Wall St Journal looks at Houston Doc who treats Rupp, other thyroid users

Asthma is different. The etiology of asthma is not exercise. Exercise can worsen asthma, but the root cause is not exercise, unlike the supposed cause of hypothyroidism in elites.

Anemia brings up an interesting ethical issue. Anemia is brought on by endurance exercise (as people are arguing hypothyroidism may be). However, as Sprintgeezer mentioned earlier in the thread, there is a difference between supplementing with a hormone (T4) and a nutrient (iron). Iron can be found naturally in many plants, animal products, and iron cookware, whereas T4 is not readily available in our every-day diets.

II--

The use of totally synthetic pain relievers should be banned in any amount.

With regards to from where the thyroid meds are obtained, are they really powdered pig thyroids? If that is the case, then I would see nothing wrong with eating thyroids, just as I see nothing wrong with eating liver.

As for concentrated forms thereof, that is interesting. It is well-known that many compounds and mixtures, both regulated and unregulated, are simply purified from natural sources, and thereby concentrated. I would submit that if the compound is a controlled substance such that it is either unlawful to possess or requires some sort of license to possess and distribute, and if circulating levels thereof can be significantly elevated by taking the purified form rather than the natural form, its use should be banned if that use is necessitated by training.

Same goes for iron, and other, supplementation. There would have to be a reliable and corroborated medical report that natural sources were tried before a purified source was permitted--and then it should be permitted only in those situations where its need was not necessitated by training.

The synthetic pain meds, forget about them. It's just another excuse to take something. You know what? I'm in pain today. I had a MASSIVE workout yesterday--my muscles are sore, I injured my rotator cuff, my left hand is sprained and all of my knuckles are bruised and swollen.

If I walked into a clinic as a normal individual and presented with these symptoms, I would be given pain relievers and likely local cortisone shots. But as an athlete? These are the sorts of conditions that produce training adaptations in response. That is the whole point of training, because next time I will be training with the aid of those adaptations, unless I go too hard too fast and exceed the pace of adaptation.

Any artificial means of increasing the body's natural pace of adaptation--whatever that is for any individual--should be disallowed, including Tylenol, Ibuprofen, whatever. For that matter, any artificial means of temporarily masking the symptoms of training-induced stimulus should be disallowed.

So, if thyroids meds are indeed "powdered pig thyroids", in the sense that they are entire thyroids that are dried and powdered, and the powder is then ingested, I don't see that as any different from eating whole, fresh or cooked thyroids. I would allow it. However, if there was any purification or concentration of the active ingredient, and that ingredient was a controlled substance, I would disallow it where its need was occasioned by training.

This thread continues to be a good read!

a/: "taking this medication if you don't need it"

I don't think that is the entire issue being discussed here.

For sure, it is PART of the discussion, in those cases where treatment is prescribed for sub-clinical hypothyroidism.

But the remainder of the discussion focuses, I think, on those situations where a clinical need arguably exists, but is created by the athlete himself through training.

That was the best post so far and I can't agree more.

Side note:

Here is the ORIGINAL RUPP thyroid thread from 2006

http://www.letsrun.com/forum/flat_read.php?thread=1337043&page=0

A lot of the same arguments BUT more information.

1. They stated the Bob Kennedy was dealing with other issues that were being caused by his thyroid. It was also a Genetic disorder that has plagued his parents and grandparents.

2. Galen Rupp's father is also being treated for a Thyroid Problem. Salazar is getting pretty tricky now. He is even getting Rupp's parents treated for a disorder so he can claim it is "Genetic" (Sarcasm intended)

3. It goes into Dan Browne and Goucher being put on thyrod meds and depending on the athlete they were either Hypo or Hyper

4. As one person stated the doctor did fine tune the thyroid meds more than they would have for a normal person because an athlete can work with a smaller range to get the full use of the medicine.

addddf wrote:

Anemia brings up an interesting ethical issue. Anemia is brought on by endurance exercise (as people are arguing hypothyroidism may be). However, as Sprintgeezer mentioned earlier in the thread, there is a difference between supplementing with a hormone (T4) and a nutrient (iron). Iron can be found naturally in many plants, animal products, and iron cookware, whereas T4 is not readily available in our every-day diets.

