'Foetal Programming - An underlying cause of metabolic disease, thyroid disease, hypertension and the related complex of health problems rep

Hi Guys. This long bloggish piece (what’s new ? ) is to float the topic of foetal programming, share some information and encourage some feedback. Bear in my mind that I’m not medical – this is an ad-hoc summary of what I seem to have picked up.

It may or may not be news to some of you, but it certainly created a big a-ha moment for me – given the fit between my birth circumstances and the list of conditions known to originate from disturbances to adult adrenal function as a result of foetal programming.

It’s in one way disappointing, in that it perhaps suggests that the root causes of the health issues reported by some of us are not easily soluble. It’s also positive, in that it may provide some into means for prevention for others, and treatments in our own cases.

Foetal programming may or may not be a big cause of metabolic and thyroid disease in the general sense – see below for some indicators of likelihood.

I’ve been searching for a solution to long running high blood pressure and (despite pretty optimal it seems T4 + T3 thyroid replacement) limited stamina – I’ve long been unable to work normally.

Longstanding chronic fatigue, undiagnosed hypothyroidism and a whole raft of associated immune and other related conditions led in my own case to a thyroidectomy for a thyroid cancer. Which likely developed from thyroid auto-immune disease – this in 2005. Which in turn may well have had it roots in adrenal issues originating with my foetal programming.

Work with the usual suspects that many of us are familiar with has since enabled a progression from chronic illness to reasonable basic health and well being - that’s stuff like T3, vitamin D, B12, nutritional supplements, omega oils, adrenal supplementation, removal of mercury from tooth fillings etc. It’s not unfortunately resolved the stamina or the blood pressure issues.

The question has always been what the missing cause/X factor was.

My sleep has for many years been marginal (lots of sleeping, but minimal refreshment/trouble waking up), so I recently started looking at melatonin as a possible means of improving the situation. This quickly led to information on how it partners with DHEA via the HPA (hypothalmus [brain]/pituitary [gland in the brain that controls most endocrine functions including adrenals and thyroid T4] axis) to control waking and sleeping cycles.

Foetal programming popped up as a possible underlying cause of problems in this regard, but the a-ha followed from the realisation that the consequent disturbances in the HPA are also linked to the very familiar series of the complex of health issues that many of us report.

Foetal programming has been an extremely active research topic for the past ten years and more - I’ll try to link papers below to capture some of the basic points.

One issue seems to be that while it’s getting a lot of attention there doesn’t seem to be much about by way of treatment strategies.

First off what is foetal programming? In simple terms it turns out that birth is triggered in part by the spurt of rapid growth and maturation of bodily systems necessary for survival once born. This is in turn triggered by activation of the foetal HPA - the unborn baby releases (and obtains from the mother) a cocktail of endocrine hormones over a month and more to make this happen.

The hormones are mostly ACTH and cortisol – adrenal hormones.

The issue that can develop is that if the mother becomes severely stressed, or due to health/lifestyle issues the baby becomes stressed it can prematurely trigger the HPA/this release of hormones.

It seems to be a survival mechanism, in that the result is an incomplete/less than optimised fast-forwarding of the development of bodily systems required for survival after birth, and the triggering of premature birth.

Stress is in this case a very general term. It can mean externally stressful circumstances, overuse of alcohol, dietary deficiencies, diseases, health issues and the like in the case of the mother - or anything leading to low blood oxygen levels (hypoxia) or exposure to excessive levels of adrenal hormones from the Mother for the foetus.

One result is that the ‘adrenal thermostat’ (the HPA) gets set too high in the baby - meaning that the child and eventual adult is ‘programmed’ to produce too much adrenal hormone in response to a given stress level. Another is that he/she is left for life with a number of less than optimum/less than completely developed bodily systems.

The bad news is that these tendencies seem to create a predisposition to a wide range of long- term health issues in the eventual adult – most of which many of us will recognise.

There are some differences in male and female tendencies – seemingly as a result of the influence of the sex hormones.

