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Endocrinology / Diabetes / Thyroid

 

Endocrinology is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions calledhormones, as well as the integration of developmental events proliferation, growth, and differentiation (including histogenesis andorganogenesis), and also the psychological or behavioral activities of metabolism, growth and development, tissue function, sleep,digestion, respiration, excretion, mood, stress, lactation, movement, reproduction, and sensory perception as caused by hormones.

The endocrine glands are numerous "ductless glands" which secrete specific chemicals called hormones, which are required for the smooth functioning of the body. Some of these glands are the thyroid gland, adrenal glands, pituitary gland, ovaries, testes and the pancreas.

Endocrinology deals with disorders of these vital organs.

The endocrine glands can either secrete an excess of a particular hormone or be deficient in that particular hormone and it is then described as "hyper" or "hypo" conditions respectively. Endocrinology also deals with the problems of obesity, increased hair growth and osteoporosis.

Our endocrinologist is available to discuss any of these issues, providing necessary treatment and advice. 

 

The thyroid gland is prone to several very distinct problems, some of which are extremely common. These problems can be broken down into those concerning the production of hormone (too much, or too little), those due to increased growth of the thyroid, causing compression of important neck structures or simply appearing as a mass in the neck, the formation of nodules or lumps within the thyroid which are worrisome for the presence of thyroid cancer, and those which are cancerous. Each thyroid topic is addressed separately and illustrated with actual patient x-rays and pictures to make them easier to understand. The information on this web site is arranged to give you more detailed and complex information as you read further.

Goiters ~ A thyroid goiter is a dramatic enlargement of the thyroid gland. Goiters are often removed because of cosmetic reasons or, more commonly, because they compress other vital structures of the neck including the trachea and the esophagus making breathing and swallowing difficult. Sometimes goiters will actually grow into the chest where they can cause trouble as well. Several nice x-rays will help explain all types of thyroid goiter problems.

Thyroid Cancer ~ Thyroid cancer is a fairly common malignancy, however, the vast majority have excellent long term survival. We now include a separate page on the characteristics of each type of thyroid cancer and its typical treatment, follow-up, and prognosis. Over 30 pages thyroid cancer.

Solitary Thyroid Nodules ~ There are several characteristics of solitary nodules of the thyroid which make them suspicious for malignancy. Although as many as 50% of the population will have a nodule somewhere in their thyroid, the overwhelming majority of these are benign. Occasionally, thyroid nodules can take on characteristics of malignancy and require either a needle biopsy or surgical excision. Now includes risks of radiation exposure and the role of Needle Biopsy for evaluating a thyroid nodule. Also a new page on the role of ultrasound in diagnosing thyroid nodules and masses.

Hyperthyroidism ~ Hyperthyroidism means too much thyroid hormone. Current methods used for treating a hyperthyroid patient are radioactive iodine, anti-thyroid drugs, or surgery. Each method has advantages and disadvantages and is selected for individual patients. Many times the situation will suggest that all three methods are appropriate, while other circumstances will dictate a single best therapeutic option. Surgery is the least common treatment selected for hyperthyroidism. The different causes of hyperthyroidism are covered in detail.

Hypothyroidism ~ Hypothyroidism means too little thyroid hormone and is a common problem. In fact, hypothyroidism is often present for a number of years before it is recognized and treated. There are several common causes, each of which are covered in detail. Hypothyroidism can even be associated with pregnancy. Treatment for all types of hypothyroidism is usually straightforward.

Thyroiditis ~ Thyroiditis is an inflammatory process ongoing within the thyroid gland. Thyroiditis can present with a number of symptoms such as fever and pain, but it can also present as subtle findings of hypo or hyper-thyroidism. There are a number of causes, some more common than others. 

 

Thyroid Surgery

 Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

1.excisional biopsy – removing a small part of the thyroid gland (rarely in use today);

2.lobectomy – removing half of the thyroid gland;

3.removing nearly all of the thyroid gland (subtotal thyroidectomy – leaving a small amount of thyroid tissue bilaterally or near-total thyroidectomy – leaving about one gm or cm of thyroid tissue on one side); or

4.total thyroidectomy, which removes all identifiable thyroid tissue.

There are specific indications for each of these operations. The main risks of a thyroid operation involve possible damage to important structures near the thyroid, primarily the parathyroid glands (which regulate calcium levels) and the recurrent and external laryngeal nerves (which control the vocal cords).

 

Questions and Considerations:

 

Why do I need an operation?

The most common reason for thyroid surgery is to remove a thyroid nodule, which has been found to be suspicious through a fine needle aspiration biopsy (see Thyroid Nodule brochure). Surgery may be recommended for the following biopsy results:

1.cancer (papillary cancer);

2.possible cancer (follicular neoplasm); or

3.inconclusive biopsy.

