Putting The Cart Before the Horse: The Child Obesity And Thyroid Study

A new study on childhood obesity has hit the headlines. Doctors at the Regional Hospital of Bolzano in Italy measured serum free T3, free T4 (two types of thyroid hormones, TSH (thyroid-stimulating hormone, thyrotropin), performed a thyroid ultrasound, and measured antithyroid antibodies in a group of overweight and obese children. There are some rather questionable conclusions from this study which are drawing most of the attention, and which we will get to in a minute, but some of the other correlations deserve a bit of attention first. To quote:

Results: A total of 23 children (12.4%) showed antithyroid antibodies and an ultrasound pattern suggestive of Hashimoto’s thyroiditis (group A). Of them, 20 (10.8%) showed antithyroid antibodies and normal ultrasound (group B). A total of 70 subjects (37.6%) showed absent antithyroid antibodies and an ultrasound pattern suggestive of Hashimoto’s thyroiditis (group C), and 73 children (39.2%) showed no thyroid antibodies with normal ultrasound (group D). TSH was higher in groups A and C compared with groups B and C, and controls

Notice that out of the overweight children only 39% (group D) had both normal thyroid structure, antibodies, and hormones! More than half of the kids have thyroid abnormalities.

It is very well established that underactive thyroid causes weight gain, and overactive thyroid causes weight loss and wasting. A study that came out just this March found that even small increases in TSH (levels of TSH have an inverse relationship to the thyroid hormones you need to function, and which are replaced in the deficient) WITHIN what has historically been considered normal, are associated with weight gain. Now imagine if the thyroid changes are the CAUSE of the weight gain, as any experiment with altering thyroid hormone levels would support. Then the "mystery" of increasing childhood obesity would be much less of a puzzle, or at least, an avenue towards treating it would be clear.

The Claim

The doctors behind the childhood obesity study however, do not believe that thyroid problems are the cause of the obesity however, but rather, reverse the proposition, and suggest that obesity is the cause of the thyroid problems (seen here on the BBC and Reuters for example).


Why the cause, rather than the result? Well Hashimoto's thyroiditis, the most common cause of thyroid insufficiency in the US, and a major cause throughout the world, is an autoimmune disorder. Continual attack by the immune system causes the thyroid to swell and interferes with thyroid function. Hashimoto's disease is generally diagnosed in no small part through the detection of antibodies and while the study found that no less than 12.4% of the children in the study had the classic signs of Hashimoto's disease (a rather large number by the way, if the sample is representative) many of the children had a swollen thyroid like Hashimoto's disease, but lacked the antibodies.

There was reason to think that the thyroid was indeed swollen and abnormal (and not just naturally bulky) because one of the thyroid hormones was out of balance, and TSH levels [which when high, indicate insufficient thyroid (T3 and T4) hormones], were elevated over controls, and moreover, correlated with the degree of obesity.

In other words, a full 37.6% of the overweight and obese children looked as if they might have a hypothyroid problem, and tests were pointing to the appropriate associated hormone levels, BUT the doctors could not detect an autoimmune attack on the thyroid. Because they cannot detect an attack on the thyroid the doctors behind this study suppose that a "low-grade inflammation state" CAUSED by being overweight is making the thyroid malfunction.

Other Explanations Perhaps?

Doubtless, you can see how this novel theory might be incorrect, but the problem is worse than this. Your adaptive immune system, the portion of your immune system that can learn from past attacks and which vaccines are designed to train, is divided into two sections, the cell-mediated, or Th1-type immune response, and the humoral or Th2-type response. Both portions of your immune system work together to defeat viruses, bacteria, fungi, and other immune threats, but each is better at attacking certain types of threat. The Th2 system for example, produces antibodies, and is better at attacking bacteria, while the Th2 system includes T-cells that recognize and destroy a cell when it has been "hijacked" by a virus. Because each of the two 'wings' of the immune system are better at fighting separate threats, your body will tend to 'turn up' either Th1 or Th2 when it is under attack, and will 'turn down' the less effective half of the immune system.