Thyroid problems often arise as a result of a complex of immune, gut and thyroid suppression issues resulting from raised levels of adrenal hormones and other pre-disposing factors.

The classic indicators that an individual may be in this category are a highly premature birth, and a low birth weight. (seemingly 1kg or below) Anything more than 10% below average birth weight is seemingly suggestive of the possibility of some issues however.

These problems normally don’t appear until adulthood – often it seems with the first experience of prolonged stress in e.g. work.

I was in the above category - over two months premature and around 1 kg at birth. It’s open to speculation as to how big a factor this is in general. My health collapsed about ten years after I started working – in response to a sustained period of moderately heavy stress and a serious motor accident.

What’s unclear is how common foetally programmed illness may be, or how the effect reduces as gestation periods and birth weights increase towards normal. They seem to be very common though - in that the realisation of just how wide ranging the implications for child and adult health are have led to the topic (and related matters like measures to minimise stress during pregnancy and protect the fetus) being placed high on many national research priority lists.

I’m unclear at this stage what may or may not be possible by way of interventions to help those of us who may be in this situation as adults.

There’s a diagram and descriptions of symptoms and causes of Cushing-ism/Cushing’s disease well down this very useful site: pathguy.com/lectures/adr-th... That’s the effects of too much adrenal hormone. The physical symptoms seem very familiar to me.

I’ve been worked up a couple of times and told that I didn’t have Cushings, but on other occasions tested for high levels of adrenal hormone which were not sustained. It seems possible that the issue could be that I respond excessively to stress as a result of foetal programming – but that its transitory nature means it’s not resulted in a diagnosis of high adrenal hormone.

I’m about to engage with my (pretty progressive and relatively new) endo on the topic, so wish me luck…

It’s worth noting that there are other situations during pregnancy that can programme endocrine and/or thyroid trouble in later life – for example low availability of thyroid or adrenal hormone from the Mother, or inherited tendencies and problems with the various bodily systems. That’s before the more commonly discussed life issues and their effects on endocrine health are considered.

Here are some papers (a Googled selection of mostly abstracts) on aspects of foetal programming, and some of the medical conditions it seems may originate from it:

(1)http://www.ncbi.nlm.nih.gov/pubmed/11738803

ncbi.nlm.nih.gov/pubmed/123...

How foetal stress, and consequent early HPA axis activation and exposure to adrenal/stress hormones lead to premature birth and low birth weights and the risk of poor adult health.

(2) jcem.endojournals.org/conte...

The correlation of low birth weight with excessive adrenal response in adults, and also with metabolic and cardiovascular disease, glucose intolerance, insulin resistance, hypertension etc.

(3) ncbi.nlm.nih.gov/pubmed/159...

asdresearchinitiative.wordp...

ncbi.nlm.nih.gov/pubmed/236...

Disturbance of the HPA axis thermostat by pre-natal stress and/or alcohol exposure – resulting in excessive exposure to adrenal hormone, reduced stress tolerance, reduced immune system competence, and increased immuno-suppression while stressed.

(4) fn.bmj.com/content/82/3/F25...

Functioning of the HPA axis, and the existence of foetal programming.

(5) neuroschool.univ-lille1.fr/...

nature.com/pr/journal/v69/n...

researchgate.net/publicatio...

Pre-natal stress and foetal programming result in a disposition towards anxiety, depression, cognitive dysfunction (autism etc), psychiatric illness and vulnerability to drugs. Linking pre-birth exposure to excessive levels of stress hormones and psychiatric disorders.

(6) ncbi.nlm.nih.gov/pubmed/208...

Pre-disposition to gut trouble and irritable bowel as a result of dysfunctional brain/gut communication. Discussion of immune, neurological, HPA, reduced gut barrier function (leaky gut), alterations to microflora (bugs), exaggerated stress response and gut hypersensitivity in this regard.

