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I’ve written enough articles on thyroid health to fill an entire e-book: all about low T3 syndrome, five thyroid patterns that won’t show up on standard lab tests, the little-known cause of hypothyroidism, and the gut–thyroid connection.
Thyroid hormone regulates a great deal of metabolism, and virtually every cell in the body has a receptor for thyroid hormone. In a recent podcast, I mentioned poor thyroid function as one of the six underlying causes of high cholesterol. In this article, I’ll discuss exactly how your thyroid impacts lipid metabolism, cholesterol levels, and other risk factors for cardiovascular disease. First, though, a quick review of the major hormones involved.
The thyroid is a small butterfly-shaped gland that sits at the front of the neck. It receives a hormone signal from the pituitary and secretes other hormones into the bloodstream. You might be familiar with these hormones, which are included in a full thyroid panel:
Thyroid-stimulating hormone (TSH): This hormone is released by the pituitary gland and reflects the body’s need for thyroid hormone. This means that when TSH is high, not enough thyroid hormone is being produced (hypothyroidism). When TSH is low, there is more than enough thyroid hormone in the body (hyperthyroidism).
Do you have heart disease or high cholesterol? You might want to get your thyroid checked
Thyroxine (T4): The thyroid gland releases large amounts of this largely inactive form of thyroid hormone, which must be converted into the more active T3 by deiodinase enzymes. Low amounts of T4 may indicate hypothyroidism; high amounts may indicate hyperthyroidism.
Triiodothyronine (T3): This is the active form of thyroid hormone, secreted in small amounts by the thyroid gland and formed from the conversion of T4 to T3. T3 is the primary thyroid hormone that will act on cells all over the body to regulate metabolism. Low amounts of T3 may indicate hypothyroidism or low T3 syndrome; high amounts indicate hyperthyroidism.
If thyroid medication is given for hypothyroidism, it is usually in the form of T4, T3, or a combination of the two.
The association between thyroid function and cholesterol has been known for quite some time. As early as 1934, it was recognized that “the concentration of blood cholesterol is usually raised in hypothyroidism, and lowered slightly in hyperthyroidism” (1). Today, a PubMed search for thyroid and cholesterol yields more than 3,000 articles—yet few people, and even few doctors, are aware of how various thyroid conditions can impact cholesterol levels.
Let’s review the four major types and how they impact basic cholesterol measurements:
Hypothyroidism: People with an underactive thyroid, or hypothyroidism, often have increased levels of total cholesterol and LDL cholesterol (2) and may have elevated triglyceride levels as well (3). Thyroid medication can significantly improve lipid profiles. A study in newly diagnosed hypothyroid patients found that total cholesterol and LDL cholesterol levels decreased after T4 treatment. Those with higher TSH levels (indicating a greater need for thyroid hormone and a greater degree of hypothyroidism) at baseline saw a more dramatic reduction in cholesterol levels with T4 therapy (4).
Subclinical hypothyroidism: Subclinical hypothyroidism (SH) is characterized by elevated serum TSH with normal levels of free T4 and free T3. Subclinical hypothyroidism is far more common than overt hypothyroidism and may affect up to 9 percent of the population (5). Studies are mixed on the effect of subclinical hypothyroidism on lipid profiles, but even within the normal range of values, increasing TSH is associated with an increase in total cholesterol and LDL cholesterol (6, 7). One systematic review found that T4 substitution therapy on average resulted in an eight mg/dL decrease in total cholesterol and a 10 mg/dL decrease in LDL cholesterol in people with subclinical hypothyroidism (8).
Thyroid autoimmunity: Autoimmunity is a major cause of hypothyroidism. An estimated 90 percent of people with underactive thyroid have autoimmune thyroiditis, also known as Hashimoto’s disease. People with high-normal TSH levels that have positive anti-thyroid antibodies are even more likely to have abnormal cholesterol levels. On the bright side, their cholesterol levels are more likely to respond to thyroid medication (9).
Hyperthyroidism: While not as common, hyperthyroidism is associated with low levels of total cholesterol, HDL cholesterol, and LDL cholesterol (10, 11). While this may seem like a good thing, low blood cholesterol has been associated with altered cell membrane function, depression, anxiety, memory loss, and increased mortality (12, 13, 14).
