45 - Keith Littlewood - Hormones, the thyroid & more

Episode 45 of the Long Covid Podcast is a chat with endocrinology wizard Keith Littlewood about hormones, the thyroid & how this could all link in with the Long Covid puzzle. We chat through all things thyroid, why it can be so complicated and what to look out for (as well as what could be done to help).

We also chat around loads of other stuff - it was super interesting for me, so I hope there's something in there for you too!

Website - lots of really useful info

Medical nemesis - Ivan Illich

Drugs for life - Joseph Dumit

Follow Keith on Instagram

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(music credit - Brock Hewitt, Rule of Life)

Transcript

Jackie Baxter  0:00  
Hello, and welcome to this episode of the long COVID podcast, I am delighted to welcome Keith Littlewood as my guest today. So he's a bit of a wizard around endocrinology and hormones, amongst other things. So we're going to be chatting a whole lot about that today. So welcome to the podcast.

Keith Littlewood  0:18  
Thanks for having me.

Jackie Baxter  0:19  
So I'm really happy to have you here today. Would you mind just introducing yourself a little and saying, just I guess you know a bit more about what you do?

Keith Littlewood  0:28  
Sure, I kind of fell into the fitness industry around 1995. And that progressed into personal training, owning my own gym and health club, then I realized I didn't really like managing people. So I moved out of that, moved into more rehabilitation and nutrition. And I did my first degree was in fitness and health. And then I got kind of interested, I kind of gave up training in 2010, and move more into rehab and, and pain science. And I did that for a number of years. And I've been reading in the background, some works of some scientists around hormones, which really piqued my interest because they were talking about it in a different way. 

And I kind of challenged my bias back in 2017 by going back to university to do a post grad and a master's degree in endocrinology. And I gave up the rehab side of things to move solely into that and do research and I'm pursuing a PhD at Reading, looking at the role of pollutants and thyroid physiology, which is this kind of gland in the neck that controls every aspect of the body. So I'm quite keen at looking at that. And when you look at that, I think you look at pretty much everything within the human body. I don't think there's a aspect of function that's not touched by thyroid. So it's an interesting, worthwhile subject.

Jackie Baxter  1:36  
Yeah, definitely. And I think it's a little bit of a, certainly to me, it seems a bit like a mystery thing - the thyroid, you know, you hear about it, and people sort of test around it. But certainly I've don't have that much understanding about what it really does. Would you mind kind of just explaining a little bit more around the thyroid and what it what it does, I guess?

Keith Littlewood  1:58  
Sure so the thyroid produces typically something called diroxin, which is T4, and then you have a more active component called T3. And usually it's secreted in an amount of say, four to one ratio. Now, T4 is sometimes viewed as that the non active form that's converted to T3 and T3 does have these very strong, what are called nongenomic effects around metabolism. But ultimately, if you don't produce enough thyroid hormone, you could get constipated, your hair falls out, you have low energy, you get brain fog, you can become infertile, develop PCOS, it can be linked to cancers, it can be linked to other kinds of pathophysiology, or disease processes, high cholesterol, metabolic syndrome, high blood pressure, excess muscular skeletal injuries, I mean, you can see here, it's quite broad, right. 

So that's why I kind of, I felt this was kind of like a real challenge to look at, because I think when you can get a good understanding of thyroid, it is inextricably linked to function, I also think it has an inextricable link to COVID that's not being looked at efficiently because the way that blood tests are conducted, I don't believe they're the most accurate form of diagnosing a thyroid problem. And this is probably something we'll be going to going into. But when someone's stressed, you know, we produce other hormones that can inhibit the production of another - well it's not a thyroid hormone, it's a pituitary hormone, we have a very small gland in the brain, called the pituitary. That is sometimes under the behest of another gland, or an area in the brain called the hypothalamus. The hypothalamus secretes something called TRH, which we won't go into the name of, it's a bit boring for everybody. And that stimulates the pituitary gland, to then produce thyroid stimulating hormone, which should then send a signal to the thyroid to ramp up the production. And that goes through a various amount of processes using iodine and, and selenium and certain enzymes to produce these thyroid hormones. 

Now, so there are various signaling issues at work, there are various alterations from pollution that can create certain problems. What I've looked at it from from research and looking at quite a few papers over the last year, is that there are many compounds that kind of interact with thyroid hormone receptors. So if we think about the hormone itself, it has a specific binding, where it can bind with its appropriate receptor to kind of have these effects. These kind of tend to be more genomic effects. So we can see genes being expressed in a certain manner that can be associated with diseases or lack of diseases as it were. But they're not the only effects. As I mentioned earlier, they have like a nongenomic effect, which is linked to metabolism, how we produce our energy, and all the other aspects of function are kind of around how our metabolism works. 

It's a key driver of how the liver functions. So when we see issues like non alcoholic fatty liver disease, as an example, thyroid is intimately linked, there are certainly nutritional components and there are certainly pollutant components. And unfortunately, within females estrogen which is deemed a female hormone. It's not a female hormone, men produced estrogen, just like females do, they just produce a higher amount. But this amount that they produce renders them 10 times more likely to have a thyroid issue, or what's what's deemed an autoimmune type issue. So this has a specific effect on the liver as well, because if you can't use your liver properly, you can't metabolize and degrade estrogen is properly, you can't metabolize and degrade certain pollutants properly. And this is why the liver often becomes the center of a problem that affects the whole body as well. So I think it's kind of worth considering the fact that, that when when hormones are disrupted at any particular level, and the process of how we respond to certain viral assaults or insults, as it were, is dependent on not just those but a multifactorial kind of, you know, load of issues that can make us either able to respond to problems or or to succumb to them. 