(7) nah.sagepub.com/content/19/...

ncbi.nlm.nih.gov/pubmed/196...

ncbi.nlm.nih.gov/pubmed/164...

hyper.ahajournals.org/conte...

Foetal programming of hypertension and reduced nephron count, reduced kidney capability and kidney disease.

(8) hindawi.com/journals/jnume/...

ajcn.nutrition.org/content/...

Foetal programming of obesity and weight loss problems.

(9) sciencedirect.com/science/a...

ncbi.nlm.nih.gov/pubmed/123...

publish.csiro.au/paper/SRB0...

Foetal programming and low melatonin, sleep/circadian rhythm disorders and depression.

(10) ttuhsc.edu/fostersom/pediat...

Foetal programming & wider effects of drugs.

(11) ncbi.nlm.nih.gov/pubmed/175...

Health effects of foetal programming are passed from generation to generation – by creating Mothers with a tendency to get stressed whose high stress hormone levels in turn create the condition in the unborn child.

(12) nah.sagepub.com/content/19/...

Importance of avoiding stress during pregnancy.

(13) file:///Users/ianmaybury1/Documents/ian/personal/medical/foetal%20programming/managing%20adrenal%20hormone%20levels%20via%20circadian%20rythym,%20eating%20&%20diet.html

Managing stress hormone levels in life to optimise health. (one informal view)

(14) utoronto.ca/DOHAD/Research....

Canadian research group active in the field of foetal programming.

ian

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  • CLARIFICATION - FOETAL PROGRAMMING CREATES A DISPOSITION TOWARDS THYROID DISEASE...

    Think I should have brought this out more clearly in the main piece...

    One long accepted fundamental cause of thyroid and the related gut and immune problems is chronic stress, and the associated sustained high levels of adrenal hormone - and foetal programming it seems often results in a disposition towards exaggerated stress responses/high HPA setting/permanently (?) raised adrenal 'thermostat settings.'

    The excess adrenal hormone (cortisol) produced during periods of stress blocks the production of TSH and reduces the hormone output of the thyroid, it also reduces or blocks the conversion of T4 to T3 in the body.

    This happens it seems because if high levels of adrenal hormone (normally used for short term ramping up of enenergy processes when fight/flight may be required) and thyroid hormone (sets the base level of metabolic processes) were to occur together we would end up over stimulated/overheated. So the two hormone systems are controlled relative to each other to prevent this. More elegantly here: womentowomen.com/adrenalhea...

    Knock on effects of this reduction in availability of thryoid hormone (set out by many of the well known thyroid pioneers - guys like Barnes, Mercola and the like) are the slowing of gut function (which leads to reduced uptake of nutrients and the key minerals needed by the thyroid among many other effects), and immune suppression.

    It's as above necessary that thyroid hormone is to whatever degree disabled in times of stress, but if the stress is chronic/sustained in the long term then we're left long term with not only minimal amounts of active thyroid hormone in circulation, but also with long term suppressed gut and immune system function and thyroid conversion.

    Which if left unresolved risks before very long progressing into the troika of thyroid, gut and immune problems that can in some of us quite quickly deliver stuff like Hashimotos/other auto immune conditions, thyroid disease, damaged gut function and the impaired thyroid hormone conversion and use that so many of us are familiar with....

    ian

  • Ta guys. It's highly relevant territory for many of us I think - and couldn't be much more fundamental in that chronically elevated cortisol levels are arguably a major trigger for much of the thyroid and related disease seen these days..

    Foetal programming as a result of stress in the womb produces adults with exaggerated responses to stress that as a result run abnormally high levels of cortisol. Which leads into thyroid, fatigue/wellbeing, immune, gut, psychiatric, obesity, ageing, glycaemic (blood sugar issues), cardiovacular, renal (kidney) and hypertensive problems - which lead on into most of the diseases that will kill most of us.

    All this as a result of being left with improperly developed organs and dysfunctional hormone systems and processes.

