The thyroid hormones act on nearly every cell in the body. They
act to increase the basal metabolic rate, affect protein synthesis, help
regulate long bone growth (synergy with growth hormone) and neural maturation,
and increase the body's sensitivity to catecholamines (such as adrenaline) by
permissiveness. The thyroid hormones are essential to proper development and
differentiation of all cells of the human body. These hormones also regulate
protein, fat, and carbohydrate metabolism, affecting how human cells use
energetic compounds. They also stimulate vitamin metabolism. Numerous
physiological and pathological stimuli influence thyroid hormone synthesis.
Both T3 and T4 are used to treat thyroid hormone deficiency (hypothyroidism). They are both absorbed well by the gut, so can be given orally. Levothyroxine is the pharmaceutical name of the manufactured version of T4, which is metabolised more slowly than T3 and hence usually only needs once-daily administration.
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LEVOTHYROXINE Available at JAN AUSHADHI STORES
PRICE
50 mcg- 45 Rs /100 tab
100 mcg-Rs 56/100 tab
Levothyroxine,
also known as L-thyroxine, is a manufactured
form of the thyroid hormone, THYROXINE (T4). It is used to treat thyroid
hormone deficiencyincluding the severe form known as myxedema coma. It may also
be used to treat and prevent certain types of thyroid tumors. It is not
indicated for weight loss. Levothyroxine is taken by mouth or given by
injection into a vein. Maximum effect from a specific dose can take up to six
weeks to occur.
Side effects
from excessive doses include weight loss, trouble tolerating heat, sweating,
anxiety, trouble sleeping, tremor, and fast heart rate. Use is not recommended
in people who have had a recent heart attack. Use during pregnancy has been
found to be safe. It is recommended that dosing be based on regular measurements
of TSH and T4 levels in the blood. Much of the effect of levothyroxine is
following its conversion to triiodothyronine (T3).
Levothyroxine
was first made in 1927. It is on the World Health Organization's List of
Essential Medicines, the most effective and safe medicines needed in a health
system. Levothyroxine is available as a generic medication.
USE
Levothyroxine
is typically used to treat hypothyroidism, and is the treatment of choice for
people with hypothyroidism, who often require lifelong thyroid hormone therapy.
It may also be used to treat goiter via its ability to lower
thyroid-stimulating hormone (TSH), a hormone that is considered
goiter-inducing. Levothyroxine is also used as interventional therapy in people
with nodular thyroid disease or thyroid cancer to suppress thyroid-stimulating
hormone (TSH) secretion. A subset of people with hypothyroidism treated with an
appropriate dose of levothyroxine will describe continuing symptoms despite TSH
levels in the normal range. In these people, further laboratory and clinical
evaluation is warranted as they may have another cause for their symptoms.
Furthermore, it is important to review their medications and possible dietary
supplements as several medications can affect thyroid hormone levels.
Levothyroxine
is also used to treat subclinical hypothyroidism which is defined by an
elevated TSH level and a normal-range free T4 level without symptoms. Such
people may be asymptomatic and whether they should be treated is controversial.
One benefit of treating this population with levothyroxine therapy is
preventing development of hypothyroidism. As such, it is recommended that
treatment should be taken into account for patients with initial TSH levels >
10 mIU/L, people with elevated thyroid peroxidase antibody titers, people with
symptoms of hypothyroidism and TSH levels between 5–10 mIU/L, and women who are
pregnant or want to become pregnant. Oral dosing for patients with subclinical
hypothyroidism is 1 µg/kg/day.
It is also
used to treat myxedema coma, which is a severe form of hypothyroidism
characterized by mental status changes and hypothermia. As it is a medical
emergency with a high mortality rate, it should be treated in the intensive
care unit with thyroid hormone replacement and aggressive management of
individual organ system complications.
WHO and UNICEF have recommended taking oral iron supplements for adolescents and young children in the countries where 40 percent of anaemia is prevalent in the population. Most of the oral iron formulations are available in the form of ferrous sulphate as well as in the form of ferric compounds consisting of iron polymaltose complex. These iron compounds differ in their safety, bio-availability, cost and side effects.Apart from the different chemical states of iron formulations available in the market, they also exist in different galenic forms.
Clinically, iron salts that are bivalent like ferrous sulphate, ferrous fumarate and ferrous gluconate are widely used than the ferric iron forms. The bio-availability of ferric forms of iron are 3 to 4 times less than the ferrous forms (10 to 15 percent bio-availability). Ferric forms of iron are poorly soluble in alkaline solutions and hence they have to be transformed into ferrous forms before they are absorbed.
Oral iron preparations have followed the conventional‘prolonged-release’ formulation, which improves the toleration capacity of the gastrointestinal tract and enhances the bio-availability. After the ferrous form absorption, iron reaches its maximum in the blood for about 7 hours and stays in that state for 24 hours.