Surgery may be also recommended for nodules with benign biopsy results if the nodule is large, if it continues to increase in size or if it is causing symptoms (pain, difficulty swallowing, etc.). Surgery is also an option for the treatment of hyperthyroidism (see Hyperthyroidism brochure), for large and multinodular goiters and for any goiter that may be causing symptoms.

 

Are there other means of treatment?

Surgery is definitely indicated to remove nodules suspicious for thyroid cancer. In the absence of a possibility of thyroid cancer, there may be nonsurgical options of therapy depending on the diagnosis. You should discuss other options for therapy with your physician.

 

How should I be evaluated prior to the operation?

As for other operations, all patients considering thyroid surgery should be evaluated preoperatively with a thorough and comprehensive medical history and physical exam, including cardiopulmonary (heart) evaluation. An electrocardiogram and a chest x-ray prior to surgery is often recommended for patients who are over 45 years of age or who are symptomatic from cardiac disease. Blood tests may be performed to determine if a bleeding disorder is present. Any patients who have had a change in voice or who have had a previous neck operation should have their vocal cord function evaluated preoperatively. This is necessary to determine whether the recurrent laryngeal nerve that controls the vocal cord muscles is functioning normally. Finally, if medullary thyroid cancer is suspected, patients should be evaluated for coexisting adrenal tumors (pheochromocytomas) and for hypercalcemia and hyperparathyroidism.

 

What are the risks of the operation?

The most serious possible risks of thyroid surgery include:

1.bleeding that can cause acute respiratory distress,

2.injury to the recurrent laryngeal nerve that can cause permanent hoarseness, and

3.damage to the parathyroid glands that control calcium levels in the body, causing hypoparathyroidism and hypocalcemia.

These complications occur more frequently in patients with invasive tumors or extensive lymph node involvement, in patients requiring a second thyroid surgery, and in patients with large goiters that go below the collarbone. Overall the risk of any serious complication should be less than 2%. However, the risk of complications discussed with the patient should be the particular surgeon’s risks rather than that quoted in the literature. Prior to surgery, patients should understand the reasons for the operation, the alternative methods of treatment, and the potential risks and benefits of the operation (informed consent).

 

How much of my thyroid gland neds to be removed?

Your surgeon should explain the planned thyroid operation, such as lobectomy or total thyroidectomy, and the reasons why such a procedure is recommended. For patients with papillary or follicular thyroid cancer many, but not all, surgeons recommend total or neartotal thyroidectomy when they believe that subsequent treatment with radioactive iodine might be beneficial. For patients with large (>1.5 cm) or more aggressive cancers and for patients with medullary thyroid cancer, more extensive lymph node dissection is necessary to remove possibly involved lymph node metastases.

Thyroid lobectomy may be recommended for overactive one-sided nodules or for benign one-sided nodules that are causing symptoms such as compression, hoarseness, shortness of breath or difficulty swallowing. A total or near – total thyroidectomy may be recommended for patients with Graves’ Disease (seeHyperthyroidism brochure) or for patients with enlarged multinodular goiters.

 

What can I expect once I decide to proced with surgery?

Once you have met with the surgeon and decided to proceed with surgery, you will be scheduled for your pre-op evaluation (see above) and will meet with the anesthesiologist (the person who will put you to sleep during the surgery). You should have nothing to eat or drink after midnight on the day before surgery and should leave valuables and jewelry at home. The surgery usually takes 2-2½ hours, after which time you will slowly wake up in the recovery room. Surgery may be performed through a standard incision in the neck or may be done through a smaller incision with the aide a a video camera (Minimally invasive video assisted thyroiectomy) Under special circumstances, thyroid surgery can be performed with the assistance of a robot through a distant incision in either the axilla or the back of the neck. There may be a surgical drain in the incision in your neck (which will be removed the morning after the surgery) and your throat may be sore because of the breathing tube placed during the operation. Once you are fully awake, you will be moved to a bed in a hospital room where you will be able to eat and drink as you wish. Most patients having thyroid operations are hospitalized for about 24 hours and can be discharged on the morning following the operation. Normal activity can begin on the first postoperative day. Vigorous sports, such as swimming, and activities that include heavy lifting should be delayed for at least ten days.

 

Will I be able to lead a normal life after surgery?

Yes. Once you have recovered from the effects of thyroid surgery, you will usually be able to doing anything that you could do prior to surgery. Many patients become hypothyroid following thyroid surgery, requiring treatment with thyroid hormone (see Hypothyroidism brochure). This is especially true if you had surgery for thyroid cancer. Thyroid hormone replacement therapy may be delayed for several weeks if you are to receive radioactive iodine therapy

What is diabetes?

Diabetes is a complex group of diseases with a variety of causes. People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia.

