Tuesday, 26 May 2015

Why butter and eggs won't kill us after all: Flawed science triggers U-turn on cholesterol fears


  • Foods high in cholesterol branded a danger to human health since 1970s
  • Now US government is to accept advice to drop cholesterol from list of 'nutrients in concern'
  • Doctors are now focusing concern on sugar as the biggest dietary threat
By CHRIS BROOKE FOR THE DAILY MAIL

PUBLISHED: 22:40, 25 May 2015 | UPDATED: 01:16, 26 May 2015

For decades they have been blacklisted as foods to avoid, the cause of deadly thickening of the arteries, heart disease and strokes.

But the science which warned us off eating eggs – along with other high-cholesterol foods such as butter, shellfish, bacon and liver – could have been flawed, a key report in the US has found.

Foods high in cholesterol have been branded a danger to human health since the 1970s – a warning that has long divided the medical establishment.

A growing number of experts have been arguing there is no link between high cholesterol in food and dangerous levels of the fatty substance in the blood.

Now, in a move signalling a dramatic change of stance on the issue, the US government is to accept advice to drop cholesterol from its list of 'nutrients of concern'.

The US Department of Agriculture panel, which has been given the task of overhauling the guidelines every five years, has indicated it will bow to new research undermining the role dietary cholesterol plays in people's heart health.

Its Dietary Guidelines Advisory Committee plans to no longer warn people to avoid eggs, shellfish and other cholesterol-laden foods.

The U-turn, based on a report by the committee, will undo almost 40 years of public health warnings about eating food laden with cholesterol. US cardiologist Dr Steven Nissen, of the Cleveland Clinic, said: 'It's the right decision. We got the dietary guidelines wrong. They've been wrong for decades.'

Doctors are now shifting away from warnings about cholesterol and saturated fat and focusing concern on sugar as the biggest dietary threat.

The Daily Mail's GP Martin Scurr predicts that advice will change here in the UK too.

He said last night: 'I think we're at a tipping point where cholesterol is concerned. There have been a lot of vested interests in people talking about cholesterol because it's easy to convey to the public that fatty foods like butter, cheese and red meat are furring up their arteries. In fact there are many other risk factors involved but somehow we've become obsessed with cholesterol.'

London-based cardiologist Dr Aseem Malhotra, science director of campaign group Action On Sugar, wrote in the British Medical Journal that it was time to 'bust the myth of the role of saturated fat in heart disease'.

He added that the food industry had effectively contributed to heart disease by lowering saturated fat levels in food and replacing it with sugar.

Matt Ridley, a Tory peer and science author, yesterday said there should be an inquiry 'into how the medical and scientific profession made such an epic blunder'.

He described the change of advice in the US as a 'mighty U-turn' and said studies linking high cholesterol and saturated fat in food to heart disease were 'tinged with scandal'.

Monday, 18 May 2015

The Beginning of the World


From The Sword & Trowel 2014, issue 2 by Dr Peter Masters

The first chapter of a new book on Genesis due to be published in 2015

Setting aside evolution and affirming a literal six-day creation, this article focusses on the rich spiritual significance and the lessons of the order of events.

THE BOOK of Genesis is in every way the foundational book of the entire Bible. It is the supreme book of beginnings, chronicling the origin of the universe and the human race, the entry of sin into the world, and the launching of the history of redemption.

Many Christians do not know that all the great doctrines of the faith are introduced in this book, and portrayed in its pages.

This is in character a book of history, describing literal events. That is clearly how it presents its material, and how it expects to be understood. That is also how the rest of the Bible treats it. There is no human literature to equal the book of Genesis in depth and richness, explaining as it uniquely does the sinful human condition and situation.

Written by Moses, much of Genesis may have been drawn from pre-existing histories, compiled by inspired patriarchs of each generation, but if this is so, Moses would also have received a perfect revelation of all that took place. He did not have to sift and validate records like an uninspired historian. If they existed, he would have been moved by the Spirit to bring them together, and if necessary to correct them, by special inspiration.

In surveying the message of the opening chapters of Genesis, we will not give attention to the theory of evolution, or seek to demonstrate the scientific integrity of the biblical record. There are many books that do this very well, leaving us free to focus on the spiritual purpose and message. We certainly affirm that the Genesis record is literal, and not fictional, or analogical poetry.

The opening words are almost breathtaking for their dogmatic assertion of God. He is simply declared as the God who exists and rules over all. No attempt is made to justify belief in him. There could be no grander beginning, disregarding the insolence of mortal specks of dust who might demand a justification of God. The words, ‘In the beginning, God created…’ point in adoration and submission to the one true God, who pre-exists all material things, and is the Creator of all.

There was a beginning, we are told, when God brought everything into being out of nothing, and then created an ordered earth in stages. The point and message of these stages interests us considerably.

The first stage shows the earth without form and void. It appears to have been liquid mass, presumably containing suspended in it all the materials needed for the composition of the dry land, together with its biological decorations, and its creatures. At the very beginning it had no shape or form. Not that this indicated a disorganised mess, for ‘without form’ only refers to the absence of detailed features.