Ferrous ascorbate results from the reaction of ascorbic acid with iron. Iron is absorbed very well in the presence of ascorbic acid, as this compound is known to convert ferric iron into ferrous iron. Ferrous form of iron is soluble at neutral pH and can be absorbed three times higher than the ferric form. Oxidation is prevented by Ascorbic acid, which can thus act as reducing agent as well as maintain the iron in ferrous form. Ferrous ascorbate is known to exist intact inside the gastrointestinal tract due to the stable chelation of iron with ascorbate. This compound does not dissociate due to any of the food inhibitors. Iron gets absorbed easily in vivo from ferrous ascorbate than from ferrous sulfate. It is found that ferrous ascorbate dissociates in aqueous solution into ascorbate ion and ferrous ion where ascorbate ion acts as a monodentate. Ferrous ascorbate is known to dissociate at pH5. At pH6 to 8, the solubility effect is enhanced by ascorbate, which is beneficial for the absorption of iron from ferrous ascorbate.
A clinical study was conducted comparing the ferrous ascorbate formulation with that of ferrous sulphate in 18 healthy volunteers. The intestinal absorption was not different when measured after 21 days. But, hemoglobin content has come to baseline values in both the groups. Another study by the same research group was conducted in which the bio-availability of trivalent iron form (FeIII hydroxide polymaltose) was compared with the bivalent form (ferrous ascorbate). The iron absorption in the intestines was evaluated in the fasting state by the estimation of plasma iron tolerance curves and whole body iron retention values. The estimation of plasma iron showed lower FeIII content (1.2+/-0.1percent) compared to 43.7+/-7.1percent of ferrous ascorbate. After taking a meal, there was a change in divalent iron absorption than the trivalent iron absorption.
The increase in hemoglobin levels after prescribing 100mg dosage of iron for 28 days was higher in the case of divalent formulations than that of the trivalent formulations. A few other similar studies have proved that divalent form of iron or ferrous ascorbate has greater bio-availability than the trivalent form of iron. Hence, ferrous salts and especially ferrous ascorbate is chosen over other iron forms for preparing the drugs as they are efficient, cost effective and have tolerability.
Withania somnifera, known commonly as ashwagandha,Indian
ginseng, poison gooseberry, or winter cherry is a plant in the Solanaceae or
nightshade family. Several other species in the genus Withania are
morphologically similar. Although commonly
used as a medicinal herb in Ayurvedic medicine.
In several studies,
ashwagandha has been shown to lower blood sugar levels.
One test-tube study found
that it increased insulin secretion and improved insulin sensitivity in muscle
cells (2).
Also, several human studies
have confirmed its ability to reduce blood sugar levels in both healthy people
and those with diabetes (3, 4, 5, 6).
Additionally, in one
four-week study in people with schizophrenia, those treated with ashwagandha
had an average reduction in fasting blood sugar levels of 13.5 mg/dL, compared
to 4.5 mg/dL in those who received a placebo (5).
What's more, in a small
study in six people with type 2 diabetes, supplementing with ashwagandha for 30
days lowered fasting blood sugar levels as effectively as an oral diabetes
medication (6).
SUMMARYAshwagandha may
reduce blood sugar levels through its effects on insulin secretion and
sensitivity.
Animal
and test-tube studies have found that ashwagandha helps induce apoptosis, which
is the programmed death of cancer cells (7).
It
also impedes the growth of new cancer cells in several ways (7).
First,
ashwagandha is believed to generate reactive oxygen species (ROS), which are
toxic to cancer cells but not normal cells. Second, it may cause cancer cells
to become less resistant to apoptosis (8).
Animal
studies suggest that it may help treat several types of cancer, including
breast, lung, colon, brain and ovarian cancer (9, 10, 11, 12, 13).
In
one study, mice with ovarian tumors treated with ashwagandha alone or in
combination with an anti-cancer drug had a 70–80% reduction in tumor growth.
The treatment also prevented the spread of cancer to other organs (13).
Although
there are no studies to confirm these results in humans yet, the research to
date is encouraging.
SUMMARYAnimal and test-tube
studies have shown that ashwagandha promotes the death of tumor cells and may
be effective against several types of cancer.
Cortisol
is known as a "stress hormone" because your adrenal glands release it
in response to stress, as well as when your blood sugar levels get too low.
Unfortunately,
in some cases, cortisol levels may become chronically elevated, which can lead
to high blood sugar levels and increased fat storage in the abdomen.
Studies
have shown that ashwagandha may help reduce cortisol levels (3, 14, 15).
In
one study in chronically stressed adults, those who supplemented with
ashwagandha had significantly greater reductions in cortisol, compared to the
control group. Those taking the highest dose had a 30% reduction, on average (3).
