Hormones, Vitamins, and minerals all have extensive interactions in the give-and-take of the bodies’ ballet of homeostasis. No where is this more clear-cut than the interplay of parathyroid hormone, vitamin D, and calcium.
Although it has many other actions in the body, calcium is best known as the prime component of our bones. It is essential for making them healthy and strong. The bones act as a storehouse or vault for the bodies calcium. The parathyroid hormone is the key that unlocks the vault to release the calcium so it can perform its many other roles in the body. An elevation of the calcium in the blood stream shuts down the parathyroid Glands.
Parathyroid hormone also acts to instruct the body to absorb more vitamin D, just as the vitamin D causes the intestinal tract to absorb more calcium. The parathyroid glands are in the upper poles of the thyroid which as we mentioned before sits astride the windpipe. Sometimes the parathyroid gland develops an adenoma which causes too much secretion of parathyroid hormone.
This results in an excess of calcium in the body and a variety of symptoms, such as joint pain muscle weakness, fatigue, nausea and vomiting. One of the technicians in my medical practice developed hyperparathyroidism. It was detected by a metabolic panel, which showed an elevation of serum calcium.
This discovery, early in my practice, made me a big fan of metabolic panels when patients have general symptoms. Her condition, a parathyroid adenoma, was cured by surgery. Conversely, surgery for an overactive thyroid can sometimes accidentally remove the parathyroid glands if the surgeon isn’t careful. The parathyroid glands are tiny, but they perform a huge function.
Thyroid stimulating hormone (TSH) is one of a series of regulatory hormones to come from the pituitary gland, often called the “master gland“ of the body. Most of the pituitary hormones are released upon signals from the hypothalamus, part of the real master coordinator of the body, the brain.
TSH Instructs the Thyroid gland to produce more Thyroid hormone. When more Thyroid hormone is produced, The increase of Thyroxin in the bloodstream causes the TSH level to drop.
Our metabolism is full of these servomechanisms which control the level of critical substances. When the thyroid does not function properly, and the thyroid level drops, the TSH is increased. An elevated TSH it is presently the best test we have for hypothyroidism.
Conversely, when there is excessive thyroid activity (hyperthyroidism), the TSH level drops to vanishingly low amounts. Tomorrow the subject will be thyroxin.
Most boys and perhaps some girls would prefer to be taller. Human growth hormone is secreted by the pituitary gland with increased production during puberty. Pituitary growth hormone stimulates the liver to produce insulin like growth factor, and assay of IGF-1 is a test for GH deficiency.
Small stature and low growth velocity in children often benefit from growth hormone, But adults have closure of the growth plate and do not grow taller with GH.
Pituitary tumors require the removal of the pituitary gland, and this is the major cause of low growth hormone in adults. Replacement growth hormone is clearly indicated here. Most adult use of growth hormone is because of its apparent beneficial effects on vigor and aging, but this may be ill advised; please check the following Harvard article.
Since growth hormone is anabolic, and favors growth and protein synthesis, it enjoys some use in athletics and the health industry. Most likely, it is a two edge sword that should be regulated properly and not used in the absence of deficiency.
Colonoscopy is good preventative medicine for everybody over the age of 50. A video was posted yesterday on colon cancer metastatic to the liver. Although this is treatable, metastatic colon cancer is a miserable condition, markedly lowering quality of life. You are much better off preventing colon cancer then having to deal with it, and in this sense, colonoscopy is a very good trade off.
Colonoscopy is no fun. You have to modify your diet well in advance, and take a magnesium citrate clean out in order to get rid of fecal matter that would prevent proper visualization of your colon. You should get your first colonoscopy at age 50 or earlier depending upon your family history of polyps, colon cancer, and other bowel problems.
In my own case, I had a number of colonoscopies, and nothing serious was discovered. I still think it is a very good idea. Although I never had a colon polyp or cancer discovered, I have recently, at the age of 89, developed bladder cancer of the slowly progressive and non-invasive kind.
The thought occurred to me that getting regular cystoscopies might catch bladder cancer at an earlier stage. I was told by an authoritative Physician that this has previously been tried and not proven to be useful. I also recommend going into a dermatologist regularly to remove actinic keratoses, which have the capability of developing into cancer. I believe you cannot be too vigorous with preventative therapy.
Interestingly, good sleep, diet and exercise are recommended in the prevention of colon cancer. Please refer to the mayo clinic article on colonoscopy for more information.
