[JanSz]

To eat or not to eat?

Well, possibly enemas should work better?

Suitable donor may be important issue.

Comments please.

Boracay eats and it helps him.
http://musclechatroom.com/forum/showthread.php?t=13652&highlight=boracay&page=10

===========================================

http://perfecthealthdiet.com/?p=269

Bacterial Replacement Therapies Work
So if IBS patients are missing 25% of the thousand or so species that should populate the gut, or 250 species, and if common probiotics provide only 8 or so species and not the ones that are missing, how are the missing species to be restored?

The answer is simple but icky. Recall that half the dry weight of stool consists of bacteria. A healthy person daily provides a sample of billions of bacteria from every one of the thousand species in his gut. They are in his stool.

So a “fecal transplant” of a healthy person’s stool into the gut of another person will replenish the missing species.

[JanSz]

@DrMariano 3298 wrote:

O.K. I agree. It was a poor choice of words.

If I did not know the person and just have labs, then I would suspect thyroid hormone signaling is not working well if one or more of the following is present in an adult:

Total T4 < 8.0 ug/dL
Total T3 < 100 ng/dL (this varies)
Free T3 < 340 pg/dL
Free T4 < 1.2 ng/dL
TSH > 2.0 uIU/mL (this varies depending on the presence of metabolic problems. Also, if the goal of treatment is optimization, then this criteria is tightened so that a TSH > 1.0 would be suspect for suboptimal thyroid signaling).

Whether or not to add thyroid hormone depends on several factors.

This is where obtaining the necessary information via history, physical exam, and other lab tests is important.

For example, if Total T4 is between 8.0 to 12.0 (this range is shifted upwards in women who take birth control), then I would hesitate to add more thyroid hormone. The reason is that there is sufficient thyroid hormone to activate and do it signaling job. If the person shows signs and symptoms of hypothyroidism, but adequate T4, then it is not thyroid hormone production that is the problem but what happens to the thyroid hormone after it is released.

For example, under some circumstances, such as infection, more T4 becomes converted to Reverse T3 than usual. This would then lead to a loss of T3 production and symptoms and signs of hypothyroidism. Adding T3 is an option. Some people respond to T3, with subsequent reduction of Reverse T3 production and normalization of thyroid hormone activation. In some people, however, T3 can also increase inflammatory signaling in the immune system, causing the situation to worsen. T3 may then be not tolerable due to occurrence of palpitations. The best solution would be to investigated further to determine why T4 is becoming converted more so to Reverse T3 then treat the cause, such as infection. Once the cause is determined and treated, thyroid activation to T3 can return.

If Free T3 is low but T4 is normal, then additional questions include: are thyroid binding proteins elevated? For example, if a person is taking birth control pills or if the person has excess estrogen production, then estrogen signaling is elevated. This triggers thyroid binding globulin production from the liver. TBG then binds to thyroid hormones, reducing the free levels of thyroid hormone, causing then a relative state of hypothyroidism.

If T3 is low and T4 is sufficient, then conversion of T4 to T3 is suspect. Questions to ask then include: is there sufficient deiodinase enzyme production to do the conversion? Is there sufficient selenium to make these enzymes? Is there sufficent norepinephrine signaling to trigger deiodinase enzyme production? Is there impaired liver function? etc. etc.

If T4, Free T4 and Free T3 are sufficient, yet TSH is elevated, then the questions include: Is there a problem in transporting thyroid hormone past the blood brain barrier so that it can do its work in the brain? Are there nutritional deficiencies (such as with vitamin A, iron, etc.) which are impairing thyroid signaling? Determining the questions to ask as to why thyroid hormone is not working and determining solutions to the problem would be the better answer, not just adding more thyroid hormone.

Etc. Etc. Etc.

Despite having thyroid test results, there is a lot more information that needs to be obtained to determine whether or not one should add thyroid hormone.

If the physician is confident and wants to dive in to do thyroid replacement, in a clinical trial, to see if it is beneficial, then he or she can do so after doing a risk assessment for the intervention.

There is a lot of complexity underneath the surface of what seemingly is a simple treatment.