    It's in fact all a matter of degree. There's probably many of us with the above syndrome/inheritance (low birth weight and premature birth are as above the dead giveways), but relatively normal people suffer from chronically high cortisol levels too given our tendency to choose to live stressful lifestyles in challenging environments. (the latter in dietary and exposure terms)

    It's dead important. My sense is that there's minimal recognition of the harm that can be done to the unborn as a result of lifestyle and circumstances during a pregnancy.

    We've a tendency to see adrenal issues as transitory too - 'just boost the tired old adrenals and we'll be fine'. That may not be so easy in the case of the likely many of us where congenital problem account for much of the situation.

    The million dollar question is what if anything can be done to reduce or counter the effects of chronically high cortisol levels.

    I'd love to see this topic get some interest from Thyroid UK and other thyroid groups, because my guess is that it's far more prevalent than is realised. (it's seemingly found it's way to the top of some major national research priority lists) The hard bit is that knowing more about foetal programming isn't necessarily going to do a lot to help those of us already affected. Against that maybe it will point to mechanisms for treatement.

    Here's a few less formal links on symptoms and managing the problem. It's notable that there's little sign so far of there being a magic bullet/drug about that truly solves the cortisol problem. There's some used in severe cases (full blown Cushing's), but the lists of quite likely side effects are pretty scary.....

    Informative and practical discussion of the effects of high cortisol on ageing and thyroid:

    virginiahopkinstestkits.com...

    Causes and symptoms of high cortisol:

    diagnose-me.com/symptoms-of...

    Effects of high cortisol, and how to reduce it (Sarah Gottfried):

    saragottfriedmd.com/2012/05...

    More on symptoms and management of high cortisol:

    womentowomen.com/adrenalhea...

    Over to you guys....

    ian

    PS I used the term 'adrenal hormone' quite a lot in the first post. Cortisol is just one of several adrenal hormones, but as the one that determines medium term levels of arousal (the others seem to be more short term in effect) it seems (?) to be the one we're talking about right through this topic.

  • Ian, when I do a 'reply to this' it is not being attached to that particular part of the blog, it just ends up somewhere on the blog. PR

  • When my son was born, he was in great distress for far too long before an emergency caesarian was carried out, after 19 hours!!!!! I believe I was also suffering from hypothyroidism. My son was a very sick baby with frequent infections and he cried all the time. I took him to the Osteopathic Centre for Children, where they kept telling me that the BIRTH PATTERN had caused his distress and can affect a person forever. For years he had treatment there and is now a normal guy with a degree.However he still cannot tolerate stress and still needs treatment sometimes.They treat his pituitary gland! among other things.

  • Hi JJ. Who knows what life brings?

    If it's of interest there's mentions of new techniques both to help the foetus in the womb, and also in the weeks after birth in some of the papers on the topic. That's when the various endocrine systems are so underdeveloped that e.g. low cortisol levels threaten survival of the baby. Low levels either in the womb or afterwards seem to each bring their own risks.

    There's even what seemed to be the suggestion that there is one drug that was pretty much standard usage for highly premature babies which has turned out may longer term be somewhat harmful.

    I guess it helps to look at life in a wider context than just nice/not nice. My own health issues have dominated and completely changed my life, but have also been the means of my heading down really important paths (meditation, lifestyle, spiritual work and the like) that my conditioning would otherwise have knocked off the agenda...

    ian

  • Vajra, both my son's and my own health issues, have taken us down paths that we might not have travelled if we had been well. Cranial osteopathy and acupuncture have played a large part in our recovery, also the examination of more spiritual pathways.Like you, we have been able to turn things round and find the good and positive.

    I was obviously a hypothyroid mother, without being diagnosed until my son was five and this must have impacted on my son's endocrine development. I wish we had found cranial osteopathy while he was still in the womb,as practitioners are able to work on pregnant women, easing the stress of mother and baby.But we found help in the end.