But why did God not bring the finished creation into being immediately, at a word, instantly forming dry land and seas, vegetation, hills and valleys? Why were there distinguishable stages of creation over six days?

In a way, a six-day creation is as good as an instantaneous creation, because only God could work so quickly. The unique and mighty power of God is just as fully demonstrated over six days, as in one. A creation period of six months may begin to suggest a limitation in God’s power, but a mere six days does not. But there is a reason to be sought for the elongated period.

One day there was a formless, inert, empty mass, lacking energy or movement. There was no character to it, and yet it would not be correct to say it was chaos in the modern sense of the word.1* Though formless and inert, it was a latent treasure store, an untapped source of wonders, a masterpiece in waiting.

It is the theory of evolution that starts the world as a disorganised, confused mass and puts disorder, confusion and meaninglessness at the forefront of its process. But God began creation with a first stage like an artist’s canvas, prepared as the foundation of a most marvellous work. It is evolution that must conjure order out of chaos by a cataclysmic accident.

We come back to the question – Why did God start with the formless stage? Part of the answer is that in Genesis 1 we see God presenting himself as the incomparable divine craftsman, building something wonderful. He calls us to see and follow his work, and to marvel at each stage. If all had been done suddenly, it would certainly have been marvellous, but we would not be able to appreciate the details.

However, the supreme reason for a phased creation is that God is exhibiting the significance of man, showing that he was working to a grand conclusion. The steadily building picture shows God fashioning everything especially for mankind, who would be the pinnacle of creation; the end-point, the highest peak. The great tapestry of creation unfolds in stages to show how much God has done for mankind.

* * *

THE BEGINNING of energy and form came as a distinctive act of God. We read that ‘darkness was upon the face of the deep. And the spirit of God moved upon the face of the waters.’ Then the Spirit of God exerted divine power, imparting energy to that inert, watery deep. The power of electromagnetic energy streamed in, and particles began to operate and function.

At the same time, or immediately afterwards, God pronounced: ‘Let there be light,’ and although there would be no sun until the fourth day, light flooded in directly from God, extinguishing the darkness. The sun would be formed later to show that God creates all energy himself, and the sun is merely an agent and a servant. To us the sun may seem mighty and supreme as a source of energy, but the creation order shows its true place. God was the founder of light, and in due course devolved that action to the sun.

‘God saw the light,’ we read, ‘that it was good: and God divided the light from the darkness.’ Light without the sun is right at the forefront of the creation of an environment for mankind, and this stirs us to reflect. The gift of light gives such a remarkable range of benefits. It is an extraordinary provision for man, being involved in countless biological systems, and especially given for man’s pleasure and delight; for discovery and education. Obviously, light exhibits and glorifies the features of God’s creation, in all their colour, movement and detail. And it constantly lifts the moods to which we are subject in our fallen phase of world history.

Light also speaks of divine influence, providing a metaphor for truth, spiritual understanding and salvation. If God ‘saw the light, that it was good,’ so should we, meditating thankfully on the great goodness of God in giving us the gift of vision, and filling the world with beauty.

We also read that God divided the light from the darkness. Even before the Fall, in a good and perfect world where there was no sin, there would be darkness, and there was a purpose in this. Even if man had lived on without a Fall, he may well have taken light for granted. By means of darkness we appreciate light, and here is a lesson in how God provides many fluctuating providences, so that we never take blessings for granted, and forget the One who gives them. From the beginning we are taught that God’s blessings are not necessarily constantly enjoyable, and we must learn to appreciate them by their temporary absence and withdrawal. So darkness is ordained, and so is rest, under its cloak of stillness.

Darkness, and the need for rest, would have taught Adam and Eve that even in the time of their perfectness, they were weak and dependent beings. God ordained the need for rest and revitalisation.

In our spiritual walk we may encounter a period of lost assurance not due to sin. It may be that God has drawn the clouds across the heavens so that we will seek him afresh, and appreciate the value of assurance of salvation. This principle was written into the earth even before the Fall, in the alternation of light and darkness.

On a technical point, we may be quite certain that in Genesis 1 the narrative refers to 24-hour days because it is so carefully, elaborately and repeatedly spelled out. The period of light is called day and the period of darkness, night. The evening and morning is said to constitute the first day. The formula is then repeated for every subsequent day. Short of accusing the Holy Spirit of misleading thousands of generations of readers, it is not possible to transcribe the narrative into poetic metaphor.

For the second day, we read, ‘And God said, Let there be a firmament in the midst of the waters, and let it divide the waters from the waters.’ A firmament means an expanse, referring it seems to the atmosphere. The earth is ‘the waters’ for the land has not yet been formed, above which is a layer of atmosphere, and above that is more water – an immense covering of moisture, far denser than the clouds we see today. This, presumably, was emptied upon earth at the time of the Flood. Though containing millions of gallons of water, it was a transparent layer of vapour, through which could be seen (once they were created) sun, moon and stars – the upper atmosphere. God called the firmament around the earth heaven, or skies. 

On the third day God commanded the waters of earth to be gathered together, and the land to appear, calling the land earth, and the waters, seas. So the land masses, perhaps the continents and islands, appeared. The narrative shows the environment being progressively modelled. Light is given, and darkness, then the atmosphere with its moisture canopy, and then land, possibly with great variation. God is seen forming all these step by step, making an exceptionally beautiful realm for the inhabitation of man.