Adrenaline (epinephrine) was first discovered when the adrenal gland was ground up and injected, producing an increase in the pulse rate. it has a myriad of uses, and often In emergencies when speed of injection is of great importance. You may you recall the controversy when the price of EpiPen was jacked up to ridiculous levels.
Adrenaline is intimately involved with cortisol in emergency stress reactions. Adrenaline increases cortisol production, and cortisol increases the number of cell membrane adrenoreceptors. Adrenaline is much more rapidly acting, and cortisol sticks around for a while keeping the stress response going.
Adrenaline produces a myriad of responses that are beneficial when you’re trying to run away from that sabertooth tiger. Just like cortisol, it increases the pulse rate, blood pressure, blood sugar and heart rate. It opens up the bronchial tubes so you can breathe better, and also increases muscle strength and alertness, with a negative affect.
As mentioned in the article on cortisol, stress has a negative connotation at present, even though it was vital to our survival as a species. I can’t tell you how many shots of adrenaline I gave to my asthmatic patients. Medications to prevent asthma are much more numerous these days and adrenaline is rarely needed for Asthma any more.
Adrenaline is still very useful, however, in cardiac arrest, and Anaphylactic reactions. You may recall having read about Anaphylactic reactions from the Propylene glycol in some Covid immunizations. In the long run You will do better to keep your stress levels down. Try to avoid talking about family affairs, religion, and politics.
Its decision time for Covid vaccines, especially for 88-year olds. The choice is among live-attenuated vaccines, whole virus vaccines, Split virus vaccines, and RNA vaccines, and I prefer the latter because of its simplicity. It delivers just the mRNA coding for covid spike protein, without the risk of a live vaccine, and the extra substances in whole and split- virus vaccines.
mRNA utilization for a vaccine is not new technology. The idea has been floating around for decades in cancer immunotherapy research. The sophisticated understanding of the technology is reassuring. It has a high efficacy, approaching 95%. Between the Pfizer and Moderna mRNA vaccines, I prefer the Moderna vaccine, because the Company was already working on a mRNA platform for MERS, a Covid-family virus, and has developed their own lipid capsule as a vector.
The Moderna vaccine does not require the extremely low storage temperatures like the Pfizer product. With all production located within the company, Moderna will be ready to go if a new strain nullifies covid 19 vaccines, or if another virus spreads worldwide. Timing is important. The mRNA vaccine requires 2 doses. I intend to take the first Moderna dose when I can get it locally without standing in line.
Since I intend to continue Masking and Distancing until the cases in my community are low, I will probably delay the second dose until summer, to increase my likelihood of effective antibody levels this coming fall and winter. Also, there will be more information by that time on the Vaccine’s effectiveness and duration in the Elderly.
The pathogenicity of the English, or any other newly mutant strain will be hopefully known by Summer. The rapid Covid test using sputum, and outpatient treatment with monoclonal and convalescent antibodies for early cases will then be available. I want a treatment plan in case I get infected. This is a treacherous, nasty infection.
Mutation is engrained in the very nature of life. Even if there were no X-rays, free radicals or toxic chemicals, mutation still would take place because of errors in the replication of DNA that occasionally escapes the proofreading mechanisms of meiosis and mitosis.
The majority of germline mutations produce LOSS OF FUNCTION, and are weeded out by evolution. In vertebrates, mutation is vital in producing the random changes in the DNA of germ cells of the ovaries and testes. If the mutation is beneficial, involving a GAIN OF FUNCTION, environmental selection acts to preserve the change, producing the diversity of organisms in the world, each exploiting a different environmental niche.
It is the rare species so versatile, like the shark, that can remain almost the same over eons without dying out. In the teeming unicellular world, mutation in the genome is similarly useful in allowing for variations which often prove useful for survival. The mutations thrive if the proper environment presents itself. For instance, antibiotic resistance may be encoded in a few members of a bacterial species, which become the dominant members in an infected patient on antibiotic treatment, and crowd out family members without the mutation.
In Viruses, RNA is often the Memory nucleotide. RNA is less stable than DNA. The resulting instability allows more mutations, and sometimes greater success. An example is the English Covid variant in the spike protein which leads to greater contagion. Hopefully, the spike protein change will not be so successful as to interfere with the effectiveness of vaccine-produced protective antibodies.