Fair warning, this section contains the nitty gritty details of lipid metabolism. If you’re not in the mood for a physiology lesson, you can skip on to the next section!
Thyroid hormones regulate cholesterol synthesis
You may have heard that dietary cholesterol doesn’t have much impact on blood levels of cholesterol. This is because cholesterol is also synthesized by the liver. This process is tightly regulated by several hormones, including thyroid hormones. TSH increases the expression and activity of an enzyme called HMG CoA reductase, which controls the rate of cholesterol synthesis (15). This means that hypothyroidism increases the amount of cholesterol produced in the liver. This cholesterol is then packaged with triglycerides into VLDL particles, which are shipped out to the bloodstream.
Thyroid hormones affect lipoprotein lipase (LPL)
VLDL particles travel through the bloodstream until they reach the small blood vessel beds, where they encounter an enzyme called lipoprotein lipase (LPL). This enzyme breaks down the triglycerides in the VLDL particle into fatty acids, which are taken up by adipose, heart, and muscle cells. T3 stimulates LPL to increase this breakdown of triglyceride-rich VLDL (16). Eventually, the cholesterol content of the lipoprotein becomes higher than the triglyceride content, and these particles become LDL.
Thyroid hormones increase LDL particle uptake
LDL particles circulate around in the blood until they bind to LDL receptors. This binding triggers the capturing of LDL particles into the cell. There, the LDL particles are degraded and the contents used for cell membrane structure or converted to other steroid hormones. Through several mechanisms, T3 increases the expression of LDL receptors (17, 18). This reduces the amount of time that LDL particles spend circulating in the blood and the total number of LDL particles in the blood.
Thyroid hormones affect LDL particle oxidation
Excess LDL particles in the blood can cause some particles to “crash” into the blood vessel wall and be taken into the inner lining of the blood vessel. Once there, the LDL particles can become oxidized, which triggers inflammation and is thought to be the major event initiating the formation of arterial plaque. T3 acts as a free radical scavenger and may protect LDL from oxidation (19). However, high free T4 can also enhance LDL oxidation (20). Thus, both hypo- and hyperthyroidism can lead to LDL oxidation.
If you’ve been following my work for a while, you probably know my opinion of statin drugs. Here are just a few of the articles I’ve written on statins:
But it turns out that statin use is particularly concerning when the cause of high cholesterol is poor thyroid function. This is due to the effects of statins on creatine kinase levels.
Creatine kinase (CK) is an enzyme expressed in many different tissues throughout the body, though it’s probably most well-known for its action in muscle cells. CK is responsible for adding a phosphate to creatine to form phosphocreatine, which serves as an energy reservoir and allows for the quick release of energy in times of need.
Both statins and hypothyroidism result in CK release into the blood, and the cumulative effect is severe CK elevation (21, 22). This can potentially amplify the adverse side effects of statins. Statins can cause a variety of skeletal muscle problems, including damage and inflammation to the muscle. Based on several case reports, researchers have speculated that the use of lipid-lowering agents in hypothyroid patients may severely increase the risk of myopathy and rhabdomyolysis (23, 24).
Yet, in reviewing the relevant medical records of 77 patients treated receiving statins in a hospital, a team of medical researchers discovered that only 23 percent of patients had received a thyroid panel before beginning statin treatment. Worse yet, 12 percent of patients with overt hypothyroidism received statins without receiving a thyroid panel or hypothyroid diagnosis (21).
The authors commented on their findings, emphasizing the need for routine thyroid screening in patients with lipid abnormalities:
“We must not begin and continue to use these drugs without checking the possibility of hypothyroidism.” (21).
Statin drug information in Japan and the UK now includes warnings that emphasize the need for careful use in patients with hypothyroidism. The same cannot be said for the United States or in other countries. Thus, it’s very important to exclude other diseases that cause high cholesterol, such as hypothyroidism, diabetes, and kidney dysfunction, before even considering taking a statin.
Wait, but I thought cholesterol tests were out—aren’t lipoprotein particle numbers what we really care about?
