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Holistic Health Topics will introduce you to the world of holistic and alternative medicine, covering such subjects as body typing, herbal therapies and nutrition. Holistic Health Topics also considers various common disorders from a natural and holistic viewpoint. These disorders include asthma, Chronic Fatigue Syndrome, and thyroid disorders such as hypothyroidism and Wilson's Disease.
ACNEM Australian Practitioner List
http://www.acnem.org/opening_material/...
cortisone as a cause of depression, Evidence accumulates implicating .
Although many have tried to dismiss elevated cortisol levels in depression as a result rather than a cause, scientific evidence has long indicated otherwise. ... initial trials with drugs to lower cortisol levels are proving to have a significant antidepressant effect.
Ciguatera Fish Poisoning
http://www.holistichealthtopics.com/HMG/ciguatera.html
Graham Williamson
webmaster@holistichealthtopics.com
02/10/06
Ciguatera - General Description and Incidence
Ciguatera is a type of sea food poisoning caused by the consumption of fish, especially certain tropical reef fish, which contain one or more naturally occurring neurotoxins from the family of ciguatoxins and maititoxins. It has also been suggested that ciguatera may be caused by occupational exposure to ciguatoxic fish organs during repetitive handling or processing of fish ( Codella: pers. comm. ). In confirmation of this are reports that cleaning of ciguatoxic fish may cause tingling of the hands ( 18a ), clear evidence that ciguatoxins may be absorbed through the skin (18).
Ciguatera is reported to be the most common form of sea food poisoning in the world (1, 2, 4) with the estimated number of cases ranging from 50,000 (1, 2) to 1,000,000 (3, 9) annually. In view of the fact that only 2% - 10% of ciguatera cases are actually reported (2), and many doctors have never heard of ciguatera, it is clear that the true prevalence of this disorder could be much greater than these figures suggest. Although ciguatera is often considered to be a mild non fatal disease, it has a world wide mortality rate ranging between 0.1% - 12% (2) with isolated outbreaks as high as 20% (1, 8, 18 ).
Symptoms and Duration of Ciguatera
Since ciguatera may be caused by a cocktail of different fat and water soluble toxins, this disorder may cause numerous different symptoms. The variation in symptoms in different cases, which may also follow a geographical pattern (2, 6, 12, 18, 30), is thought to be caused by the different biological effects of the various toxins which may be involved (1, 2, 11, 12, 18).
Ciguatera typically presents as an acute gastrointestinal ( and perhaps neurological ) illness, which may, in some cases, only last for a few days ( 1, 5, 6, 12, 18 ), following the consumption of contaminated fish ( 1, 2, 12 ). This initial illness is then frequently followed by a chronic, mainly neurological illness, which may last for months, or even as long as ten years ( 5, 7 ), with claims that the toxin could even remain in the body for 25 years ( 18b ). Since ciguatera is particularly damaging to the nervous system, recovery may not occur until the damaged nerves regenerate and it seems that this may not always occur. Ciguatera, it should be emphasised, can also present as a psychiatric disorder or a dermatologic disorder.
Ciguatera may also have a slow insidious onset if there is a gradual accumulation of toxins due to the continuing consumption of fish which have a low level of toxicity (10, 30). Such cases of course, would be most unlikely to obtain a correct diagnosis.
Once a person has contracted ciguatera poisoning they may develop an extreme sensitivity to any further exposure to ciguatoxins (2, 18, 30). A second attack of ciguatera therefore, may be much more severe than the first one (2, 18, 32).
.. suffer relapses following the consumption of seemingly innocuous foods (2, 12, 18, 32). For instance, consumption of nuts, nut oils, caffeine, alcohol, or animal protein foods, has been known to cause relapses months or years after the initial attack ( 2, 12, 18, 32 ). Consumption of any type of fish can also cause relapses (2, 18). Even the consumption of poultry which has been fed fish meal has been known to have this effect (18, 32). ...