The Mutations we have been discussing refer to GERMLINE mutations, which occur in the gonads. In higher animals, germline mutations affect the offspring, which then carry the mutation. A GAIN OF FUNCTION mutation may confer greater adaptability and survivability, and perhaps may lead even to a different species, if the troop number is small and the environment demanding. Non-germ SOMATIC cell mutation may lead to undesirable effects like cancer, which is another discussion.
The RNA molecule is central to life. It is the information molecule of the Pandemic SARS CoV 2 virus, whose Messenger RNA specifying Spike proteins is the basis of 2 recently-released vaccines.
“RNA Life” is the leading theory for the Origin of Life itself, more than 3 Billion years ago. DNA evolved as the blueprint information molecule in cellular life, but the ubiquitous RNA may well have become the first viruses.
The stage was set for the ongoing battle of life: Parasite vs. Host, Pathogen vs. Target, but recent research reveals a much more nuanced picture. Viruses and bacteria can be BENEFICIAL as well as deleterious. We now speak of the MICROBIOME, usually referring to our host of resident BACTERIA, and the VIROME referring to all of our indwelling VIRUSES.
INFECTION is how we experience our interaction with microorganisms, their benefits unseen. Bacteria, viruses and parasites have always been with us, increasing in impact as Paleolithic man crowded into agricultural settlements.
Enlarging cities became more dense, favoring spread of infection and PLAGUES. The Bacterium, Yersinia Pestis,emerged in Roman times, causing the Justinian plague, and resurfaced in the 14th C. as the Black Death. Viral Plagues, including Smallpox, were devastating during European adventures into the New World.
Malaria, a one-cell Eukaryotic Parasite, may be the greatest killer of all time. Modern Sanitation and improving medication have lately pushed bacterial infections into the background.
Viral infections such as Influenza and most recently Covid have become the Modern face of infection. Many Viruses reduce Immunity, however, paving the way for bacteria to invade: Haemophilus influenzae, a bacterium, may have caused much of the mortality of the 1817-1918 Flu epidemic.
IV drug usage has facilitated the spreading of the viruses causing Hepatitis and AIDS. The immune-compromising nature of the latter has reinvigorated TB and Syphilis, both bacterial infections. Only a few years ago, bacterial infection was thought to be conquered by antibiotics, and viral infection contained by Vaccines.
Microorganisms are constantly evolving, however, and often share their resistance factors. Infection is no more a thing of the past than War. The Battle continues.
The adaptive immune system is the “big gun”, later evolved, big brother of the innate immune system. The innate immune system acts a little like prejudice does in society. There is INSTANT RECOGNITION of a salient characteristic of many common disease-producing organisms, that are not present in the person being infected.
For instance, ENDOTOXIN is a lipopolysaccharide present in many bacteria, and is immediately recognized by Toll-like Receptors (TLR-4) on dendritic cells and macrophages. This triggers the Natural Killer (NK) cells to destroy the invader. The problem is that the innate immune system is indiscriminate, reacting against whole classes of molecules like a shotgun, and may produce unwanted damage. It also fails to recognize many genuine threats.
The ADAPTIVE immune system is more complex, discriminant, and SPECIFIC, but is SLOWER to gear up, and takes several days to be effective. Once engaged, however, it has a MEMORY for the infection that is SPECIFIC to the organism involved. This memory makes a SECOND EXPOSURE response much more rapid and comprehensive, AMPLIFIED as it is BY ANTIBODIES.
This first experience can be PROPHYLACTICALLY accomplished by VACCINES, so that the second, real exposure generates a RAPID PROTECTIVE RESPONSE. ATTENUATED vaccines are weakened, but LIVING ORGANISMS, and usually provide a more DURABLE immunity, but because they are living, they are more worrisome.
SPLIT-PRODUCT Vaccines are safer, but expose the immune system to a narrower range of pathogen markers, and may therefore be less Protective.. The FDA is very dedicated to SAFETY. Like all Bureaucracies, it is relatively independent of Political pressure, of which I am increasingly appreciative.
When the COVID-19 VACCINE, for example, is released to the general public, it WILL BE SAFE. The vaccine-deniers are mis-informed people who should not, in my opinion, be allowed to interfere with the HERD IMMUNITY that comes with having a supermajority of the population vaccinated.