Often more data is necessary to help determine risk prior to even a clinical trial of thyroid hormone.

http://www.bprcem.com/article/S1521-690X(09)00074-8/abstract

Volume 23, Issue 6, Pages 769-780 (December 2009)

Thyroid function is modulated by genetic and environmental causes as well as other illnesses and medications such as gonadal or sex steroids. The latter class of drugs (sex steroids) modulates thyroid function. Gonadal steroids exert their influence on thyroid function primarily by altering the clearance of thyroxine-binding globulin (TBG). While oestrogen administration causes an increase in serum TBG concentration, androgen therapy results in a decrease in this binding protein. These effects of gonadal steroids on TBG clearance and concentration are modulated by the chemical structure of the steroid being used, its dose and the route of administration. Despite the gonadal steroids-induced changes in serum TBG concentrations, subjects with normal thyroid glands maintain clinical and biochemical euthyroidism without changes in their serum free thyroxine (T4) or thyroid-stimulating hormone (TSH) levels. In contrast, the administration of gonadal steroids to patients with thyroid diseases causes significant biochemical and clinical alterations requiring changes in the doses of thyroid medications. Similarly, gonadal steroid therapy might unmask thyroid illness in previously undiagnosed subjects. It would be prudent to assess thyroid function in subjects with thyroid disease 6–8 weeks after gonadal steroid administration or withdrawal.

===============================

Increasing TT

reduces SHBG
reduces TBG

---

CBG ??????

what is does to CBG (cortisol binding globulin)

……

[JanSz]

@Figuring 2928 wrote:

I’m also taking DHEA and pregnenolone. They seem to help my mood some but have not done much for my major issues.

I am not a doctor.

Do you happen to have pregnenolone and progesterone tested?
Post results.
If they are low, this may help you.

Describe what kind pregnenolone are you taking?

In my case, the only pregnenolone that made to the blood stream so when I tested I could see the difference, is:

Sublingual Pregnenolone from source Naturals, comes in small pills I find it hard to use.

Pregnenolone that actually works for me (and number of people that I have a contact with), is over the counter:

Nutricology Pregnenolone Micronized Lipid Matrix, 150mg (scored)

They also make 100mg and 50 mg
but I think that 150mg tabs are very convenient.

You may want to try this pregnenolone, (75-300)mg/day taken at wakeup time.

It actually works.
You should stop day before supplementation with
HC(cortisol)
DHEA
progesterone
florinef(aldosterone)

if you are taking thyroid hormones, you may want to stop them two days earlier or reduce by 1/2 (just to play safe).
Expect increased conversion T4—>T3 (within an hour) and reduction in RT3 slowly.

If it makes a difference, you may want to vary dose until you figure one that suits you best. (75-300)mg/day always taken at wakeup time.

When you reach stopping point, may want to test pregnenolone and progesterone.

Making further adjustments, aim at about top levels of pregnenolone and progesterone.
If you need, use over the counter Progesta-Care from Life-Flo, to tweak progesterone.

When you reach plateau, consider this testing (must be at Quest Diagnostics):

1

---

CAH Panel 6B (Comprehensive Screen) (10299X)
2

---

Estradiol [4021X](13- 54 pg/mL)
3

---

Estrogens, Fractionated, LC/MS/MS (36742X)*
4

---

Testosterone, Free, Bio/Total (LC/MS/MS) Code: 14966X
5

---

Dihydrotestosterone*
6

---

3a-Androstanediol Glucuronide
7

---

Pregnenolone, LC/MS/MS (31493X) 28373P
8

---

DHEAs
9

---

Aldosterone
10

---

7:30AM/12PM/3:30PM—Cortisol, Free and Total
11

---

CBG (CortisolBindingGlobulin)
12

---

Renin Activity, Plasma
13

---

ACTH, Plasma
14

---

Comprehensive Metabolic Panel w/EGFR
15

---

CBC w/ diff/PLT
16

---

T3, Total
17

---

T4, Total (Thyroxine)
18

---

T3, Free
19

---

T4,Free
20

---

T3, Reverse
21

---

Ultrasensitive TSH
22

---

Thyroid Peroxidase and Thyroglobulin Antibodies
23

---

Thyroglobulin
24

---

Thyroxine-binding globulin
25

---

T3 Uptake
26

---

SHBG
27

---

DHT
28

---

Prolactin
29

---

IGF-1
30

---

IGFBP3
31

---

Ferritin
32

---

Lipid profile

---

#1 is interesting test.