Other symptoms
Dermatitis, itch, rash, aches and pains, arthralgia, myalgia, general weakness, salivation, breathing problems, dyspnea, neck stiffness, headache, ataxia, exhaustion, fatigue, sweating, depression, and metallic taste in the mouth. Ciguatera, it should be noted, may also be sexually transmitted (2, 18) and may cause premature labour or spontaneous abortion (2). Ciguatoxins may also be transmitted via breast milk (2, 5, 18).
Ciguatera and Chronic Fatigue Syndrome
Chronic ciguatera poisoning may so resemble CFS that it may be difficult to distinguish between the two illnesses (13, 31, 36). But are they separate illnesses? CFS it seems, has actually been caused by ciguatera (14, 15, 33, 36). It is indeed interesting to note that CFS may actually be caused by toxins which closely resemble ciguatoxin (37). ...
... all these infections or toxins may cause considerable and prolonged internal stress and therefore may have a considerable impact on the adrenal system. ...
The nature of ciguatoxins, both their persistence in the body and their extreme toxicity, ensures that ciguatera has a very real capacity to impact upon the adrenal system.
The Nature and Origin of Ciguatera Toxins
Ciguatera toxins or ciguatoxins, are said to be amongst the deadliest mammalian poisons known (2, 4, 36), reportedly being, volume for volume, 1000 times more potent than arsenic (10). These heat stable toxins originate from a type of microorganism which attaches to certain species of algae on dead or damaged coral in tropical areas around the world (1, 11, 18, 30). Increasing damage to coral reefs therefore correlates with an increasing frequency of ciguatera outbreaks (16, 18). ..
... fish oil and fish liver oil supplements, it should be emphasised, that although fat soluble ciguatoxins may accumulate throughout the flesh of a fish, it is the organ areas such as the liver which accumulate the greatest concentration of these toxins (2, 11, 18). These parts of the fish are by far the most toxic (2, 11, 18). Since there is no simple routine test for the presence of ciguatoxins, stringent steps should be taken to ensure the source, and safety, of fish oil products. ...
Treatment of Ciguatera
... From my experience, the two most effective treatments were the complete elimination of all sea food from the diet, and the use of megadoses of vitamin B12.
... symptoms which were very similar to vitamin B12 deficiency.
These symptoms were largely neurological and occurred predominantly below the waist, although I also experienced some similar symptoms around the scalp, face, eyes and mouth. It was the symptoms in the lower back and legs which were most severe however. These symptoms included burning sensations, numbness, and pain and weakness which would be greatly exacerbated by standing for only a few minutes. These symptoms were progressive until I began weekly supplements of 4000 mcg tablets of vitamin B12 ( smaller doses were ineffective)
My response to the B12 was dramatic with a very rapid improvement in vitality and well being and a more gradual improvement in the neurological symptoms. I found however, that if I did not take the B12 weekly I would relapse. This continued for several months when I then found I could discontinue the B12 with no repercussions.
Vitamin B12 blood tests which were not done until after I began B12 supplements, revealed that my B12 levels were in the low end of the normal range, even less than 24 hours after taking the vitamin. This led to the suggestion that I was malabsorbing B12, however a subsequent vitamin B12 absorption test was normal.
... since toxins produce their toxic effects by disrupting normal metabolic pathways, it would not surprise if there was some kind of interaction between ciguatoxins and vitamin B12.
In view of the ability of ciguatera to destroy nerve tissue, it is indeed interesting to note that high doses of methylcobalamin, the active form of vitamin B12, has recently been shown to stimulate regeneration of damaged nerve tissue ( 28, 29, 35 ). Futhermore, various neurological disorders have been linked to a deficiency of methylcobalamin ( 28, 29, 35 ).
Ciguatera Prevention
Since ciguatoxins are unaffected by cooking or processing of food (1, 2, 5, 16, 26, 32), and contaminated fish is not detectable by appearance, taste, or smell (1, 2, 5, 26, 32), prevention of this disorder can only be achieved by avoiding contaminated fish (2). ...
... For a more comprehensive list of species go to
http://www.fishbase.org/search.cfm and search for ciguatera under topic search.
...