Diabetes is a disorder of metabolism—the way the body uses digested food for energy. The digestive tract breaks down carbohydrates—sugars and starches found in many foods—into glucose, a form of sugar that enters the bloodstream. With the help of the hormone insulin, cells throughout the body absorb glucose and use it for energy. Diabetes develops when the body doesn’t make enough insulin or is not able to use insulin effectively, or both.

Insulin is made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood.

 

Diabetes Is A Metabolism Disorder

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.
When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose.
Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop.
A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.

Simple Steps to Lower Your Risk

Making a few lifestyle changes can dramatically lower the chances of developing type 2 diabetes. The same changes can also lower the chances of developing heart disease and some cancers.

 

Control Your Weight

Excess weight is the single most important cause of type 2 diabetes. Being overweight increases the chances of developing type 2 diabetes seven fold. Being obese makes you 20 to 40 times more likely to develop diabetes than someone with a healthy weight.

Losing weight can help if your weight is above the healthy-weight range. Losing 7 to 10 % of your current weight can cut your chances of developing type 2 diabetes in half.

 

Get Moving—and Turn Off the Television

Inactivity promotes type 2 diabetes.

Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose. This puts less stress on your insulin-making cells.

Long bouts of hot, sweaty exercise aren’t necessary to reap this benefit. Findings from the Nurses’ Health Study and Health Professionals Follow-up Study suggest that walking briskly for a half hour every day reduces the risk of developing type 2 diabetes by 30%

This amount of exercise has a variety of other benefits as well. And even greater cardiovascular and other advantages can be attained by more, and more intense, exercise.

Television-watching appears to be an especially-detrimental form of inactivity: Every two hours you spend watching TV instead of pursuing something more active increases the chances of developing diabetes by 20%; it also increases the risk of heart disease 15% and early death 13% The more television people watch, the more likely they are to be overweight or obese, and this seems to explain part of the TV viewing-diabetes link. The unhealthy diet patterns associated with TV watching may also explain some of this relationship.

 

Tune Up Your Diet

Four dietary changes can have a big impact on the risk of type 2 diabetes.

1. Choose whole grains and whole grain products over highly processed carbohydrates.

Women who averaged two to three servings of whole grains a day were 30% less likely to have developed type 2 diabetes than those who rarely ate whole grains. When the researchers combined these results with those of several other large studies, they found that eating an extra 2 servings of whole grains a day decreased the risk of type 2 diabetes by 21%.

Whole grains don’t contain a magical nutrient that fights diabetes and improves health. It’s the entire package—elements intact and working together—that’s important. The bran and fiber in whole grains make it more difficult for digestive enzymes to break down the starches into glucose. This leads to lower, slower increases in blood sugar and insulin, and a lower glycemic index. As a result, they stress the body’s insulin-making machinery less, and so may help prevent type 2 diabetes. Whole grains are also rich in essential vitamins, minerals, and phytochemicals that may help reduce the risk of diabetes.

In contrast, white bread, white rice, mashed potatoes, donuts, bagels, and many breakfast cereals have what’s called a high glycemic index and glycemic load. That means they cause sustained spikes in blood sugar and insulin levels, which in turn may lead to increased diabetes risk.

2. Skip the sugary drinks, and choose water, coffee, or tea instead.

Like refined grains, sugary beverages have a high glycemic load, and drinking more of this sugary stuff is associated with increased risk of diabetes. 

Studies also suggest that fruit drinks— Kool Aid, fortified fruit drinks, or juices—are not the healthy choice that food advertisements often portray them to be: Women in the Black Women’s Health study who drank two or more servings of fruit drinks a day had a 31% higher risk of type 2 diabetes, compared to women who drank less than one serving a month.

Health Study, women who increased their consumption of sugary drinks gained more weight than women who cut back on sugary drinks.

Several studies show that children and adults who drink soda or other sugar-sweetened beverages are more likely to gain weight than those who don’t,  and that switching from these to water or unsweetened beverages can reduce weight.

Even so, however, weight gain caused by sugary drinks may not completely explain the increased diabetes risk. 

What to drink in place of the sugary stuff? Water is an excellent choice.

Coffee and tea are also good calorie-free substitutes for sugared beverages (as long as you don’t load them up with sugar and cream).

And there’s convincing evidence that coffee may help protect against diabetes; emerging research suggests that tea may hold diabetes-prevention benefits as well, but more research is needed.

3. Choose good fats instead of bad fats.

The types of fats in your diet can also affect the development of diabetes.

Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes.Trans fats do just the opposite.

These bad fats are found in many margarines, packaged baked goods, fried foods in most fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. Eating polyunsaturated fats from fish—also known as “long chain omega 3” or “marine omega 3” fats—does not protect against diabetes, even though there is much evidence that these marine omega 3 fats help prevent heart disease.

If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease.

