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How to Cure Hypothyroidism and Anxiety

January 24, 2020 by Dr. Gil Winkelman 19 Comments

In medicine, hypothyroidism and anxiety aren’t typically associated. It is usually depression associated with a low thyroid function and anxiety with high. But many of my patients found their anxiety disappear with proper thyroid function. Why is this? Could low thyroid be the answer to treatment-resistant anxiety? Many patients come to me taking thyroid but are not feeling better. Others presented with subclinical hypothyroid. Why is this? Let’s explore more about these issues. I should note that hormone interactions in the body are very complex. This article does not serve as a full primer but a short introduction.

Before jumping into the complexity of hormones, I want to review the scope of the problem. Anxiety occurs in 30-40% of patients with hypothyroid. They can also have irritability, depression, learning issues, and poor concentration.

The Causes of Hypothyroidism (and Anxiety)

Most research suggests that doctors should not give medications for depression and anxiety until they check thyroid levels. While I agree with the approach in theory, it’s not as simple as testing thyroid.
To understand the paradox of this problem, I want to explain a bit about the hypothalamic-pituitary axis (HPT). This may be technical but bear with me. The hypothalamus and pituitary are in the brain, controlling hormonal function in the body through different hormones. The hypothalamus produces Thyrotropin-releasing hormone (TRH) to signal the pituitary to make thyroid-stimulating hormone (TSH). TSH signals to the thyroid to produce T4 (Thyroxine) which is stored in the thyroid gland until the body needs to use it. When the body needs energy, T4 converts to T3 (Triiodothyronine).

Because T3 is so potent, the body only converts what it needs when it needs it and mostly inside the cell. T3 then crosses into the nucleus and started turning genes on. If you have listened to my podcast about methylation and epigenetics, there may be a connection here. Remember that everything you eat, drink, breathe, and experience can change your genetic expression. Specifically, high or low methyl may affect T3 binding at specific sites, thereby producing different results. The following are  required for the thyroid to work:

  • Hypothalamic/pituitary function
  • Secretion of TSH
  • Thyroid function (secretion of T4)
  • Thyroid hormone transport into the cell
  • Conversion of T4 to T3
  • Receptor binding
  • Downstream activation

There are a lot of steps. I want you to remember this list because it will be important in a moment.
But the doctor said my thyroid levels were normal!
Both the tests for thyroid and their interpretation are problematic. Typically, most doctors only run a TSH to see if thyroid is functioning well. But many recent research studies suggest that TSH is a poor measure of thyroid function. Several studies concluded that looking at just TSH does not show how cells are utilizing thyroid.

Some doctors know this and also measure T4 to determine thyroid function. There are problems with this approach. First, both TSH and T4 measure supply of thyroid hormone. A normal TSH means that the pituitary receives the message from the hypothalamus to tell the thyroid to produce thyroid. When these numbers are normal, most likely, your  thyroid is working. But often in hypothyroidism, the problem stems from somewhere further downstream from the gland. Look at the list above. There are four more steps below the level of the thyroid that can lead to hypothyroidism.

More Problems with Thyroid Tests

If TSH or T4 is off, most clinicians give T4! That helps nothing further downstream, and it could make things worse for many people too. Why? Because the body may convert too much T4 to reverse T3. This blocks the receptor sites for good T3 but no cell activity changes. Reverse T3 also stops conversion of T4 to T3. When this occurs, treatment to reduce reverse T3 must be given before thyroid function can return to normal.
The other big problem with this testing is that it presupposes that if there’s T4 that the T4 is getting into the cell and the body is converting it all to T3. But that is not always the case.

But my doctor tested the T3 and it was normal!
I’ve done that too but what we are finding that measuring T3 and T4 are not always good indicators of thyroid function either. One problem is that T3 is an intracellular component meaning that we don’t see a lot in the blood. Therefore, doing a blood test tells us nothing about how the cell is utilizing T3.