Sometimes I wake up in the morning with a feeling of RELAXED ENERGY. My mind is clear, I have no fatigue, and believe once more that the world is wonderful, and it’s great to be alive.
I St-re-tch, exercise my hands (I have Osteoarthritis, and they are stiff), take out my Nite guard ( I grind my teeth at night and would otherwise wear them away), take my beta blocker eye drops ( to lower my intraocular pressure) and wash down my Eliquis ( an anticoagulant to prevent stroke from my Atrial Fibrillation) with 16 oz. of water, while thinking about all of the delights awaiting me.
Yes, my body was in better shape 60 years ago; but I had much more responsibility then, and much less discretionary time. All things considered, I like to believe that I am happier now.
The KEY is to stay in GOOD HEALTH. GOOD SLEEP is critical, but it cannot be had by willpower alone. As I have discussed previously, you need a bedtime routine, good SLEEP HYGIENE.
You also need a…….. GOOD DIET. with lots of fruits, vegetables and whole grains. Fatty, spicy foods will stay in your stomach and bother you at night, particularly if you eat Late. I like to finish eating by 5 PM. Late dinner is also likely to produce GERD, and maybe Sleep Apnea.
GOOD EXERCISE is also critical. If you are not tired at the end of the day, it is hard to get good sleep. I always seem to sleep better on the day when I walk the hills for an hour, which is 3 days a week. Try not to exercise within 2 hours of bedtime. Assuming that you have a good base of SLEEP, DIET and EXERCISE, there are other mechanisms that can foul things up. INFLAMMATORY conditions often cause fatigue.
The most common inflammatory diseases are OBESITY, METABOLIC SYNDROME and DIABETES. OBESITY is the defining disease of our EXCESSIVE SOCIETY, where there is too much of everything, and excessive consumption is relentlessly advertised everywhere.
External correction is probably a pipe dream, since there is no will even to Tax Sugar-containing Beverages, the “low hanging fruit” of dietary excess. Internal correction is all that is left, and that takes WILL POWER, also in short supply.
INFECTIOUS DISEASES are a subset of inflammatory conditions. COVID 19 is the poster child of infection, and FATIGUE is one of the hallmarks of the disease. Interleukins, like TNF-alpha, IL-1, andIL-6 are some of the defense factors which cause the fatigue. AUTOIMMUNE Diseases like Rheumatoid Arthritis and Lupus are also associated with fatigue-producing interleukins.
Fatigue even has its own flagship disease, CHRONIC FATIGUE SYNDROME. Chronic viral disease has been suspected as the cause of this condition, and inflammatory cytokines may be elevated. This condition, and the similar GULF WAR SYNDROME are still poorly understood. Several CFS patients were sent to me when I was in practice, and I had some success in getting them to exercise regularly, which seemed to help. CANCER is another category of diseases where Fatigue is prominent.
Inflammation plays a role in these diseases, which also drain energy substrates from the Patients body; Cancer cells have a high metabolic requirement. MEDICATIONS, Cancer meds especially, but a variety of other Drugs are associated with FATIGUE. I went through MY MEDICATION LIST. Lo and behold, 3 of them are associated with fatigue.
Finasteride is a relic of my prostate operation, recommended to keep it from growing back. It causes fatigue, probably because of its ANTITESTOSTERONE effect. At least I can still pee, and am not bald. I take METFORMIN because of its fame in prolonging life. Its mechanism is that of interacting with the Sirtuin system, and increasing the inefficiency of mitochondria. Isn’t this surprising?
Like many other things in physiology, you place a stress on the body, and the body responds by improving its performance. If you are fatigued, you exercise. Respecting the body works with drugs as well. If you are drinking a ton of coffee and stop it, after a few weeks you will feel less fatigued.
And when you ARE FATIGUED, you drink a LITTLE coffee, and it wakes you right up. Caffeine works by displacing ADENOSINE, which causes Fatigue as it increases through the morning, peaking at SIESTA (or tea) time,at about 2 PM. OMEPRAZOLE, which I take to prevent HEARTBURN, also is related to fatigue especially if it blocks MAGNESIUM for long enough. DEPRESSION overlaps with fatigue, as does SLEEPINESS, to increase the complexity of the situation.
Many chronic LUNG, KIDNEY and LIVER diseases are associated with fatigue as a secondary concern. STAY HEALTHY!
–Dr. C
Empowering Patients Through Education And Telemedicine
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