Jackie Baxter  5:51  
Right, that is so interesting. I mean, you were talking about right at the start that the several different hormones that start in the back of the brain and sort of link all the way down to the thyroid. And that's a lot of links that could potentially go wrong as well, isn't it?

Keith Littlewood  6:07  
Yes, and it should be kind of, I believe there should be more kind of autonomous conversion of thyroid hormones that are going on peripherally throughout the body. So we know that the liver, the kidneys, skeletal tissue, and other organs all have thyroid receptors, and all were able to convert T4 to T3, that this should be happening throughout the body. And I would kind of look at the brain as a fallback mechanism. 

If we look at say menopause as an example, when a woman goes through menopause, the failure of the ovaries to secrete the hormones like estrogen and progesterone, you see an up regulation from the pituitary and luteinizing hormone and follicle stimulating hormone. And it's the same with the thyroid - when the thyroid is not producing enough or when the body is not, you know, converting it properly. Or perhaps there's even a block at the receptor because of pollutants acting in that manner, then you won't see that conversion going on. Or if you do, the pituitary will then respond to produce TSH, so that it will stimulate the thyroid hormone further.

Jackie Baxter  7:00  
Course, yes. And a lot of the sort of symptoms that you mentioned, I mean, people with long COVID have got, you know, lists of like 200 different symptoms, but a lot of the ones that you mentioned, are some of the most kind of common ones that people with long COVID seem to describe. And that doesn't seem like a coincidence.

Keith Littlewood  7:22  
No, I don't think so. I kind of go on a stance here without - and this statement isn't meant to diminish anyone's suffering because people all experience suffering and levels of illness - that I don't think the idea of long COVID as a diagnosis is is appropriate. I think what we're looking at here is like, let's say for example, you have a crash and you break your leg and your leg, the way that it heals is dependent on what type of break have you experienced that the leg? Is a spiral fracture, is a relatively clean break, was there damage done to the knee, was it damaged in any of the ankle ligaments? So the recovery of that leg bone is going to be dependent on the structures around it. And if the leg is taking  longer to recover, you wouldn't say you had long leg break. So the idea is, is that somebody has a specific deficit. 

But what the deficit is, is going to be problematic, because we know that human physiology at this particular time is exposed to such a milieu of pollutants, environmentally, we're inheriting stresses from our parents, and we're accumulating their damage into offspring, depending on how you look at biology. But as a rule, you can accumulate damage and pass on those traits to your offspring. So PCOS mothers often pass on PCOS type traits, hypothyroid mothers and fathers pass on these traits to their offspring, to the extent that they're going to express those traits will be dependent on the environment that they're there in. So it could be the nutrition that they're exposed to, it could be the exposure in utero that they're exposed to during very key developmental stages of life, it could be the amount of air pollution, the amount of water pollution, even to a degree we could say tentatively the amount of electromagnetic stress that's going on in our environment. All of these factors can converge and create specific deficits that would give someone a very much harder time to recover from, say something like COVID. 

And if you look at the issues, like what people experience - I'm going to draw on a recent study that came out and it was a study, I can't remember the author paper, but I can find it for anybody listening. But it basically had a control group of people that didn't have COVID, weren't suffering, and then they've had post COVID sufferers. And so what you saw in that is that those who had COVID or had just recovered from COVID or they weren't recovered, they all had symptoms, which were fatigue, you know, breathing difficulties. We were talking about, I think the control group was about 120, and I think the COVID sufferers was about 190, but for between 7 and 30% the main symptoms experienced with fatigue, cognition, breathing difficulties, and they were the major ones. And then there were much smaller ones, whether it was processing of information, or various other markers. 

But then what they found is when they looked at the actual specific tests that you might look at, and I'm going to read these because it's not something I'm familiar with a lots of these tests. So you had the anti nuclear body antibodies, the rheumatoid factors, the proby natural peptides, troponin, which is a heart damage one, which is something I'm very well versed in, and anticardiolipin antibodies, there was no difference between the the people who didn't have COVID and the long COVID sufferers, they had the same values within the tests. It's a very small study group 120 in the control & 190 in the, in the sufferers. And also there are other things, the cognition, the brain processing, the mental aptitude, they were all the same, they had to show no difference between the control. Distance walked I think, there was no difference again, in a six minute test, I think the non suffers walked 600 or 590 meters, and the sufferers had 560 meters. So you can see there's very little difference in physical function. 

Now, either these tests weren't the right tests to measure the deficits of what the person was actually experiencing. Or perhaps that there are just very substantial individual deficits that are existing within each individual and they could be broad, for example, it could be a vitamin A deficiency from retinol, you know, if you're not getting foods that are rich in in retinol, like liver and other foods like that, that's a key component of how your immune system functions. Now, you know, there's a trend with people going more vegetarian or vegan these days, and shying away from kind of rich, rich nutrient muscle meats. So there's a cohort of people that might not be responding as well as they could do. 

One huge one is progesterone deficiency. Now, if you're a female and suffer from anything like PCOS, PMS, as an example, alterations to your menstrual cycle, fibroids, endometriosis, and other issues around that might be a disturbed menstrual cycle or reproductive tissues, it's quite likely that you have a progesterone deficiency, usually mediated with a high estrogen value as well. Now, as you might know, is that men often tend to fare much worse than females in COVID, the mortality rate was higher in older males. And one of the theoretical papers that expands upon that is the idea is that men don't have enough progesterone, they produce progesterone, but they don't produce enough of it. Men produce estrogen as well, but they don't produce anywhere near times the amount of females do. Now, you could argue as well, in failing physiology, you know, the the older groups that suffered that had high mortality rates, is that they were failing biology. So there are various other aspects of function that were declining. So we know that those with metabolic syndrome, hypertension, diabetes suffered much worse. These are all very substantial metabolic deficits that make any kind of viral insult, you know, we get a lot of people who die from flu, who their biology is declining so much that they can't cope with a relatively common virus. And that's what happens when biology becomes frail. 

