Running progressions / Health regressions

Running progressions / Health regressions

I’ve mentioned a few health issues in previous posts; some make reference to ongoing injuries, others mention malabsorption of vitamins and minerals, depression, hormone imbalances, digestive issues and a history of an eating disorder. I struggle with energy, fatigue and generally getting out of bed in the morning, and it has worsened since late last year.

Without subjecting you to TMI, I’ve had a series of small operations for uterine polyps and an endometrial ablation, and have polycystic ovaries and adenomyosis. A year ago I was advised to have a hysterectomy but I postponed it (because I didn’t want to stop running). I held onto hope that the next doctor I saw or procedure we tried would fix my hormones. I’ve continued running despite how I feel physically because it is the only thing that helps the way I feel emotionally/mentally.

It seems that as my running has progressed – from 10km and an occasional half marathon, totaling 35-50km per week – to marathons and ultramarathon training, totally 80-100km per week – my health has regressed. Some consistent blood tests are now starting to come together. I’ve moved around a bit and never had a regular doctor so the puzzle has taken longer to solve. My issues: hormones, digestion, fatigue and depression are all connected. It might appear like individual problems but there is a pattern that involves: hormones, leaky gut, adrenals and thyroid (and we still don’t know the driving force).

My doctor diagnosed hypothyroidism (Hashimotos, an autoimmune thyroid condition). However she does not believe this is my main issue. In the short term, I’m looking for ways to manage my thyroid and continue running. Below are selections of information I have sourced from the Internet. I’m keen to hear from anyone else who deals with similar problems and also refuses to let it stop you from running! I’m interested in knowing if you medicate? I’m looking for positive steps forward. For me, this is a relatively mild health problem and I’m grateful for that. I’m grateful that I can still run, and I want to run as much as my body will allow.

http://www.scienceofrunning.com/2013/04/thyroid-madness-everything-you-need-to.html

Thyroid madness- Everything you need to know

Posted by Steve Magness

What it is and How it’s diagnosed:

The large majority of hypothyroidism occurs because of an autoimmune disorder (Hashimoto’s) which essentially means that your body is attacking itself.  SO, your antibodies essentially attack the thyroid and if nothing is done, the thyroid is eventually “destroyed.” This would be called primary hypothyroidism. Other forms include secondary hypothyroidism and tertiary hypothyroidism. Secondary refers to when the Pituitary gland is messed up and doesn’t create enough TSH (Thyroid Stimulating Hormone), and tertiary is when the hypothalamus doesn’t release enough Thyrotopin-releasing hormone (TRH) which doesn’t stimulate the pituitary to produce TSH, and so on.

The symptoms of it are unpleasant. You can look those up yourself, but just so people understand, it goes beyond the idea of just “fatigue”. For example, hair loss, impaired cognition, inability to focus, inability to tolerate cold, depression, and on and on.  In fact, occasionally, clinical depression is found to be due to a thyroid problem and not the traditional route.  Bottom line, is it kind of sucks. And it’s an every day suck. If you have overt hypothyroidism you lose ability to go through your normal everyday life.

1.       Thyroid Stimulating Hormone (TSH)-

It stimulates the production of T4 which is then converted to T3. It’s not the be all end all like many portray it but it’s the first marker that essentially says, “hey, something is off here.” 

That’s why you look at TSH, freeT3, freeT4, and reverse T3 also. These with TSH provide a broader picture of what is going on. 

Antibodies

2.  Antibodies show up. Not a great sign. Probably means autoimmune disease.

You can have people with normal TSH, but have antibodies. That generally means they have an autoimmune disorder but it hasn’t progressed to overt hypothyroidism yet. Do you wait 5 years until their thyroid is damaged enough to start treatment, or do you treat now?

What do you do if you have an actual thyroid problem and what does treatment entail?

If you are legitimately hypothyroid, then the solution is to take supplemental synthetic thyroid.  The most prescribed drug is levothyroxine (name brand synthroid or levoxyl) which is synthetic T4. Other treatment options are synthetic T3.

Once you find the right dosage, that doesn’t mean it’s the right dosage for the long term, you have to have a blood test every 3-6 months to make sure nothing has changed.

Genetics and a quick theory:

Before ending let’s look at how thyroiditis develops. The majority of cases (85-90%) in the U.S. are autoimmune related. Meaning that the thyroid is essentially destroying itself. The question is how does this develop? 

