The
following article describes Thyroid
and Adrenal problems that effect many people with "low energy".
It is written by a colleague and mentor, Dr. Weatherby.
If you have questions or want to schedule for an initial
evaluation for your symptoms, please call the office
at
614-529-8171....
Low
Energy States- Part I
by Dicken Weatherby, ND
I
have recently been looking
at the whole concept of low energy states and the difficulty they pose
for a practitioner. One of the most common chief complaints we face is
fatigue and low energy and we need to be able to diagnose the exact
cause of this state in our patients. We are also faced with cases of
fibromyalgia, chronic fatigue syndrome, and other fatigue related
conditions. These symptoms and other health problems we deal with are
closely connected to a state of poor metabolism and low metabolic
energy.
What
does this mean?
The
majority of the systems
in our body rely on energy in the form of ATP (adenosine tri
phosphate). Macromolecules are converted into ATP via glycolysis, the
TCA cycle, and oxidative phosphorylation in the mitochondria, which
produces ATP so our bodies can perform metabolic work. ATP is the
universal "currency" of energy and is used by every cell in the body.
When levels of ATP begin to fall below optimal levels physiological
processes begin to function sub-optimally and we get the emergence of
signs and symptoms.
In
the muscles this may cause
easy tiring and even spasms, cramp, and pain. Muscles require ATP in
order to relax. In the brain sub-optimal levels of ATP cause
difficulties in thinking, cognitive dysfunction such as poor memory,
and mood disorders such as depression. In the immune system this can
manifest as asthma, allergies, frequent infections, and even cancer.
There are few systems that are not affected and the difficulty is to
find out what the cause is and not try and treat each system
individually. This is especially true for our patients who may have
been to visit many specialists and be on multiple drugs and alternative
protocols to correct this problem.
What
Causes Low Metabolic
Energy?
If
we are to back up and look
at a hierarchy of systems we recognize that low metabolic energy must
involve the thyroid, which acts as the metabolic accelerator in the
body, the pituitary, which is the "master gland" that controls the
ultimate activity of the thyroid, and the adrenal glands, which deal
with stress in all its forms. These three glands play a huge role in
the development of low metabolic energy states.
The
Thyroid
The
thyroid influences the
rate of metabolism through the production of T4 from the thyroid and
the peripheral conversion of T4 into the more metabolically active T3,
which stimulates energy production on the cellular level via its
ability to act as a "key" on cellular receptor sites and increase the
production of ATP from the cell, or a molecule called Reverse T3 or
rT3, which acts as a metabolic brake.
The
majority of T4 released
by the thyroid is bound to a protein called thyroid binding globulin
(TBG). Only about 0.03 - 0.05% of circulating T4 is in the free form.
T4 is converted to T3, Reverse T3 or rT3, or is eliminated unconverted
via conjugation, deamination or decarboxylation in the liver. It is
estimated that about 70% of T4 produced in the thyroid is eventually
deiodinated in peripheral tissues into either T3 or rT3 via deiodinase
enzymes that cleave an iodine molecule from the quaternary form.
T3
is the considered the most
metabolically active thyroid hormone.
T3 is 4 -5 times more metabolically active than T4 and its systemic
effects and half-life are shorter. Although some is produced in the
thyroid, approximately 80 – 85% is produced outside the
thyroid in peripheral tissues, primarily by conversion of T4 in the
liver and kidneys. Within the liver and kidney, the enzyme responsible
for the peripheral conversion of T3 is a selenium dependent enzyme
called 5´-deiodinase. Similar to T4, the majority of T3 is in
a bound form. Free T3 represents approximately 8 – 10% of
circulating T3. Free T-3 is more available for tissue receptors and
provides an accurate measurement for thyroid assessment than total T3
in patients that are estrogen dominant or on some form of estrogen
replacement (birth control pills, HRT etc.).
Our
energy systems need to
not only turn energy production on but also switch it off. Throughout
the day there are times when our systems require either more or less
energy, depending on the level of activity. Short term control is
governed by the conversion of T4 into active T3 for stimulating ATP
production or into the molecule called Reverse T3 or rT3, which acts as
a metabolic brake.
Reverse
T3
Reverse
T3 (rT3) is a
metabolically inactive thyroid hormone. Small amounts of rT3 are made
within the thyroid; however, 95% of rT3 is produced from peripheral
conversion of T4. Reverse T3 is formed by the removal of a different
iodine molecule from the quaternary structure of T4 than the one
removed for T3 conversion. The enzyme responsible for this conversion
is 5-deiodinase and is not believed to be dependent on selenium. Under
normal conditions it has been estimated that 45 – 50% of the
daily production of T4 is transformed into rT3. Reverse T3 can be seen
as a sort of "blocker molecule" that fits in and occupies the T3
receptors on the cell membrane, but does not permit T3 to enter and
increase energy production. It functions to slow down ATP synthesis
within the cell.