So is iron from liver, spinach, or a skillet not doping, but taking iron pills, heme iron, etc. is doping?

By that standard is Synthroid doping, but natural thyroid (dessicated pig thyroid glands) is doping?

Athletes that are anemic will say I am taking iron because I am anemic.

Athletes that are taking thyroid meds are providing "no comment". Why?

They obviously see it as different than those that are taking iron.

Missing: "Unfortunately, we'll never find the answers to these questions because of privacy laws."

It's not really "privacy laws", it is the doctor-patient privilege that is accorded to the patient, with the aim of furthering full disclosure in the pursuit of medical care.

The patient can of course make any disclosure whenever they want.

Also, the privilege is not absolute--physicians can be compelled to produce evidence under certain circumstances, especially where those relate to the health of the patient.

The upshot is that if athletes really had nothing to hide, they would make full disclosure when asked.

addddf wrote:

Asthma is different. The etiology of asthma is not exercise. Exercise can worsen asthma, but the root cause is not exercise, unlike the supposed cause of hypothyroidism in elites.

Anemia brings up an interesting ethical issue. Anemia is brought on by endurance exercise (as people are arguing hypothyroidism may be). However, as Sprintgeezer mentioned earlier in the thread, there is a difference between supplementing with a hormone (T4) and a nutrient (iron). Iron can be found naturally in many plants, animal products, and iron cookware, whereas T4 is not readily available in our every-day diets.

Exercise-induced asthma is probably caused in part by exercise. Look at the sheer number of swimmers, x-country skiers, and distance runners who have EIA, and it's hard to believe that it's just chance.

According to this NYTimes article (http://well.blogs.nytimes.com/2010/01/13/why-do-so-many-winter-olympians-have-asthma/), 17% of elite distance runners and greater than 50% of XC skiers have EIA.

Skater wrote:

If these athletes have a thyroid condition, they should take a LONG break, and be monitored. Not drugged up synthetically and allowed to continue degrading their health with more hard work which is so unhealthy to them.

Again, this is NOT a problem that goes away with rest. I haven't run a step in 3 years, and I still have to take daily meds. I have tried weaning myself off them a number of times, and my digestive system shuts down, I get extremely cold, a brain fog settles in, and I crash again.

This suggests that there are other things at play here other than just high volume training. Hypothyroidism is probably a result of a complex relationship between genetics, epigenetics, environment and training -- with unfortunate permanent results.

The place to look for answers on this is not the medical community -- you need to look at the body of research that informs the medical community. Doctors are in the unenviable position of having to make diagnoses that sound certain even in areas where there is still debate. And if you look at the literature, there is still considerable debate and ongoing research.

The fact that the American Association of Clinical

Endocrinologists (AACE) revised their TSH upper limit to 3.0 mg/L in 2003*, a level much lower than the 5.0 mg/L that many of you are quoting, shows that this is an area of current debate.

*"Subclinical Thyroid Disease". Guidelines & Position Statements. The American Association of Clinical Endocrinologists.

interesting--

See my recent post where I fumble through an answer to this.

I would ask again, are available thyroid meds really only "powdered pig thyroid" and nothing more? No further purification or concentration?

Also, dd hits it right on: what is needed is review of these athletes' medical histories, to make an informed determination of the likely cause of the symptoms, and the ultimate products used and their source.

Ho Hum--

Absolutely correct about the number of swimmers who have EIA.

fair enough--

Assuming you are being honest, your experience is just that--yours.

FOR YOU, it has not been a problem that has gone away with rest, or not running for 3 years.

I would ask, what do you mean by those symptoms: digestive system "shuts down", you "get cold", you get a "brain fog", and you "crash".

For instance, I experience all of these things at various times, to varying degrees (except for the digestive system thing).