Now, with progesterone, it actually provides a very potent antiviral component, it's well known to restore neural function in the brain, it's been used with traumatic brain injury. The progesterone receptors are found in the epithelium of the nose, and that, they're used to helping to restore aspects of the immune system. They improve macrophages and also phagocytosis and breakdown of viral particles. It restores aerobic metabolism, which we mentioned just earlier on. And that's your aerobic metabolism is the key component of your physiology. You need your aerobic metabolism to continue from birth through to death, we'll fall back on the anaerobic system quite a lot when we're sprinting for buses, racing for last orders, or the ice cream truck, whatever it is, right. But we can't stay in that system forever. We have to keep our complex physiology working. And when our complex physiology breaks down. This is why we get these kinds of artifacts like metabolic syndrome, you know, hypoxia is a big one and progesterone reverses hypoxia, it by that very mechanism of restoring aerobic metabolism, hypoxia tends to occur and Hypoxia is obviously - it's starvation of oxygen. And if we starve the cells of oxygen, we have to work anaerobically. But if you work anaerobically we produce lots of lactic acid, the physiology become super, super acidic, and this breaks down function. And further the amount of hypoxia because we were running off glycolysis a very inefficient form of energy if we're trying to rely on it. Now this hypoxia creates further downstream problems, which eventually leads to cell death. 

What progesterone does, it can rescue that just like many other things can can rescue that, because it helps to restore aerobic metabolism, so that at the end range of our energy production, we produce energy, which is in the form of ATP. It's just our energy compound. We also produce water and carbon dioxide. Now, if you're not producing enough carbon dioxide, sometimes it's difficult for the oxygen to dissociate. So whilst we need carbon dioxide, we can have too much of it or too little of it at the same notion. So having enough progesterone in the system, or not having enough in the system, were another primary reason why people suffered worse than others. 

And I would also argue with that in mind that there are probably many people that have the symptoms of long COVID that may have something like a progesterone deficiency, it could be a vitamin a deficit. Now, if you go in the sun in any amount of time, you'll need more vitamin A, if you're under immune stress, you will need more vitamin A.

The thyroid can be suppressed. And I talk about the thyroid, as I said, if you're getting blood tests done, and a lot of studies have looked at kind of people who are going into intensive care, and then we're looking at blood tests. Now, if you're looking at someone's thyroid test, who's under an extraordinary amount of physiological, even emotional stress, in some cases, you're producing a lot more adrenaline and cortisol, and that will block the production of this pituitary amount of TSH. So if you're going in and saying, oh, their thyroid looks absolutely fine. That's because you're looking at it in a very stressed state that the thyroid will be pushed down. Because what the body will be trying to run off adrenaline, it doesn't like what's happening to it, it's running off stress hormones. And in a way, it's also not able to use this aerobic system efficiently. 

And in advanced states of COVID you saw sepsis, because instead of having programmed cell death, which is apoptosis, a nice disordering deconstruction of cells so that they're kind of degraded and taken away. What tends to happen then is we get this kind of loss of that, and you'll get cell necrosis. When you get cell necrosis, you'll get sepsis, when you get sepsis, you get all sorts happening, like low blood pressure, but you basically get this breakdown of aerobic metabolism because the system has been so poisoned. So you know, aspects like progesterone can work against these things. And there are many, many other things as well that from a nutritional perspective, for example, there have been a few studies that have likened the severity of COVID to, to an excess of fatty acids. And that can be if you're eating saturated fat to excess, but also unsaturated fat. Saturated Fat tends to be more protective, particularly when it's used within the aerobic system, used as a fuel because it produces less metabolic byproducts. When you cook with coconut oil in the frying pan, you'll notice that it doesn't start smoking until, like a lot of the other oils, which smoke very, very quickly produce kind of what are called toxic aldehydes and these breakdowns, because when you heat them, they become quite toxic. And when that happens in the human body, this can cause problems because it breaks down structures a lot easier. 

And I talked about one of the blood tests that I mentioned from that particular test, which is called anti cardio lipid antibodies. Now, sometimes we produce antibodies because tissues are damaged, and the body wants to take those tissues away. So that it's not being used for further viral fuel, or bacterial fuel, or even cancers, we don't always produce antibodies in response to, to the immune ret, it's also when the tissue is being broken down and needs to be sequestered away so it can't be used. So cardio Lipin is intimately linked within what's perceived as a cell membrane. So if cardio Lipin is damaged, and it can tends to be damaged when there's an excess of the unsaturated fatty acids in the cell membrane. So cardio lipin, if it's broken down, there'll be antibodies produced to remove that from the surrounding structures and the cells, particularly at this cell membrane border as well. 

