MIM Health - November 2007

In this issue: Doctor's Corner: Staying Healthy During the Holidays Upcoming Appearances - Tune in this Sunday Health Topic: Oprah's Thyroid Natural Tip™: Spice it up with Cayenne pepper Recipe: Brown and Wild Rice Stuffing

Doctor's Corner

I went to the Gallatin Valley Mall (our local mall, for those of you who don't live here) a couple of days after Halloween and was surprised to hear Christmas music playing. It seems to me that retailers put out their Christmas displays earlier and earlier each year. I can understand this from a business stand point, since sales during this time of year can make up to 30% or more of their annual revenue. So the pressure is on to market earlier and more aggressively each year to get your business.

Whatever your thoughts on this, it's official--the Holiday Season is upon us. Thanksgiving marks the start of what I like to call the "gorging season." For many, it's excess everything--too much high-calorie, high-fat food; too much alcohol; too many commitments; too much rushing around; too much stress of all kinds. Each year it feels like the sprint between Thanksgiving and New Year's leaves many of us exhausted, broke and barely able to button our pants.

If this sounds like you, then I challenge you to approach the holidays differently. Focus on quality and not quantity. Spend quality time with your family instead of saying yes to every invite. Eat your favorite holiday foods you enjoy (unless, of course, you've been diagnosed with a food allergy to one or more of their ingredients), but just enjoy them in moderation. Research shows that when people eat slower they eat less. So slow down and savor the food you're eating, and the people with whom you're spending time. Enjoy the smells and tastes of the season, but don't sacrifice your health.

And don't sacrifice exercise. Make your workouts just as much of a priority as getting your holiday shopping done. Next month I'll give you more tips on how to make it through all those parties and family dinners without throwing sensible, healthful eating out the window. In that spirit, this month's recipe is Brown and Wild Rice Stuffing, a delicious, decadent-tasting dish that's actually full of whole grains, fiber and healthy fats.

Also in this issue I'm introducing a new section of the newsletter, called Natural Tip™, which features simple, easy-to-implement recommendations to help prevent or treat illness.

Each Thanksgiving my family has a tradition of going around the table and saying what we're thankful for. Near the top of my list this year are my inspirational patients throughout Montana and the people with whom I consult and coach towards health around the country. I learn more from you than any textbook could ever teach me. You've entrusted me with your health and, often times, the collective health of your entire families. Whether it's blowing up an exam glove to make a balloon and entertain a four-year old during a well-child exam, treating the common cold and flu or doing intensive biochemical testing to get the root of symptoms that have caused suffering for far too long, it's a privilege and an honor to be your partner in health. Thank You to all my patients who allow me to continue working in a career I love. Have a happy and healthy Thanksgiving!

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Upcoming Appearances

Dr. Neustadt will be co-hosting the Sunday morning radio show, Gesundheit! with Jacobus, this Sunday November 11, 7:00-10:00 AM on KMMS AM 1450. We will be interviewing Dr. Michael Murray, widely regarded as one of the world's leading experts in natural medicine. Dr. Murray is the author of more than 20 books, including the Textbook of Natural Medicine and How to Prevent and Treat Cancer with Natural Medicine. Dr. Murray will be on the phone with us for first hour. The remainder of the program will be dedicated to listener questions, so grab a cup of coffee, tune in and call us with your health questions.

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Oprah's Thyroid

My wife Romi, a big Oprah fan, showed me the October issue of O Magazine, in which she discussed her recent struggle with hypothyroidism (low thyroid function). Oprah's public discussion of her health issues has brought widespread attention to this condition. Thyroid hormone is sometimes called the "master hormone" since it affects every system in the body. That's why I wanted to spend some time educating my readers about this essential element to good health. 

The thyroid is a butterfly-shaped gland at the base of the neck. It produces the thyroid hormones levothyroxin (T4) and triiodo-thyronine (T3). About 80% of thyroid hormone is T4 and about 20% is T3. T4 is inactive and is converted into active T3 in different tissues in the body.

This is why low thyroid function can cause such wide-ranging symptoms. According to the Merck Manual, the American Association of Clinical Endocrinologists, and the Thyroid Foundation of America symptoms of hypothyroidism in adults include feeling cold; depression; fatigue; weight gain; inability to lose weight; coarse, dry hair that is brittle and falling out; constipation; dry, coarse skin; puffiness or swelling around the eyes; joint aches; restlessness; forgetfulness; decreased sex drive; and more frequent infections. And this is just a partial list. Low thyroid function can also occur in neonates and children, which requires immediate medical attention as it can cause stunted growth and developmental delays.

Within adults there are two general categories of hypothyroidism--autoimmune and non-autoimmune. An autoimmune condition is one where the immune system attacks the person's own tissues. Autoimmune thyroid dysfunction is called Hashimotos Thyroiditis after the doctor who discovered it in 1912. There appears to be a genetic link, as Hashimoto Thyroiditis tends to run in families. Therefore, if a relative of yours has been diagnosed with an autoimmune thyroid condition and you are experiencing any of the symptoms above, you may want to get your thyroid tested. More on thyroid testing in a moment.

