Text of paper I originally submitted November 12, 2013 for ENGL 201 at Midwives College of Utah
Pregnant women with hypothyroidism often have concomitant risks associated with obesity and deficiencies in iodine and iron. Furthermore, hypothyroid patients may not respond to mainstream treatment modalities, especially if they do not address all issues simultaneously. Due to the high risks related to anemia, iodine deficiency and hypothyroidism during pregnancy, midwives should consider the therapeutic utilization of bioavailable plant-based nutrition, including herbal supplementation.
Zimmerman determined that obesity increases the amount of hepcidin produced by the liver. He found that heightened hepcidin levels not only predict iron deficiency but are also implicated in a decreased physiological ability to absorb iron from the diet (2009). A correlation between low iron and high hepcidin levels in the blood was also found by Roe et al (2009). In 2011, Dambal, Indumati and Kumari discovered that obese people suffer from low micronutrient levels. Scholars have acknowledged the correlation between hypothyroidism and obesity but debates have continued as to which condition is the root factor (Verma et al, 2008; Biondi, 2010).
The link between hypothyroidism and iodine has been well established (Barnes & Galton, 1976; Stern & Altschule, 1936). Vila et al recently confirmed that iodine deficiency is the leading cause of hypothyroidism (2013). Barnes discovered a connection between the hypothyroid condition and heart disease (1976) while Zimmerman expanded that understanding. He found that low iodine raises TSH concentration in the blood, possibly precipitating “dyslipdemia and other cardiovascular disease risk factors” (2009). Both Zimmerman and Barnes recommended therapeutic iodine supplementation (1976, 2009). Along with iodine, Barnes endorsed the use of natural dessicated thyroid (NDT), as did Stern & Altschule, thus illustrating the oncecommon use of this dual therapy (1976; 1936). Today’s medical professionals typically treat hypothyroidism with inexpensive levothyroxine sodium, a synthetic form of thyroxine (Vila et al, 2013). Practitioners have advocated replacing NDT with levothyroxine because of the belief that NDT has “highly variable biologic activity” (Nava-Ocampo, Soldin & Koren, 2004). However, it should be noted that the FDA issued a similar statement in regard to levothyroxine in a 1997 warning about its variable potency levels. The attempt should always be made to ameliorate the hypothyroid condition, since low thyroid hormone levels deleteriously affect all systems of the body (Curley, 2009, p.20-21).
For over a decade, scholars and doctors have warned of decreasing iodine intake in the United States (Hollowell et al, 1998; Dunn, 1998; Eastman & Zimmerman, 2009, Brownstein, 2012; Cousins, 2013). Brownstein has argued that people are not getting enough iodine from table salt and asserted that iodine supplementation will not instigate or aggravate thyroid disorders (2012). Toxic bromide has replaced iodine in the dairy and bread industries (Hollowell et al, 1998; Brownstein, 2012). Furthermore, Eastman and Zimmerman listed many thyroid-harming substances found in the environment, including radiation and organochlorides like DDT (2009).
Iodine and thyroid hormone deficiencies have serious implications for pregnancy. Hypothyroid women are more likely to develop gestational hypertension (Nava-Ocampo et al). After age 30, they are at high risk for endometriosis, ovarian failure, recurrent miscarriage and reduced success with artificial insemination (Vila et al, 2013). The higher hormone levels pregnancy requires cannot be accomplished without increased iodine uptake and it has been shown that mothers with insufficient iodine can experience thyroid malfunction, excessive glandular stimulation, hypothyroxinemia and goitrogenesis (Preedy, Burrow & Watson, 2009). In addition, fetal risks substantially increase for intrauterine death, intrauterine growth retardation, neonatal goiter, pre-eclampsia, miscarriage, placental abruption, prematurity, perinatal mortality and stillbirth (Eastman & Zimmerman, 2009; Nava-Ocampo et al, 2004; Vila et al, 2013). Babies may be born with cretinism, hearing loss, goiter, “permanant mild to severe psychoneuro-intellectual impairment” and greater susceptibility to radioactive iodine (Preedy et al, 2009, p.501; Hollowell et al, 1998). Patients desiring iodine supplementation are typically encouraged to use inorganic forms of iodine such as potassium iodide (SSKI) or Lugols (Brownstein, 2012; Barnes, 1976).
