Applied nutrition for thyroid health

During this webinar Kyla discusses the potential causes of thyroid issues and the signs and symptoms to look out for in order to determine whether thyroid dysfunction may be a factor in your clients’ conditions. The negative health effects of thyroid dysfunction, including alterations in metabolism, skin health, digestive issues and fertility, will be covered. Kyla then goes on to discuss the tests available to better understand the extent and type of thyroid dysfunction and the nutritional and lifestyle approach to support thyroid health.

1. Applied nutrition for thyroid health By Kyla Williams DipION, BSc, MSc 1

2. Summary     The thyroid gland function Causes of thyroid issues Signs and symptoms of thyroid dysfunction N egative health effects of thyroid dysfunction M etabolism, skin health, digestive issues and fertility T ests to better understand the extent and type of thyroid dysfunction N utritional and lifestyle approach to support thyroid health 2

3. An introduction to the thyroid gland Positioned in the neck below thyroid cartilage Consists of 2 connected lobes Endocrine gland Secretes hormones directly to the blood Impacts energy metabolism, protein synthesis Regulates growth Regulates several functions in the body 3

4. Functions of the thyroid gland T4 (thyroxine / tetraiodothyronine ) production T3 (triiodothyronine) production Growth & development Metabolism Body temperature Heart rate Calcitonin production Regulates blood calcium and phosphate levels Calcitonin released from thyroid = blood calcium falls Effects long bone growth 4

5. Functions of the thyroid gland Composed of follicles that absorb iodine Secretes T4 and T3 through a single layer of epithelial cells surrounding the follicles 5 Thyroid gland

6. Parathyroid glands 4 small glands, positioned on the back of the thyroid gland Different roles from the thyroid gland: Glands release PTH (parathyroid hormone – also known as parathormone) PTH controls calcium and phosphate homeostasis PTH has opposite effects to calcitonin: PTH causes osteoclasts to break down and release calcium = increasing blood calcium levels Increases gastrointestinal absorption of calcium 6

7. Thyroid stimulation 7

8. Negative feedback loop When T4 levels are high = TSH production = thyroid function Exposure to cold = TRH = TSH production = thyroid function Glucocorticoids / sex hormones / high iodine = TSH = thyroid function 8

9. T4 to T3 conversion Thyroid produces both T4 and T3 T4 is produced in significantly greater quantities compared to T3 Up to 80% of the T4 is converted in the body to T3 T3 is more biologically active than T4 Conversion by other organs: liver, kidney, spleen and thyroid It is possible to have normal levels of T4 and low levels of active T3 (with low or high TSH) ‘Free’ T4 and T3 have been transported to tissues and cleaved from their protein carriers 9 T 3 T 4

10. Synthesis of T 4 and T 3 hormones T3 and T4 required for thyroid function Tyrosine and iodine are required for synthesis of T3 and T4 Ensure adequate tyrosine and iodine in the diet 10 T 3 T 4

11. Tyrosine Amino acid Rich food sources – eggs, cheese, turkey Can be synthesised in the body from phenylalanine (food sources - chicken, fish, cheese, beans, etc) 11 Tyrosine

12. Tyrosine supplements To support synthesis of T4 and T3 Used in the body to produce noradrenalin and dopamine, anti-stress 500 – 1000 mg (3 x per day) 30 mins – 1hr before food Do not take if you have manic symptoms or high blood pressure Do not take alongside prescription thyroid medication Note: tyrosine supplements can cause digestive discomfort and migraines in some individuals 12

13. Iodine Trace element Rich food sources include seaweed, fish, seafood and eggs Follicles in the thyroid gland absorb iodine Thyroglobulin (Tg) is a protein produced by the thyroid gland which stores iodine 13 Iodine

14. Thyroid dysfunction Hypothyroidism (underactive thyroid) Hyperthyroidism (overactive thyroid) Thyroiditis (inflammation of the thyroid gland) Thyroid cancer / nodules 14