The thing is, while Hashimoto's disease is recognized by antibodies, part of the Th2 system, the better portion of the cellular damage is caused by "a cell mediated autoimmunity induced by Th1 cytokines". The test for Hashimoto's disease thus is able to detect that there is a problem, when the Th1 portion of the immune system is able to recruit the Th2 to attack one's own body. Even when it recruits the Th2 system however, the Th1 remains dominant in Hashimoto's disease. To quote:

The above findings suggest that a Th1 pattern of immune response characteristic of cellular immunity is dominant in HT (Hashimoto's thyroiditis), whereas the predominance of Th2 cytokines in GD (Graves' Disease) indicates a humoral pattern of immune reaction.

This study that I just quoted also helps to highlight the importance of thyroid disease as a cause, rather than as an effect of obesity. Both Hashimoto's thyroiditis and Graves' disease are autoimmune disorders where the immune system attacks the thyroid gland.

Hashimoto's disease, where the Th1 portion of the immune system is dominant, causes hypothyroid, with the body not getting enough of the T3 and T4 thyroid hormones. A shortage of T3 and T4 thyroid hormones will turn down a person's metabolism, and just as one would expect, Hashimoto's disease tends to make those who suffer from it become overweight.

Graves' disease on the other hand, features a dominant Th2 immune attack on the thyroid gland, and instead of causing an underactive thyroid, producing too little T3 and T4 hormones, Graves' disease induces an OVERACTIVE thyroid, that produces TOO MUCH T4 and T4 thyroid hormone. Because of the excess of thyroid hormone, Graves' disease causes people to LOSE WEIGHT.

So, just to restate and lay everything out, when the immune system malfunctions and attacks the thyroid, it produces different results depending on whether the Th1 orTh2 portion of the system is dominant in the malfunction. When the Th1 is dominant, amongst other symptoms, the person is likely to become overweight, with their metabolism depressed. When the Th2 portion of the immune system is dominant, the victim's metabolism is revved up, and the person loses weight (along with other symptoms).

In both of these cases, there is a serious malfunction, but the Th1 attack and underactive thyroid is detected when a test picks up that the OTHER, non-dominant side of the immune system is attacking the body. Diagnosis of a Th1 autoimmune attack thus depends on the detection of a secondary attack by the other half of the immune system.

Now your body is not supposed to attack itself. Might it be, that even if one portion of your immune system decides to attack your own body, that the other half of the immune system would, in some cases hold off? As everyone knows, immune reactions such as allergies can vary widely in severity. What if a person's immune system launched a more mild autoimmune attack? Might it be that only half of the immune system would go rogue?

In the Italian study, 12.4% of the overweight children had a full blown Hashimoto's type problem but 37.6% showed the signs that one might expect if half, rather than ALL of the immune system went haywire.

Yet another thing that might trigger a thyroid problem and accompanying obesity.

An AUTOIMMUNE reaction to one's own body is not the only thing that can cause thyroid swelling and dysfunction. A simple immune reaction will do the trick just fine. An immune reaction, with the victim suffering from an underactive thyroid would logically be triggered by a persistent virus, rather than a bacteria, because the Th1 portion of the immune system, which is stronger in attacking viruses, would be the portion of the immune system that would trigger thyroid suppressing damage. While my limited knowledge, and I suspect, modern medicine's limited knowledge prevent me from putting here a long list of appropriate viruses, there is one that can serve to make the point. Chronic hepatitis C, the third major type, for which there is now no vaccine is well known to cause thyroid problems, indeed including both autoimmune thyroid disease, and thyroid cancer. Hepatitis C also is a good example of how a virus could be a significant problem, and yet escape detection. Blood borne hepatitis is a major threat that can often be lethal, and both hepatitis A and B were known and identified by the 1970s, but by the middle of the decade, it had been established that neither hepatitis A or B was responsible for most blood-transfusion induced hepatitis. Despite this, nobody identified the causative virus until 1987. Hepatitis caused liver failure, a rather dramatic and distinctive outcome, and yet escaped detection for many years. The symptoms of an epidemic that tended to induce slight thyroid dysfunction or chronic thyroid infection by contrast, could be rather easily attributed to the lifestyle of those affected. There is no doubt that there is an epidemic of obesity around the globe, and while this cannot be said to constitute proof positive of an infectious cause, it is also difficult to imagine how such an illness, if it existed, would manifest itself differently.