SUMMARYAshwagandha
supplements may help lower cortisol levels in chronically stressed individuals.
Ashwagandha is perhaps best
known for its ability to reduce stress.
Researchers reported that it
blocked the stress pathway in the brains of rats by regulating chemical
signaling in the nervous system (16).
Several controlled human
studies have shown that it can effectively reduce symptoms in people with
stress and anxiety disorders as well (14, 17, 18).
In a 60-day study in 64
people with chronic stress, those in the supplemental group reported a 69%
average reduction in anxiety and insomnia, compared to 11% in the placebo group
(14).
In another six-week study,
88% of people who took ashwagandha reported a reduction in anxiety, compared to
50% of those who took a placebo (18).
SUMMARYAshwagandha has been
shown to reduce stress and anxiety in both animal and human studies.
Although it hasn't been
thoroughly studied, a few studies suggest ashwagandha may help alleviate
depression (14, 18).
In one controlled 60-day
study in 64 stressed adults, those who took 600 mg of ashwagandha per day
reported a 79% reduction in severe depression, while the placebo group reported
a 10% increase (14).
However, only one of the
participants in this study had a history of depression. For this reason, the
relevance of the results is unclear.
SUMMARYThe limited research
available suggests that ashwagandha may help reduce depression.
Ashwagandha supplements may
have powerful effects on testosterone levels and reproductive health (15, 19, 20, 21).
In one study in 75 infertile
men, the group treated with ashwagandha showed increased sperm count and
motility.
What's more, the treatment
led to a significant increase in testosterone levels (21).
The researchers also
reported that the group who took the herb had increased antioxidant levels in
their blood.
In another study, men who
received ashwagandha for stress experienced higher antioxidant levels and
better sperm quality. After three months of treatment, 14% of the men's
partners had become pregnant (15)
SUMMARYAshwagandha helps
increase testosterone levels and significantly boosts sperm quality and
fertility in men.
Research has shown that
ashwagandha may improve body composition and increase strength (4, 20, 22).
In a study to determine a
safe and effective dosage for ashwagandha, healthy men who took 750–1,250 mg
per day gained muscle strength after 30 days (4).
In another study, those who
took ashwagandha had significantly greater gains in muscle strength and size.
It also more than doubled the reduction in body fat percentage, compared to the
placebo group (20).
SUMMARYAshwagandha has been
shown to increase muscle mass, reduce body fat and increase strength in men.
Several animal studies have
shown that ashwagandha helps decrease inflammation (23, 24, 25).
Studies in humans have found
that it increases the activity of natural killer cells, which are immune cells
that fight infection and help you stay healthy (26, 27).
It has also been shown to
decrease markers of inflammation, such as C-reactive protein (CRP). This marker
is linked to an increased risk of heart disease.
In one controlled study, the
group who took 250 mg of ashwagandha daily had a 36% decrease in CRP, on
average, compared to a 6% decrease in the placebo group .
SUMMARYAshwagandha has been
shown to increase natural killer cell activity and decrease markers of
inflammation.
In addition to its
anti-inflammatory effects, ashwagandha may help improve heart health by reducing
cholesterol and triglyceride levels.
Animal studies have found
that it significantly decreases these blood fats.
One study in rats found that
it lowered total cholesterol by as much as 53% and triglycerides by nearly 45% (28).
While controlled human
studies have reported less dramatic results, they have observed some impressive
improvements in these markers (3, 4, 5, 6).
In a 60-day study in
chronically stressed adults, the group taking the highest dosage of ashwagandha
experienced a 17% decrease in “bad” LDL cholesterol and an 11% decrease in
triglycerides, on average (3).
SUMMARYAshwagandha may help
reduce the risk of heart disease by decreasing cholesterol and triglyceride
levels.
Test-tube and animal studies
suggest that ashwagandha may reduce memory and brain function problems caused
by injury or disease (29, 30, 31, 32).
Research has shown that it
promotes antioxidant activity that protects nerve cells from harmful free
radicals.
In one study, epileptic rats
treated with ashwagandha had nearly a complete reversal of spatial memory
impairment. This was likely caused by a reduction in oxidative stress (32).
Although ashwagandha has
traditionally been used to boost memory in Ayurvedic practice, there
is only a small amount of human research in this area.
In one controlled study,
healthy men who took 500 mg of the herb daily reported significant improvements
in their reaction time and task performance, compared to men who received a
placebo (33).
Another eight-week study in
50 adults showed that taking 300 mg of ashwagandha root extract twice daily
significantly improved general memory, task performance and attention (34).
SUMMARYAshwagandha
supplements may improve brain function, memory, reaction times and the ability
to perform tasks.
However, certain individuals
should not take it, including pregnant and breastfeeding women.
People with autoimmune
diseases should also avoid ashwagandha unless authorized by a doctor. This
includes people with conditions like rheumatoid arthritis, lupus, Hashimoto's
thyroiditis and type 1 diabetes.