Then greater beauty begins to appear: vegetation, grasses, herbs, trees, according to their kind, providing lavish decoration and fruit, ‘and God saw that it was good.’ All such things were produced in their mature state, fully grown, manifesting an apparent age. Perhaps if you had cut down a tree on the third day of creation you would have found it complete with rings, as though it had existed a long time.

On the fourth day the sun, the moon and the stars appeared, late in the creation order to demonstrate that they were created objects under the command of God, and not themselves gods to be venerated and worshipped. By the time of Moses the worship of heavenly bodies was everywhere embraced, but the inspired Genesis account refutes and rebukes it.

After the creation of heavenly lights came the fish and the birds (the fifth day), and suddenly the earth was filled with sentient life and moving beauty. The world was filled with wonder as the creation moved to a grand conclusion. Finally came the mounting climax of the sixth day when the animal kingdom was made complete, small and large land animals, all at first docile, amenable and extraordinarily beautiful, so that the earth was finished, furnished, and filled with interest and glory. Then, and not until then, God said, ‘Let us make man.’

The narrative here pauses and God appears to speak with himself. It is a pause to produce solemnity and attention, because the great purpose of creation is to be revealed, the chief objective. First, a glimpse is given of the incomprehensible, eternal council of the eternal persons of the glorious Trinity. The pause is a narrative affectation, in which even God appears to reflect on the momentous event of the birth of mankind.

‘And God said, Let us make man,’ the pinnacle of his plan, and let us make him ‘in our image, after our likeness’. Man will not be made divine, sharing his Maker’s divinity, but unlike the animals he will resemble God in priceless and significant ways. He will be given dominion over all other creatures, because he shares in small measure some of the very powers of God.

He will have the capacity to relate to God, uniquely (among creatures) possessing a soul. He will have the faculty of spiritual communication. He will also have the power of reason, like God, yet we barely dare to say so because man’s reason is immeasurably minute by comparison with God’s. Nevertheless he will have the gift of reason and rationality.

He will possess a will, a power to determine what to do, making him able to choose between options. He will have emotions far more elaborate than those of any animal. He will have moral consciousness, which will be housed in a conscience (which will be strongly activated from the time of the Fall). He will also have gifts of creativity and design, and language.

The dominion given to man over all other creatures would demonstrate his superiority and seniority over them. Man would so obviously be the special object of God’s love, and the purpose of creation. Not that man would have sovereign dominion, for that is God’s alone, but he would be manager of many things under God.

Of man, the record says that he was made ‘male and female’, introducing the institution of marriage.

We learn that our first parents were vegetarians, God saying, ‘Behold, I have given you every herb bearing seed, which is upon the face of all the earth, and every tree…to you it shall be for meat.’ The animals also consumed no flesh. Matters changed after the Fall, with the coming of ‘nature red in tooth and claw’, and man also being permitted meat (if not from that time, certainly after the Flood).

The Genesis record informs us that ‘God saw every thing that he had made, and, behold, it was very good.’ All was perfect. Nothing jarred refined sensitivity; nothing cruel was seen; no death was present, and no cry of pain. Probably animals lacked fierce teeth and savage claws before the Fall, and no predators stalked the earth, tearing apart weaker creatures.

The second chapter of Genesis continues the initial record of creation for three verses, which describe the conclusion of God’s work and the setting apart of the seventh day as a special day. ‘Thus the heavens and the earth were finished, and all the host of them. And on the seventh day God ended his work which he had made; and he rested on the seventh day from all his work which he had made. And God blessed the seventh day, and sanctified it.’

Had man not fallen, we presume that Adam and Eve and their offspring would always have commemorated the sabbath, making it a special day of remembering God’s creative work, and worshipping him.

People sometimes ask about the angels, but nothing is said, because they are not part of the material realm, and not relevant to the Genesis account until the Fall when Satan appears in the body of the serpent.

Critics of the Genesis record have long claimed that the second chapter presents information from an entirely different source, introducing major contradictions, but the claimed discrepancies turn out to be without foundation and even absurd. The second chapter introduces additional facts, but no contradictions.

Other doubters of the Genesis record, including mistaken Christians, are shaken by the claims of evolutionary theory, and give way to it. They take the view that the Bible is not a book of science, and must yield to the evolutionary explanation of origins. They say Genesis is a kind of allegory for the unsophisticated people of a pre-scientific age, and should not be taken as serious history. But throughout the Bible the Genesis account is attested as literal truth (including by Christ our infallible, divine Lord), and we must therefore believe it to be true.

Some Christians take a midway position, insisting that the creation account is not literally true when it speaks of a six-day creation (they prefer evolution over millions of years), but that it becomes literally true from the appearance of Adam and Eve. There are insurmountable problems with this idea, not least that it is not what the Bible says, and also, because it envisages a cruel earth with constant death operating the process of natural selection for millions of years before the Fall. However, it was by man’s sin that the Fall took place, and death came as the result. Before the Fall there was no death, and without death there can be no evolution, so we cannot accept the ‘halfway’ position that some Christian teachers have adopted.