If the reason for low thyroid function is not an autoimmune condition, there are several explanations. First, some medications and diseases may decrease thyroid function. Second, it may be that the conversion of T4 (inactive thyroid hormone) to T3 (active thyroid hormone) is not happening well enough. This conversion requires the minerals selenium and zinc. If a person is deficient in either of these nutrients, they could have difficulty creating T3. This condition is called "functional hypothyroidism" because your thyroid gland is producing enough of the thyroid hormones, but they're not being transformed into the active form. Additionally, high levels of cortisol, a stress hormone secreted when people are under stress, inhibits the creation of T3.

Finally, thyroid hormones come from the phenylalanine, an essential amino acid, meaning that your body cannot produce it, but that it must be ingested from food or dietary supplements. Phenylalanine is transformed in the body to tyrosine, which requires iron, and then down its pathway to form thyroid hormones.

While there can be many different explanations for the myriad symptoms associated with hypothyroidism, a comprehensive thyroid evaluation includes a physical exam and blood tests for TSH (thyroid stimulating hormone), Free T4, Total T3, red blood cell intracellular selenium and zinc, serum ferritin (the most sensitive laboratory indicator of iron deficiency) and plasma amino acids. If an autoimmune hypothyroid condition needs to be ruled out, then your doctor will order an antithyroglobulin antibody and antithyroid microsomal antibody blood tests.

Unfortunately, conventional medical screening for thyroid function does not test for the actual thyroid hormones themselves or for any of the nutritional factors required to produce and activate thyroid hormones. Instead, the standard screening test for low thyroid function is a measurement of TSH, which is actually produced in a region of the brain called the anterior pituitary gland. Its role is to stimulate the production T4 and T3 in the thyroid gland. In "functional hypothyroidism" the TSH and T4 are normal, but the T3 is low. This may simply be due to low selenium or zinc. People who only receive the conventional medical workup can experience depression, fatigue, difficulty losing weight, and frequent coldness when the underlying cause may be low thyroid function because of nutritional deficiencies and/or chronic stress. I have had many cases of people with normal TSH, normal T4 and low T3, which have been corrected by identifying nutritional deficiencies and prescribing those nutrients to the patients.

This leads me to the interpretation of the TSH test. Many labs are still relying on the old reference range, which has an upper limit of normal of 5.0. An elevated TSH is the laboratory criteria for diagnosing hypothyroidism. However, what is considered "normal" has been changing. In 2002 the American Association of Clinical Endocrinologists (AACE) recommended that upper limit of normal be lowered to 3.0, and also in 2002 the National Academy of Clinical Biochemistry (NACB) suggested the correct upper range of normal will someday be lowered to 2.5. Many clinicians use a combination of laboratory values and symptoms to determine when to treat, and most, including myself, will consider prescribing thyroid replacement hormone when the TSH is 2.5-5.0 when the patient is symptomatic and other causes are ruled out. If your TSH is greater than 2.5 and you are symptomatic, you may want to discuss with your doctor if it's appropriate to try low-dose thyroid replacement hormone.

The thyroid gland is incredibly important. If you have not been getting regular thyroid tests at your annual physicals, I recommend you do so. At the very least, get your TSH checked regularly.

(Note: Dr. Neustadt was voted as one of the leading thyroid doctors in the Thyroid Top Doctors Directory.)

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Natural Tip: Cayenne pepper for pain and weight loss Cayenne pepper (also known as chili or red hot pepper) is the fruit of Capsicum annuum, a shrub that grows to 3 feet high. It is in the Solanacea family, which also called the nightshade family. Related plants in this family include potato, eggplant, belladonna and tomato. Cayenne is native to the tropics, specifically Mexico and Central America, but is now cultivated

in tropical regions throughout the world for food and medicine.

Cayenne is used to add spice and heat to food. The hotness is from a chemical called capsaicin, which is also one of its principle therapeutic substances. Other active constituents include carotenoids, vitamins A and C and volatile oils. Cayenne has been used historically for asthma, upper respiratory infections and to prevent ulcers. More recently, research has been conducted on cayenne pepper for its analgesic effects.

The sensation of pain involves complex nervous system and hormonal pathways and interactions. One signaling molecule that increases the sensation of pain is called Substance P. Capsaicin cream can deplete Substance P and reduce pain in such conditions as arthritis, neuralgia (nerve pain) and low back pain.

Additionally, eating cayenne pepper may be helpful in losing weight and in decreasing insulin resistance (pre-diabetes and diabetes). Regular dietary intake of cayenne pepper significantly reduced insulin in a clinical trial. In this study, participants who consumed 30 g/day of chili peppers, with 55% being cayenne pepper, had a 60% decrease in insulin levels after four weeks compared to those who did not eat this diet. It's not realistic to think most people will be eating 30 g/day of peppers, but adding it to your diet in moderation may help with increasing metabolism and burning fat. Plus, it will likely keep you warmer this winter!

Most contemporary clinical research into the therapeutic effects of cayenne pepper focus on the use of capsaicin creams. Commonly available creams contain 0.025% or 0.075% capsaicin. The topical use of these creams may provide significant relief of pain in people suffering from many conditions, including diabetic neuropathy, cluster headache, osteoarthritis, and rheumatoid arthritis.