http://www.questdiagnostics.com/hcp/testmenu/jsp/showTestMenu.jsp?fn=10299N.html&labCode=SJC
CAH Panel 6B (Comprehensive Screen) (10299X)
Congenital Adrenal Hyperplasia(CAH)
Test Components
30543X*- 11-Deoxycortisol, LC/MS/MS, Serum
67652P*- 17-Hydroxypregnenolone, LC/MS/MS
17180X*- 17-Hydroxyprogesterone, LC/MS/MS
17182X*- Androstenedione, LC/MS/MS
11281X*- Cortisol, Total, LC/MS/MS
16568P*- Deoxycorticosterone
21964P*- DHEA (Dehydroepiandrosterone), Unconjugated, LC/MS/MS
17183X*- Progesterone, LC/MS/MS
15983X*- Testosterone, Total, LC/MS/MS

=================

Supplement with Selenium, iodine/iodide.

//////////////

[JanSz]

I noted that variety of ways of supporting EPA/DHA works rather well.
That is confirmed by Fatty Acids Analysis that I am doing from time to time.

Lacking is GLA that is I heard on many radio discussions but not to often discussed on bulletin boards.

..
There is at least two GLA supplemnts that I look at, not sure which one would be preferable

borage oil
Primrose Oil

Borage oil is mutiple times less expensive.
Which one is healthier and why?

Examples:
NOW® Super Primrose Oil 1300mg 120 sgels (GLA)
Borage Oil 1050mg, 240mg GLA, 120 Softgels, NOW Foods

..

[JanSz]

@corky1121 1470 wrote:

Has anyone that tested low ferritin also had high reverse T3? I have low ferritin and low vitamin D levels, but they are edging up slowly. I also take low doses of Armour or NT and just recently added 10mcg of Cytomel 2x a day.

I have most of the low thyroid symptoms and my initial Free T4 before taking any medications was .93. My level has gone up slightly, but I found my Reverse T3 was 390 and the high range at my lab I think was 380.

My worst symptom is muscle pain. I believe I have fibromyalgia with trigger knots around many of my muscles. I believe the cause of this condition is from inadequate thyroid production. Now that could be because of the low ferritin and low D.

I have read Dr. Lowe’s theories on fibro pain and high Reverse T3 and he treats with large doses of T3.

I’m at 1.5 grains NT and 10mcgs of Cytomel and my last lab results of Free T3 came back 3.6 (2.3-4.2), my Free T4, 1.15 (0.61-1.76), Total T4, 7.0 (4.5-12.0), Total T3 185 (85-205).

Ferritin came back 53 and that is up from 31 before taking any supplements. D came back 46 and that is up from 28 before supplements.

Anyone with low ferritin also have high Reverse T3 and problems with muscle pain or fibro? I’m going to address all deficient levels, but I’d like get close to which is the culprit in this awful pain syndrome.

I am not a doctor.

Check your pregnenolone and progesterone blood levels.
If low, use
Nutricology Micronized pregnenolone Lipid Matrix, 150mg tabs, scored.
Use enough to raise both preg & prog (or one of them) to about top range, but no more.
Use it at wakeup time.
Dose (75-300)mg

In my case, pregnenolone have woken up my deiodinases.
That happened within first 1-3 hrs from swallowing FIRST preg pill (so, be prepared).
I have gone thru thyroid dump (high pulse, temp, raised BP)
Had to drastically cut my thyroid hormones intake (to zero).

Was taking 1.5grainArmour(old style) + 50mcg-T3=(57mcg-T4) + (63.5mcg-T3)
Latter, ended up with 50mcg-T4
My temperatures stabilized at 36.5-36-7C

I have a number of rules for good thyroid supplementation,
but, when facing high RT3, the most important is:
Do not use natural thyroid hormones (containing T4 + T3) or outright T4 when RT3>197 pg/ml=19.7ng/dL

---

Muscle pains and specially muscle nuts are often correlated with low magnesium levels.