One reason why Christians sometimes shrink from the six-day creation of Genesis is that they feel it is a hindrance to evangelism. Is it a stumbling block to witness? After so many years of evolutionary teaching it undoubtedly is. This was no doubt the aim of Satan in bringing about the theory of evolution. The intention was to shatter belief in the Bible, and to make it seem ridiculous.

However, even before evolutionary theory came on the scene the biblical account of a six-day creation drew scorn. John Calvin, writing in the sixteenth century, tells us that people called it absurd. It has long been a stumbling block to talk about creation, but it is just as much a stumbling block to talk about sin, or to mention hell, or to tell people about condemnation, or to speak of God coming in the person of Jesus Christ.

For millions of people all these things seem to be foolish, but we do not abandon the message on that account. We know that salvation is a spiritual work, and the Holy Spirit is at work applying it to souls. No matter how doubtful people may be about creation, or the Fall or the Gospel, when the Spirit works they grasp the reality and magnificence of these things, and are humbled before God.

We are aware that humanly speaking a six-day creation is a hindrance to belief, but because God is at work, to move, convince, and convict, we make no attempt to avoid it. The apostle Paul gives us confidence to trust the work of the Holy Spirit in the words of 2 Corinthians 4.6: ‘For God, who commanded the light to shine out of darkness, hath shined in our hearts, to give the light of the knowledge of the glory of God in the face of Jesus Christ.’

To Christians cowed by evolution, who choose to believe that God took millions of years to create the world and higher life forms, we say, What would God achieve by using such a process? Why would he do that when he possesses all the necessary power to fulfil his purposes at a word?

The writer has watched the building of the new American Embassy tower in London, and its surrounding apartment developments. They are high, and densely packed. Numerous high cranes have been erected, and there have been hordes of workmen, yet the development has risen laboriously slowly.

One of the grandest aspects of the Genesis account is that we see the entire creation, resplendent with extraordinary beauty and life, and finally culminating in man, achieved within six days; and all from nothing. We are not called to believe in a God who takes millions of years to do something, which might suggest to our mind weakness or inability, but in a God who extends the creation process across a mere week, and that only to show his thoughtfulness toward mankind.

Yet creation was no longer than six days, to show that nothing is beyond God’s power, including the salvation – in moments – of the most stubborn, arrogant and wilful sinners. Creation in six days engraves on our minds a worthy concept of the creative power of God, who can answer our prayers, and minister to us in the hardest conceivable situations and predicaments. Creation is God’s witness to the fact that nothing is too hard for him.


1* When our forebears used the word ‘chaos’ they simply meant that it was a formless mass, but in modern times the word chaos has assumed another meaning, signifying a disordered and confused mess.

Monday, 11 May 2015

You See Just The Tip Of The Iceberg and No, I’m not just ‘just tired'


A message for ME Awareness Week,  10 -17 May 2015

We have an illness called Myalgic Encephalomyelitis. You may know it as ME or Chronic Fatigue Syndrome.

You will rarely see us. Like the iceberg below water, 90% of us are invisible. We are at home, in bed. When you do see us, we look OK. Slow, pale and drawn, yes, but you will see no scars or bandages. Yet we are very ill.

Our quality of life is less than cancer and multiple sclerosis patients up to six months before their death but we are treated as though we just lack the will to do something. When young, this devastating illness is the biggest cause of long term absence from school. It robs us of our youth. When older, we lose our jobs, friends, and often our carers. That’s what our illness does.

The 10th of May is the start of ME Awareness Week. The ME Association has a very simple message. “Take ME seriously”. With your awareness and understanding, we can change the damaging perceptions of this illness and help to improve the lives of those who face it.

Neil Riley
Chairman, The ME Association

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No, I’m not just ‘just tired' - Mumsnet guest blog by Catherine Hale, 11 May 2015


As M.E. Awareness Week kicks off, CATHERINE HALE shares her experience of living with the illness.

Imagine this scenario: you’re woken in the night by chest pain. When you get up the next morning to do the kids’ breakfast your legs are like lead, your vision is blurred and when your seven-year-old asks for Coco Pops your brain reacts as though they’ve asked you for the cubic volume of the moon.

Suddenly you can’t stand up any more and everything around you disconnects. You are alone with the kids and you can’t get yourself to a doctor. Would you call a cab or an ambulance to take you to A&E?

I wouldn’t call either, because I know there’s no point. I have the illness known as M.E. or Chronic Fatigue Syndrome. This scenario is a regular occurrence for me when I have a flare up. Yet even when I’ve been taken to A&E, unable to move or speak, doctors draw a blank as to what’s going on inside my body. I get sent home with a paracetamol and a pat on the head, if I’m lucky.

M.E. is so poorly understood that doctors can’t even agree on its name. It stands for Myalgic Encephalomyelitis, but the medical establishment prefers the term Chronic Fatigue Syndrome. There is no test for it, let alone a cure, and it affects about 250,000 people in the UK.

The reason we sufferers hate the term Chronic Fatigue Syndrome (or CFS) is because the name is like a whitewash. People are disabled by M.E. to the point of losing the ability to walk, drive or read a newspaper – even to the point of needing tube feeding. But the label CFS implies we are just “tired”.