T3
is like the accelerator in
your car and reverse T3 is more like the break. If there is a sudden
need for less energy production, we make more rT3 from T4. If this
reduced need for energy persists over months, we make less T4 by
reducing the output of TSH from the pituitary. This leads to a
situation of low normal TSH, which in turn reduces T4 production and
produces a low normal level of T3. The body, in its infinite wisdom,
wastes less effort in manufacturing thyroid hormone that will not be
used.
Adrenal
Function
What
role, I hear you say,
does the adrenal glands play in all of this? The adrenal glands have
many metabolic functions in the body. One of the most important of
which is to help the body maintain stability and equilibrium in the
face of both exogenous and endogenous stress. Stress comes in many
forms and can be:
1.
Emotional- family dysfunction, fear
2. Physical- injury, surgery, over
exercise, chronic pain
3. Biological- chronic infections
(epstein barr virus)
4. Metabolic- excess metabolic
stimulation from hyperthyroidism, or early stage Hashimoto's thyroiditis
5. Chemical- exposure to toxicity, drugs,
or heavy metals
6. Nutritional- excess yo-yo dieting,
vitamin or mineral deficiencies, calorie deficiencies
The
adrenals have a hard time
interpreting "bad" stress as described above, or good stress such as
the adrenaline rush of reeling in a big fish! The adrenals deal with
stress through the production of cortisol and DHEA. We evolved to be
able to use our adrenal glands to help us deal with short term stress.
If we live in stress for long periods of time, we begin to lose the
ability to keep up with the stress and begin to function as if the
adrenals are fatigued. As the adrenals fatigue they go through a number
of phases of fatigue. The first is marked by high cortisol and low DHEA
output. In latter stages we see a generalized decrease in not only
cortisol and DHEA but also other adrenal hormones such as testosterone
in both males and females, and aldosterone that regulates mineral
metabolism. In response to the high levels of stress the hypothalamus
will signal the pituitary to produce less TSH. The overall effect being
a decreased production of T4 and a lowering of metabolic activity.
In
the early 1990s Dr. Wilson
recognized a condition of low energy when he saw the condition where
thyroid tests were normal but from a functional perspective the patient
functions as if they were hypothyroid. This phenomenon used to be
described as Euthyroid Sick Syndrome or Low T3 Syndrome, which describe
a non-thyroidal illness marked by reduced peripheral
5´-deiodination conversion of T4 into T3 due to liver or
renal dysfunction (Euthyroid Sick Syndrome) or stress, malnutrition,
low calorie diets, lack of exercise etc. (Low T3 Syndrome). Dr. Wilson
called this phenomenon Wilson's syndrome and went further by describing
it as a condition in which the body increases reverse T3 output and
gets "stuck" there indefinitely. The conditions that cause this pattern
include increased exposure to stress, food and calorie deprivation, and
yo-yo dieting, which sends our body into storage mode in the
anticipation that calories will be hard to come by in the future.
Low
Energy due to Thyroid and
Adrenals
The
basic pattern described
by Dr. Wilson relates to the body producing less energy because it is
trying to conserve energy. The body activates an ancient system for
conserving energy in the face of potential famine. The problem is
there's no famine! This pattern can best be called a Low Energy State
due to the Thyroid. Dr. Bruce Rind (an MD in the Washington DC area)
recognized that this only partly described the phenomenon and he went
further in describing a second pattern that he called Low Energy State
due to the Adrenals. In this state the body is trying to limit energy
production because large amounts of energy are being poured into a body
that cannot cope or manage so much energy. Some of the causes of low
metabolic energy states are listed below.
Causes
of Low Metabolic
Energy states
Based
on the above
explanation, some of the contributors of low metabolic energy include:
*
The thyroid gland cannot produce enough T4. The body is trying to
produce less energy because it is trying to conserve energy.
* Adrenal glands that are too
weak to deal with the body's increased metabolic activity, which forces
the body's energy production to slow down.
* The actual chemical creation
of ATP can be compromised by chemical interferences such as increased
levels of metabolic toxins, a lack of essential ingredients (vitamins,
minerals, essential fatty acids, and other accessory co-factors),
inhibitory factors such as Trans fatty acids, or a general breakdown in
the energy production system due to auto-immune disease or viral damage.
* Imbalances in essential
hormones such as Human Growth Hormone (HGH), Testosterone,
Progesterone, or Estrogen.
* Severe calorie restriction.
* Nutritional deficiencies
Both
Low Energy States due to
Thyroid and Adrenals have low metabolic states and low body
temperature. Some of the signs and symptoms are shared by both. However
many are not. In part 2 I will continue with this topic and discuss the
physical signs and symptoms of Low Energy States due to Thyroid and Low
Energy States due to Adrenals, and the commonalities and differences
between the two as seen in the history and physical exam findings. In
part 3 I will look at the changes on a regular chemistry screen and
look further at ways to get even more information out of our thyroid
panels. Please keep an eye out for these upcoming articles.
©
2005 Weatherby
& Associates, LLC
Dr.
Dicken Weatherby is
creator of the best-selling 'Full Functional Blood Chemistry Analysis
System". To learn more about Functional Blood Chemistry Analysis and to
sign up for his FREE Functional Diagnosis articles and FREE audio
class, visit www.BloodChemistryAnalysis.com