So if you get an abundance of the unsaturated fatty acids, if you get someone who is in poor nutritional health, if you get somebody who has vitamin A deficient, progesterone deficient, perhaps the thyroid is not working efficiently, then we can see an abundance of reasons and there are more, there are potentially 1000s more reasons - it could be a Selenium deficit, it could be a zinc deficit. Low vitamin D has been suggested as a common theme and why people suffer. And I think that there are differing reasons why some studies have particularly good effects. And some don't. I mean, if you're getting your vitamin D from sunshine, and you're getting an abundance of all the other rays that have very healing capacities, like red and orange lights, as an example, and yellow lights, that's going to be very different from just getting your vitamin D in a supplement which you'd get from an ultraviolet ray. So there are different reasons why, you know, Sunshine might be better than a vitamin D supplement, as an example, but low vitamin D has been implicated in long COVID as well. So I think just understanding that, you know, whilst this idea that long COVID gives someone a name to what they're feeling. There could be a plethora of reasons of just an individual subjective deficit that needs restoring.

Jackie Baxter  19:56  
Yeah, that's really interesting because there's just so many different things that could have sort of tipped it off. 

Keith Littlewood  20:02  
Yes. 

Jackie Baxter  20:02  
And it's, you know, exploded in this big pile of different symptoms that seem to be different in every single person. So that I suppose the fact that there are all sorts of different things that could potentially have triggered it. It sort of seems obvious when you pointed out?

Keith Littlewood  20:19  
Yes, well, I think so. I think the problem is, I know I've kind of done a reasonable amount of reading on the failures between industry and medicine. And you know, I would encourage people to go and read some really interesting books, and Medical Nemesis by Ivan Illich is one. And he wrote that back in 71, and I think his writings are so on point for what's been going on recently. But his idea is, like, you know, the creation of trying to create a customer from cradle to grave by kind of, you know, the diagnosis, rather than just saying someone's unwell. And it's almost like doing away with kind of the older kind of cures where people were encouraged to kind of, you know, rest. But we're constantly looking for a name and a treatment that has to work. And that doesn't always seem to pan out. 

And again, other books like Drugs for Life by Joseph Dumit, it just looks at how people, you know, the, the hook for getting people in and kind of diagnosing and getting people onto a specific medication, and I just don't think that's helpful. Because unless you've got the foundation of nutrition right. Unless you've got the foundation of being able to look after yourself right. It becomes like just, you know, the little boy trying to plug the holes in the dike, when you're just kind of trying to look at one magic button. And that magic magic button just never really works. And don't get me wrong, there can be some magic magic buttons for some people, right? There's something that's missing, and it goes - that was the thing that was missing for me. But you have to get this foundational aspect, right of nutrition, good sleep, time in the sun, meaningful relationships, you know, a worthwhile kind of vocation. And all the other things that that kind of mean that you live life reasonably well, and I think sometimes that if you don't have that, then it becomes difficult to find a solution for some people. 

I mean, you were talking about how kind of breathing was particularly instrumental in helping you and I've used bag breathing, just breathing into a paper bag with so many clients for stimulating altitude. Because when you live closer at sea level, you have a lot more oxygen available, but you need carbon dioxide to help oxygen dissociate efficiently. And what you don't want sometimes is hyper oxygenated states, because that's just as bad as low oxygen and hypoxia. It's about getting that balance in between. And bag breathing stimulates this kind of high altitude or higher altitude type effect, depending on how long you're breathing into it for, but I've seen, you know, blood glucose responses improve, I've seen sleep improve, I've seen aspects of energy improve. Menopausal clients who are getting hot sweats, that can be a relationship between kind of getting low progesterone and not high estrogen, mind you. And the bag breathing can help to ameliorate that. Because sometimes when you have excesses of nitric oxide, and everyone thinks nitric oxide is really, really good, but again, nitric oxide in excess can cause problems. And bag breathing can help to kind of have the same effect without these rampant increases in nitric oxide that can cause hot flushes and, and all of the other wham wanted symptoms and issues associated with that. So again, it's just finding that right thing, I think,

Jackie Baxter  23:20  
yeah, that mean, that's really interesting, because from everything that I have discovered from my own experiences, and from speaking to other people that have recovered, or that are, you know, that things are improving, it's always seems to have been sort of improving this, and working on that, and doing a little bit of this, and a little bit of that, and just kind of, you know, tipping your body kind of back into balance. And, you know, it happens gradually. And, you know, some things have helped more than others. But you know, it's all about kind of trying to get that kind of, yeah, well balance, I guess that the word that was the word you used, wasn't it? You know, right, for your health to kind of tip back from bad into the good zone? I guess.

Keith Littlewood  24:01  
Yes. And then sometimes, what people I think need to do sometimes is not trying to overwhelm the system by trying to do too many things at once. Because then you don't know what's working, you don't know what's working, and then you're kind of back at square one. Sometimes I get clients in the start that come to me, and they're already taking like 15 different supplements. And it's like, well, let's just stop that and kind of Wheedle it back of it. 

I think also using kind of very basic diagnostic tests, which I've been using for a really long time. I use body temperature and pulse to get a general overview of someone's kind of metabolic health. It doesn't give me all of the things but if someone's coming in with a low body temperature all the time, and I imagine there are quite a few people with kind of these long COVID like symptoms that suffer from fatigue and brain fog. And when you go and test their body temperature, they're often nowhere near the 37 degrees that they need to be. Now mammals regulate their body temperature at a very fine window. I've read about 37 degrees throughout the year. 

Now. There again, there was a really interesting paper, they found that people with a lower body temperature, and it was just suggestive because it was an observational study. There's no interventions with it. But what they found that was that people with lower body temperatures that came in with severe COVID, and were unable to regulate their temperature and often went excessively higher, you know, towards a 40 degree mark were the people that had the worst outcomes. 