As my lovely friend M confessed to me the other day, after five years of our daughters being best friends: “It’s hard to understand you guys with M.E. because when you say you’re tired, it’s like, ‘well we get tired too’.”

Welcome to planet parent. How many other mums I know are thinking the same thing?

So what’s it really like to live with M.E.? Well, think of your mobile phone, which probably runs out of charge by the end of the day. People with M.E. are like mobile phones with knackered batteries that only charge up to about 10, 20 or 30 percent. After the equivalent of sending a couple of texts and checking the weather app our battery dies and we crash. That could be simply having a shower and getting dressed.

Friends see me walking my girls to school and smiling at the school gates, but what they can’t see is that the school run uses up about 60% of my energy charge for the whole day. Do the maths, and that doesn’t leave much for doing the dinner, the homework, the bedtime, the washing and the pre-teen dramas that command my daughters’ full attention.

I hate having to explain that I have a disability that prevents me taking my girls to Brownies after school, joining the camping weekend, pitching in with the school fair or helping friends out when they’re stuck for childcare – because for that snapshot in the day they see me looking entirely “normal”.

And I’m one of the lucky ones. My disability may be invisible, but the really invisible people with M.E. are those you never even see or hear about, because they are confined to a bed in a darkened room for years and sometimes decades at a time.

Every time I feel sorry for myself because I’m a disabled single parent I think of Jenny, and others like her. At 29, beautiful, talented Jenny longs for her first kiss and the chance to be outdoors with her friends, because a very severe form of M.E. has cruelly stolen her youth from her. M.E. doesn’t usually kill, but it can take your life away.

When I was 23 my M.E. was as bad as Jenny’s. My ‘battery’ wouldn’t charge at all, leaving me virtually paralysed and intolerant to all sensory stimulation. I couldn’t sit up, feed myself, hold a conversation or even listen to the radio. My mum and dad had to care for me as you would a newborn baby. I inexplicably recovered. Today I am ‘only’ moderately ill, whereas Jenny has remained in this state (which you can barely call living) for the past 12 years.

Every time I get down about all the things I can’t do with my girls – take them to the park, sometimes even read them a bedtime story – I remember there are others who would give their right arm to have even the halfway recovery that I’ve had. And the miraculous fact that I’ve had children at all chokes me up inside.

So next time someone tells you they have M.E., take it as a compliment that they’ve even shared this information with you. Assume nothing from their appearance about their day to day life. Don’t tell them about how you get tired too. Above all, remember: for every person you encounter with M.E., there’s another one who has disappeared from view.