Infectious Obesity

In fact, contagion induced thyroid illness would be only one of several mechanisms that have come to light over the past few years by which germs are able to cause weight gain.

Some viruses for example, force stem cells that COULD become fat cells to DO so, and moreover, they cause the new fat cells to take up more fat, becoming bigger.

cranial nerves VII and VIII and selected structures of the inner and middle ear. 1 Nervus vestibularis, 2 Nervus cochlearis, 3 Nervus intermediofacialis, 4 Ganglion geniculi, 5 Chorda tympani, 6 Cochlea, 7 Ductus semicirculares, 8 Malleus, 9 Membrana tympani, 10 Tuba auditiva Creative Commons Attribution ShareAlike 2.5

Damage to the chorda tympani nerve seems to make people like sweet, salty, and fatty foods more than they would otherwise, and ear infections as a small child seem to cause just this sort of nerve damage.

Another virus can double total body fat, and triple visceral fat in experimental animals, even when the infected and the control animals consume the same amount of food.

Compared to these problems, damaging and infecting a gland, preventing its proper function, is quite prosaic, even if the effects on the infected are dramatic. No fewer than 10 types of infectious agent, from viruses, to prions, to bacteria, have been found to cause obesity in experimental animals, or have been associated with obesity in humans.
Summing Up

The doctors of Bolzano may have found a new, and common type of autoimmune disease, or they may have found a mechanism by which infectious diseases induce obesity, and provided that their sample is representative, they have certainly established that many obese children have thyroid dysfunction of some sort, but to simply claim that being overweight causes the thyroid dysfunction, rather than the other way around, is remarkable........and not in a good way.

Whether the cause of this dubious conclusion is a lack of imagination, a lack of courage, or a desire to jump on the bandwagon of lifestyle modification advocacy is not clear, but the resulting failure and faulty logic is not difficult to detect.

There is a story here, and a big one likely to affect adults as much as children. History is replete with examples where science and medicine set aside, for a time, the facts and evidence in favor of moralizing and to avoid crossing past assumptions (and the distinguished people behind those false assumptions). Hopefully someone, perhaps even someone reading this, will see through the smoke of convention and punch through the sticky web of existing assumption to lead science and medicine forward against the dramatic advances of infectious illness and the ancient claws of the autoimmune.

Could declines in smoking be behind the autism epidemic?

No good deed goes unpunished

An Autism Epidemic?

One spring day in 1999, a Los Angeles Times newspaper article brought a problem to the attention of the nation. A fiercely disabling, but previously rare childhood developmental disability, autism, was being seen in more and more children throughout California, with a 273% increase in incidence in the previous 10 years. Parents of autistic children, struggling to help them, wanted a cure, prospective parents worried about being in the same position, and this report soared to national attention. Soon many, perhaps even most, Americans had heard of autism.Bar chart of the number (per 1,000 U.S. resident children aged 6–17) of children aged 6–17 who were served under the Individuals with Disabilities Education Act (IDEA) with a diagnosis of autism, from 1996 through 2007.

GNU Free Documentation License

Vaccines To Blame?

An additional reason for alarm was a 1998 paper published in the prestigious medical journal, the Lancet, with the author, Andrew Wakefield suggesting that the MMR vaccine in some cases induced an adverse autoimmune reaction in the vaccinated children, causing autism and an associated bowel disorder.