Yep. I’ve discussed in several articles and on my podcast why lipoprotein particle numbers are much better predictors of cardiovascular risk than cholesterol levels. However, there are few studies that have assessed the effects of thyroid hormones on lipoprotein particle number, compared to the number of studies that have assessed standard cholesterol measurements. Still, we see similar effects:
Thyroid health also impacts other cardiovascular risk factors:
I hope I have convinced you that thyroid function plays a major role in lipid metabolism. I can’t tell you the number of patients I have seen in my clinic with lipid abnormalities that had undiagnosed thyroid conditions. Restoring thyroid health by correcting nutrient deficiencies, rebalancing the immune system, and making simple diet and lifestyle changes can often make a major difference in cholesterol levels and cardiovascular risk markers. In some cases, thyroid support in the form of medication may also be helpful and is much less harmful than statins.
Now I’d like to hear from you. Do you have cardiovascular risk factors? When was the last time you had a full thyroid panel? Did you know about the thyroid–cholesterol connection? Share your thoughts in the comments below.
As it’s a much better reflection of what actually goes on offline and in our chats.
– We like to cheat snack
– We like to > travel (With the new S-curvish bod)
– We like to look the part, but aren’t fitness addicts (Which is why we’ve come up with super efficient ways
Even in person. I can usually spot a stranger from a far (Woman). And can tell if she would be, or currently is, a fan of the lifestyle we live here.
I haven’t talked about this topic for a while. And I’ve recently been giving out a lot non-fitness info to help you along @ life.
But the fact is… Your goals will change over time.
This is what it looks like for most.
We had to break it down like that inside the S-curve formula process too. So that it can be effective for everyone.
Aphrodite Butt Building routine – For women aged 18-35 (Ambitious over 35’s).
Short Splits Routine – For busy women aged 25-45.
S-curve Bodyweight Circuits – Not age specific. But definitely for those who live a more mobile lifestyle.
But the one thing I can say. Is that starting earlier in life, is much, much better.
Not so much in regards to looks (Although that is the protocol goal). But more so for the…
– Habits you’ll build
– The increased positive energy that starts to surround you @ people
– The increased confidence and fixed mindset
Once again… All of that is non-fitness stuff. Which is arguably more important. And definitely helps you keep your physical results when they come.
Also… Your muscles start to fade after 18 years old. And the time doesn’t come back. So you really need to be saving your current day old self.
Because today is the youngest you’ll ever be, ever again.
Your body can look hot up until 60 years old, if you stay active, in the way that is taught.
Your skin and your face is what may let you down though. We’re not experts in that area. But some starter tips would include…
– Drink plenty of water
– Don’t stay in the sun for too long
– Get your 8 hours sleep
– Eat A-C rated foods/meals
– Brush your teeth
Ya… Basic s***. You just need to do it all consistently.
Habit building helps with that… Hence, why we have a process for achieving that within the S-curve formula.
A lot has changed in regards to that, since the start of the year. But we’re still hot on the topic. Just keep on watching.
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Evening primrose oil, also known as EPO, is a popular supplement with numerous health claims. But is it as healthy as it seems, and what are the potential health benefits?
Evening primrose oil is a plant native to North America, which bears yellow flowers that bloom in the evening, hence the name evening primrose oil. EPO is found in the plant’s seeds and is high in essential fatty acids (roughly 25 percent EFAs), meaning they are required and essential for our health, but cannot be made by the body. The seeds of the flower are gathered together and cold pressed to make their oil, which can later be encapsulated to be used as a dietary supplement.
EPO is the most researched source of GLA, which can also be found in borage oil, black currant oil, hemp, and spirulina.
While EPO has several proven health benefits, it’s especially helpful for these six areas.
Essential fatty acids are the building blocks of hormones, which are required for nearly every metabolic process in the body. Fatty acids found in EPO can help support hormone balance, reduce inflammatory prostaglandins, and even support endocrine disorders such as PCOS, which can impact fertility, ovulation, and the regularity of menstrual cycles.