Assuming your symptoms rise to the level at which pharmacologic intervention is agreed-upon as indicated, and assuming that the symptoms aren't the result of training, then OK, that would be legitimate province for a TUE.

Sprintgeezer:

The most common cause of hypothyroidism is Hashimoto’s disease, which is an autoimmune disorder where your body kills your thyroid gland. For these people, medication is the only solution for the rest of their lives. This has been my experience so far, it is the experience of many older people I know who have had the disease their entire lives, and it is what my doctor told me when I was diagnosed. It does not go away for the majority of people that have the disease.

As for my symptoms, you could probably get descriptions by just looking up symptoms of hypothyroidism. I don't sh*t for days, I have to wear a hat/double socks/gloves to keep my extremities warm in a 70 degree house, I cannot concentrate enough to read more than a page at a time, and I get incredibly depressed. In fact, I was getting treated for depression when they finally found out that hypothyroidism was the root cause. The fact that all of these symptoms manifest themselves immediately after I stop taking medication shows it is more than just a coincidence. And my diagnosis of hypothyroidism is "only" subclinical, with TSH levels that would not have warranted treatment a few years ago.

oh brother wrote:

If you can't answer that question, then your arguments are all mute.

I can hear A Duck's arguments loud and clear. Therefore, whether or not I agree with them, they are NOT all mute.

As I understand it, there are different kinds of thyroid medication that can be prescribed with one not being necessarily more effective than the other. Leovthyroxine (Synthroid) is a synthetic chemical-

http://en.wikipedia.org/wiki/Levothyroxine

Dessicated thyroid extract is pig thyroid glands where the "glands are dried (desiccated), ground to powder, combined with binder chemicals, and pressed into pills"-

http://en.wikipedia.org/wiki/Desiccated_thyroid_extract

In principle, dessicated thyroid extract is as "natural" as beef bouillon, a Slim Jim, or calf sweetbread.

As to banning ibuprofen or Advil, that would certainly expand the definition of doping well beyond what anyone currently considers doping.

I had my first ever asthma attack not long after I started running, though it was allergy rather than exercise induced. I'm on 5 meds including corticosteroids.

There is a thread on Reddit regarding this, although I don't know if its relevant at all?

"The shift in American genetics and thyroid problems from 1985 to now."

Heres the link to the map in the thread:

http://imgur.com/a/9UK1i

Link to thread:

http://www.reddit.com/r/WTF/comments/1c22kp/the_shift_in_american_genetics_and_thyroid/

Missing the point wrote:

So to me the real proof is in how they take the drug. Is Rupp taking Synthroid every single day for the rest of his life? Or is he taking it during certain phases of his training? For example, Synthroid does boost metabolism and reduce weight. So if I was going to cheat with Synthroid, I would start taking it a few weeks prior to the big race, and watch my weight drop 3-5 pounds. Pretty significant, especially when that weight loss occurs without having to do other things harmful to your physical fitness, like reduce calorie intake or increase calorie burn.

Anyone who has had to take synthroid and had to lower their dose because their TSH came back too low knows that when you lower your dose, you tend to tank a bit. So they would need to take this forever. Your body gets used to being at a certain level and you feel worse if you have to veer off of this level. It's is not something you can cycle in and out of.

A few general comments:

To those who support this whole idea of athletes getting their blood and body composition analyzed, and getting the appropriate hormones topped off, etc, all in the name of "that's what you have to do to be the best", come on, really? Is that what our sport has come to? Am I supposed to be a fan of a sport where those with access to the best technology and "secrets" win?

Would Pre have done it this way, Nike?

I wish people would stop saying Dr Roberts is a "great" doctor, "top" doctor, etc. It seems clear that he's just a compliant kook who will prescribe TSH to just about anyone. What's "top" about him? Has he ever done any research? Why did he go to such a crappy medical school? Why does he have to many bad customer reviews from his Houston practice if he's so great?

Salazar calls him "one of the best exercise endocrinologists in the world" (or something like that). Really? How does he know? How many has he tried out? What makes him better? Are there any other "exercise endocrinologists"?