4. Limit red meat and avoid processed meat; choose nuts, whole grains, poultry, or fish instead.

The evidence is growing stronger that eating red meat (beef, pork, lamb) and processed red meat (bacon, hot dogs, deli meats) increases the risk of diabetes, even among people who consume only small amounts. The latest support comes from a “meta analysis,” or statistical summary, that combined findings from the long-running Nurses’ Health Study I and II and the Health Professionals Follow-Up Study with those of six other long-term studies.

They found that eating just one daily 3-ounce serving of red meat—say, a steak that’s about the size of a deck of cards—increased the risk of type 2 diabetes by 20%. Eating even smaller amounts of processed red meat each day—just two slices of bacon, one hot dog, or the like—increased diabetes risk by 51%.

The good news from this study: Swapping out red meat or processed red meat for a healthier protein source, such as nuts, low-fat dairy, poultry, or fish, or for whole grains lowered diabetes risk by up to 35%.

Not surprisingly, the greatest reductions in risk came from ditching processed red meat.

 

If You Smoke, Try to Quit

Add type 2 diabetes to the long list of health problems linked with smoking. Smokers are roughly 50% more likely to develop diabetes than nonsmokers, and heavy smokers have an even higher risk.

 

Alcohol Now and Then May Help

A growing body of evidence links moderate alcohol consumption with reduced risk of heart disease. The same may be true for type 2 diabetes. Moderate amounts of alcohol—up to a drink a day for women, up to two drinks a day for men—increases the efficiency of insulin at getting glucose inside cells. And some studies indicate that moderate alcohol consumption decreases the risk of type 2 diabetes. If you already drink alcohol, the key is to keep your consumption in the moderate range, as higher amounts of alcohol could increase diabetes risk.

If you don’t drink alcohol, there’s no need to start—you can get the same benefits by losing weight, exercising more, and changing your eating patterns.

 

Risk factors for prediabetes and diabetes-in addition to being overweight or obese or being age 45 or older-include the following:

 - being physically inactive

 - having a parent, brother, or sister with diabetes

 - having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander

 - giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes-diabetes first found during pregnancy

 - having high blood pressure-140/90 mmHg or above-or being treated for high blood pressure

 - having HDL, or "good," cholesterol below 35 mg/dL, or a triglyceride level above 250 mg/dL

 - having polycystic ovary syndrome, also called PCOS

 - having impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on previous testing

 - having other conditions associated with insulin resistance, such as severe obesity or a condition called acanthosis nigricans, characterized by a  - dark, velvety rash around the neck or armpits

 - having a history of cardiovascular disease

 

 

 

What is prolactin?

Prolactin is a hormone named originally after its function to promote milk production (lactation) in mammals in response to the suckling of young after birth.  It has since been shown to have more than 300 functions in the body.  These can be divided into a number of areas: reproductive, metabolic, regulation of fluids (osmoregulation), regulation of the immune system (immunoregulation) and behavioural functions.

In humans, prolactin is produced both in the front portion of the pituitary gland (anterior pituitary gland) and in a range of sites elsewhere in the body.  Lactotroph cells in the pituitary gland produce prolactin, where it is stored in small containers called vesicles.  Prolactin is released into the bloodstream by a process called exocytosis.  Human prolactin is also produced in the uterus, immune cells, brain, breasts, prostate, skin and adipose tissue.

How is prolactin controlled?

One of the main regulators of the production of prolactin from the pituitary gland is the hormone called dopamine, which is produced by the hypothalamus, the part of the brain directly above the pituitary gland.  Dopamine restrains prolactin production, so the more dopamine there is, the less prolactin is released. Prolactin itself enhances the secretion of dopamine, so this creates a negative feedback loop.

Oestrogen is another key regulator of prolactin and has been shown to increase the production and secretion of prolactin from the pituitary gland.  Studies have shown small increases in prolactin in the blood circulation of women during stages of their reproductive cycle where oestrogen levels are at their highest.  This is also the case during and after pregnancy, which makes sense, since a higher level of circulating prolactin is needed to cause lactation to start.

In addition to dopamine and oestrogen, a whole range of other hormones can both increase and decrease the amount of prolactin released in the body, with some examples being thyrotropin-releasing hormone,oxytocin and anti-diuretic hormone.

 

What happens if I have too much prolactin?

The condition of having too much prolactin circulating in the blood is called hyperprolactinaemia.  The most common causes of hyperprolactinaemia include pregnancy, medications that reduce dopamine action in the body, thyroid underactivity and benign pituitary tumours (known as prolactinomas).  Symptoms can include the unwanted production of milk, disturbances to the menstrual cycle and symptoms due to oestrogen deficiency (in women) or testosterone deficiency (in men).  The vast majority of patients with aprolactinoma can be treated successfully using drugs which mimic the action of dopamine.  The most commonly used is cabergoline.

 

What happens if I have too little prolactin?