15. Hypothyroidism (underactive thyroid) Low production of T3 and T4 High production of TSH Causes Thyroid abnormalities from birth Autoimmune (Hashimoto’s) I odine deficiency Surgical removal of thyroid gland (cancer) 15

16. Hypothyroidism (underactive thyroid) Symptoms Weight gain Feeling the cold Brittle hair Brittle nails Dry skin Swelling (goitre) Reduced metabolism, sluggish digestion (constipation) and reduced fertility 16

17. Hyperthyroidism (overactive thyroid) Overproduction of T3 and T4 Causes Autoimmune (Graves’ disease) – autoimmune disorder: antibodies attack thyroid gland and occasionally tissue behind eyes and over shins on legs. Possible genetic predisposition Plummer’s disease – benign lumps that produce too much T4 Thyroiditis – inflammation of the thyroid gland: causes excess thyroid hormone stored to leak into bloodstream Overactive thyroid = enlarged = goitre (can be toxic) Thyroid grows due to lack of negative feedback 17

18. Hyperthyroidism (overactive thyroid) Symptoms Enlarged swollen neck E levated heart rate Increases cells’ sensitivity to adrenaline Anxiety Protruding eyes Weight loss Goitre, leading to other problems Intolerant of heat, excessive sweating Excess skin growth on lower legs (similar appearance to psoriasis) Increased metabolism, fast digestion (diarrhoea) and reduced fertility 18

19. Thyroiditis Autoimmune inflammatory condition Fluctuating overactive / underactive thyroid leading to hormone and mood swings Hashimoto’s thyroiditis De Quervain's thyroiditis Postpartum thyroiditis 19

20. Thyroid cancer / nodules Often no significant symptoms other than feeling lumps in neck With or without pain Refer to GP 20

21. Medical treatment options Physical examination over the outside of the neck, feeling for abnormal growths and the size of the thyroid Blood tests (e.g. thyroglobulin) Neck ultrasound (to safely and sensitively measure abnormalities in thyroid gland) CT Scan MRI scan PET scan 21

22. Diagnostic tests Measure basal temperature Test serum levels of TSH, total T4, T3, free T4, free T3 Test T4 to T3 conversion, by testing for serum levels (for someone with possible selenium deficiency, very stressed) Test reverse T3 (metabolite of T4, inactive form) Test anti-TG (thyroglobulin) antibodies and anti-TPO antibodies To identify thyroid tissue damage due to autoimmune conditions, e.g. Graves’ disease, Hashimoto’s thyroiditis Test urine T3, T4 and T4/T3 ratio 22

23. Diagnostic tests Test iodine Serum vs urine testing Blood tests most commonly used by GPs Urine tests are more sensitive, measuring levels over a 24 hour period Urine tests identify subclinical hypothyroidism References ranges GP ‘normal’ ranges not necessarily optimal Wide ranges, not necessarily normal for everyone 23

24. Iodine Iodine Iodised salt Sourced from sea vegetables, fish Problems can occur with too little or too much Symptoms of deficiency Enlarged thyroid gland (swollen neck) Stunted growth Developmental delays including brain Some vegetables can block the absorption of iodine Containing goitrogens 24

25. Micronutrients Selenium Helps to regulate T4 to T3 conversion May reduce inflammation Zinc Deficiency associated with hypothyroidism Iron Consider malabsorption Required for T4 and T3 production Possible toxicity Copper Required for hypothalamus To be balanced with zinc 25

26. Control inflammation Omega-3 EPA increases T4 production and improves sensitivity to thyroid hormones Anti-inflammatory diet including EPA 26

27. Omega-3 EPA Omega-3 EPA supplements may be beneficial for controlling inflammation 1000mg EPA without DHA most effective for inflammation Pure EPA derived from wild anchovies, sustainable source Pharmepa RESTORE: 90% EPA – 1000mg (added vitamin E) Pharmepa MAINTAIN: 80% EPA – 640 mg, GLA – 18mg (added vitamins B5, D3 & E) 27 Directions for use Adults 1-2 (Pharmepa step 1: Restore) 2-4 (Pharmepa step 2: Maintain) capsules daily. Take with food for optimal absorption.