Now, I would posit that that one of the primary reasons that is that their low metabolic rate means that they're colder, when you're colder, the thyroid might be a driving force behind that, because the thyroid is instrumental in warming the body up, it creates this part of the aerobic metabolism that keeps you warm, and you're able to regulate your energy for foodstuffs, amongst other things. And so if you're colder, you tend to be more disorganized, your ability to sometimes move is decreased. Not saying move, but you know, your ability to contract and relax muscles is decreased. Sometimes you see that your cardiovascular system doesn't respond as efficiently, you'll see things like the heart slow down a little bit and go kind of lower. I think a normal healthy heart rate is around about 70 to 85 beats per minute. And when it goes lower than that, and you've got low body temperatures, that could be a sign that your thyroid's not working efficiently. Equally, your heart rate could be higher, because you've been stuck in the stress response for so long trying to compensate for that, you might be running off adrenaline. 

So there are various different nuances to that. But using something like temperature and heart rate, on Waking, compare it to then after you've had something to eat, say 45 to 60 minutes afterwards, that can be just one of a few basic things that you can do to analyze your health yourself and say, well hang on, I'm eating food and my body temperature is below 36 degrees, that can be an indicator of something not functioning. And that's not a test that generally a lot of people look at. If you're interested in thyroid function, a lot of people who are interested in thyroid function will take the thyroid tests with a pinch of salt sometimes and look at more the aspect of temperature, pulse rate. But what are the symptoms that are driving someone. So it's very good looking at Clinical Biochemistry tests, and everything looks absolutely fine. But if you have no idea what the person's eating, what their sleep was, like the night before, how much pollutants are exposed to in any given environment, how much perceived stress they're under that blood test can mean absolutely nothing.

Jackie Baxter  27:12  
Yeah, I mean, I think one of the chief frustrations with a lot of people that I've spoken to and I've heard from is that the tests are coming back normal, but they still feel really ill, which is frustrating, because you know, everybody's telling you that you're fine. But you know, you know very well that you're not, because your symptoms are there. But also this idea of normal isn't necessarily optimal. And I'm sure I was chatting about this, I think it was with somebody who were talking about nutrition. And she was talking about you know, getting you know, different tests for different people and how you know, the amount of certain nutrients that is right for her wouldn't necessarily be the same for me. 

Keith Littlewood  27:50  
Sure. 

Jackie Baxter  27:51  
But obviously, that makes it more difficult to test for I guess, doesn't it? Because you know, you need to work out what's right for each individual person.

Keith Littlewood  27:59  
Yeah, I think to a degree, I think getting in, you know, most of your major macronutrients and getting a balance of fats, carbohydrates, proteins, can be slightly different. And certainly, depending on your kind of stress, your activity levels will require more or less, you know, you could argue some people need slightly more cofactors nutrients, maybe it's B vitamins. I think there are some huge similarities between human physiology and some basic tenants that need to be underpinned, and that's eating enough food. I often find a lot of females under eat. And that's a huge problem. Because then when you don't eat enough food, you don't get enough the micronutrients in, you don't get enough of the minerals in so yeah, there can be various different reasons why people have different varying needs. And I think that the human body will usually flag up when it's deficient in something, we'll see if specific things we might see, you know, B vitamins kind of flag up in certain areas that with skin around the lips, we might see Vitamin A again, you might see dry, flaky skin, or you might see splits in the heels or something, you know, lots of different things that will flag up and the body will usually tell you. I think, unfortunately, a lot of people aren't prepared to spend the time of understanding nutrition properly. And they might go and see a nutritionist. And that can be very, very helpful. 

But understanding what deficits that you have is really easy to fix. And I say that with some complacency because I've spent a lot of time studying this. And I guess that's why a lot of people come to me with that, but just kind of being keyed into what, keep a diary. What are the things that are kind of flagging up on a regular basis, because if you're in a bad way, you just go through this cycular kind of spiral of just not knowing where you're going. It's almost like going to a pit of learned helplessness, because you know, you have no feedback to compare anything against. 

I always say this pretty much every single podcast that I do, is that there are markers of health and that's energy, digestion, sleep, libido, absence of pain and mood. I think they're really good markers for understanding if something's working for you. And if you don't have those then you need to start looking at other things. But you know, look for little windows, it might be - some people wake up to pee at night because their blood sugar's not functioning efficiently. By the way, bag breathing before going to sleep is a great way of clearing that up. It's just one of the things - not drinking too much water. And so yeah, there are things that, you know, it might be okay, I didn't wake up to pee last night, that's a really good sign, or I didn't wake up at all last night, or I was less irritable today, you know, keeping a diary, looking at the kind of specific things. 

I think when you're looking at the symptoms make a list of all the symptoms, and look at trying to tick them off. And that's the thing is because each one of those will have a specific nutritional deficit, or hormonal deficit, something that's driving the symptom that you have. And I've worked with 1000s of people with specific symptoms that some of them just clear up with some very general approaches to nutrition. You know, eating enough carbs, for example, is key for a lot of people, there's a lot of people kind of still going on about low carb for improving health. And, and this is perhaps what kind of brings us into COVID is that, you know, people see hyperglycemia and kind of blood sugar dysregulation and also hypoglycemia, blaming sugar intake, if it's not excessive, for all those woes, it's problematic. 

And this is where it comes back to thyroid as well, because the thyroid controls the pancreas. Pancreas will obviously secrete insulin and digestive enzymes as well. And if that's off, there are various number of pollutants that also cause insulin to rise. And also, poor insulin signaling and poor glucose responses and elevated glucose as well. If that tends to increase and you're not looking at the things that are causing that. 