The condition of having too little prolactin circulating in the blood is called hypoprolactinaemia.  This condition is very rare and may occur in people with pituitary underactivity.

A decrease in the amount of prolactin secreted can lead to insufficient milk being produced after giving birth. Most people with low prolactin levels do not have any specific medical problems, although preliminary evidence suggests they might have reduced immune responses to some infections.

 

Autoimmune disorders

Causes

The white blood cells in the body’s immune system help protect against harmful substances.

Examples include bacteria, viruses, toxins, cancer cells, and blood and tissue from outside the body. These substances contain antigens. The immune system produces antibodies against these antigens that enable it to destroy these harmful substances.

When you have an autoimmune disorder, your immune system does not distinguish between healthy tissue and antigens. As a result, the body sets off a reaction that destroys normal tissues.

The exact cause of autoimmune disorders is unknown. One theory is that some microorganisms (such as bacteria or viruses) or drugs may trigger changes that confuse the immune system. This may happen more often in people who have genes that make them more prone to autoimmune disorders.

 

An autoimmune disorder may result in:

  • The destruction of body tissue

  • Abnormal growth of an organ

  • Changes in organ function

 

An autoimmune disorder may affect one or more organ or tissue types. Areas often affected by autoimmune disorders include:

  • Blood vessels

  • Connective tissues

  • Endocrine glands such as the thyroid or pancreas

  • Joints

  • Muscles

  • Red blood cells

  • Skin

 

A person may have more than one autoimmune disorder at the same time. Common autoimmune disorders include:

  • Addison's disease

  • Celiac disease - sprue (gluten-sensitive enteropathy)

  • Dermatomyositis

  • Graves' disease

  • Hashimoto's thyroiditis

  • Multiple sclerosis

  • Myasthenia gravis

  • Pernicious anemia

  • Reactive arthritis

  • Rheumatoid arthritis

  • Sjogren syndrome

  • Systemic lupus erythematosus

  • Type I diabetes

 

What Are Some of the Most Common Autoimmune Diseases?

The following are some of the more common autoimmune diseases:

 - rheumatoid arthritis—inflammation of joints and surrounding tissues

 - systemic lupus erythematosus—affects skin, joints, kidneys, brain, and other organs

 - multiple sclerosis—affects the brain and spinal cord

 - celiac sprue disease—a reaction to gluten (found in wheat, rye, and barley) that causes damage to the lining of the small intestine

 - pernicious anemia—decrease in red blood cells caused by inability to absorb vitamin B12

 - vitiligo—white patches on the skin caused by loss of pigment

 - scleroderma—a connective tissue disease that causes changes in skin, blood vessels, muscles, and internal organs

 - psoriasis—a skin condition that causes redness and irritation as well as thick, flaky, silver-white patches

 - inflammatory bowel disease—a group of inflammatory diseases of the colon and small intestine

 - Hashimoto’s disease—inflammation of the thyroid gland

 - Addison’s disease—adrenal hormone insufficiency

 - Graves’ disease—overactive thyroid gland

 - reactive arthritis—inflammation of joints, urethra, and eyes; may cause sores on the skin and mucus membranes

 - Sjögren’s syndrome—destroys the glands that produce tears and saliva causing dry eyes and mouth; may affect kidneys and lungs

 - Type 1 diabetes—destruction of insulin producing cells in the pancreas

 

What Causes the Immune System to Attack Healthy Body Cells?

The cause of autoimmune disease is unknown. If you have a family member with an autoimmune disease, you may be more susceptible to developing one. There are many theories about what triggers autoimmune diseases, including

 - bacteria or virus

 - drugs

 - chemical irritants

 - environmental irritants

 

What Are the Symptoms of an Autoimmune Disease?

Because there are so many different types of autoimmune disease, the symptoms vary. However, most of them cause fatigue, fever, and general malaise (feeling ill). Symptoms worsen during flare-ups and lessen during remission.

Autoimmune diseases affect many parts of the body. The most common organs and tissue affected are:

 - joints

 - muscles

 - skin

 - red blood cells

 - blood vessels

 - connective tissue

 - endocrine glands

 

How Are Autoimmune Diseases Diagnosed?

Ordinarily, your immune system produces antibodies (proteins that recognize and destroy specific substances) against harmful invaders in your body, such as viruses, bacteria, parasites, and fungi. When you have an autoimmune disease, your body produces antibodies against some of your own tissues. Diagnosing an autoimmune disease involves identifying the antibodies your body is producing.