By Catherine Hale

Catherine tweets as @octoberpoppy

Saturday, 2 May 2015

Treating Thyroid patients like children – Dr Malcolm Kendrick

http://drmalcolmkendrick.org/2015/05/01/treating-thyroid-patients-like-children/

Here is an imagined, but not far off the truth, conversation between a doctor and a patient.
‘Why can’t I have T3 doctor? I feel so much better when I do?’
‘Because I say so, now go away.’
Nowadays doctors, at least when they are in training, are repeatedly told that they must NEVER be paternalistic. To do so will result in immediate censure. In the UK it is also a very rapid way of failing the GP entrance exams. We are told that we must explore the patients’ expectations, listen to their worries and fears, and work with them in partnership to lead to a therapeutic partnership…. or some such left wing xxxxxxxx. [Joke]
How exactly that fits within the National Institute of Health and Care Excellence (NICE) guidelines is up for grabs. For those who don’t know, NICE decide on which drugs and interventions can be prescribed, or paid for, within the NHS. So you can explore expectations with your patient till the cows come home, only to find that you cannot prescribe what the patient wants, even requires. Even if it makes them feel much better and costs very little. Would you call this paternalism? Oxford entrance exam, discuss.
Don’t get me wrong, I think rationing is increasingly vital for healthcare provision, and at one point I supported NICE. I now realise how na├»ve and misguided I was…but that is a discussion for another day.
Where was I? Oh yes, T3. Most people have never heard of it. But I am willing to bet that if you have heard of it, and you are a patient, you will certainly know all about this particular hormone. You will definitely know about a thousand times as much as your GP, who may nod sagely when you mention T3. But frankly they are unlikely to have any idea what it is, or does.
To be honest, until about a year ago I had no real idea what T3 was either, but I have learned quite a lot since. Wikipedia states that: ‘The thyroid hormones, triiodothyronine (T3) and its prohormone, thyroxine (T4), are tyrosine-based hormones produced by the thyroid gland that are primarily responsible for regulation of metabolism.’ I would like to draw your attention to the fact that, in Wikipedia, at least, T3 is mentioned before T4 – which makes it more important?
In reality, in a physiological sense at least, T4 comes before T3, in that T4 is produced almost exclusively by the thyroid gland in a ratio of about 17:1 T4 to T3. Once inside various tissues and organs T4 is then converted to T3, where it becomes the biologically active hormone.
Whichever does come first, it can be argued that T3 that is the key thyroid hormone, because T4 is basically a ‘prohormone.’ From Wikipedia again: ‘A prohormone refers to a committed precursor of a hormone, usually having minimal hormonal effect by itself. The term has been used in medical science since the middle of the 20th century. Though not hormones themselves, prohormones amplify the effects of existing hormones.’ Although the figures are not absolutely clear cut, it is usually stated that T3 is five times more biologically active than T4.
Therefore, if someone is hypothyroid, which is normally taken to mean that the thyroid gland is not producing a sufficient quantity of thyroid hormone, you would want to prescribe the active hormone T3, would you not?
This is a rather rhetorical question because what doctors do, at least since the 1960s, is to prescribe synthetic T4 (levothyroxine). Once T4 is in the body it is converted to T3 (through the kidneys, liver, spleen and brain – and numerous other thyroid hormone receptors throughout the body) and does its thing. In most cases this is a perfectly good treatment. However, there is a kicker, which I will get to.
At this point I feel I need to add that hypothyroidism is a very, very common condition. By the age of 60, 10% of people have ‘lab’ test abnormalities that would define them as having subclinical hypothyroidism. At least 2% of the population has overt, clinical, symptoms. Which means that we are talking about millions of people in the UK, possibly tens of millions in the EU and US.[It affects women ten times as much as men].
TSH
I now need to bring in another player called Thyroid Stimulating Hormone (TSH). As with all systems in the human body, a negative feedback loop controls the function of the thyroid gland, and it works something like this:
If you have a high T4 level, this is detected by the pituitary gland, which sits deep within your brain. At which point the pituitary gland reduces the production of Thyroid Stimulating Hormone. As TSH is the hormone that instructs the thyroid gland to produce T4/T3, production of T4/T3 falls. [There are actually a couple of other steps, but this is essentially what happens].
If T4 falls too far, the pituitary gland swings into action to produce more TSH. In turn stimulating the thyroid gland to manufacture more T4…and so it goes. Up and down, up and down, up and down. Endlessly until, of course, you get too old and drop dead. And there ain’t no feedback loop for that.
TSH is also important in that it is usually the substance you measure to decide whether or not someone is hypothyroid. If TSH is very high this means it is trying to ‘drive’ the thyroid gland into action – and failing. You also use the TSH level to determine the dose of T4 that is required as replacement therapy. If the level of TSH is low, this suggests you may be giving too much T4. If the level of TSH is high, this suggests you may be giving too little.
As you may have noticed, at this point I have slipped into talking about TSH and T4, with T3 getting very little mention. That is because this is where the medical profession now stands. Hypothyroidism means high TSH and low T4. You are getting adequate thyroid replacement hormone if TSH in the ‘normal’ range. End of.
Here is what the Royal College of Physicians (RCP) and the British Thyroid Association (BTA) have to say on the matter. Key points only
  • The only validated method of testing thyroid function is on blood, which must include serum TSH and a measure of free thyroxine (T4).
  • Overwhelming evidence supports the use of Thyroxine (T4) alone in the treatment of hypothyroidism. Thyroxine is usually prescribed as levothyroxine. We do not recommend the prescribing of additional Tri-iodothyronine (T3) in any presently available formulation, including Armour thyroid, as it is inconsistent with normal physiology, has not been scientifically proven to be of any benefit to patients, and may be harmful. [Then again, it may not be – harmful, that is]
An aside – (Additional information, as provided to me)