28. Antioxidants Antioxidants to reduce oxidative stress Reduce thyroid cell damage Selenium Vitamin E 28

29. Foods to possibly avoid Aspartame and other artificial ingredients C hemical oestrogens May cause harm to thyroid gland Non-fermented soy Isoflavones in soy can mimic activity of oestrogen hormone = reduced thyroid activity Goitrogen-containing foods, inhibit uptake of iodine: Spinach, Brussels sprouts, broccoli, cabbage, cauliflower, strawberries, peaches Fully cook foods to reduce goitrogens Gluten Link between gluten intolerance and autoimmune diseases 29

30. Lifestyle for thyroid health Moderate exercise is key Too much intense exercise can compromise function of thyroid gland, making weight loss very difficult Recovery and rest required Stress relief Adequate sleep supports recovery 30

31. Summary – Nutrition protocol for thyroid health Identify symptoms to consider thyroid abnormalities and thyroid activity Refer to GP if client complains of swelling or lumps Test for T4, T3, TSH and iodine Consider protein consumption for intake of tyrosine, and intake of Iodine Balance inflammation 31

32. Summary – Nutrition protocol for thyroid health 6. Include plenty of nutrient-dense foods, providing selenium especially 7. Cut out offending foods such as gluten and aspartame 8. Offer lifestyle advice concentrating on thyroid health, not just weight loss / gain 32

33. References (1) Taraghijou P, Safaeiyan A, Mobasseri M, Ostadrahimi A. The effect of n-3 long chain fatty acids supplementation on plasma peroxisome proliferator activated receptor gamma and thyroid hormones in obesity. J Res Med Sci 2012 Oct;17(10):942-6. (2) Venditti P, Di SL, Di MS. Vitamin E management of oxidative damage-linked dysfunctions of hyperthyroid tissues. Cell Mol Life Sci 2013 Sep;70(17):3125-44. (3) Sathyapalan T, Manuchehri AM, Thatcher NJ, Rigby AS, Chapman T, Kilpatrick ES, et al. The effect of soy phytoestrogen supplementation on thyroid status and cardiovascular risk markers in patients with subclinical hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab 2011 May;96(5):1442-9. (4) Stazi AV, Trinti B. Selenium status and over-expression of interleukin-15 in celiac disease and autoimmune thyroid diseases. Ann Ist Super Sanita 2010;46(4):389-99. (5) Kuriyama C, Mori K, Nakagawa Y, Hoshikawa S, Ozaki H, Ito S, et al. Erythrocyte zinc concentration as an indicator to distinguish painless thyroiditis -associated transient hypothyroidism from permanent hypothyroidism. Endocr J 2011;58(1):59-63. (6) Triggiani V, Tafaro E, Giagulli VA, Sabba C, Resta F, Licchelli B, et al. Role of iodine, selenium and other micronutrients in thyroid function and disorders. Endocr Metab Immune Disord Drug Targets 2009 Sep;9(3):277-94. (7) Naiyer AJ, Shah J, Hernandez L, Kim SY, Ciaccio EJ, Cheng J, et al. Tissue transglutaminase antibodies in individuals with celiac disease bind to thyroid follicles and extracellular matrix and may contribute to thyroid dysfunction. Thyroid 2008 Nov;18(11):1171-8 . (8) Wall R, Ross RP, Fitzgerald GF & Stanton C (2010) Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids.   Nutrition Reviews.   68:280-9. 33

34. 34 www.igennus.com 0845 1300 424 [email protected] Kyla Williams DipION , BSc, MSc Nutrition Technical Advisor [email protected]