity. Another study on metabolic disorders indicated that mineral deficiencies, including Mg, were found in

MAGNESIUM

patients with autoimmune thyroid disease, alongside

Magnesium (Mg) is a vital part of cellular reactions; it is

protein and vitamin deficiencies (A, B’s and C). It suggests

involved in metabolism, DNA replication, repair, transport

that an improved diet via maintenance of required daily

mechanisms and cell proliferation. Food sources that are

intakes of vitamins and minerals could help decrease symp-

high in magnesium are whole and unrefined grains, seeds,

toms and prevent recurrence of malnutrition-induced

cocoa, nuts, almonds, green leafy vegetables, avocados

thyroid disease (Kawicka, 2015). Although this study was

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feature

Evidence has suggested a relationship pattern between lower Mg levels and their potential correlation that could help in treating thyroid autoimmune and other thyroid-related diseases.

done on a malnourished population, it offers unique results

secondly, the kidney converts calcidiol into 1,25 dihydroxyvi-

that warrant further exploratory studies to see if the effect

tamin D (calcitriol) (NIH, 2015). The function of vitamin D

to correct the thyroid diagnosis is maintained in a non-mal-

in the body is for bone and cell growth, neurological func-

nourished population. One prospective cohort study showed

tion, normal inflammatory response and thyroid optimiza-

no evidence of association between thyroid cancer and

tion. Food sources of vitamin D include cod liver oil,

micronutrient levels, including Mg, however this may have

swordfish, salmon, milk and liver.

been partly attributed to the low statistical power of the study and lack of detail surrounding the population studied

EVIDENCE FOR VITAMIN D

(O'Grady, 2014). Additionally, details were obtained via a

The role that vitamin D plays in the development and

food frequency questionnaire; it is possible that numerical,

treatment of thyroid conditions, such as Graves’ disease

measurable outcomes could have different results if utilized

and thyroid cancer, remains to be uncovered. One study

in further study.

showed that the prevalence of vitamin D deficiency was

A well designed, cross sectional study divided patients

significantly higher in GD patients when compared to

into five groups: 1) subclinical-hypothyroid (SHY), 2)

control subjects (56.25 vs. 10.00 %, p < 0.001). The same

overt-hypothyroid (OHY), 3) subclinical-hyperthyroid (SHE),

study also demonstrated that GD radioactive iodine therapy

4) overt-hyperthyroid (OHE), 5) patients under thyroxine

(RIT) failed in 27 (37.50 %) of patients whose serum 25(OH)

therapy (EU), and normal controls. It showed that overtly

D levels were < 20 ng/ml (Li, 2015). This suggests that

hypothyroid patients had reduced serum Mg levels-OHY

vitamin D deficiency might be an independent risk factor

group, among other abnormal serum levels of nutrients

for predicting failure of RIT in GD subjects. Another study

(Abdel Gayoum, 2014), thus suggesting the need for diet

found that low vitamin D was associated with three types

modification and supplementation with this micronutrient.

of autoimmune thyroid disease (Ma, 2015).

It would also be beneficial to do an extension of this type

Although the study of molecular mechanisms of vitamin

of study to examine whether this effect changes and/or is

D are beyond the scope of this article, the following should

maintained past six months. A study examined the effects

be noted as it illustrates the potential for future vitamin D

of Mg levels after treatment with thyroid medication; exam-

therapy. The mortality due to anaplastic thyroid cancer

ining Mg as a pathology marker. The study demonstrated

(ATC) is high because of fast progression of the disease

that using Methimazole in the treatment of hyperthyroidism

and its high metastatic potential with no effective treatment

due to Graves’ Disease led towards normalizing Mg levels

existing. The active form of vitamin D3, 1α,25(OH)2D3, has

(Klatka, 2013). These results are useful with further inves-

been shown to thwart metastases in pre-clinical studies,

tigation on whether, in addition to Mg as a pathology marker,

but has not been used clinically because of its potential to

it could be used therapeutically, and a correction of Mg

create a state of hypercalcemia. A recent study unveiled

deficiency could be beneficial towards correcting thyroid

that a category of less-calcemic vitamin D analogs,

abnormalities.

19-nor-2α-(3-hydroxypropyl)-1α,25-dihydroxyvitamin D3 (MART-10), is more potent than 1α,25(OH)2D3 in repressing

VITAMIN D

cancer growth and metastasis in a variety of cancers. The

Vitamin D is a fat soluble vitamin that is found in certain

study showed that both 1α,25(OH)2D3 and MART-10 could

foods and can be produced internally when ultraviolet rays

effectively inhibit the migration and invasion of ATC cells,

hit the skin. It is inactive and has to go through two trans-

suggesting hopeful future clinical application (Chiang,

formations to be biologically active: primarily, the liver

2015). Another emerging supplement for thyroid disorders

converts vitamin D to 25-hydroxyvitamin D (calcidiol), and

is carnitine.