I really saw a really interesting paper recently on how Polyperfluor alcohols which is a kind of Teflon pans - the new generation Teflon bands were implicated in an increase in gestational diabetes. But then their approach would be Oh, you need to cut down on your sugar intake or we need to put you on a Metformin it's like, well, let's kind of if there are these all these other things, let's kind of try and look at those. But nobody's thinking about the complex interactions between the environment that caused these problems and they go, right, it's the sugar, you've got to cut back on your sugar. 

And I think sugar and carbohydrates have their place in the diet, and can help to alleviate stress. I don't know if you've ever been kind of not eaten for a long period of time, and you felt pretty irritable. Well, having something sweet and salty is a pretty good way of lowering adrenaline and increasing the blood sugar to temporarily take you out of stress. That's why when you go to accident emergency, they don't put a Keto or steak into your arm on IV, they put sugar and salt saline salt solution, because that's the best thing that's going to bring you to a relatively balanced state that the body can deal to get you out of threat. So I think understanding some of the components around food and nutrition are going to be helpful, but also understanding these environmental factors. 

Jackie Baxter  32:58  
Yeah, of course, I mean, you know, what you put into your body is going to have a huge impact on how it performs, I guess, isn't it?

Keith Littlewood  33:04  
Yes, yeah, I believe so. And certainly 75% of my clients all do really well on just changing their foods and getting them in the right portions at the right time - for some people who've been so used to dieting or skipping breakfast or kind of not eating enough. Getting them to eat kind of four or five small meals a day is great way of just balancing them out. Do you need to stick like that forever? No, they can probably go back to three square after a while. And then some don't do that well, and nutrition is just not enough for them. They need supplements or perhaps a hormone intervention that that will help to create some balance. And this is where I bring it back to kind of females, and sometimes males, needing progesterone as well.

Jackie Baxter  33:43  
Yeah, I mean, that was exactly where I was going to head back around to. And anecdotally, I think long COVID and, you know, other sort of chronic health conditions, do seem to affect predominantly women. I think from all of the studies that I've read, and you know, people that I've spoken to. And you know, obviously females have this huge fluctuation in hormones, you know, on a very regular basis that I guess men just don't have. 

Keith Littlewood  34:11  
Yeah. 

Jackie Baxter  34:12  
I mean, that, I guess is why they're gonna be more adversely affected? 

Keith Littlewood  34:16  
Yeah, I think there's a number of things to consider. I mean, estrogen can accumulate in the body quite easily. And again, that was surrounded in the environment. Not so much now, since moving to the country, but particularly more urban areas as well, there's lots of environmental pollutants, even a house can have certain pollutants like, if you think about cleaning products, decreasers and all of these kind of very harsh kind of chemical compounds. I remember someone I class as a mentor said - if you can smell it, it's already in your bloodstream, because it will enter via the respiratory tract. And if you're constantly cleaning, you know, cleaning the house or if you're kind of in an environment where there are chemicals being produced or whatever, you know, airborne pollutants can act like estrogens. And it's this accumulation of estrogens both from the environment, and the internal sources, that converge together that can cause estrogen excesses. They can both antagonize and agonize the estrogen receptor. But if estrogen is increased, it can have a varying effect. So it can have an effect on the liver where it can accumulate. And if you don't have enough B vitamins, particularly thymine, it can cause estrogen just to keep accumulating, accumulating, you don't you don't break the estrogens down. 

It's the same with thyroid, estrogen will cause thyroid to be displaced. And therefore you don't have high enough thyroid levels. And thyroid is a key component of keeping estrogen in check. You know, very heavy cycles, menorrhagia, you know, chronic heavy bleeds, clotting and stuff is estrogen excess. And usually that can be resolved either with a good B vitamin, or adequate thyroid hormone. So you can see these issues that respond really, really well. But they tend to be a cause of these converging factors. You know, oral contraceptives, can be a cause as well. Phytoestrogens from alcohol, if you're drinking too much, that can be a factor as well, bringing it back to nutrition, again. 

And you rightly said, is that females are 10 times more likely to have thyroid issues, depending on what publication you read, in which experts, some say anywhere between five to 10% of the world's population is hypothyroid. Some say up to 20%. Some of the older researchers said perhaps even 50%. And I think if you're looking at kind of very polluted areas where air is getting dirtier, or there are various pollutants, whether it's your cleaning products, whether it's your household products, whether it's kind of being sat in a car on a busy road in town, you know, all of these factors can converge to create this estrogen dominance and can lead to these kinds of high incidence of reproductive tissues, you know, malformations, tumors, endometriosis, and even the quite common occurrences of pituitary tumors, which are quite common these days, they're relatively benign, most of them but we get this kind of hyperplasia and growth of this pituitary gland, which is stimulated by estrogen and sometimes lead to - one of the most common ones is called prolactinoma. So you know, the hormone, prolactin, one of its roles is to kind of sensitize the breast ready to produce milk as well as one of them, but also the estrogen will sensitize the pituitary just to become larger and larger. And it's often the lactotroph that produces the prolactin hormone to increase in size. And sometimes we get heavily secreting tumors and just ones that just grow quite large and can either be shrunken with appropriate therapy or sometimes surgically removed. But they've certainly increased substantially as well. 

Jackie Baxter  37:39  
Yeah, those percentages that you were saying, you know, even if it is "only" 20%, rather than 50%, it's a huge number.

Keith Littlewood  37:47  
It's a huge amount, right?

Jackie Baxter  37:49  
And I guess if you think about there are this many people that have potentially have some of these issues and their body isn't quite in balance. When you then add a stressor such as COVID, then I guess it's hardly a surprise  that a lot of people are ending up with more issues as a result of it.