... large carnivorous reef inhabiting fish such as the barracuda are generally considered the most toxic species (2, 9, 11,18, 26) although pelagic fish like the Spanish mackerel seem to cause the most outbreaks of ciguatera (18) Some fish, such as red bass ( bohar snapper ) and paddletail, may be banned from sale in some localities (18, 32). ...
Skipjack tuna in particular, is a well known cause of ciguatera poisoning (20). This is extremely important since the dark fleshed skipjack is by far the most commercially important species of tuna in the world, comprising 50% of the total world tuna trade in 1999 (22, 23). ... the darker fleshed forms of canned tuna may contain skipjack, yellowfin, or bluefin ( 25).
.. Since it is impossible to say where a given fish has been, or where its dietary victims have been, it is impossible to guarantee the absolute safety of a particular fish. As has been aptly noted, "any fish living in the sea may be a potential vector of ciguatoxin (18, 18c). Having said this however, it is clear that the risk of ciguatera may be minimised by selecting a suitable species of fish.
Hypothyroidism and Treatment
http://holistichealthtopics.com/HMG/thyroid.html
29 printed page extensive report, important reading.
In my opinion my hypothyroidism was caused by CFS, the onset of which preceded the diagnosis of my thyroid disease by around10 years. In retrospect however, it is my belief that the thyroid disease started a number of years before it was actually diagnosed.
Right from the outset, my Hashimoto's disease was complicated by severe thyroxine intolerance. Although my starting dose of T4 was only 50mcg, the ill effects were so severe that this was quickly reduced to 25mcg daily. Even on 25mcg I experienced severe restlessness, insomnia, sweating, diarrhea, "overheating", tremor, palpitations and even pain and tightness around the heart upon exertion. These symptoms were so intense that for many months I could not take thyroxine continuously, but would have to cease taking it for a few days every week or so. These symptoms occurred even when thyroid tests revealed that my dosage of thyroxine was insufficient.
I also learned rather quickly that a change in my T4 dosage would have rather rapid and dramatic effects. While an increase in dose would effect me within 24 hours, a reduction in dose would take a little longer, around 48-72 hours. Many doctors, believing that it takes at least two weeks for a change of dose to have any noticeable effect, could not believe the rapidity of the effect in my case.
Even after my body eventually adjusted to the thyroxine and I ceased having side effects, these problems could all return if I contracted a significant infection such as influenza, whooping cough or glandular fever. Such infections would necessitate that I dramatically reduce my thyroxine dosage because of the sudden onset of severe thyroxine intolerance. If for instance I had been stable on a dose of 250mcg daily for six months, the onset of a significant infection would normally require me to reduce this dose to 25-50mcg daily. Even at this reduced dosage I would experience signs of hyperthyroidism which were absent, prior to the infection, when I was taking the higher dose.
This situation could continue, although sometimes with fluctuations, for many months or even years, following an infection. Blood tests performed when I was taking the high dose, or on the other hand, the low dose, would usually, but not always, confirm the appropriateness of the dose. Notable exceptions to this did occur however. For instance, on one occasion when I was taking 25mcg daily for months because of severe thyroxine intolerance (even though prior to this I had been stable on a much higher dose), I was medically diagnosed as suffering from all the symptoms of hyperthyroidism and told I should not be taking any thyroxine at all. However after obtaining the results of a blood test which was done to confirm the diagnosis, the doctor claimed I was taking insufficient thyroxine and I should increase the dose.
Eventually, as I recover from the infection, I would reach a point when I would begin to tolerate the reduced dosage and feel considerably better. This would then be followed by a sudden and sometimes very dramatic attack of hypothyroidism. I would then have to begin to restore my thyroxine dosage to its correct, pre-infection level.
I should also point out that exposure to infections which aggravate my CFS, in addition to causing a sensitivity to the ill effects of thyroxine, also simultaneously cause me to become partially resistant to the good effects of this hormone. Following an infection, in other words, I sometimes appear to suffer from the effects of both hypothyroidism and hyperthyroidism, something which is not unusual in cases of thyroxine resistance. Only when I fully recover from the infection, which may take months or years, do these anomalies return to normal.
The following facts emerge from my experiences.