One thing about the autoimmune version of thyroid disease is that there is a very strong genetic component.  In twin studies, there’s anywhere from 38-55% concordance rate.

So let’s look at how it develops:

(Chart from: Christiakov (2005). Immunogenetics of Hashimoto’s thyroiditis.  Journal of Autoimmune disease)

The first two are the interesting and important components.

1.       There is a genetic predisposition.

2.       Breakdown of immune tolerance

The question needs to be asked if a large training stress COMBINED with a genetic predisposition is enough to trigger this breakdown of immune tolerance and lead to Hashimoto’s at let’s say at 20 instead of 50.

The key though is that without the genetic predisposition, you can’t just train hard and get Hashimoto’s.

It’s just a theory at this point, but the thing to realize is that it has to be genetically there. You can’t just train to get it the disease. Whether it is training induced or an environmental trigger that distance running accelerates, it’s interesting to look at the idea.

The chart above also demonstrates how the body develops a thyroid problem, which is an important consideration.  Thyroid disease is generally a slow progression over many years. It’s one of the reasons why it usually is seen in women in their 50’s.

For a more thorough breakdown, read this journal article (http://www.jautoimdis.com/content/2/1/1)

So what?

If you have to have your thyroid removed, you need supplemental thyroid to function in regular life.

If you have Hashimoto’s or an autoimmune disease, you need supplemental thyroid to function in regular life because your thyroid is destroying itself…

Hopefully, you also realize that this isn’t a training caused problem in people with actual thyroid diseases. And hopefully you realize that if you have a thyroid issue, taking the medication does not give you superhuman powers. It simply returns you to functioning.

Above all, the best thing you can do if you face this problem is be your own educated advocate. You’ll know enough to get the right tests, have a thorough evaluation, and see if you have a legitimate problem or not.

http://drknews.com/the-hypothyroid-athlete/

The Hypothyroid Athlete

Competitive athletes seem unlikely candidates for hypothyroidism, a disease that frequently causes fatigue, depression, and malaise.

But some athletes are surprised to learn their dwindling performance and failure to build muscle stems from improperly managed hypothyroidism.

The fact that athletes are typically fit and slender makes it easy for doctors to overlook their symptoms. And like 90 percent of Americans with hypothyroidism, most athletes have Hashimoto’s, an autoimmune condition that thyroid hormone medications alone do not properly address.

As a result, performance declines until the athlete may be forced to stop competing and participating in a lifestyle she loves. Studies show hypothyroidism affects athletic performance in a number of ways. It creates more muscle weakness and cramping, impairs cardiac function and blood flow, and hampers the ability of muscles to use fatty acids for energy, thus limiting endurance.

Athletes should avoid over training

Athletes set themselves apart by their ability to push themselves physically and mentally when most people would give up. However repeatedly pushing the body too far can produce negative health consequences.

What I commonly see in athletes, particularly endurance athletes, is adrenal fatigue, excess inflammation, and sometimes a form of anemia caused by the breakdown of red blood cells, another consequence of over training.

These factors could lend a hand in triggering an autoimmune thyroid condition in someone genetically predisposed, and they can certainly exacerbate and existing thyroid condition.

I have seen many athletes boost flagging performance by adapting changes that include: Lightening up their training schedules, Managing adrenal imbalances, Eliminating foods to which they are intolerant, Repairing inflamed and permeable guts, and Managing any autoimmune conditions.

What’s required to modulate adrenal function and tame inflammation will be different, but most see improved performance and more enjoyment from their sport after tending to these issues.

Taking more thyroid hormones is not the answer

It may be tempting to take very high doses of thyroid hormones to boost metabolism and hence performance, but this is a trap. Too much thyroid hormone can cause resistance to the thyroid and hypothyroid symptoms. Also, studies show taking excess thyroid hormone can overstimulate the production of dopamine, which could predispose one to a dopamine deficiency. It’s more important to address the underlying cause of the thyroid imbalance and address that. For some athletes, due the high amount of stress they subject themselves to, it could mean lowering stress and supporting the body’s stress-handling mechanisms. It is best to work with a qualified practitioner and read Why Do I Still Have Thyroid Symptoms? to learn the best way to manage your thyroid condition.

To be continued...