I should mention here that I have been told that the RCP has been asked on numerous occasions to cite references to research/studies showing “overwhelming evidence supports the use of thyroxine (T4 alone)”, but to date, they have provided none. A Freedom of Information (FOI) request that the RCP provide such evidence – again met with no response. A request was made via the ‘Ask for Evidence’ website, run in association with ‘Sense About Science’ asking for evidence on the safety and efficacy of L-T4 as a treatment for hypothyroidism. This request was directed to the RCP who eventually responded stating “The RCP’s guidance is based on the opinion of an expert panel which was temporarily formed for this purpose. The evidence they used to form their individual opinions has not been collated and therefore the RCP cannot provide any evidence list”(Jollyas they say, good)
Restricting the diagnosis and treatment of hypothyroidism to measuring T4 and TSH, and nothing else, is the approach that seems to be used by conventional medicine in the rest of the World. I recently received an e-mail from someone in Singapore telling me that their doctor was about to be struck off for prescribing T3 to patients- against Singaporean medical rules. In the UK, T3 testing is virtually banned, and the medical authorities are making it virtually impossible to prescribe T3 in any form.
In the UK, a doctor called Gordon Skinner was repeatedly dragged in front of the General Medical Council (GMC) for prescribing thyroxine to patients whose T4 and TSH levels were in the ‘normal range’. He was also attacked for prescribing natural thyroid extract (NDT) (a combination of T4 and T3) to his patients – who he felt would benefit. He is now dead. It has been suggested that constant and repeated efforts to strike him off the medical register may have had an impact on his health. I couldn’t possibly say.
Now, there is no doubt that this area is highly complex and for those who know this area, you will be aware that I am keeping things as simple as possible. But I think it is important to make a few points:
The lab tests, especially for TSH, are far from 100% reliable, to say the very least. In fact the man who developed the test in the UK, at Amersham International in Wales, has told me that the test is virtually worthless in many cases (especially continuous testing when patients are taking thyroid hormone replacement).
The conversion of T4 into T3 can be significantly reduced in some people. So these individuals can have normal T4 and TSH, but they are still effectively hypothyroid. For those who are interested in a bit more detail, there is a population with a defective DIO2 gene. This blocks T4 to T3 conversion, and results (amongst other things) in reduced T3 levels in the brain, which can lead to mood disorders2. I mention this single example to make it clear that there is solid scientific evidence to back up the conjecture that it is possible to be functionally ‘hypothyroid’ with normal blood tests.
A lot of people have reported significant improvements in their health through taking thyroxine, with normal blood tests, and also natural thyroid extract when their laboratory tests were ‘normal’. Please look at this article in the Daily Telegraph3…then look at the comments section – which is very, very telling. A cry of despair!
I am not going into further detail of how T4 binding and conversion in various organs can be affected by stress hormones, inflammation, trauma, adrenal insufficiency, lack of converting enzymes in tissues, and infection of various sorts. I shall just keep this simple by stating that it is possible to have enough T4, even T3 in your bloodstream, but these hormones have reduced ‘bioavailability’. This is not crank ‘woowoo’ stuff. This is real and measurable and you can find studies on this in peer-reviewed medical journals.
Far more telling, from my point of view, is the fact that hundreds, indeed thousands of patients report that, although their blood tests were normal, they felt terrible, and that they have felt so much better when they have been given ‘excess’ T4 and/T3, or NDT (natural desiccated thyroid). Whilst there is no doubt that some of them are, to quote a medical colleague, ‘not tightly wrapped.’ I have spoken to many, many, people who are calm, rational and reasonable, and their stories are compelling. A hellish existence that was ‘cured’ by Dr Skinner and his like. I refuse to believe that all of these patients are ‘somatising’ fruitcakes.
Comparing the use of SSRIs and ‘Unconventional’ Treatments for Hypothyroidism
At this point I will change tack slightly. For I think it is fascinating to compare and contrast the treatment of depression using SSRIs, with hypothyroid patients who complain that they are unwell, despite ‘normal’ T4 and TSH tests.
Today, almost all doctors you speak to believe that depression is due to a low level of serotonin in the brain. This is why they prescribe SSRIs (Selective Serotonin Reuptake Inhibitors) by the lorry-load. Drugs such as Prozac, Zoloft, Paxil etc.To quote from a recent article in the BMJ ‘Serotonin and depression, the marketing of a myth’4.
‘…the number of antidepressant prescriptions a year is slightly more than the number of people in the Western World.’
This all happens despite the fact that:
‘There was no correlation between serotonin reuptake inhibiting potency and antidepressant efficacy. No one knew if SSRIs raised or lowered; they still don’t know. There was no evidence that treatment corrected anything.’
In short, with depression, there is no lab test, no way of measuring the impact of anti-depressants. They are prescribed purely and simply on the basis of the patient history. Equally, there is no doubt at all that SSRIs have significant side-effects, some of which are very, very serious e.g. increased suicidal tendency. They are also addictive and patients can end up stuck on them for years. So, they do cause harm.
Equally, as you may be aware, clinical trial data in this area have been horribly distorted….
“…That said, the fact that the class of antidepressants known as the selective serotonin reuptake inhibitors (SSRIs), are basically useless in treating depression in children and adults is not news to the FDA. Back on September 23, 2004, during testimony at a hearing before the House Oversight and Investigations Committee on Energy and Commerce, Dr Robert Temple, the FDA’s Director of the Office of Medical Policy, discussed the agency’s review on the efficacy of SSRIs with the children.”
He noted that it was important in a risk-benefit equation to understand the benefit side. “Of the seven products studied in pediatric MDD (Prozac, Zoloft, Paxil, Celexa, Effexor, Serzone and Remeron),” he testified, “FDA’s reviews of the effectiveness data resulted in only one approval (Prozac) for pediatric MDD.”
“Overall,” Dr Temple said, “the efficacy results from 15 studies in pediatric MDD do not support the effectiveness of these drugs in pediatric populations.”
Also in 2004, a study of previously hidden unpublished data as well as published studies on five SSRIs, was conducted by Tim Kendall, deputy director of the Royal College of Psychiatrists’ Research Unit in London, to help analyze research to draw up the clinical guidelines for British regulators, and published in the Lancet.