- Any infection which aggravates my CFS will cause both erratic thyroid test results and erratic response to thyroxine.
- Although conventional thyroid tests do not reveal the precise mechanism underlying this thyroid disturbance, these erratic responses have been repeatedly observed by various doctors.
- Medical theories advanced to explain these phenomena include thyroxine resistance or CFS caused disturbance of mitochondrial transport of thyroxine.
Hypothyroidism: symptoms and signs.
Hypothyroidism has been described as the "great masquerader" (33) because of the many vague symptoms it may cause which resemble symptoms of numerous other diseases. Although there are various "classical" hypothyroid symptoms related to the general slowing of metabolism such as tiredness, fatigue, depression, coldness, reduced sweating and slowed thinking, speech and movements, there are also many other lesser known or paradoxical symptoms. These symptoms, which include mania, hyperactivity, anxiety, palpitations and insomnia, may be related to deficiency of T3 in brain cells. Perhaps even more important however, is the fact that hypothyroidism may cause stimulation of the adrenal gland and the sympathetic nervous system with increased levels of cortisol, adrenalin, and noradrenalin.
Diagnostic Dilemmas with Hypothyroidism
According to Arem (11):
"At any given time in the United States, more than 20 million people suffer from a thyroid disorder, more than 10 million women have low-grade thyroid imbalance, and nearly 8 million people with thyroid imbalance remain undiagnosed."......"at any given time, more than half the patients in our population with low-grade hypothyroidism remain undiagnosed."
Or, in the words of Shames and Shames (12):
"although extremely common, low thyroid is largely an unsuspected illness. Even when suspected, it is frequently undiagnosed. When it is diagnosed it often goes untreated. When it is treated, it is seldom treated optimally."
According to the recent Colorado Thyroid Disease Prevalence Study (3, 4, 5), 10% of Americans, or 13 million adults have an undiagnosed thyroid disorder. Brownstein (13) claims that the figure of 10% seriously understates the problem since conventional medical tests fail to diagnose around 30% of those with hypothyroidism. This makes the true incidence of hypothyroidism in America around 40% or 52 million adults (13, 32, 33). ....
There are many factors which may interfere with thyroxine utilisation or peripheral T4/T3 conversion. These include: stress, chronic illness, heavy metals, drugs ( HRT, beta blockers, steroids, antidiabetic drugs, cholesterol lowering drugs, oestrogen etc. ), cigarette smoking, carnitine, alpha lipoic acid, consumption of soy products, and nutritional deficiencies such as selenium, zinc, and vitamin B6 (11, 12, 13, 46, 109).
.. adrenal hormones play an important role in T4/T3 conversion and the peripheral utilisation of thyroxine (12, 13, 46). According to Shames and Shames (12): "some adrenal hormones assist in the conversion of T4 to T3 and perhaps assist in the final effect of T3 on the tissues. Some scientists believe that even the entrance of thyroid hormone into our cells is under the influence of adrenal hormones."
While low levels of cortisol may cause a deficiency of T3 because of reduced conversion from T4 (46, 109), excessive amounts of cortisol on the other hand, or an elevation of the cortisol/DHEA ratio, causes T4 to be converted to reverse T3 (46, 52). Reverse T3 (rT3) displaces normal T3 from receptors in cells and causes a T3 deficiency (46, 52, 53, 109). The adrenal hormone DHEA is also involved with the conversion of T4 to T3. ...
Similarly, according to Rothfeld and Romaine (109):
"countless people who are taking a thyroid supplement still suffer from subtle but disruptive symptoms such as an inability to lose weight, weight gain, lack of energy, irritability and moodiness, fertility problems in women and men, and for women, menstrual problems including premenstrual syndrome (PMS), cramping, and heavy flow. While it's bad enough to have these symptoms, what can make matters even worse is a doctor who says, 'Your lab results are normal, so I don't know why you're having these problems.' ...
In order to prevent or reduce such reactions it is vitally important that thyroxine therapy is commenced at a small dosage and increased slowly as tolerance permits (78, 79). Additionally, it may be necessary to utilise adrenal supplements, although such treatments need to be carefully supervised by a practitioner. I have also found that various herbal YIN tonics ( 80, 81 ) may assist in counteracting the ill effects of thyroxine.