But the biggest problem with these tests is that many common conditions skew the results. For example, patients with fibromyalgia have low normal TSH normal T4 but low T3. Doctors typically treat these patients as though their thyroid is either normal or on the high end. Patients who are obese typically have thyroid results that do not correlate with their symptoms. The same is true of patients with high levels of inflammation and diabetes.

Many conditions may be issues of conversion of T4 to T3. Why is this happening? Much of the research suggests that chemicals such as flame retardants, bisphenol A, plastics, heavy metals and such. These compounds may disrupt the energy production mechanisms in cells called mitochondria.

Why am I Anxious if I’m Hypothyroid?

You may wonder how this related to anxiety. The short answer is we don’t know. My best guess is that the sympathetic nervous system kicks in to speed up processes in the body. Adrenaline rushes over long periods leads to anxiety.

If you suffer from anxiety, depression, learning issues, or brain fog, it’s time to get your thyroid checked. There are better ways to test thyroid than just doing a TSH including taking your temperature or measuring other hormone in the body such as sex hormone binding globulin. This is what I do in my practice now instead of measuring just the thyroid levels.  I am certified in Wilson’s Temperature Syndrome therapy, a novel approach to correct issues with thyroid conversion. In  fact many people who were previously diagnosed with Hashimoto’s or other thyroid issues, regained healthy thyroid function after  this  treatment  approach. Schedule  with me if you want to learn  more.  Your path to feeling better is just around the corner.

Filed Under: Uncategorized

Pyroluria Supplements and Test Kits: How to Improve Your Anxiety

February 7, 2018 by Dr. Gil Winkelman 13 Comments

Jason’s parents brought him to my clinic because of violent behavior. (I am not using anyone’s real name.) Several suspensions from school alerted his parents there may be a problem. But it was his punching a hole in the wall of his bedroom that led to the call to me. Lisa’s anxiety became so debilitating that she didn’t want to leave her house. By the time she called to make an appointment, she had confined herself to only her room and the adjoining bathroom. Clark’s sudden mood swings correlated with depression and not knowing what he wanted to do with his life. Though very smart and done well in school, Clark was currently underemployed. His mom convinced him to see me. We sent pyroluria test kits to all three of these patients, and I knew the results would be positive.

While depression, anxiety, oppositional defiance disorder (ODD), and reactive attachment disorder (RAD) may arise from different causes, pyroluria should be ruled out as the cause of these and other mental health problems. Testing is easy to do at home. The lab sends a pyroluria test kit; the sample is collected and sent back to the lab. After Jason’s mom called, we had results within two weeks, and I developed a treatment plan of vitamins and minerals ready for Jason.

“He’s a different kid,” his mom reported to me after the first follow-up appointment. “Had I known that treatment was so simple, I would have called you much sooner!”

Jason is not unusual. I have treated hundreds of people with pyroluria over the last seven years with great success. A pyroluria test kit is inexpensive and easy to do. Pyrrole supplements cost little and are simple to take. If that is the only imbalance in the body, we see changes in the person within a month.

What is Pyroluria?

What exactly is pyroluria? Confusion abounds as to how to explain pyroluria or Pyrrole Disorder. Other names include Mauve Factor and Kryptopyroluria. Many doctors do not recognize the clinical significance of pyrrole disorder. Though I didn’t learn about it in medical school, I can assure you that pyroluria is real.

Kryptopyrroles seem to appear under conditions of oxidative stress in the body. The body produces an unusable form of the part of the red blood cell that holds the oxygen, called a heme-ring. This molecule, harmless in most people, will deplete the body of nutrients such as zinc, vitamin B6, and gamma-linolenic acid (GLA) in others. People who have pyroluria be in normal range for these nutrients in their blood tests but still have symptoms. What are some of the symptoms? The chart below shows the effects of pyrrole disorder. You only have to have two or three to be positive. Oddly, there isn’t always a correlation between symptoms and amount of pyrroles. I have seen patients with extremely high numbers but few signs and patients with lots of symptoms and a low kryptopyrrole result. Over the course of the next could of articles, I’ll explain why that is. Suffice to say, pyroluria can affect different parts of the body in different ways.