Magnesium is hard to raise using supplements
Magnesium have (extremely) bad range on laboratory tests.
Most everybody is misled to believe that they have good blood magnesium range,
that suggest that huge part of population is magnesium deficient.
Laboratory ranges are derived statistically from population that is tested.
Proper magnesium levels are conducive to:
lower resting pulse, bp and pulse pressure (Sys-Dia)

http://www.jle.com/fr/revues/bio_rech/mrh/e-docs/00/04/0C/99/article.phtml

Optimal concentrations are > 0.80 mmol/L and ELIN has proposed an evidence-based lower limit of 0.85 mmol/L.

> 0.80 mmol/L=1.95mg/dL
0.85 mmol/L=2.07mg/dL

2.5mg/dL=6.08mmol/L
2.6mg/dL=6.33mmol/L

to convert from mg/dL to mmol/L multiply by the conversion factor;
Magnesium mg/dL 0.411 mmol/L

Magnesium laboratory range is magnesium(1.5-2.5)mg/dL
it should be changed to —>magnesium(2-2.5)mg/dL

I have spend a year, unsuccessfully, trying to raise my magnesium using pills, liquid, orally and magnesium oil, transdermally.
Finally I learned about Epsom Salt enemas.
There are ways to do this neatly.

So the real choice in raising magnesium are (painful) IV and Epsom Salt enema.

---

Ferritin;
I am on good and steady testosterone supplementation for the last 6 years.
Always had good Hgb/Hct
For years I was trying to raise my ferritin, it was coming up slowly, very slowly.
Until I learned about UNILIVER (dried compressed liver).
UNILIVER is inexpensive and it works, there are other twice as expensive liver pills.
During last 6 years I had three surgeries with total anesthesia.
After my last surgery (Apr 2006) I felt different.
My Hgb went up (Hgb=17.5), yesterday I had my second phlebotomy (Hgb=16.5).
Ferritin ~80 (week before surgery), now probably less.

I am searching high and low, looking for a ways to raise Ferritin when facing high Hgb/Hct.

I know now how to raise Ferritin, but do not know how to avoid high Hgb/Hct.

=========================

[JanSz]

@DrMariano 3233 wrote:

When a person is not feeling well, then there is something wrong in the system. This may including structural problems, signaling problems, metabolic problems, nutritional problems, and psychosocial-environmental problems. Each of these levels interacts with the others. Each change may be secondary or be in response to a more primary or core change.

For example, when a person has a belief system (their internal model of reality) which directly conflicts with the data coming in from the senses, then stress may arise, and various signals (neurotransmitters, hormones, etc.) may change. And structure of the nervous system can change – to accommodate learning, for example.

Psychological factors can directly change structure and signaling in the nervous system.

The key is to determine where the problem is occurring when where to best approach treatment. This is guided by what is determined to be the core problem or problems.

For example, if a person is iron deficient, thyroid hormone signaling may not function despite having adequate hormone levels. Norepinephrine signaling may increase to compensate for ATP production loss. The treatment may not be necessarily aimed to reduce norepinephrine or increased thyroid but to address the more core problems of iron deficienicy.

Psychological interventions, behavioral interventions (such as meditation, exercise, psychotherapy) are also biological interventions in that they affect physiologic function in the mind and nervous system. These may be appropriate in many patients.

Iron deficiency may be hard to address.

I have adequate and steady testosterone and Hgb/Hct levels for last about 6 years (T is supplemented).
Low Ferritin
Was able to raise Ferritin from 28 to 44 (took 2 years, using iron pills)
44-80, took few months, using UNILIVER (dried compressed beef liver)
Preparing for surgery everything was ok in this area.

3 weeks after surgery check reveled very high Hgb/Hct, had to give a pint of blood.

Any explanation?

.

[JanSz]

@DrMariano 3194 wrote:

In addition to high testosterone signaling, other conditions may drive excessive red blood cell production, resulting in high hemoglobin and hematocrit. Such conditions, such as respiratory illness which may drive erythropoietin production up or hemochromocytosis, need to be assessed for and treated if necessary. In these conditions, essentially, iron is being shifted from cells of the body to the blood, leaving the rest of the body at a deficit of iron.

When testosterone replacement to supraphysiologic levels is driving production of red blood cells to excessive levels, to the point ferritin cannot be raised adequately to supply the body with adequate iron for metabolism, I would consider reducing testosterone replacement to achieve more physiologic levels. This would allow iron supplementation to supply the body rather than the blood with iron, restoring ferritin levels.