Yet Eastman and Zimmerman informed us: “very little scholarly information is known on the bioavailability of iodine… [In fact] inorganic iodine (in excess) [is] goitrogenic” while the effects of iodine deficiency are “similar to those exhibited with thyroidectomy” (2009). The bioavailability of a micronutrient is that amount which is not just ingested but actually assimilated by the body (Davidsson & Haskell, 2011). The preeminent herbalist of the 20th century, Dr. John R. Christopher, long asserted that inorganic iodine is poisonous while organic iodine is not. Organic iodine is available from the green husk of two species of the walnut, Juglans nigra and Juglans regia (1976, p. 200-201). Dudnic found walnut extract efficacious in the treatment of induced hypothyroidism (2009). A study on mice showed Juglans regia enhanced thyroid activity and was minimally toxic (Ozturk, Aydin, Arslan, Baser & Kurtar-Ozturk, 2006). In 2013, another investigative team determined that Juglans regia’s flowers are antihemolytic (Ebrahimzadeh, Nabavi & Nabavi). Three sources from Drum (2012) have explained the high importance of daily natural iodine ingestion, especially in light of heightened worldwide levels of radioactive iodine since the Fukishima disaster. Drum also highlighted the importance of obtaining adequate sleep and avoiding all other members of the halogen family, junk food, dairy and stress (2012). Schlussel also warned against foods and substances that contribute to malabsorption of micronutrients (n.d.). Finally, Preedy et al reported the key finding that for some populations, iron deficiency and iodine deficiency occur together, and for these individuals, iron deficiency impairs iodine absorption. Furthermore, “iron deficiency in itself can affect thyroid function even in the absence of iodine deficiency” (2009, p.53).
In the herbal world, anemia has been defined as a shortfall in the number of red blood cells, hemoglobin or both that causes increased levels of carbon monoxide in the blood (Herbal Legacy, n.d.). It has been shown that most cases of anemia are not caused by iron deficiency (Oregon Evidence-based Practice Center, 2006). In fact, Erslev reported that the origins of anemia are complex and may involve many organs and systems. He observed, “many hypothyroid patients have a hypoplastic anemia that is unresponsive to therapy with iron, vitamin B12 or folic acid and is very similar to the form of anemia observed in thyroidectomized animals” (n.d.). Preedy et al pointed out that parasites could thrive in an iodine deficient environment and cause anemia (2009, p.503-511). In 1936, Stern & Altstadt explained that the anemia of myxedema, or severe hypothyroidism, was caused by decreased formation of blood due to lack of bone marrow resulting from low levels of circulating thyroid hormone. While no significant changes occurred when large doses of iron were given, they treated the anemia successfully with NDT. Dambal et al found significant hypoferremia among overweight and obese individuals though they could not determine the cause (2011). In 2009, Zimmerman postulated that higher hepcidin levels found in obesity reduce dietary iron absorption. A team of scholars also uncovered a significant correlation between hepcidin levels and iron levels in the blood (Roe, Collings, Dainty, Swinkels & Fairweather-Tait, 2009).
Anemia during pregnancy carries associated risks for mother and baby. Mothers may require blood transfusion, have poor pregnancy outcomes and suffer from postpartum depression (Oregon Evidence-based Practice Center, 2006). Negative outcomes for the infant include premature birth, low birth weight, prolonged neonatal care, developmental delay, the onset of iron-deficiency anemia in infancy (Oregon Evidence-based Practice Center, 2006) and serious, permanent damage to both the hippocampus of the brain as well as the nervous system (Radlowski & Johnson, 2013). Herbalists have taught that most iron supplements prescribed to correct anemia are inorganic, destroy vitamin E levels and cause problems throughout the body (Herbal Legacy, n.d.). They have recommended the daily intake of iron-rich foods as the appropriate prophylaxis (Schulze, 2008; Herbal Legacy, n.d.).
Bearing in mind that greater fertility problems are associated with hypothyroidism (Vita et al) it can be inferred that the fetus of a hypothyroid woman has already overcome great odds by reason of its conception. Midwives should bear this in mind while remembering that though the risks of imbalances related to hypothyroid gestation are clearly understood, science is just beginning to comprehend the delicate, manifold relationships between thyroid hormone levels, weight gain, blood iodine quotients and anemia. Therefore, midwives should be bold to investigate, encourage and utilize both mainstream and alternative nutritional modalities for best maternal and fetal outcomes.
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AUTHOR’S NOTE TO THE READER 26 Jul 2014: