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WWW.IHPMAGAZINE.COM WINTER 2016
Natural Options in Thyroid Disease
CAM in Europe
THYROID HEALTH
001.IHP Cover_noimages.indd 1 2016-01-25 12:32 PM
contents
DEPARTMENTS
FEATURES
WINTER 2016 • IHPMAGAZINE.COM 4
5 Publisher’s Letter
6 Editorial Board
8 Bits and BitesIndustry and Research News
22 Product Pro�les
24 Clinic Pro�leDarou Wellness
38 Post Scriptum
20 The 12th International Conference of the Society of Integrative Oncology: A Canadian perspective
28 Evidence for novel, therapeutic, natural options in thyroid disease
32 Emotional Effects of Thyroid Cancer and Patient Needs
34 Complementary and Alternative Medicine in Europe
�nd us on348
28
IHP Contents.indd 4 2016-01-25 1:22 PM
WINTER 2016 • IHPMAGAZINE.COM 5
publisher’s letter
O ver the years, I have always found
that one of the best ways to meet
fellow industry members is at a
trade show or convention. I recently attended
the 2016 Canadian College of Naturopathic
Medicine (CCNM) student event, and I caught
up with some old friends—and met some
new ones.
At the show itself, there was a sense of
excitement in the air. It was a pleasure to
meet graduating students and future natu-
ropathic doctors who are stoked on starting
their own clinics. I met with many exhibitors
who were excited to showcase their new
and innovative products. I also liased with
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,
naturopathic medicine in Ontario acquired
a new status. With the Naturopathy Act, 2007,
proclaimed in June, the naturopathic pro-
fession became self-regulated, which brings
it to the next level in terms of integration.
New doctors, new clinics, new and inno-
vative products, experienced—and very
passionate—doctors are all ingredients of a
growing and vibrant industry. Now, that is
something to be excited about.
Please don’t forget to download
your IHP App to have access to
exclusive content and full-length
reference material.
Founder Sanjiv Jagota
Publisher & Editor-in-Chief Olivier Felicio
Senior Managing Editor Phill Feltham
Managing Editor Inna Levchuk
Art Director Scott Jordan
Graphic Designer Kaitlin Yep
Contributors
Rita Banach, Jason Boxtart, Julie Ennis, Rochelle Fernandes,
Hannah Lemke, Ellen McDonell, Marie-Jasmine Parsi, Susanne
Schunder-Tatzber
IHP Magazine Inc.
President Olivier Felicio
General Manager Melanie Seth
General Customer Care Manager Lucy Holden
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Advertising Olivier Felicio Weng Ng(416) 203-7900 x 6107 (416) 203-7900 x [email protected] [email protected]
WINTER 2016 • Volume 9 Issue 1
Olivier Felicio
Publisher/Editor-in-Chief
EXCITEMENT IN THE AIR
IHP PubLetter.indd 5 2016-01-25 1:23 PM
WINTER 2016 • IHPMAGAZINE.COM 28
feature
INTRODUCTIONThyroid disorders affect about 200 million people in the
world (0.8-5% of the population), and are four to seven
times more common in women (Mircescu, 2010). These
disorders are ubiquitous in the context that they are the
root of many other diseases. Thyroid conditions include
hyper/hypothyroidism, goiter, thyroid cancer, Graves’
disease (GD) and Hashimoto’s thyroiditis. Conventional
treatment option for nodules and cancer is surgery.
Medications are also used for many thyroid conditions.
Pharmaceutical medications that are common for hypo-
thyroid status include Synthroid and Cytomel.
Hyperthyroidism is treated by radioactive iodine or anti-thy-
roid medications, such as Methimazole. There are several
natural options available to treat thyroid conditions that
can be used in conjunction with these medications or on
their own, such as selenium (Se), kelp and zinc. However,
more recent attention has been drawn to other options,
such as magnesium, vitamin D and carnitine. The following
is a summary of the current evidence on these natural
treatment options.
MAGNESIUMMagnesium (Mg) is a vital part of cellular reactions; it is
involved in metabolism, DNA replication, repair, transport
mechanisms and cell proliferation. Food sources that are
high in magnesium are whole and unrefined grains, seeds,
cocoa, nuts, almonds, green leafy vegetables, avocados
and fish (Blaszczyk, 2013). Magnesium has been used in a
wide array of diseases, such as arrhythmia, hypertension,
high cholesterol, premenstrual syndrome, asthma, diabetes
and attention deficit hyperactivity disorder (ADHD), in
doses of 100-400mg on average taken with meals
(Micromedex, 2015). More recently, the relationship between
Mg abnormalities and the development of thyroid disorders
has been considered.