Why would oxidative stress lead to the creation of kryptopyrroles? The short answer is we don’t know. There are many different theories, but the one I like the best is trauma. Early childhood trauma seems to be a commonality of people with this condition. Pyrrole disorder and oxidative stress, in general, seems to be a physiologic response to emotional or physical trauma. Jason’s parents adopted him as a baby. Early childhood wounding contributed to his behavior. Pyroluria may be a clue to mind-body connections; the bridge between the trauma that one experiences when younger and the physical symptoms that occur later in life. A diagnosis doesn’t mean that psychotherapy is unnecessary, but it can make it more successful.

pyroluria supplements and symptoms

Pyrrole supplements make a huge difference in the patients who have pyroluria. Treatment plans are inexpensive and easy to follow. While the number of pills can be daunting, most people find it effortless to integrate the task into their day. And the results are extraordinary. Lisa’s anxiety abated so she could continue her life again. Jason finished high school and responded to the new counselor his parents arranged. Clark’s mood swings disappeared with pyrrole treatment, and his motivation returned. “I feel that I have my son back,” his mother said to me. “He’s calm, funny, and is starting to have direction in his life again. He’s doing great!”

You too can get help. If you or a loved one has some of the symptoms listed, call or email us today. We will be happy to send out a pyroluria test kit and consult about the results, which we can do via an online doctor consultation. Pyrrole supplements can be life-changing. We’d be happy to help facilitate moving you into a happier place.

Though the patients mentioned in this article had an easy time with treatment, not everyone does. The next article will discuss some of the pitfalls of self-treatment.

Filed Under: pyroluria, Treatments, Uncategorized, Walsh Protocol

How to Benefit from Online Doctor Consultations

January 26, 2018 by Dr. Gil Winkelman 6 Comments

Online doctor consultations are becoming more popular. And why not? Patients don’t have to travel to the office, park the car, and wait for the doctor. You can stay in the comfort of your home and consult with the doctor through your computer or phone. But are online doctor appointments good for everyone? Not likely. But for many people, virtual medical visits provide a simple approach to medical care. Let’s explore what online doctor consultations look like with Dr. Gil and what sort of conditions are appropriate for treatment.

Online Doctor Consultations with Dr. Gil

Dr. Gil has been using telehealth services for mental health for many years. The process begins with either a phone call or email and determine if labs need ordering. If you have the correct labs run relatively recently, there’s no need to repeat them just yet. Sometimes Dr. Gil orders additional labs, especially if you attempted similar treatments that didn’t work or only had partial results. Labwork performed by other providers may be reviewed before your appointment.  Labs aren’t required for every patient before the first appointment but can expedite the treatment process. For most patients in the US, we can arrange for the lab collection to occur near your location. Outside the US, some results are challenging but not impossible to obtain. The office staff assists as best it can to help you get what is required.

Before the appointment, you will fill out an extensive questionnaire that combined with the lab results helps Dr. Gil uncover possible causes of the ailment.  The first appointment lasts up to an hour whereby Dr. Gil comes up with a treatment plan for your condition. You can merely order the vitamin and supplements from Dr. Gil’s medicinary or obtain through another source.

Conditions Treated During Online Doctor Consultations

It is difficult to say what conditions can or cannot be treated online. New technologies are making it possible to do medicine via telehealth services. Dermatology, for example, is moving to a model that allows doctors to diagnose skins conditions via online doctor consultations. Some situations require an in-person visit before telehealth services will be useful. The Walsh Protocol, a system that uncovers nutrient deficiencies causing mental health issues, can be productive using telehealth services for mental health.  Some of the conditions that Dr. Gil treats using online doctor consultations include:

  • Oppositional Defiance Disorder
  • Reactive Attachment Disorder
  • Conduct Disorder
  • Anxiety
  • Depression
  • Bipolar
  • Schizoaffective Disorder
  • Autism/Asperger’s
  • Obsessive Compulsive Disorder
  • Attention Deficit Disorder (ADD/ADHD)
  • Migraine Headaches

Insurance may or may not cover telemedicine visits but may reimburse the lab fees. Check with us first about whether coverage is possible. Neurofeedback services typically require appointments to be in-person.