The following tests are used to diagnose an autoimmune disease:

 - antinuclear antibody tests—a type of autoantibody test that looks for antinuclear antibodies, which attack the nuclei of cells in your body

 - autoantibody tests—any of several tests that look for specific antibodies to your own tissues

 - complete blood count (CBC)—measures the numbers of red and white cells in your blood. When your immune system is actively fighting               something, these numbers will vary from the norm

 - C-reactive protein (CRP)—elevated CRP is an indication of inflammation throughout your body

 - erythrocyte sedimentation rate (ESR)—this test indirectly measures how much inflammation is in your body

 

How Are Autoimmune Diseases Treated?

Autoimmune diseases are chronic conditions with no cure. Treatment involves attempts to control the process of the disease and to decrease the symptoms, especially during flare-ups. The following is a list of things you might do to alleviate the symptoms of an autoimmune disease:

 - eat a balanced and healthy diet

 - exercise regularly

 - get plenty of rest

 - take vitamin supplements

 - take hormone replacement, if necessary

 - get blood transfusions, if blood is affected

 - take anti-inflammatory medication, if joints are affected

 - take pain medication

 - take immunosuppressive medication

 - get physical therapy

 - decrease stress

 - limit sun exposure

 - avoid any known triggers of flare-ups

 

 

Vitamin D deficient

 

Symptoms of bone pain and muscle weakness can mean you have a vitamin D deficiency. However, for many people, the symptoms are subtle. Yet, even without symptoms, too little vitamin D can pose health risks. Low blood levels of the vitamin have been associated with the following:

  • Increased risk of death from cardiovascular disease

  • Cognitive impairment in older adults

  • Severe asthma in children

  • Cancer

Research suggests that vitamin D could play a role in the prevention and treatment of a number

of different conditions, including type1 and type 2 diabetes,hypertension, glucose intolerance,

and multiple sclerosis.

Causes of Vitamin D Deficiency

Vitamin D deficiency can occur for a number of reasons:

You don't consume the recommended levels of the vitamin over time.

This is likely if you follow a strict vegan diet, because most of the natural sources are animal-based,

including fish and fish oils, egg yolks, cheese, fortified milk, and beef liver.

Your exposure to sunlight is limited. Because the body makes vitamin D when your skin is exposed

to sunlight, you may be at risk of deficiency if you are homebound, live in northern latitudes, wear long robes or head coverings for religious reasons, or have an occupation that prevents sun exposure.

You have dark skin. The pigment melanin reduces the skin's ability to make vitamin D in response to sunlight exposure. Some studies show that older adults with darker skin are at high risk of vitamin D deficiency.

Your kidneys cannot convert vitamin D to its active form. As people age, their kidneys are less able to convert vitamin D to its active form, thus increasing their risk of vitamin D deficiency.

Your digestive tract cannot adequately absorb vitamin D. Certain medical problems, including Crohn's disease, cystic fibrosis, and celiac disease, can affect your intestine's ability to absorb vitamin D from the food you eat.

You are obese. Vitamin D is extracted from the blood by fat cells, altering its release into the circulation. People with a body mass index of 30 or greater often have low blood levels of vitamin D.

 

 

 

 

 

 

 

 

 

 

Am I vitamin D deficient?

The best way to discover vitamin D deficiency is to take a blood test that will measure the level of the vitamin in your blood. You can either ask your doctor to administer the test or buy a home test kit do the test yourself. However, you are certainly vitamin D deficient if you have any of the following ailments, and you need to consult with your doctor regarding your preventive, as well as curative, options as soon as possible.

1.) The flu - In a study published in the Cambridge Journals, it was discovered that vitamin D deficiency predisposes children to respiratory diseases. An intervention study conducted showed that vitamin D reduces the incidence of respiratory infections in children.
 

2.) Muscle weakness - According to Michael F. Holick, a leading vitamin D expert, muscle weakness is usually caused by vitamin D deficiency because for skeletal muscles to function properly, their vitamin D receptors must be sustained by vitamin D.
 

3.) Psoriasis - In a study published by the UK PubMed central, it was discovered that synthetic vitamin D analogues were found useful in the treatment of psoriasis.
 

4.) Chronic kidney disease - According to Holick, patients with advanced chronic kidney diseases (especially those requiring dialysis) are unable to make the active form of vitamin D. These individuals need to take 1,25-dihydroxyvitamin D3 or one of its calcemic analogues to support calcium metabolism, decrease the risk of renal bone disease and regulate parathyroid hormone levels.
 

5.) Diabetes - A study conducted in Finland was featured in Lancet.com in which 10,366 children were given 2000 international units (IU)/day of vitamin D3 per day during their first day of life. The children were monitored for 31 years and in all of them, the risk of type 1 diabetes was reduced by 80 percent.
 

6.) Asthma - Vitamin D may reduce the severity of asthma attacks. Research conducted in Japan revealed that asthma attacks in school children were significantly lowered in those subjects taking a daily vitamin D supplement of 1200 IU a day.
 