Wakefield suggested that instead of the widely used triple vaccine, children should be immunized with separate vaccines for Measles, Mumps and Rubella (German measles) with each vaccine being spaced a year apart, to quote: "If you give three viruses together, three live viruses, then you potentially increase the risk of an adverse event occurring, particularly when one of those viruses influences the immune system in the way that measles does." Such vaccines were not generally available at the time however.

Both the medical establishment, and governments were displeased by this study. Neither trusted the public much, and they feared that parents would simply avoid the vaccinations. Moreover, three separate vaccines would increase costs.

Thus battle lines in Britain (where Wakefield worked) were drawn, and all parties performed as expected. Doctors fell over themselves to dismiss the possibility of vaccine harm, the government refused to provide separate vaccines, and the public kept their children away from the vaccinating needles.

Toxic Vaccines And Heavy Metal Poisoning.

Moreover, a new issue soon sprung to life, raising new concerns even for those who accepted studies and data analysis dismissing the possibility of autoimmune vaccine injury. As it happened, many vaccines were manufactured and dispensed with a mercury based preservative, thimerosal. Mercury is quite neurotoxic, and a handful of noted scientists in the US contended that the thimerosal contributed to the development of autism. The US government and medical establishment were generally dismissive (or at least officially dismissive) of this notion, but with several other nations demanding mercury free vaccines, it was decided that reducing mercury levels would help to ensure that the public would accept vaccination.

Mercury reduction was accordingly implemented, but as of yet, no great reduction in autism prevalence has been noted. Government and establishment sources have settled on this fact as proving the complete safety of the vaccines, but neither camp of vaccine critics is convinced. So far as the immune effects are concerned after all, nothing has much changed, with children still being injected with three weakened, but live and infectious sets of disease germs, although few Americans focus on this factor. So far as the mercury is concerned, any approval of the government's new rules is rather squelched by the fact that the officially permitted description "mercury free" does not mean that mercury is not an ingredient, but rather means simply that there is not enough thimerosal in the vaccine when it is diluted to dosage strength to provide reliable preservation. While the levels of mercury per vaccine have come down, the number of vaccines that children are now supposed to receive have gone up, and many people are thus convinced that the amount of mercury remaining is enough to cause autism.

Other Possible Causes.

Going beyond vaccines, while the geneticists are pressing the idea that the condition is almost completely inherited, people have looked to other environmental influences as well.

Studies have lately linked high rates of autism to high rainfall, suggesting a possible autism connection to vitamin D deficiency, indoor pollution exposure, or even increased juvenile television watching. The situation is further confused by questions about just how much of an epidemic there is in the first place. Autism would not be the first disease to have many of its sufferers misdiagnosed, and more widespread awareness might lead to a specific diagnosis where before a generic label like "retardation" might have been applied. Further, autism is now generally held to be a "spectrum" with several related conditions of varying severity but a common mechanism or cause. This understanding and concept might easily lead to children being diagnosed as autistic where before, despite their problems, the designation would not have been held to be appropriate.

Of course, whether or not there are more autism cases then previously, does not change the needs of the autistic kids one whit, but this question is very important if we are to catch any environmental or non-genetic provocation that will push a child towards autism.

The Latest.

Now a new study has emerged, which just might suggest an environmental cause of an entirely different sort.

COLUMBUS, Ohio – Scientists have identified a relationship between two proteins in the brain that has links to both nicotine addiction and autism............

The discovery identified a defining role for a protein made by the neurexin-1 gene, which is located in brain cells and assists in connecting neurons as part of the brain’s chemical communication system. The neurexin-1 beta protein’s job is to lure another protein, a specific type of nicotinic acetylcholine receptor, to the synapses, where the receptor then has a role in helping neurons communicate signals among themselves and to the rest of the body.

Rene Anand

This function is important in autism because previous research has shown that people with autism have a shortage of these nicotinic receptors in their brains. Meanwhile, scientists also know that people who are addicted to nicotine have too many of these receptors in their brains.