Demand for online doctor visits has increased as patients discover its advantages.  Find out for yourself how easy it is to get help for you or your family member. Schedule today for a free pre-consultation.

Filed Under: Telehealth Services, Uncategorized, Walsh Protocol

The Colossal Mistake of Everyone Taking Methylated Folate

June 9, 2017 by Dr. Gil Winkelman

NB: This article was modified March 2024. I am offering two new courses about this. The short course covers the specifics of folate, what to do, how to figure out if there’s an issue, and a decision tree to determine what to do if you have trouble with folate. The longer course goes into other problems related to anxiety and other mental health issues

(I also published this article in Holistic Primary Care about the topic.)

I get a lot of questions about the methylation cycle and taking methylated folate. In articles and podcasts, I go into great detail about undermethylation. This causes a lot of confusion amongst patients because most providers don’t understand the full impact of methylated folates. Folate is a wonderful vitamin for many people. But for undermethylators, folate can cause problems. Why is that? To understand the issue, we have to first understand more about the methylation cycle, DNA, and why genetic tests may not be the right approach.

Methylated folateUndermethylators are one of the primary subtypes described by the Walsh Protocol. To understand why folate is a problem for them, we should discuss undermethylation.

Methylation is the process where DNA gets “tagged” by a small hydrocarbon group. Methyl is one carbon and three hydrogens. Carbon can bond to four different atoms, so a methyl group has one spot that allows it to attach somewhere else. The body uses methyl in many reactions and one of them is to turn off DNA.

How does it do this?

Though we are not exactly sure, methyl groups change the charge of chromatin, making it bind tighter to histones. What does this mean? The DNA is less accessible for transcription, so turning off those genes. Acetylation has the opposite effect. Here DNA becomes more available and turns genes on. Folate appears to increase acetylation of chromatin, though the mechanism is unknown.

One gene methyl turns off is the serotonin reuptake gene. Folate or folic acid appears to turn this gene on. If you have too much serotonin reuptake happening, serotonin levels will be low. If you have too little reuptake, serotonin will be too high. (Yes, you can have too much serotonin in your body and some people do.)

Undermethylators with anxiety or depression are vulnerable to folates. The folates turn on the serotonin reuptake gene that is already not downregulated because of the lack of methyl. For some people, they find that a sudden intake of folic acid causes a precipitous drop in mood or exacerbation of symptoms.

This gets further complicated when you add in high S-Adenyl-Homocysteine (SAH) a substance that regulates the enzyme methyltransferase. (This is a topic beyond the scope of this article for the moment. But the plasma methylation test is a wonderful way to determine if one is an undermethylator and the best treatment approach.)

NOTE: If you are a pregnant woman, it is advisable to have your folate levels measured to determine the amount of folate to take.

What about Methylated Folate?

What about methylated folate? Isn’t that supposed to help undermethylators? Many providers prescribe it because folate is intimately involved with recycling homocysteine into methionine. This drives the production of methyl in the 1-carbon cycle in the body. But Dr. Walsh has shown something odd about this. All folates turn on the serotonin reuptake gene so that serotonin levels drop and you have a recipe for problems. Likely, this happens because the DNA responsible for the production of the SERT gene has greater exposure to transcription factors. Increasing methyl causes this to reverse so there is less transcription of the gene.

Having said that, many undermethylators show temporary improvement because of taking methyl folate. After two to three months, the person devolves again. The methyl donation from the methyl folate gets overshadowed by the effects of folate on the body. So the person gets worse.

This is when patients call me. Fortunately, it’s not too late to feel better under this circumstance. A proper treatment plan can benefit everyone. Undermethylators respond slowly; some people may not get a benefit for almost a year after treatment starts.