7.) Periodontal disease - Those suffering from this chronic gum disease that causes swelling and bleeding gums should consider raising their vitamin D levels to produce defensins and cathelicidin, compounds that contain microbial properties and lower the number of bacteria in the mouth.
 

8.) Cardiovascular disease - Congestive heart failure is associated with vitamin D deficiency. Research conducted at Harvard University among nurses found that women with low vitamin D levels (17 ng/m [42 nmol/L]) had a 67 percent increased risk of developing hypertension.
 

9.) Schizophrenia and Depression - These disorders have been linked to vitamin D deficiency. In a study, it was discovered that maintaining sufficient vitamin D among pregnant women and during childhood was necessary to satisfy the vitamin D receptor in the brain integral for brain development and mental function maintenance in later life.
 

10.) Cancer - Researchers at Georgetown University Medical Center in Washington DC discovered a connection between high vitamin D intake and reduced risk of breast cancer. These findings, presented at the American Association for Cancer Research, revealed that increased doses of the sunshine vitamin were linked to a 75 percent reduction in overall cancer growth and 50 percent reduction in tumor cases among those already having the disease. Of interest was the capacity of vitamin supplementation to help control the development and growth of breast cancer specially estrogen-sensitive breast cancer.

 

 

Hypertension by the Numbers

33 The percentage of adults in the U.S. with high blood pressure.

33 The percentage of adults who have high blood pressure and don’t know it.

90-95 The percentage of adults in which there's no recognizable cause of high blood pressure.

5-10  The percentage of adults with high blood pressure that's caused by a serious underlying condition.

 

How Hypertension Works

Blood is pumped out of the heart through arteries, then to arterioles (small arteries), and finally to

capillaries,which supply nutrients and oxygen to tissues and organs throughout the body. As long as the

network of blood vessels is healthy, free of obstructions, and pliable, blood can flow through the system

easily and efficiently. When those vessels narrow or become clogged, the heart has to work harder to push

blood through the arteries and the vessels become weak and damaged.

The whole vascular system is put under added pressure with every heartbeat, which is why it's called high blood pressure. The combination of events presents a triple threat: 

  • A damaged heart muscle because it’s being overworked.

  • Damaged arteries and arterioles trying to take care of the extra pressure.

  • Damaged organs throughout the body because they aren't getting enough oxygen and nutrients. Hypertension becomes a major risk factor for kidney failure, heart attack, and stroke. It can even damage the blood vessels in the eyes, causing loss of vision, and vessels in the brain, which could result in problems with memory and understanding.

 

Types of Hypertension

There are two kinds of hypertension. Primary hypertension, also called essential hypertension, develops over a period of years without a known cause and usually without symptoms. Between 90 and 95 percent of hypertension in adults is due to primary hypertension.

Secondary hypertension is involved in 10 percent or less of all high blood pressure cases. It tends to develop suddenly and with significantly higher blood pressure readings than primary hypertension. Among the organs affected are the kidneys, adrenal glands, and heart. Certain medications used for colds, pain, lung congestion, and birth control, in addition to cocaine and amphetamines, can trigger secondary hypertension.

Some of the possible symptoms of extremely high blood pressure are severe headaches, chest pain, difficulty breathing, irregular heartbeat, blood in the urine, fatigue, confusion, a pounding sensation in your ears, neck, or chest, and blood in the urine. All of these are considered serious, potentially life-threatening conditions. If you experience these symptoms, seek medical attention as soon as possible.

 

Hypertension Risk Factors

Below is a list of 10 risk factors that can contribute to hypertension.

  • Salt – Too much salt in the diet can cause fluid retention, which increases blood pressure. Potassium is needed to balance sodium (salt) intake. Too little potassium means too much sodium in the bloodstream.

  • Alcohol – Too much alcohol over a long period damages the heart, which can’t be good for an organ trying to push blood through the system. More than two or three drinks in a short period of time can cause a temporary rise in blood pressure.

  • Age – The risk of developing hypertension increases with age.

  • Race – Hypertension is more prevalent among African-Americans.

  • Family history – People with a family history of hypertension are at an increased risk of developing it themselves.

  • Weight – People who being overweight or obese are more likely to suffer from hypertension.

  • Lack of exercise – People who don't regularly exercise are more likely to develop hypertension.

  • Smoking – Tobacco damages artery walls and causes increased spikes in blood pressure, which increase hypertension risk.

  • Stress – Too much stress can increase a person's risk of hypertension.

  • Chronic conditions – People who suffer from chronic conditions such as diabetes, sleep apnea, elevated cholesterol levels, and kidney disease are more likely to develop hypertension.

 

Testing for Hypertension

Blood pressure kits are relatively inexpensive and easy to use at home, but a health professional who has better equipment and more experience should periodically measure your blood pressure. Normal blood pressure is considered to be 120/80 or less. Lower is better. The first number is the systolic blood pressure, that is, the amount of pressure exerted against arterial walls when the heart beats. The second number is called diastolic and is the reading between heartbeats when the blood vessels relax.