EVIDENCE FOR MAGNESIUMA growing body of evidence has shown the role and pattern
of magnesium levels in thyroid disorders, including thyroid
cancer and autoimmune thyroid disease. For example,
after factoring out ethnicity, one meta-analysis showed a
significant association between serum Mg and thyroid
cancer. This retrospective analysis found that individuals
with thyroid cancer had lower serum levels of Se and Mg,
but higher levels of copper (Cu) than the healthy controls
(Shen, 2015). Further benefit from these findings in a future
study would be to understand the results in the context of
ethnicity. Another study on metabolic disorders indicated
that mineral deficiencies, including Mg, were found in
patients with autoimmune thyroid disease, alongside
protein and vitamin deficiencies (A, B’s and C). It suggests
that an improved diet via maintenance of required daily
intakes of vitamins and minerals could help decrease symp-
toms and prevent recurrence of malnutrition-induced
thyroid disease (Kawicka, 2015). Although this study was
Evidence for novel, therapeutic, natural options in thyroid
diseaseBy Rochelle Fernandes (MSc., ND (cand))
Peer reviewed by Jason Boxtart (ND), Hannah Lemke (ND (cand)), Marie-Jasmine Parsi (ND (cand))
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WINTER 2016 • IHPMAGAZINE.COM 29
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feature
done on a malnourished population, it offers unique results
that warrant further exploratory studies to see if the effect
to correct the thyroid diagnosis is maintained in a non-mal-
nourished population. One prospective cohort study showed
no evidence of association between thyroid cancer and
micronutrient levels, including Mg, however this may have
been partly attributed to the low statistical power of the
study and lack of detail surrounding the population studied
(O'Grady, 2014). Additionally, details were obtained via a
food frequency questionnaire; it is possible that numerical,
measurable outcomes could have different results if utilized
in further study.
A well designed, cross sectional study divided patients
into five groups: 1) subclinical-hypothyroid (SHY), 2)
overt-hypothyroid (OHY), 3) subclinical-hyperthyroid (SHE),
4) overt-hyperthyroid (OHE), 5) patients under thyroxine
therapy (EU), and normal controls. It showed that overtly
hypothyroid patients had reduced serum Mg levels-OHY
group, among other abnormal serum levels of nutrients
(Abdel Gayoum, 2014), thus suggesting the need for diet
modification and supplementation with this micronutrient.
It would also be beneficial to do an extension of this type
of study to examine whether this effect changes and/or is
maintained past six months. A study examined the effects
of Mg levels after treatment with thyroid medication; exam-
ining Mg as a pathology marker. The study demonstrated
that using Methimazole in the treatment of hyperthyroidism
due to Graves’ Disease led towards normalizing Mg levels
(Klatka, 2013). These results are useful with further inves-
tigation on whether, in addition to Mg as a pathology marker,
it could be used therapeutically, and a correction of Mg
deficiency could be beneficial towards correcting thyroid
abnormalities.
VITAMIN DVitamin D is a fat soluble vitamin that is found in certain
foods and can be produced internally when ultraviolet rays
hit the skin. It is inactive and has to go through two trans-
formations to be biologically active: primarily, the liver
converts vitamin D to 25-hydroxyvitamin D (calcidiol), and
secondly, the kidney converts calcidiol into 1,25 dihydroxyvi-
tamin D (calcitriol) (NIH, 2015). The function of vitamin D
in the body is for bone and cell growth, neurological func-
tion, normal inflammatory response and thyroid optimiza-
tion. Food sources of vitamin D include cod liver oil,
swordfish, salmon, milk and liver.
EVIDENCE FOR VITAMIN DThe role that vitamin D plays in the development and
treatment of thyroid conditions, such as Graves’ disease
and thyroid cancer, remains to be uncovered. One study
showed that the prevalence of vitamin D deficiency was
significantly higher in GD patients when compared to
control subjects (56.25 vs. 10.00 %, p < 0.001). The same
study also demonstrated that GD radioactive iodine therapy
(RIT) failed in 27 (37.50 %) of patients whose serum 25(OH)
D levels were < 20 ng/ml (Li, 2015). This suggests that
vitamin D deficiency might be an independent risk factor
for predicting failure of RIT in GD subjects. Another study
found that low vitamin D was associated with three types
of autoimmune thyroid disease (Ma, 2015).