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CARNITINE

evidence has shown a significant reduction in carnitine

Carnitine is found in different forms. L-Carnitine (LC) is

(mostly esterified portion) in hyperthyroid individuals, with

made up of methionine and lysine. It is part of an effective

a return to normal levels as euthyroid status was achieved

shuttling mechanism that transports long chain acyl groups

(Sinclair, 2005). This indicates that further investigation

into the mitochondrial matrix to produce energy from fat

is needed to better understand the mechanisms by which

(Olpin, 2005). LC metabolism within the body occurs via

thyroid conditions could result or cause a deficiency in

dietary intake, synthesis, and reabsorption in the kidney.

carnitine. So far, LC is thought to inhibit both triiodothy-

It is absorbed by the jejunum, through a sodium dependent

ronine (T3) and thyroxine (T4) entry into the cell nuclei,

transporter (Gross, 1986). This transporter takes up LC,

and thus supplementation could be beneficial to increase

while Acetyl LC (ALC) requires the removal of the acetyl

tissue levels (Benvenga S. A., 2004).

group before absorption. The levels of absorption are dose

Other thyroid diagnoses, such as thyroid storm, were

and source dependent. Usual therapeutic dosage ranges

successfully treated with a combination of conventional

are between 500 to 2000 milligrams per day depending

treatment, such as Methimazole and LC (Benvenga S. L.,

on the use (Malaguarnera M, 2011). It has been used for

2003). Another study showed an awakening from a coma

diabetes, osteoporosis, kidney and liver disease, and more

caused by thyroid storm after intravenous administration

recently, for thyroid diseases.

of LC (Kimmoun, 2011). The methods by which carnitine elicits these effects on the thyroid is not fully understood.

EVIDENCE FOR CARNITINE

Some studies have shown that LC can also modulate thyroid

Research suggests that diminished fatty acid oxidation

hormone action in peripheral tissues, most often through

can be corrected by carnitine supplementation. One ran-

inhibition (Benvenga S. , 2005)

domized, double blind, placebo controlled study consisted of women who were given thyroid hormones to treat benign

See table 1 on your IHP app for further details on clinical

thyroid nodules. They were divided into three groups; a)

studies with magnesium, carnitine and vitamin D in associa-

those who received placebo for six months, b) those who

tion with thyroid diagnoses that were discussed in this text.

had placebo for two months followed by carnitine 2 or 4 g/day for two months, then back to placebo, and c) those

CONCLUSION

who got carnitine 2 or 4 g/day for four months and then,

Overall, given that thyroid conditions can be detrimental if

placebo. The placebo group displayed symptoms of hyper-

they are not treated and overlap with other diagnoses, it is

thyroidism, such as muscle weakness, shortness of breath,

imperative that several effective treatment options be con-

heart palpitations, nervousness, and insomnia, amongst

sidered, including conventional and natural ones. Evidence

others. The second group had hyperthyroid symptoms

has suggested a relationship pattern between lower Mg

during the two months of placebo, but those symptoms

levels and their potential correlation that could help in

disappeared after two months of carnitine supplementation,

treating thyroid autoimmune and other thyroid-related

and returned again during the last two months of placebo.

diseases. Vitamin D has shown efficacy in preventing migra-

The last group had no hyperthyroid symptoms until they

tion of certain thyroid cancer cells, helping predict the

stopped receiving carnitine at the end of the first four

success of certain conventional thyroid treatments. Carnitine

months (Benvenga, 2001). The results, although not reaching

effectively modulates thyroid metabolites in peripheral

statistical significance, were still meaningful from a clinical

tissues and can correct inherent carnitine deficiencies

standpoint, and showed a time-sensitive benefit of carnitine

caused by hyperthyroidism. These three powerful supple-

supplementation in hyperthyroidism.

ments have recently shown promise as potential effective

The basis of why carnitine supplementation is useful

therapeutic targets in thyroid disease, enabling a greater

for many clinical thyroid settings derived from the under-

spectrum of choice of natural treatments for practitioners

standing that hyperthyroidism lowers tissue carnitine

and patients.

levels. It was shown that urinary excretion of carnitine is increased in hyperthyroid individuals (Maebashi, 1977).

One study showed that there were no differences found in the serum ALC profiles between hypo-, hyper- and euthy-

View the table and references on your tablet.

roid states before and after treatment with thyroxine or Thionamide therapy (Wong, 2013). Despite this, most WINTER 2016 â&#x20AC;˘ IHPMAGAZINE.COM

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