Yin tonics, such as lily bulb (Lilium brownii; Bai He), dwarf lilyturf root (Ophiopogon japonica; Mai Men Dong), and dendrobium (Dendrobium nobile; Shi Hu) are mild but strengthening herbs which help to counteract the stimulating and heating effects of thyroxine. If stronger colder herbs are required then herbs such as water plantain root ( Alisma orientalis; Ze Xie), Anemarrhena ( Anemarrhena asphodeloides; Zhi Mu ), and American ginseng (Panax quinquefolius; Xi Yang Shen ), could also be added. Best results will be obtained by an individualised mixture prescribed by a TCM practitioner. ...
Nutrition and Thyroid Function
Nutrition is involved with every aspect of thyroxine metabolism, from hormone production in the thyroid gland through to cellular transport, utilisation and conversion to T3. Zinc, iodine, vitamins A, B2, B3, B6 and C, and the amino acid tyrosine are all necessary for the production of thyroxine (83, 108, 109). Also necessary for the cellular utilisation of thyroxine or the conversion of T4 to T3 are copper, zinc, vitamin B12 and selenium, the latter being particularly important for conversion of T4 to T3 (11, 12, 13, 109). Deficiencies of any of these nutrients may adversely effect the function of the thyroid system although caution must be exercised in the use of iodine in particular. ...
Perhaps the ultimate form of thyroxine for difficult patients is whole thyroid extracted from animals, such as Armour thyroid tablets (94, 95, 96, 97). Whole thyroid extracts not only contain T3 and T4 but they also contain T1 and T2 (12, 13) which apparently also have some hormonal activity (13, 109). According to Brownstein (13) natural thyroid extracts such as Armour also contain, in addition to T1 and T2, a diuretic constituent which corrects the fluid accumulation which occurs in hypothyroidism. Although doctors have long assumed that T2 is simply an inactive by product which is of no consequence it has recently been suggested by Rothfeld and Romaine (109) that T2 "might be the most significant form of thyroid hormone in the body." It is now believed that deficiencies of T2 and T3 may interfere with mitochondrial energy production and cause complex mitochondrial disorders (109). ...
... the connection between CFS and thyroid disease there seems little doubt that CFS has the ability to significantly alter the metabolism of thyroxine. Although some workers have reported that some CFS patients respond positively to thyroid treatment (12, 13, 66, 67), even in the absence of laboratory evidence of thyroid disease (13, 66, 67), others have found the results of thyroid treatment disappointing (54). In the latter case it has been suggested that CFS may be characterised by resistance to thyroid hormone or an inability to convert T4 to T3 (13, 54, 109). Bell (54) has noted that elevated levels of cytokines may block the metabolism of thyroxine.
... reduced adrenal function, which is common in CFS (see CFS page), may cause hypothyroid symptoms by blocking the conversion of T4 to T3 (12, 13, 46, 51, 52, 53, 68). Additionally, the adrenal hormone DHEA which stimulates the conversion of T4 to T3 is commonly deficient in both CFS and hypothyroidism (68, 69). In view of the well known adrenal abnormalities which may occur in CFS, thyroid changes which occur in this disorder may be the result of CFS rather than the cause of it.
Increasingly, evidence seems to suggest that many cases of hypothyroidism, particularly those that are more difficult to diagnose and treat, also involve a degree of adrenal hypofunction. In view of the fact that T3 therapy may be more effective when there is adrenal involvement (109) and in view of the fact that around 50% of hypothyroid patients also suffer from adrenal fatigue (109), conventional T4 therapy is rapidly becoming outdated. ...
... patients should seek a practitioner whose aim is to optimise the health of patients rather than simply normalise the results of blood tests. The patient's desire and determination to obtain optimum health should be supported by the practitioner. Any practitioner who is up to date with proper treatment will also readily acknowledge the superiority of T3 treatment, combined T4/T3 treatment, or treatment with whole thyroid extracts. ...
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