  • Ian, thanks for the info, fascinating stuff. PathGuy could take a few years to digest. Women to women I've run across before and wanted to spend more time, thanks for the reminder. Can you modulate your response to stress? For instance using one of the bio-feedback type of instruments. Did you do a salivary stress test and monitor your stress levels during the period of sampling? PR

  • I've not done the salivary test yet PR, but have to check out the options. I'm not sure if the delay in mailing samples back to London from ireland might not be a problem.

    It seems that elevated DHEA levels (the trigger of waking) at night are common in people with sleep disturbances as a result of foetal programming, and that the resulting poor sleep by stressing the body and causing increased cortisol levels worsens the problem. Another of these self reinforcing negative health spirals...

    Melatonin it seems may be helpful in some of these cases, and as a result may help to improve rest and reduce cortisol levels and high blood pressure...

    I'd appreciate a steer if there's anything you know on the bio feedback end. I've heard of the principle, but don't know the specifics....

    ian

  • Ian, I was thinking along the lines that we can't eliminate all the stressors in life but we can change how we react to them. Yoga, meditation, and bio-feedback are all ways to approach this. The drugs they have can have some 'bad' side effects as you mentioned below. I got a little device that you hold in you hand 20-30 years ago to play with. It would emit a tone and by focusing on yourself and that tone you could make it decrease in pitch as you slowed your system. The same kind of results have been achieved for years with yoga and meditation. I was just trying to think of a non drug approach that might help you to control your reaction to stress since your system is set to overreact. It is tricky trying to figure out the areas that science really knows so little about. Almost all countries have sleep centers where they can record your sleep pattern, wonder if that might be useful to you at all? Please keep us informed on what you discover. PR

  • Hi again guys. This an ongoing exploration that's zeroing in to focus on options for the management of high cortisol levels.

    I can't vouch for it, but this blog on the topic came up today. medicinegarden.com/2011/02/...

    It covers symptoms, causes, treatment and the apparently excellent results obtained by the UK writer using a specific treatment approach which is described in reasonable detail. If nothing else page 1 is an excellent summary of symptoms - mine to a tee....

    The treatment is very interesting. It seems to suggest that taking a product that blocks some of the receptors for cortisol enables the re-programming of the pituitary - and hence the normalisation of the function of HPA function.

    This is true would be the answer to the maiden's prayer....

    ian

  • Another Googled link, this time to a UK piece that very elegantly sets out the symptoms of chronically high cortisol levels. medicinegarden.com/2011/02/...

    Which are all very familiar, and very much those which many of us report.

    Quite a few of us have gone on to develop thyroid, auto immune and other diseases. (the thyroid going down is i suspect the real show stopper - we can usually struggle on for some time with chronically high cortisol/stress levels)

    The point though is that chronic stress/high cortisol levels are likely the starting point for so many of these chronic health conditions - meaning that if they can be nipped in the bud there's a decent likelihood that the progression into stuff like Hashimotos, thyroid failure and other metabolic, gut and auto immune conditions can be slowed or even reversed.

    The latter pages in the piece may be an infomercial, but if the writer's case is generally applicable then it's maybe possible to use her method to re-set the thermostat in respect of foetal or other HPA (hypothalmus/pituitary/adrenal) programming. She talks of post traumatic stress being a common cause of this, and in form of a difficult family environment the culprit in her case.

    If it stands up it would be hugely significant for many of us i think...

    Has anybody else taken a look at this area/have anything to say?

    Thanks

    ian

  • Ian, this touches on an area I am familiar with. Children age 12 or younger than have suffered sexual or physical abuse, or experienced great terror or fright, or bullying can also have the same effect. I have two experiences that qualify for the great terror or fright part and that is one of two possibilities for what I think is peripheral tissue resistance that I have. Dr. Derry is the only one that I have come across in 25+ years of reading that understood the connection. He thought the maladaptation of the biochemistry somehow allowed people to survive the experience. Much of what she says makes sense to me about the cortisol response although that is not what I experienced. I don't have the full effect, because I was so young, that most people get. I would do some more reading on the adaptogen she is talking about. Any functional medicine people where you are at? PR

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