The silent killer

Endocrine problems or simply thyroid, is perhaps less talked and increasingly more widespread among women. As we observe Thyroid Awareness Month this January, we encapsulate the reasons why urban women are falling prey to it. Is it a byproduct of busy and unhealthy lifestyles or is there more to it?

We hear about them all around. These silent killers are everywhere, sneaking into our healthy lives in subtle ways. While diabetes and heart ailments rank the highest on the charts, the lesser talked about are endocrine problems which are increasingly becoming widespread, especially among women.

January is Thyroid Awareness Month, and it only seems fitting to talk about the 3-5 per cent population that suffers with thyroid and endocrine related issues. “Roughly, one out of three women in urban India has a thyroid not functioning at its optimum,” says Rujuta Diwekar, Mumbai-based celebrity nutritionist, who is all set to launch her book titled ‘The PCOD- Thyroid Book’ in February.

In her book, she speaks about effective strategies to get healthy. The ratio of women being diagnosed with thyroid dysfunction as compared to men translates to four women for every one man. Why is this so?

Perhaps, it has something to do with the way a woman’s body functions, which makes them more susceptible to the condition. More likely, some contend, are the environmental changes, quality of life and lifestyles. There’s no debating that women’s health issues seem to be on the rise, especially among working women.

While there are varied opinions such as those mentioned above, another explanation for the increasing numbers is that it is not purely because of the lifestyles and work patterns but also because more women these days undergo tests such as the ultrasound, unlike before. Dr Madhulatha Alexander, MD and assistant professor at Gandhi Medical College says, “I think women are screened more than men for thyroid and that’s why there seems to be a higher rate of prevalence among women.”

Thyroid dysfunction can be of two types: hypothyroid and hyperthyroid, and it covers a large range of symptoms. An imbalance of the production of thyroid hormone in the body is what causes it. The most common type and seemingly more dangerous is hypothyroidism.

Signs and symptoms often include hair loss, weight gain, feeling lethargic, inability to tolerate cold weather and irregular menstrual cycles. In order to be diagnosed, the Thyroid Stimulating Hormone (TSH) needs to reach a certain level, but it is important to look at all metabolic parameters before declaring that it is hypothyroidism.

Another commonly heard of ailment among women is called Polycystic Ovary Syndrome or Disease (abbreviated as PCOS or PCOD). There seems to be a sharp rise in the diagnosis of PCOS also in recent times. Both the thyroid gland and the ovaries are part of the endocrine system, and this possibly explains one cause for their toll on more and more women.

The pituitary gland directs hormones to help the ovaries function appropriately. PCOS is an imbalance of the female sex hormones. In PCOS, the pituitary gland releases abnormally high levels of a certain hormone, disrupting the normal menstrual cycle. However, there is no definitive answer for the seeming correlation between the two conditions.

Research is still limited and on-going, especially for PCOS, which is the most common endocrine disorder in women, with one in every five women being victims of it. Symptoms of PCOS include menstrual irregularity, weight gain, a possibility of infertility, hirsutism (unwanted hair growth) and an increased risk of type-2 diabetes.

Clearly these two conditions are not just on the rise in women, but also are a cause for concern as both of them affect multiple areas of life. For Veda (name changed), a 22-year-old student from a college in Hyderabad, it has taken years for her to understand what her body requires.

Having been diagnosed with Hypothyroid at the age of 12, she says that she maintained a steady 90kg weight until the age of 16, when she realised she had to do something about it other than try medication. “In my case, my thyroid dysfunction is as a result of stress and heredity.

At 16, I decided to go to the gym regularly – and I still do. I have realised that I cannot afford to skip exercise even for one day because I know that it helps me stabilise my weight, as my thyroid levels go up along with my weight gain. From a thyroid level of 6, I had then reached an optimum 0.23. But it is so difficult to maintain the same these days with the stress of college assignments, exams and everything else!”

Amritha (name changed), on the other hand, is a BHMS final year student who was diagnosed with PCOS seven years ago. She says, “Stress is the main triggering factor, but as that is a part of life in a society like ours, it is very difficult not to succumb to it.

Having PCOS is very challenging as I’ve had to face mood fluctuations, body pigmentation, unwanted hair growth and body shaming due to the bloating of the body in terms of weight. I used to be very overweight in the initial years. I had a lot of period irregularities, continuous headaches, bowel troubles, skin rashes, hair fall, and body pains.”