“If we were to use drugs that mimic the actions of nicotine at an early time in human brain development, would we begin to help those and other circuits develop properly and thus significantly mitigate the deficits in autism? This is a novel way of thinking about how we might be able to use drugs to approach autism treatment,” said Rene Anand, associate professor of pharmacology in Ohio State University’s College of Medicine and principal investigator of the research.

Now all this is very important on its own terms, as there is the possibility of a treatment, or even cure for autism. The study begs the question however, if drugs that "mimic the actions of nicotine" might cause a brain predisposed toward autism to develop properly, then would not nicotine itself do the same thing? It would be ridiculous of course to hand a small child a cigarette "for their health", but what if someone effectively did?

As many a public health warning has pointed out, cigarette smoking by a pregnant woman affects her unborn child, and a smoker's baby is born with a brain that developed in a nicotine tainted environment. Some of the milder manifestations of autism like Asperger syndrome seem to manifest themselves as almost a hyper-nerdiness. Is it possible that an autistic child born to a chain smoker would be born weak, sickly, and undersized due to the harmful effects of smoking, just as the public health announcements tell us, but also be a notable but functional nerd, rather than be a child completely disabled by autism?

Of course there is also the possibility that the brain changes causing autism manifest primarily postnatally, and I have never seen a two year old light up! However, children are exposed to secondhand smoke. Is secondhand smoke enough to provide a dose of nicotine? Well a number of studies claim so. Even allowing for exaggeration, (it is easy to become enthusiastic when fighting so dangerous a habit) it seems reasonable, or at least not impossible to suppose that there might be enough nicotine to "shake loose" malfunctioning neural cells. If secondhand smoke would "do the job" then this is very important as well because of the truly massive historical exposure. A great many women throughout the 20'th century who did not smoke, had a spouse who did. The smoking rate has been dropping steadily and consistently however (note that the above chart goes back only to 1965, when smoking had already been declining for many years), and the decline in prenatal and childhood exposure to nicotine has been much greater because habitually smoking parents have increasingly taken steps to avoid smoking around children, having been (correctly) told that secondhand smoke is a hazard to them. Such a precaution would have been quite alien 60 or 70 years ago.

Summing Up

Overall of course, eliminating tobacco use is of enormous benefit to everyone, and the harmful effects of secondhand smoke or prenatal exposure are very well established. Even if nicotine helped to prevent autism, smoking around children would make ill more children than it would cure.

This being said however, there are exceptions and caveats to most rules or truths in the world, and it is interesting to consider the possibility of HARMFUL side effects to the reduction of the generally harmful habit of smoking. This theory, or the research that prompted it, may turn out to be incorrect, and certainly I am going to keep an open mind on the subject, but at the same time it would be a mistake to simply dismiss the study as a fluke. Until recently, the actual mechanisms behind autism were almost entirely unknown, and the new study shines some light into this dark corner of medicine. It is generally harmful to inhale significant amounts of smoke, no matter what is burning, but nicotine has its addictive and stimulant qualities because it is a near analogue to a substance naturally found in the brain and nervous system. Native Americans used tobacco in medicine, and when tobacco was introduced to Europe, well before the development of a giant industry, it was used as a medicine as well. Both tobacco and cannabis are most commonly used for recreational purposes, but both contain chemicals that naturally regulate significant portions of the human nervous system. It has been unfortunate that disapproval of recreational use has prevented cannabis from being used fully in medicine, and we should not toss the medicine out with the cigarette butt.

[FULL DISCLOSURE: I do NOT smoke tobacco (or anything else for that matter), and NEVER DID. I did NOT grow up in a family of smokers, etc. etc. I do NOT work for a tobacco company, own tobacco company stock, benefit from cigarette advertisements, or even work for a shop that sells cigarettes. I have NO CONFLICT OF INTEREST here. My opinions stand on their own intellectual merits, not some hidden agenda, and of course, implicit in the use of a blog, I certainly understand and appreciate that you, the reader might disagree. If you have a point to make, I welcome comments. ]