Following his evaluation, Mr Kendall stated: “This data confirms what we found in adults with mild to moderate depression: SSRIs are no better than placebo, and there is no point in using something that increases the risk of suicide.”
In 2005, the British Medical Journal published another study that concluded that SSRIs are no more effective than a placebo and do not reduce depression.
In December 2006, at the most recent FDA advisory committee meeting held to review studies on SSRI use with adults, SSRI expert, Dr David Healy, author of, “The Antidepressant Era,” told the panel that the efficacy of SSRIs has been greatly exaggerated, while the actual studies reveal that only one in ten patients responds specifically to an SSRI rather than a nonspecific factor or placebo.
In February 2008, Irving Kirsch’s study at the Department of Psychology at the University of Hull is the first to examine both published and unpublished evidence of the effectiveness of selective serotonin reuptake inhibitors (SSRIs), which account for 16 million NHS prescriptions a year. The largest study of its kind concluded that antidepressant drugs do not work. More than £291 million was spent on antidepressants in 2006, including nearly £120 million on SSRIs. 4
Critics complain that industry funded studies are presented in ways to exaggerate benefits and obscure side effects. “These include failure to publish negative results, the use of multiple outcome measures, and selective presentation of ones that are positive, multiple publication of positive study results, and the exclusion of subjects from the analysis,” according to the paper, “Is Psychiatry For Sale,” by Joanna Moncrieff, in People’s Voice.”5
So we have an interesting medical conundrum, do we not? On one hand, doctors are more than eager to prescribe antidepressants at the drop of a hat, based entirely on the patients reported symptoms. No need for any blood tests, and no evidence that they work for the vast majority of people.
On the other hand, if a patient dares to say that they feel better taking T4 when their blood tests are normal, or if they say they feel better taking a combination of T3 and T4/NDT, they are dismissed as ‘somatising.’ Which is a posh medical way of saying, you are making your symptoms up and we don’t believe you. Equally, if a patient complains of continuing symptoms and that they don’t feel better when they are taking T4 (or T3 and T4) and their blood test results show ‘normal’ they are again accused of ‘somatising’6
The world, my friends, has gone nuts and, in a bitter irony, the medical profession – at least in this area – has become institutionally paternalistic. ‘You cannot be feeling better, because your blood tests say you were never unwell. So you cannot have treatment. And you, Dr Skinner and your like. If you dare treat patient’ symptoms you will be attacked and struck off from medical practice.’ Now I have looked long and hard, and I have found no evidence, from anywhere, that giving T3, in the dose that’s needed, causes any significant medical problems, and I have listened to repeated testimony from people who feel they have greatly improved.
As for antidepressants, these mostly useless addictive drugs that can increase suicide risk. ‘Have as many as you like for as long as you like. Because we fully believe everything you say about your symptoms….’ No need for any silly tests, or anything like that.
Compare and contrast, then try to make some sense of the medical world that we now live in.
Sigh.
P.S. Because I am considered to have alternative views about medical matters, many people contact me to help promote their ‘alternative’ ideas. Some I believe to be completely whacko, I smile sweetly and move on. Some I cannot decide. Other issues, once I start looking into the evidence, I find the evidence compelling.
I certainly find the evidence that a large number of people are effectively hypothyroid, with ‘normal’ thyroid blood tests, to be virtually overwhelming. Both from a scientific/physiology basis, and also from a patient testimonial basis.
I now firmly believe that the medical profession is currently doing these people a great disservice, and that the guidelines on the treatment of ‘hypothyroidism’ are rigid, autocratic, and just plain wrong (for a significant minority).
As with all medical matters that I write about, I have no axe to grind, no horse in the race, no financial links to anyone or anything with regard to treating thyroid patients. I simply hope this article can have some positive impact. For it seems very clear to me that many thousands, hundreds of thousands, of people are suffering unnecessarily. And I would like it to stop.
References:
  1. http://www.scottish.parliament.uk/S4_PublicPetitionsCommittee/General%20Documents/PE1463_AAA_Petitioner_19.11.14.pdf
  2. “Common Variation in the DIO2 Gene Predicts Baseline Psychological Well-Being and Response to Combination Thyroxine Plus Triiodothyronine Therapy in Hypothyroid Patients”http://press.endocrine.org/doi/pdf/10.1210/jc.2008-1301
  3. http://www.telegraph.co.uk/news/health/alternative-medicine/10985192/Could-a-renegade-doctor-save-your-life.html
  4. Serotonin and Depression, the marketing of a myth.’ BMJ2015;350:h1771
  5. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al. “Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration.” 2008, PLoS Med 5(2): e45 doi:10.1371/journal.pmed.0050045: Access full article at http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050045
  6. http://www.lawyersandsettlements.com/articles/ssri_birth_defects/ssri-secret-00642.html#.VT-ycCG6eUk
  7. Professor A Weetman – http://www.medscape.com/viewarticle/524955
Further postscript
Malcolm – we need to clear up the fact regarding the definition of ‘hypothyroidism’ which is “underactivity of the thyroid gland” according to the RCP Policy Statement on the diagnosis and management of hypothyroidism. Hypothyroidism is easily diagnosed and more often than not, easily treated with L-thyroxine only. However, what is being missed by everybody is that over 300,000 UK citizens (15% of the thyroid community – millions worldwide) have a normally functioning thyroid GLAND, but the hormone it is secreting is not getting into the cells where it does its work. These are the folk who need T3, in combo. with T4, T3 alone or in NDT. The RCP teaching curriculum makes no mention of the possibility of a non-thyroidal condition where patients suffer the same symptoms and signs of hypothyroidism that may need to be treated with a different medication or hormone. When these patients complain of continuing symptoms when treated with L-T4 monotherapy, many are given an incorrect diagnosis of ME, CFS, FM, depression, functional somatoform disorder – or even old age blah, blah, blah – and sent on their way without further investigation or treatment. This is a serious business, which the RCP and BTA choose to ignore.