Although Vitamin A (Retinol) in excessive amounts can lead to anemia, Vitamin A (Retinol), itself, helps release iron from the storage form, Ferritin. Thus, in the presence of strong signals to produce red blood cells (such as high testosterone levels), then the simultaneous presence of Vitamin A makes it easier to shift iron from Ferritin to hemoglobin, helping testosterone produce excessive red blood cells. Vitamin A, however, is necessary to free iron from Ferritin for cells also. Without adequate vitamin A, iron becomes trapped in the ferritin form. Thus, an optimal level of Vitamin A needs to be determined for the individual.

respiratory ilness– not applicable

high testosterone replacement— not applicable. I do supplement with test and stay at current BAT level steady and for long time, years, without affecting Hgb & Hct

I supplement with vit A (and other vitamins, minerals, lipids, micronutrients), per testing (Spectracell)
So I assume that I am dosing them just right.
=======================

I suspect that my current Hct/Hgb spike is related to my Green Laser Prostate surgery or anestesia during that surgery.
Any ideas what that may be???

While supplementing with testosterone and maintaining same T levels as now, I had much heavier surgery (liposarcoma in left thigh), 5 years ago, but it did not affected my Hgb/Hct (see table in post #1).

[JanSz]

@DrMariano 3174 wrote:

It doesn’t matter if Hemoglobin is maintained via Ferritin at low or high levels.

The body will take iron (from ferritin) from tissues in order to maintain blood iron levels. Blood iron has primary priority given the importance of oxygen transport.

Ferritin represents iron that is available to cells outside of blood, for metabolic activities, including the generation of ATP – i.e. energy – from carbohydrates, proteins, and fats.

The problem of low ferritin levels is that less iron is available to cells in the body outside of the blood. This impairs numerous metabolic functions.

For example, iron is necessary to produce all of the cytochrome enzymes in the body. This includes the enzymes involved in ATP production, enzymes involved in steroid hormone synthesis (including aromatase, 11 beta hydroxylase that produces cortisol), and the P450 enzymes that get rid of various hormones and medications in the liver, the enzymes that produce Vitamin D, etc. Iron is also a cofactor in many enzyme reactions. For example, Tyrosine hydroxylase needs iron as a cofactor in converting tyrosine to L-dopa – which is later converted to dopamine. No iron, no dopamine production.

Numerous metabolic processes ground to a halt without adequate tissue iron availability (represented by Ferritin). This is why i use the analogy that iron is like oil in a car engine. And the car engine doesn’t run without engine oil.

I take that good hemoglobin and low ferritin continue to be less than desirable.

Is there a way to address low ferritin in this situation?

//

[JanSz]

@DrMariano 3171 wrote:

Testosterone stimulates red blood cell production. This will then take what iron is absorbed and stored in Ferritin and turns it into hemoglobin for red blood cell production. This can then lead to excessive hemoglobin and hematocrit when testosterone replacement leads to high testosterone levels.

Low ferritin levels may limit red blood cell production stimulated by iron. But when ferritin is raised, it allows the iron to be used in red blood cell production.

I have seen opinions that Hgb~16 is an ideal number.

What difference in health does it make if that Hgb is achieved with lower Ferritin (40-50)levels,
rather than the usually recommended Ferritin~150?

.

[JanSz]

@DrMariano 2888 wrote:

When it comes to adrenal function, one has to address immune system problems, nutritional problems and nervous system problems that may cause dysregulation of the adrenal glands. These days, I, often, do not need to do adrenal signaling support by adding hydrocortisone or other hormones when I address the other systemic problems because adrenal dysregulation is often secondary to these other issues.

Would you care to expand a little on this interesting topic or give some examples?

..

[JanSz]

@DrMariano 2882 wrote:

The problem I have with this study is that they never measured Free T3.

All of the numbers in this study are very close. Here are some (including my preferred values for mental function):

The mean T4 total was 6.26 ug/dL –> I prefer 8 to 12
The mean T3 was 92.86 ng/dL –> I prefer > 130 to 205
The mean TSH was 1.16 uU/L –> I prefer < 1.0
The mean Free T4 was 1.29 ng/dL — > I prefer 1.3 to 1.8

In general, these elderly men were hypothyroid when going by T4 and T3 alone.
The TSH indicates the brain wanted higher thyroid production.

