Monthly Archives: December 2011

Is Your Doctor a Clinical BioChemist? Considering Amino Acid deficiency as the cause of Fatigue and Depression

The statement “you are what you eat” is only partially true. The statement should be “you are what you Absorb”. This statement can reflect those substances which are harmful or helpful to the body.

When assessing a patient for disease states, it is essential to consider one’s diet as well as the ability to adequately break down food particles and turn it into the necessary building blocks needed to run the body efficiently. This concept is very apparent when considering fatigue and depression and their potential relation to adequate and specific amino acid levels in the body.

Part of the problem with our ability to adequately make this link and diagnosis exists in our failure in medicine to recall the biochemistry we were once taught in medical school. An old mentor of mine use to say “the only diagnosis you will miss is the one you don’t think of”, referring to our need to continue to read and expand our differential diagnosis. To be sure, we were taught the biochemistry, but have unfortunately, yet conveniently embraced a “pharmaceutical prescription for every malady” mentality.

Be sure to consider the probability of amino acid deficiency in the consideration of causes of depression and fatigue. For example, amino acids are an absolute requirement for the synthesis of hemoglobin (which carries oxygen in the blood), neurotransmitters (the chemicals on which your nervous system run), your hormones (which control your metabolism).

A great example of this is apparent in the loss of Glutamine in the diet and subsequent effect it has on gluconeogenesis (a vital metabolic pathway that creates glucose for energy and maintains blood sugar levels). Glutamine is also integral in the production of glutathione (an incredible substance which is Neuroprotective, a strong antioxidant, and involved as a detoxification substance in the body).

Another common example is the extreme fatigue persons who over exercise may experience from the excess loss of Isoleucine, Leucine, and Valine which are essential in skeletal muscle health. If you are exhibiting signs or symptoms of fatigue and depression, do not assume that you absolutely need a prescription or are in fact, clinically depressed until you get your amino acids (and potentially your vitamin levels) assessed. There are tests which give reliable quantitative levels and assessment of these vital building blocks.

Eating the right protein and having a healthy gastrointestinal tract to digest and assimilate the food into the correct nutrient building blocks can actually be the keys to improving or correcting your depression or fatigue.

Not Your Mother’s Thyroid Disease

Frequently, patients present having been previously diagnosed with hypothyroidism (low thyroid). Most times, patients are currently being treated with medication but are looking for relief of symptoms and not just satisfying some numerical benchmark outlined by their physician. There appears to be a disconnect between treating the numbers and treating the patient when it comes to thyroid disease. After all, what is the point of cumbersome testing or taking daily medication if not for the promise of feeling well?

Much discussion typically surrounds the use of T3 (to use vs not to use and the form in which it is used). Many times, discussion also centers around what tests are appropriate and best represents each patients clinical situation. It seems, there are as many different ways to test and treat hypothyroidism as there are practitioners. Furthermore, many practitioners tend to order only the tests they were taught to order during their training. Many times this restricts the investigation to TSH and free T4. This approach may be adequate for many “run of the mill” cases of hypothyroidism. But, if your therapy is not progressing to afford you the best quality of life possible with optimal thyroid hormone levels, further investigation may be required to get a full assessment of your malady.

There are several factors to keep in mind when considering the best treatment for hypothyroidism:
Although patients may have an adequate TSH level with treatment with Levothyroxine (T4), this does not insure adequate conversion of T4 to T3 (the much more active hormone form).
If you are on T4 or T3 and are not getting the anticipated response, it may be worthwhile to get a RT3 (reverse T3) level. This is an inactive alternate isomer form of T3 which can “clog up” the thyroid hormone feedback system, thus actually worsening the clinical picture despite what would seem appropriate medication doses. Many persons with adrenal dysfunction or iron/ferritin deficiency have the propensity to make RT3.
Excessive caffeine and alcohol can worsen the dietary intake of iron, Vitamin B-12, Vitamin C. Limiting these in excess may help to meet the necessary dietary requirements.
Excessive physical stressors such as recovering from surgery, prolonged illness, sleep deprivation, or emotional stress for prolonged periods can cause excess or low levels of cortisol production from the adrenals. These changes in adrenal function can increase the production of RT3 and decrease conversion of T4 to active T3.

If your current thyroid therapy does not seem to be working, it may be worth discussing the effect of RT3 and/or the use of T3 in addition to your current regimen.

In Health,

Dr. Gary F. Joseph

The information provided on this blog is for reference use only, and does not constitute the rendering of legal, financial or other professional advice or recommendations by the BodyLogicMD affiliated physician. This page is not for the use of diagnosing and/or treating medical issues.