EPO also helps to modulate prostaglandin production. Prostaglandins are hormone-like chemicals in the body that regulate body processes and help to stimulate others. Prostaglandins have roles in numerous things from normal blood clotting to water retention to even initiating labor in a pregnant woman. There are numerous kinds of prostaglandins, but all of them are needed for healthy body function. Evening primrose oil can help to maintain natural hormone balance through promoting normal prostaglandin levels. (4,5)
EPO has been found to increase cervical mucus and metabolic function, two key factors required for healthy ovulation and menstruation. Without enough cervical fluid, conception can be hindered as sperm has difficulty reaching the cervix to fertilize the egg. Prostaglandin E in particular, which is found in EPO, can help control and regulate hormones that deal with cell growth, which can also be used to help prepare the cervix for labor. (6,7)
EPO is often used for several symptoms associated with PMS, which can include:
All of the above symptoms can be related to hormone imbalances, and research has shown that evening primrose oil can help to moderate many of them when taken regularly. EPO should be taken on the first day of the menstrual cycle until ovulation to help ease and prevent severe PMS symptoms later in the cycle. (8,9)
Evening primrose oil can also help alleviate symptoms associated with menopause, too, making it a valuable nutrient for women’s health.
Gamma-linolenic acid, or GLA, is a conditionally essential fatty acid required for skin health. GLA has been shown to support healthy skin and the epidermis, and it can also balance skin issues that are related to hormone imbalances and inflammation.
Since the skin is the body’s largest organ, it is important to repair and rebuild skin health starting from the inside out and at a cellular level. The omega 6 fatty acids found in EPO can help support hormone regulation, reduce inflammation, improve skin elasticity, and optimize cell membrane structure. EPO has also been used for those suffering from skin issues such as eczema, psoriasis, and generalized redness. (10,11,12)
Evening primrose oil is a commonly used alternative therapy known to promote balance throughout inflammatory pathways in the body, specifically in the joints. It is best known for its use in the treatment of systemic diseases marked by chronic inflammation, such as atopic dermatitis and rheumatoid arthritis (RA).
RA can lead to pain and morning stiffness that occurs in the joints and is an autoimmune disease. Research has shown that evening primrose oil can help deal with painful symptoms associated with RA, especially when combined with lifestyle and dietary changes, too. (13,14)
Hair loss is something that is common in both men and women and hormones are largely responsible for hair health. Hormonal causes of hair loss are typically due to the hormone DHT, which is a male hormone that can actually cause hair follicles to shrink, reducing the lifespan of hair and can decrease total hair production.
When DHT is high, due to excessive amounts of androgens—which are common in women who have PCOS, thyroid issues, or other chronic health problems—hair growth decreases. The essential fatty acids found in EPO can be helpful in fighting against hair loss. (15)
If you are looking to supplement with EPO, make sure to find a brand that is standardized to around 8 percent gamma-linolenic acid and 72 percent linoleic acid, the two main omega 6 fatty acids found in this seed. As with any supplement, taking a look at the “other ingredients” section is a must, as many of the fillers can end up doing more damage than good. There shouldn’t be fructose, artificial colors, sweeteners, or things like hydrogenated oils added to the capsules or oil.
Use a high-quality non-GMO evening primrose oil that has reputable third-party certifications and adheres to good manufacturing practices. Look for a brand that has the fatty acid composition broken down for you on the supplement fact panel (for example, 40mg GLA, 295mg LA, and 26mg Oleic Acid).
If you want to take EPO to help naturally prepare the uterus and cervix to induce labor, start around the 36th week of pregnancy. This is considered safe and effective at dosages around 500mg daily. As you get closer to your due date, you can slowly increase your dosage up to around 1500mg daily. Some people experience mild cases of loose stools, diarrhea, or nausea if the dosage is too much for them, so be aware of how you feel when you take EPO.
PMS symptoms, such as cramps, mood swings, and headaches can be due to prostaglandin alterations in the body and taking EPO in the morning and the evening can help give relief from some of these symptoms. Start by taking 500mg in the morning and evening during your menstrual cycle, as well as taking the same dosage a week prior to getting your period to help prepare your body.
Evening primrose oil can be taken in oil or capsule form. EPO does have a slight blood thinning effect and can lower blood pressure, so be sure to consult your doctor if you are taking any other medications which might have interactions.
Take evening primrose oil with a meal, ideally with some fat, to increase nutrient absorption.
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