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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
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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
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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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