The study may have been clearer if they added the measurement for Free T3.

Also, they did not differentiate between specific illnesses the elderly men had. They lumped them all together. This is a huge complicating factor in assessment.

Do you have a preference for RT3?

[JanSz]

@cobra 2087 wrote:

Cortisol, free, serum…………83 mcg/dl .07-.93 8:00am-10:00am
Uric Acid…………………….. ..8.7 2.6-7.2
Total testosterone 230ng/dl 190-1037
Prolactin 15.7ng/ml 2.6-13.1 (noted high)
SHBG 12nmol/l 7-49
Every three days I give myself a cheat day.

Work in above.

Replace cheat day with day where you just drink tap water.
.

[JanSz]

@wolverine 1190 wrote:

Ferritin

---

> 142 (24-336)
Reverse T3

---

> 17 (11-32)
Thyroglobulin AB—> <20 (<20)
Anti-TPO AB

---

> <10 (<35)

Since my pituitary can’t produce much TSH (I’m secondary), my doc isn’t worried about total TSH suppression.

I suspect that you are as perfect as one can get (numerically), while on medicine.
What is your oral temperature (if you do not have any oral infections).
Goal, Oral temperature (36.25 – 36.80)C = (97.25 – 98.24)F (no sinus or oral infections)

There is talk about new ArmourThyroid formulation.
Hopefully it will not affect you.

Just in case
3GrainsArmour=114mcg(T4) + 27mcg(T3)

========================================================
Armour 180 mg a day (60 mg at 4:00 AM, 60 mg at 11:00 AM, and 60 mg at 5:00 PM).
TSH

---

> <0.01.
Total T4

---

> 4.0 (6.0-12.0)
Free T4

---

> 0.8 (0.8-1.8)
Total T3

---

> 167 (97-219)
Free T3

---

> 435 (220-440)
Reverse T3

---

> 17 (11-32)
Thyroglobulin AB—> <20 (<20)
Anti-TPO AB

---

> <10 (<35)
Ferritin

---

> 142 (24-336)

Since my pituitary can’t produce much TSH (I’m secondary), my doc isn’t worried about total TSH suppression
.

[JanSz]

Feel lucky.

I have something similar with a twist.

LipoSarcoma.

The Sarcoma part is interesting.

I have it in my left thigh.
It was a size and about shape of a quart of milk when they took it out.
In Sep 09 will be 4 years, behaves ok, so far.
====================================

Not really sure how Lipoma and LipoSarcoma are related.

Are you using GH (Growth Hormone)

If yes, how long.

Any change if frequency or appearance or any other change in Lipoma’s behavior since you started GH?
====================================

My GH (or rather IGF-1) is low, I would like to consider GH but not sure.

.
.

[JanSz]

@wolverine 1176 wrote:

Dr. Mariano, I’ve been diagnosed with secondary hypothyroidism, and have been seemingly well managed with Armour 180 mg a day (60 mg at 4:00 AM, 60 mg at 11:00 AM, and 60 mg at 5:00 PM). My initial symptoms, which were cold intolerance plus cold hands and feet, are now gone.

My most recent labs showed the following:

Total T4

---

> 4.0 (6.0-12.0)
Free T4

---

> 0.8 (0.8-1.8)
Total T3

---

> 167 (97-219)
Free T3

---

> 435 (220-440)
TSH

---

> <0.01.

I’ve read on this forum that you like to see a total T4 from 8.0-12.0, at least in part to assure that plenty of free T4 is available to cross the blood brain barrier. My doctor seems to think that as long at the free T4 is OK, the total T4 is not critical.

Without giving any specific medical advice, I’d appreciate hearing your thoughts on this issue.

Thank you.

My thoughts (I am not a doctor, not even close).

Per dr Mariano past recomendations, it is good to have Ferritin(100-150)

iodine + selenium

---

=(219-97)*2/3+97=178

Your TotalT3=167 lacking
it is (slightly) less than 2/3 of range
In recent LEF magazine they recomend thyroid management to achieve TT3 higher than 2/3 of range

---

to be tested ReverseT3 and antibodies

manage suplementation to achieve

RT3 in lower half of range
0.5
Off hand, there is a good possibility that 3Grains is too much as it totally suppresses TSH.
So possibly 2.5Grains would work better.

.

[Author]

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