Additionally, those on medication
for thyroid disease should be careful when taking ashwagandha, as it may
potentially increase thyroid hormone levels in some people.
It may also decrease blood
sugar and blood pressure levels, so medication dosages may need to be adjusted
if you take it.
Ashwagandha dosages in
studies typically ranged from 125–1,250 mg daily. In studies where different
dosages were taken, the higher dosage usually produced the most dramatic
improvements.
If you want to supplement
with ashwagandha, look for root extract or powder in 450–500 mg capsules and
take it once or twice per day.
SUMMARYAlthough ashwagandha is safe for most people, certain
individuals shouldn't use it unless authorized by their doctor. The recommended
dosage is 450–500 mg once or twice per day.
Ashwagandha
– The Unsung Adaptogen
Ashwagandha is a lesser
known adaptogenic herb. Adaptogens help you manage stressors. It is
called by many names including “Winter Cherry” and “Indian Ginseng”, and has been used for thousands of years in Indian
Ayruvedic Medicine.
It’s only been in the
last 50 years that this member of the nightshade family of plants (Solanaceae)
has emerged in the West as a potent healing herb, with growing popularity.
Besides easing fatigue
in cancer patients and improving Alzheimer’s, Ashwagandha has been shown to be
very helpful for anxiety and other emotional disorders along with improving
fertility.
Originating in India and
Northern Africa, ashwagandha is a small shrub with small yellow flowers and
teardrop-shaped leaves. It’s the leaves that hold the key to the health
benefits. The key compounds that produce the benefits are called withanolides.
Ashwagandha Fights Cancer
Studies have shown that
Ashwagandha has several healing properties for many diseases and presented
encouraging prospects in others. Some of its key benefits are the ability to
combat inflammation and tumor growth.
Cancer cell apoptosis,
or programmed cell death, is one of the ways ashwagandha is thought to exert
cancer-resistant effects. It also has the ability to generate free radicals to
kill cancer cells without harming normal cells.
Researchers have concluded that ashwagandha may be valuable for combating lung,
breast, colon, and an aggressive brain cancer called glioblastoma multiforme,
or GBM.
A study with mice with
ovarian tumors that were treated with ashwagandha in combination with an
anticancer drug resulted in a 70 percent to 80 percent decrease in tumor growth
and metastasis.
Effects on Insulin, Blood Sugar, and Inflammation
In studies with people
with schizophrenia, scientists found subjects using ashwagandha to have reduced
fasting blood sugar after four weeks. Similar results were seen in another
study, which showed effectiveness comparable to an oral diabetes drug.
Ashwagandha has been
shown to dramatically reduce oxidative stress and inflammation in multiple
studies and may be helpful for people with arthritis symptoms.
Ashwagandha Improves Depression, Stress, Anxiety and
Insomnia
Ashwagandha induces
calmness and clarity by regulating neurotransmitters such as serotonin and
dopamine and the stress hormone cortisol. When cortisol levels get
too high, it can wreak havoc on your blood sugar, blood pressure and
cholesterol levels, your immune system, and may even increase fat storage.
Research has shown that
ashwagandha not only reduces cortisol levels but also reduces chronic stress
and anxiety with no sedation. Study results provide evidence that
ashwagandha has an important role in reducing general anxiety disorders, sleep
disturbances, muscle spasms, and seizures.
Research also shows that
ashwagandha may be useful for helping patients with Opioid Drug Withdrawal as
well as reducing or eliminating dependence on drugs such as Xanax and Valium.
Fertility and Muscle Strength Increased by Ashwagandha
Stress is related to
infertility. In a study ashwagandha supplements was shown to decrease stress,
improve levels of antioxidants, and improve overall semen in test subjects.
Researchers have also
found that groups taking ashwagandha dramatically increased muscle strength and
muscle mass, as well muscle recovery after injury in several different bench
press exercises after being treated with ashwagandha supplements for eight
weeks.
In the same study,
participants taking ashwagandha lost more than double the percentage of body
fat loss in comparison to those taking placebos. Interestingly, ashwagandha is
also used in Ayurvedic Medicine to stimulate libido in women, soothe painful
periods and strengthen the uteruses of those who’ve had miscarriages.
Learning, Memory, and Neurodegenerative Disease
A traditional use for
ashwagandha is to improve memory and sharpen brain function. Modern research
has validated this practice by showing that ashwagandha boosts glutathione in
the brain which is key for clearing toxins and protecting brain cells from
oxidative stress.
Numerous studies
indicate that ashwagandha may offer benefit for patients suffering from devastating
disorders such as Alzheimer’s, Huntington’s and Parkinson’s disease. It may
also be useful for a neurological disorder called restless leg syndrome, and
for people with an under-active thyroid.
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