Keith Littlewood  38:06  
Yeah. So one of the other issues, which makes it even more complicated, that certainly been kind of born out of rodent studies is that the setpoint of these hormones is altered in gestation. So if they're being exposed to certain pollutants, this TSH, this thyroid stimulating hormone is reset. So you don't actually see where it is, because instead of responding where it should do at a much earlier stage in response to thyroid hormone, sometimes, because the thyroid hormone receptors are also affected as well, you get this poor communication where even a thyroid problem becomes even harder to detect in the offspring. 

So this is where I think the problems between low thyroid and inappropriate thyroid diagnosis have become really problematic within long COVID. Now, not to say that everybody has a thyroid problem. Again, there can be many of these kinds of other smaller, sometimes you might term even innocuous kind of small mineral things, deficits that are missing, or it could be a cofactor or something like vitamin C, for example, which we tend to go through at exorbitant rates when we're stressed as well. I had a friend and a client of mine who had some multiple back surgeries, and one of the big things that really worked for him was drinking plenty of orange juice, just getting lots of energy and lots of vitamin C, did quite a few good things for him. And yeah, but before, probably not leaning on drinking lots of that because people are often scared about how much carbohydrates is in orange juice, but it can be very protective.

Jackie Baxter  39:33  
That is really interesting, isn't it? You know, you've mentioned how the thyroid kind of, you know, it kind of oversees quite a lot of things. So, you know, it could potentially cause all sorts of havoc throughout the body, and how would somebody be able to get a more accurate reading on whether that's the issue? Because as you said, some of the tests don't really give you accurate readings. So how would somebody be able to know?

Keith Littlewood  39:58  
well, like I said, the body temperature and pulse is a crude but effective way of looking at that. You can obviously go to your doctor and request the standard tests, which is a TSH Test, the thyroid stimulating hormone, they usually they will look at a free T4. Other useful tests that can be indicators of low thyroid function are cholesterol. The only problem is that if you've been in sustained immune attack for a while, you might find that your cholesterol is on the lower side. So we don't always expect that to be raised. There's blood pressure, you know if that's elevated, that could be a good indicator for you. And all of these things, you know, using something like the bag breathing and going in and checking them. And just trying that or just even breath holds, for example, and retaining carbon dioxide, if things start to feel a bit better with doing that, that can be an indicator that the thyroid needs working as well because carbon dioxide deficiency can be a symptom of not having a good thyroid function, or benefiting from a carbon dioxide retention might I say. 

And they can be other blood tests like say hemoglobin - classically, a low iron state can also look like a thyroid state - the thyroid's instrumental in creating blood cells, it's called a hemolytic meiosis. So what tends to happen is that if you're low thyroid, you don't produce enough red blood cells. So your hemoglobin can look low, your hematocrit, you know, and the other ones, can look low as well. And then we start might see things like the RDW, the red cell distribution width increasing as well. So there's certain indicators within blood tests that you can look at. So a low iron test can come from low thyroid as well. So it's worth looking at those other markers that I think can be quite useful. 

And then, you know, tie that in with the temperature & pulse test. I mean, the key clinical indicators for low thyroid, the symptomology is constipation,air fall, infertility, cold hands, cold feet, what else we got - brain fog, fatigue, seasonal affective disorder can be implicated with it as well and kind of low mood during winter, I think is an interesting one and worth talking about as well. And so it's not always people who are overweight, who have low thyroid, you can be significantly underweight and have low thyroid. And lots of the old researchers found actually, anorexia was often a key finding in low thyroid function. So it doesn't always mean people who are overweight, it doesn't mean having all of those things at once, it could be one thing and then things start to kind of take, can take sometimes years for the thyroid to kind of be - you become become frank and overt hypothyroidism. So it can be tricky. But I think if you're given all the tools, and you're aware of it, that are some things that you can do to pester your doctor to kind of get more results from it.

Jackie Baxter  42:39  
Yeah, so it sounds like it's more of a case of, you know, lots of different things. And then taking a bit of an overview and sort of thinking, right, well, you've got those symptoms and those things that are, you know, borderline or, or whatever, and being able to kind of look at the bigger picture.

Keith Littlewood  42:52  
Yeah, yeah. To be honest, you have doctors, clinical research doctors, who've been struck off before for treating symptoms rather than blood tests, which I think is a crime. It is when you've got actually very accomplished doctors who knew more than the people that were striking them off, who used to say it would take years for the TSH to fully come up to where it should be to diagnose the live thyroid. And that's where you get into the contentiousness of subclinical hypothyroidism and when to treat it. And there are lots of different arguments around that about, you know, the trial cohort, what their nutrition was like, you know, what pollution area they were in, was there any thyroid hormone resistance was - would giving them a certain type of medication been better than the one that they've been given. There's so much, you know, discussion around it. But it still comes back to the main point that you have to get your nutrition right first, I mean, there's no good, you know, trying to take thyroid hormone, if your nutrition is crap, to be honest, it's gonna cause more problems.

Jackie Baxter  43:49  
Yes, yeah, definitely. And I guess that comes back to him in what I've kind of been thinking for ages is that, you know, there's so much that we can do and we can improve, you know. You've been talking a lot about nutrition. Breathing, I was saying, has been a big thing for me, you know, there's so many things that we can do ourselves, you know, and I like having things that I can do, I'm very bad at sitting around not doing things. But you know, having a list of things, right, I've looked at that I've looked at that. I've looked at that. And you know, to be fair, each thing I've kind of worked on, it generally has helped. So you know 

Keith Littlewood  44:23  
Well it's just about chipping away, isn't it? 