To learn more about methylation, I’m planning a course that goes into greater detail about the topic and how to recognize the differences between overmethylation, undermethylation, and another underlying issue. A deeper course covers more information  Or if you think you may be an undermethylator or overmethylator, call today to schedule an appointment. Let me review your medications and supplements to ensure you are taking what is right for your healing process.

Filed Under: Treatments, Uncategorized, undermethylation, Walsh Protocol

What you Need to Know About Getting Pyroluria Disorder Symptoms

August 29, 2016 by Dr. Gil Winkelman 8 Comments

Pyroluria is more common than previously though. Pyro-what? What is this disease? The word pyroluria is a combination of pyrrole and urine. It refers to a molecule that shows up in the urine in most people.  There are different things that can cause pyroluria. For many people, pyroluria treatment can be life changing.  And many kids with Reactive Attachment Disorder or RAD Disorder have pyroluria. Behavior problems can disappear with simple natural treatments. Pyrrole Disorder symptoms are diverse. Let’s explore what pyrrole disorder is and what the symptoms look like.

Pyroluria is a condition that leads to an incomplete breakdown of red blood cells. This causes the formation of small molecules called kryptopyrroles that bind to zinc and B6 in the body. As a result, the body registers a deficiency of both those nutrients. There are many theories about what causes pyroluria but the reality is that we don’t know.  It is definitely a sign of inflammation in the body. Some of the possible causes are as follows:

  • Genetics. Pyroluria does seem to run in families. I have tested kids who are siblings where both have had it many times. But not all the time. If a relative suffered from depression, schizophrenia, bipolar disorder, alcholism, or another mental health condition, get tested.
  • Childhood Trauma. There may be an epigenetic component to the condition. Trauma may cause a rise in inflammation in the body and lead to this condition.
  • Chronic infection. It is difficult to know if the problem exists because of the infection or if the lack of zinc leads to poor immunity.
  • Alcoholism of the sufferer or parents.
  • Environmental toxicity. Heavy metal poisoning in particular could play a factor in the cause of pyroluria.
  • Processed foods. A standard American diet of processed foods and sugar can stress the body out and lead to absorption problems.

Stress may be a trigger to pyroluria or it could be a result of it. It is not clear at the moment.

What are Pyrrole Disorder Symptoms?

Pyroluria has some distinct symptoms. I have a questionnaire that helps people determine if they have the condition. Most of the symptoms that I see in my practice revolve around mental health problems. But many people experience problems with other areas of the body.  Let’s start with the mental health symptoms first though.

Mentally, people feel stressed. There is a high amount of severe inner tension or anxiety. Tolerance to stress is low. For example, someone who easily stresses out with minimal traffic may have pyroluria. Social withdrawal is common as is sensitivity to crowds.

But more severe mental health symptoms exist too. There can be periods of mild to severe depression followed by hyperactivity. Episodic anger outbursts or other mood swings are common. Panica attacks or severe anxiety. They may enjoy an argument but be upset by criticism. In severe cases, pyrolurics may hallucinate or have delusion disorder.

Physical symptoms also exist though. Here’s a partial list:

  • Fatigue easily likely due to nervous exhaustion.
  • Insomnia.
  • Poor dream recall
  • Ringing in the ears.
  • Digestive disturbances including irritable bowel, abdominal pain, and frequent gas and bloating. (They may have tried avoiding meat as a way to deal but this actually makes the problems worse as we’ll see.)
  • Gluten intolerance
  • Blood sugar control. There may be hypoglycemia with blood sugar drops.
  • Allergies to food or the environment
  • Frequent illnesses
  • Morning nausea and poor appetite in the morning. They may skip breakfast.

There are some people who have few of these symptoms but may still have pyroluria. You may have done blood work for zinc for example and shown that it is normal but still have symptoms of zinc deficiency. This is typically caused by pyrrole disorder. So what can you do? My article about pyroluria gives suggestions but the short answer is get tested! I can do pyroluria testing and help develop a custom treatment plan via telemedicine services. Call today to learn more.

Filed Under: pyroluria, Treatments, Uncategorized, Walsh Protocol

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