Some cardiologists prefer your blood pressure be at 115/75. A condition called pre-hypertension exists when the top number is between 120 and 139, and the bottom number is between 80 and 89. Within a period of four years, almost a third of adults between the ages of 35 and 64 who have pre-hypertension develop clinically-diagnosed high blood pressure. Among those 65 and older, about half progress to hypertension.

Low blood pressure isn't a problem unless other symptoms or conditions exist. Symptoms of low blood pressure include dizziness, light headedness

, or fainting.

 

3 Keys to Hypertension Prevention and Treatment

The first line of defense against hypertension lies within changes you can make to your lifestyle.  Let the following tips guide you down a path to blood pressure reduction and management.

 

Key 1: Eat Clean 

This first key to hypertension reduction/management involves the foods you eat. The DASH (Dietary Approaches to Stop Hypertension) diet has been researched extensively throughout the years and proven effective. It emphasizes many of the same goals we set on a daily basis for our athletes and clients at Athletes' Performance and Core Performance. Use the tips below to improve your eating habits.

  • Eat plenty of fiber. Diets high in fiber-rich foods have been associated with improvements in blood pressure, as well as blood lipid profiles and blood glucose levels. Many fiber-rich foods pack a one-two-punch because they are also great sources of calcium and magnesium, which are associated with blood pressure reduction. Some great choices include:1/2 cup black beans (~7 g fiber, ~23 mg calcium, and ~60 mg magnesium), 1/2 cup white beans(~7g fiber, ~80 mg calcium, and ~56 mg magnesium), 1/4 cup raw almonds (~4 g fiber, ~78 mg calcium, and ~99 mg magnesium).

  • Color your plate. This is a catch phrase we use a lot at Athletes’ Performance and Core Performance to remind our athletes/clients to incorporate more micronutrient-rich fruits and vegetables into their daily diet. All fruits and vegetables are great additions to your diet, but for blood pressure reduction, focus on those rich in potassium, calcium, and magnesium. These particular micronutrients all have the potential to reduce your blood pressure. Some great choices for each micronutrient include: - Potassium (1 banana: ~486 mg, 1 small baked potato: ~738 mg, 1 medium orange: ~333mg)- Calcium (1/2 cup cooked spinach: ~120 mg, 1/2 cup cooked kale: ~90 mg, 1/2 cup cooked turnip greens: ~99 mg)- Magnesium (1/2 cup cooked spinach: ~75 mg, 1 small baked potato: ~48 mg).

  • Choose healthy fats. Replacing foods loaded with saturated and trans fats with foods rich in poly and monounsaturated fats has also been associated with blood pressure reduction. Nuts and seeds are great sources of these healthy fats and can also be high in magnesium (benefits stated earlier). Be sure to choose raw and unsalted varieties, and also be aware of portion sizesbecause these foods are calorie dense. Try a small handful of the following as a healthy snack: almonds, cashews, and pumpkin seeds.

  • Reduce sodium intake. Diets containing between 1,500 and 2,300 mg of sodium per day have been shown to reduce blood pressure. Some great tips to reduce your sodium intake include choosing spices and herbs over table salt, reducing your condiment use by asking for these on the side, and replacing salty snacks with fruits, vegetables, and unsalted nuts and seeds.  

 

Key #2: Live Clean 

Now that we’ve addressed your food choices, let’s clean up your habits away from the table to help reduce blood pressure.

  • Move more. Yes, this means training. Increased physical activity has been shown to positively influence your blood pressure. Utilize the training portion of Core Performance and begin to train for life. Make it your goal to break a sweat every day.

  • Take time to recover.  Now that you've increased your physical activity and started training for the game of life, you must incorporate recovery techniques to maximize the benefits. Incorporating recovery techniques into your daily routine can be a great way to reduce stress, and guess what…stress reduction has been associated with blood pressure reduction. Remember, WORK + REST = SUCCESS. 

  • Manage your weight. If you start to eat clean, train, and recover, then you're well on your way to managing your weight.

  • Stop smoking and drinking alcohol. As mentioned earlier, tobacco and alcohol use is associated with elevated blood pressure.  If you use these substances, stop. 

 

Key 3: Think Clean

The final key to reducing your blood pressure lies within your mindset. 

  • Stay current with the research. You should always strive to not only keep your body in top condition, but your mind. By staying current with the research, you can begin to incorporate the latest research-supported techniques for blood pressure reduction. Always be a savvy consumer of information, look for reputable sources, and be sure to consult your physician for his or her approval.

  • Monitor your progress. Don’t shy away from monitoring your blood pressure. The only way to know if your new lifestyle changes are effective is to monitor your numbers. Remember, ignoring the fact won't make them disappear.   

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