Jackie Baxter  44:25  
Yeah. 

Keith Littlewood  44:25  
So it's chipping away to get to that root root cause of what's missing. And I think if you can do that, you're going to be in a good state along the way. So it's almost it's about being patient as well, sometimes. I was trying to think of a good analogy, but it's like, it's sometimes bad comparing mechanical kind of systems to complex biological systems. But, you know, you'll be driving your car one day and you take it for the MOT and you think nothing's wrong with it. And the mechanic, if they're honest, brings up four or five things that doesn't let the car pass. And how many people would have been exposed to an infection where they just had no idea where their physiology was at - whether bordering on blood glucose issues, whether they had low immune system function, whether their thyroid was low, thinking their nutrition was right. 

And you know, the concept of good nutrition everybody thinks they know or good nutrition is. But some people do really badly on a healthy diet full of vegetables, some people just do absolutely atrociously on it. Because especially if we're going for raw green veg, it's like, plants have evolved over millennia, and they produce very potent plant toxins that can slow down physiology and slow down function. So people who think they're on a good healthy diet, who do lots of exercise, that doesn't mean you're healthy and able to fight viruses half the time. So I think the ultimate question is, what dictates good physiology? And, you know, there are kind of many different opinions on what constitutes good physiology.

Jackie Baxter  45:50  
Yes, and I guess it's getting your nutrition and the things that you're doing to help and getting that to match what you're expecting of your body. So if you're doing a lot of exercise, you're probably not gonna have the same nutrition as somebody who does very little.

Keith Littlewood  46:03  
Yeah. Also, the point I want to make is that the concept of doing more fitness than you need to can suppress physiology. And this is kind of bringing it back to thyroid function is like, some people - with clients are found they want to exercise six or seven days a week, because when they stop exercise, their body temperature goes down. So they repeatedly do lots of exercise to bring their body temperature up, which makes them feel better, until the next time when they do it again. So they think exercising every single day is really good. And you take them, get them to take a holiday for two weeks. And they feel like absolute crap, because they haven't been going through this kind of, you know, treadmill of increasing body temperature, wait til it decreases. 

And that's sometimes how people support their physiology by stress, because they run off adrenaline, wait for the next hit of adrenaline, and then the next hit of adrenaline. And that's how they keep themselves up in that state without actually knowing. And I'm not saying exercise is bad here - strength training and all types of exercise are absolutely fantastic. But doing the right amount, rather than doing six, seven days a week is essential. A good strength program, and you get great results from two to three days a week, you can walk everyday, you don't need to be pushing yourself into a hole. And that's why I think where we saw some kind of people who were saying, This guy was super fit and look how he suffered. It's like, fitness does not equate to health, when you're kind of pushing the boundary. Athletes aren't all aren't healthy. It's like they're fit - fitness performance is very different from health. It's very rare, you see lots of kind of high level athletes living into their hundreds.

Jackie Baxter  47:27  
Yeah, that's a very fair point, actually. And you know, that there are a lot of people - I was very fit before I had COVID. But as it turns out, I probably wasn't that healthy. And you know, the same is true of a lot of people who have ended up with with long COVID. And, you know, they were, you know, fit and healthy in inverted commas beforehand. So, you know, on paper should have been fine. But when you look a little bit deeper into it, maybe a lot of them weren't.

Keith Littlewood  47:54  
Yeah. Sometimes you just don't know. Right? You think we're doing the right thing - told to work hard and eat really healthy foods that kind of - Are they actually that healthy? So it's, unfortunately, you don't find out until too late, though, do you sometimes?

Jackie Baxter  48:07  
Well, exactly. You know, there's nothing like being ill for two and a half years to make you realize all the things that you were doing wrong beforehand.

Keith Littlewood  48:13  
And not to say that, you know, it's always the way I'm saying it is - there can be outliers. So you know, there's absolutely no doubt. I'm not absolutist, and too dogmatic to say that I know everything. I don't. I'm just going working with my own context of people and their diagnosis they've come to me with before, and I'm working with people to get into better health. So I just think there are lots of kinds of deficits that need resolving for a lot of people. I stand by those major components that I kind of talked about, and there are plenty more behind them.

Jackie Baxter  48:39  
Yeah, absolutely. I think you've given like loads and loads and loads of tips. Is there anything else you want to mention that that people could could do to help?

Keith Littlewood  48:48  
Oh, well, I've seen a number of people respond really, really well to methylene blue, which is a synthetic dye, which has been used in ADHD, Parkinson's, parasites, resolving poisoning, cyanide poisoning and all of these kinds of things. It's worked, it works very, very well. I think it's something worth looking at. You can get it from R&D Labs. I've seen it work well in clients that have been injured by vaccines and clients that have been injured by COVID alike. It works very, very well for restoring physiology. 

There are hundreds of papers on the use of methylene blue. There's a very good paper on the effects of methylene blue inhibiting SARS covid 2. It's one of those things that should have been used as a medication. In fact, there's a guy in India, who's a respiratory physiologist who's been using it to cure TB scarring in lung patients for decades. And he's  a very accomplished respiratory physiologist. So there are a number of uses of methylene blue that have very good clinical results. And I would encourage people to look at that and look at the research on that.

Jackie Baxter  49:47  
Amazing. Well, thank you so so much for joining me today. I've certainly learned a lot and I'm sure everybody else listening has as well. So it's been really, really fascinating. I'll make sure I dropped the link to your website into the show notes, so yeah thank you so much for chatting to me into giving up your time

Keith Littlewood  50:07  
pleasure thanks for having me

Transcribed by https://otter.ai