She says she has tried many medicines but there hasn’t been much of a positive effect. However, she claims diet and exercise have been helping her of late. These real-life cases are not rare. Rujuta Diwekar supports this, “A recent research put Indian women as the most stressed out women in the world.

Women in middle-income countries like ours do bear the double burden of work and home and find little appreciation for themselves in the society. Over a period of time, this leads to an increasing level of stress because, in spite of all the things that women do, most of us go to bed feeling that we haven’t done much today.”

She adds that this lack of appreciation from ourselves and the constant struggle to find time invariably lands us with less than optimum metabolic health.Rujuta Diwekar’s explanation is very relatable to anyone, even with or without the two disorders being talked about.

She adds, “A lot of us women tend to forget that in the whole journey of multi-tasking our homes and work, our food, exercise and sleep is not even close to optimum. But we, or people close to us, don’t seem to think of that as a problem until we find ourselves staring at a hormonal disorder.”

What then should women do in this hour to avoid falling prey to these health concerns? According to Dr Madhulatha Alexander, weight loss is crucial – even more than medication. “Even a five per cent weight loss in those diagnosed with PCOS leads to ovulation, even in the absence of medication.”

Dr Bhavani, MBBS, MD - DGO, Professor of Obstetrics & Gynaecology from Dr Bhavani Fertility Centre says, “These days, women’s biological clock is getting disturbed because of working at irregular timings, as late as 3 am. Quitting one’s job entirely is not at all the solution. Instead, women should ask to work according to the standard Indian timings, during the daytime.”

Annabel Boys from the UK, a health coach (with a PhD in Psychological Medicine) specialises in working with women with PCOS. She shares the most important tips to follow – “Eat a low Glycemic Index (GI) diet with a combination of plenty of veggies, good quality protein and healthy fats (omega 3s). Get good rest, regular exercise to help manage your stress well.” She further adds that balancing the blood sugar levels is tricky but something that women with PCOS have to strive to do.

“Balancing your blood sugar well is key. This is because big blood sugar swings are stressful for the body – and in times of prolonged stress, our bodies tend to shut down the reproductive system, which is not helpful for balancing the sex hormones.”

Annabel Boys who was diagnosed with PCOS herself, states that she is proof to the miracles that dietary changes can have on managing the condition. “After years of struggle, I personally manage my symptoms now entirely through diet and lifestyle changes and I know lots of other women who do the same too.” Food that contains high levels of glucose even has the potential to lead to type-2 diabetes in women with PCOS.

Dr Bhavani says that the TSH levels should optimally be below 3 and maximum 4.5. “Iodised salt should be consumed as opposed to rock salt. Rice and soya should be avoided. Also, every 3-6 months one needs to go for the checkup. Positive thinking also helps a lot.”

Another angle to this whole topic, Rujuta Diwekar opines, “Most times, it is almost like people are waiting to be declared with a thyroid problem. The levels go up to just about 5 and even if other metabolic parameters like glucose tolerance, triglycerides, Vitamin D status, etc is in place, they are happy to get on to a pill. It is like feeling relieved that they can blame their weight on some gland versus really looking to changing their lifestyles to bring about long-lasting changes in both the weight and in hormonal health.”

Even as we as a society fight for women empowerment and gender equality, which has changed many lives for the better, it is still necessary to take into consideration the toll it is taking on women’s health. This is not to say that women should quit their jobs, but to point to better measures of taking care of oneself.

To trade some of the habits that are commonplace today, with healthier choices – to live similar lives to the early man (or rather woman), if you will – by staying active and eating healthy food rather than the more famous processed food that lines the racks of our supermarkets.

Areas that need to be taken care of

• Avoid long meal gaps and plan meals in advance.
• Make 150 minutes of exercise per week a non-negotiable aspect. Plan everything else around exercise, and not the other way around.
• Go gadget free an hour before bedtime.
• Take regular breaks. Even if it is a one-day break every two-three months because most Thyroid and PCOS cases are triggered by stress.
• TSH levels should optimally be below 3 and maximum 4.5
• Go for checkups every 3-6 months.
• Work according to the standard Indian timings, during the daytime.
• Eat a low Glycemic Index (GI) diet with a combination of plenty of veggies, good quality protein and healthy fats (omega 3s).
• Even a five per cent weight loss in those diagnosed with PCOS brings great results.
• Good rest, regular exercise helps to manage stress well.