Although the study of molecular mechanisms of vitamin
D are beyond the scope of this article, the following should
be noted as it illustrates the potential for future vitamin D
therapy. The mortality due to anaplastic thyroid cancer
(ATC) is high because of fast progression of the disease
and its high metastatic potential with no effective treatment
existing. The active form of vitamin D3, 1α,25(OH)2D3, has
been shown to thwart metastases in pre-clinical studies,
but has not been used clinically because of its potential to
create a state of hypercalcemia. A recent study unveiled
that a category of less-calcemic vitamin D analogs,
19-nor-2α-(3-hydroxypropyl)-1α ,25-dihydroxyvitamin D3
(MART-10), is more potent than 1α,25(OH)2D3 in repressing
cancer growth and metastasis in a variety of cancers. The
study showed that both 1α,25(OH)2D3 and MART-10 could
effectively inhibit the migration and invasion of ATC cells,
suggesting hopeful future clinical application (Chiang,
2015). Another emerging supplement for thyroid disorders
is carnitine.
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.
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WINTER 2016 • IHPMAGAZINE.COM 31
CARNITINECarnitine is found in different forms. L-Carnitine (LC) is
made up of methionine and lysine. It is part of an effective
shuttling mechanism that transports long chain acyl groups
into the mitochondrial matrix to produce energy from fat
(Olpin, 2005). LC metabolism within the body occurs via
dietary intake, synthesis, and reabsorption in the kidney.
It is absorbed by the jejunum, through a sodium dependent
transporter (Gross, 1986). This transporter takes up LC,
while Acetyl LC (ALC) requires the removal of the acetyl
group before absorption. The levels of absorption are dose
and source dependent. Usual therapeutic dosage ranges
are between 500 to 2000 milligrams per day depending
on the use (Malaguarnera M, 2011). It has been used for
diabetes, osteoporosis, kidney and liver disease, and more
recently, for thyroid diseases.
EVIDENCE FOR CARNITINEResearch suggests that diminished fatty acid oxidation
can be corrected by carnitine supplementation. One ran-
domized, double blind, placebo controlled study consisted
of women who were given thyroid hormones to treat benign
thyroid nodules. They were divided into three groups; a)
those who received placebo for six months, b) those who
had placebo for two months followed by carnitine 2 or 4
g/day for two months, then back to placebo, and c) those
who got carnitine 2 or 4 g/day for four months and then,
placebo. The placebo group displayed symptoms of hyper-
thyroidism, such as muscle weakness, shortness of breath,
heart palpitations, nervousness, and insomnia, amongst
others. The second group had hyperthyroid symptoms
during the two months of placebo, but those symptoms
disappeared after two months of carnitine supplementation,
and returned again during the last two months of placebo.
The last group had no hyperthyroid symptoms until they
stopped receiving carnitine at the end of the first four
months (Benvenga, 2001). The results, although not reaching
statistical significance, were still meaningful from a clinical
standpoint, and showed a time-sensitive benefit of carnitine
supplementation in hyperthyroidism.
The basis of why carnitine supplementation is useful
for many clinical thyroid settings derived from the under-
standing that hyperthyroidism lowers tissue carnitine
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-
roid states before and after treatment with thyroxine or
Thionamide therapy (Wong, 2013). Despite this, most
evidence has shown a significant reduction in carnitine
(mostly esterified portion) in hyperthyroid individuals, with
a return to normal levels as euthyroid status was achieved
(Sinclair, 2005). This indicates that further investigation
is needed to better understand the mechanisms by which
thyroid conditions could result or cause a deficiency in
carnitine. So far, LC is thought to inhibit both triiodothy-
ronine (T3) and thyroxine (T4) entry into the cell nuclei,
and thus supplementation could be beneficial to increase
tissue levels (Benvenga S. A., 2004).
Other thyroid diagnoses, such as thyroid storm, were
successfully treated with a combination of conventional
treatment, such as Methimazole and LC (Benvenga S. L.,
2003). Another study showed an awakening from a coma
caused by thyroid storm after intravenous administration
of LC (Kimmoun, 2011). The methods by which carnitine
elicits these effects on the thyroid is not fully understood.
Some studies have shown that LC can also modulate thyroid
hormone action in peripheral tissues, most often through
inhibition (Benvenga S. , 2005)
See table 1 on your IHP app for further details on clinical
studies with magnesium, carnitine and vitamin D in associa-
tion with thyroid diagnoses that were discussed in this text.
CONCLUSION Overall, given that thyroid conditions can be detrimental if
they are not treated and overlap with other diagnoses, it is
imperative that several effective treatment options be con-
sidered, including conventional and natural ones. 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. Vitamin D has shown efficacy in preventing migra-
tion of certain thyroid cancer cells, helping predict the
success of certain conventional thyroid treatments. Carnitine
effectively modulates thyroid metabolites in peripheral
tissues and can correct inherent carnitine deficiencies
caused by hyperthyroidism. These three powerful supple-
ments have recently shown promise as potential effective
therapeutic targets in thyroid disease, enabling a greater
spectrum of choice of natural treatments for practitioners
and patients.
View the table and references on your tablet.
IHP CoverStory.indd 31 2016-01-25 1:02 PM
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