Neuralgia (nerve pain)
The US Food and Drug Administration (FDA) approved topical capsaicin cream for the treatment of postherpetic neuralgia (nerve pain caused by a herpes virus outbreak). For example, in one study 39 patients with chronic postherpetic neuralgia (average duration 24 months) were treated with 0.025% capsaicin cream for 8 weeks. During therapy the patients rated their pain. Of those treated, 48.7% had improved substantially, 12.8% elected to stop the therapy because of side effects (burning sensations), and 38.5% received no benefit from this approach. The results of this clinical trial are consistent with other studies.

In one clinical trail, 12 patients diagnosed with trigeminal neuralgia used 1 gram of a 0.05% capsaicin cream three times daily over the affected areas during flare-ups. Ten of those patients experienced either complete or partial relief of pain and discomfort. These results are promising, since surgery has historically been considered the only effective therapy in many cases.

Postmastectomy Pain
Women who have undergone mastectomy surgery may complain of postsurgical pain. In one double-blind study 23 patients with postmastectomy pain 0.075% capsaicin cream applied four times daily for 4 to 6 weeks resulted in 62% of the women rating their response as good-to-excellent, with a 50% or greater decrease in pain and discomfort.

Arthritis
Research supports the use of capsaicin cream in relieving osteoarthritis and rheumatoid arthritis pain. In on study, 14 patients with osteoarthritis with hand pain rubbed cream containing 0.075% capsaicin four times daily into their hands. Capsaicin cream the pain arthritis pain. In a second study, 31 people with rheumatoid arthritis rubbed 0.025% capsaicin cream on painful knees four times daily. Those people using the capsaicin cream experienced significantly greater pain relief than those in the placebo group. Those with rheumatoid arthritis had a 57% mean reduction of their pain.

Dosage
People can add cayenne pepper freely to their diet. Capsaicin creams generally contain 0.025% or 0.075% capsaicin, and should be rubbed into the affected areas up to four times daily.

Toxicity
The only adverse effect noted with topical capsaicin creams is local burning, which tends to decrease with time and continued use. However, the pain can be severe enough in a minority of people that they elect to discontinue using capsaicin cream. Dietary consumption of cayenne pepper is regarded as very safe. However, since cayenne is quite hot, this pepper may cause pain and discomfort in people with gastric or peptic ulcers. Some reports have also cited an increase in gastric reflux (gastroesophageal reflux disorder or GERD) in people consuming cayenne pepper.

Where to find Cayenne pepper
Supermarkets sell cayenne pepper and preparations of cayenne cream are available in most drug stores. You can also find more health-related information and recipes using cayenne at The World's Healthiest Foods website.

References
Ahuja K, Robertson I, Geraghty D. Effects of chili consumption on postprandial glucose, insulin, and energy metabolism. Am J Clin Nutr. 2006;84(1):63-69.
Pizzorno J, Murray MD. Textbook of Natural Medicine, Third Edition. Vol 2. St. Louis: Churchill Livingstone Elsevier; 2005.
Yoshioka M, St-Pierre S, Drapeau V. Effects of red pepper on appetite and energy intake. Br J Nutr. 1999;82:115-123.
Yoshioka M, St-Pierre S, Suzuki M, Tremblay A. Effects of red pepper added to high-fat and high-carbohydrate meals on energy metabolism and substrate utilization in Japanese women. Br J Nutr. 1998;80:503-510.

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Recipe: Brown and Wild Rice Stuffing
(Have a recipe you want to share? Email it to us and it may appear in a future issue of MIM Health.)

This is now a holiday staple in our house, replacing the traditional bread stuffing that comes with higher calories and fat and lower fiber. And every year it seems to get better a day or two after Thanksgiving as the flavors really soak into the grains. Feel free to leave out the dried fruit or nuts if you prefer; it's delicious without them. Also, keep in mind that stuffing the turkey can be tricky business since the stuffing must reach 165 degrees throughout to kill all bacteria. The safer option is to cook the stuffing on top of the stove, or if possible with your favorite recipe, separately in a casserole dish.

INGREDIENTS:

DIRECTIONS:
In a large pot, heat olive oil on medium heat and saute onion until soft and translucent. Add mushrooms, celery and garlic and cook until mushrooms are cooked. Add dried herbs and stir to mix. Add rice and stock, and a couple pinches of salt and pepper, and bring to a boil. Then reduce to a simmer, covered for 50 minutes or until rice is tender. While the rice is simmering, roast nuts in a skillet on medium-low heat, stirring consistently to avoid burning (this is easier and quicker than roasting in your oven, which will likely be full of turkey). Your nose will tell you when they're done (taste one, too). It should be little tender with the nuts oils giving off a delicious smell; probably 5-7 minutes.

When your rice hits the 40-minute simmering mark, add in the cranberries and nuts and stir. Replace lid and finish for another 20 minutes, or until water is gone. Stir and fluff with fork before serving. Now, go stuff yourself!

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Montana Integrative Medicine
1087 Stoneridge Drive, Suite 1, Bozeman, MT 59718, tel. 406-582-0034