Your thyroid is a master gland at the base of your neck which helps control your metabolism. If your thyroid function is sub-optimal (on the low side), you may experience symptoms such as fatigue, difficulty losing weight, depression, foggy thinking, hair loss, cold extremities, and feeling burned out. This could be the case even if your thyroid tests look “normal” by conventional standards.
If your thyroid hormones are truly out of the “normal ranges”, you will most likely be prescribed Synthroid or levothyroxine, which is a synthetic form of the thyroid hormone, T4. However, this T4 needs to be converted into the active thyroid hormone, free T3. Many patients that I see have T4 levels that look fine or even on the high side of normal, but they still have symptoms. Giving them more T4 won’t help! We need to promote the proper conversion of T4 into T3, and some patients do better when we switch them from Synthroid to Desiccated Thyroid (which contains a little active T3 in it).
So, here are 5 ways to help improve that T4 to T3 conversion, in order to boost your metabolism!
1) Get enough sleep
If you aren’t getting enough sleep, you aren’t giving your body a chance to produce enough Growth Hormone (produced in your slumber). Growth Hormone increases that T4 to T3 conversion. If you’re having trouble sleeping, you could also have a melatonin deficiency, a hormone which you produce when it is dark and which helps make you sleepy. Melatonin is also needed for proper T4 to T3 conversion.
2) Get adequate protein in your diet
Protein is essential as a building block for tissue repair and proper enzyme function in your body. The average person needs about 60-70 grams of protein per day. You can get this from lean protein sources such as fish, chicken, eggs, nuts, hemp hearts and other seeds, and legumes (however, if you have an autoimmune thyroid issue, some of these may not be recommended). Avoid soy protein sources, especially the non-fermented ones, as they can slow down thyroid function. Enough protein in the diet helps build muscle, decreases fat storage, improves satiety, decreases cravings for sweets, and helps burn more calories.
3) Balance your blood sugar
Foods high in sugar or refined carbohydrates (found in processed foods, white flour, fluffy breads, bagels, and most baked goods) spike up your blood sugar, which leads to insulin being released to help bring the sugar into your cells. Guess what insulin does… It decreases the conversion of T4 into T3, resulting in less active thyroid hormone! Eating a mostly plant-based, unprocessed diet, with adequate amounts of protein, helps to balance blood sugar levels, keeping them more steady and avoiding the big insulin-triggering spikes.
4) Decrease stress
Chronic stress leads to the production of the stress hormone cortisol. Cortisol interferes with proper metabolism in several different ways. First of all, it decreases the conversion of T4 into T3. It also shunts some of the T4 away from producing T3, and into producing reverse T3 instead. Reverse T3 functions as a brake on metabolism! Also, chronic stress decreases the ability of insulin to effectively bring sugar into the cells, leading to more insulin being needed for the same effect (insulin resistance)!
5) Optimize essential nutrients and vitamins (especially selenium, iodine, zinc, iron, Vitamin A, Vitamin B12, Vitamin D)
These essential nutrients are very important for producing enough thyroid hormone, and some are also useful if there is an autoimmune thyroid issue such as Hashimoto’s thyroiditis. Work with a naturopathic doctor to ensure you have optimal levels of these, supplementing when necessary. It is possible to take too much of these too, so make sure you’re taking the right amounts for you!
Still feeling sluggish and having trouble losing weight? I can help!
Working with a naturopathic doctor can help you eliminate the guesswork, get some testing done, and approach your goal in an individualized and systematic way. There are so many factors as play regarding metabolism, many of which I did not mention here. Come on in for a visit, and we’ll get you started on a program tailored for you!
Bray GA, Smith SR, de Jonge L, Xie H, Rood J, Martin CK, Most M, Brock C, Mancuso S, Redman LM. Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating: a randomized controlled trial. JAMA. 2012 Jan 4;307(1):47-55.
Image from 123RF.com, Copyright: <a href='https://www.123rf.com/profile_magone'>magone / 123RF Stock Photo</a>
Scott, TD, Speidel, K. (2017). Essential Elements of Prescription Hormone Compounding. LP3 Network. Conference 2017 Apr 29-30.
We all deal with stress. Stressors such as losses, job interviews, presentations, medical diagnoses, lack of sleep, job and home life balance, or challenging relationships can make us feel overwhelmed. Our bodies should be able to deal with these stressors, for a short period of time. And that’s the key: for a short period of time. The problem is, most of us are chronically stressed!
How Heavy Is The Burden You Carry?
You’ve probably heard of the analogy of holding a glass of water. Hold it for a minute, and it feels light. Hold it for an hour, and your arm will start to ache. Hold it for a day, and your arm will be numb and the glass will feel unbearably heavy. We often don’t remember to put the glass down until it’s too late. Until we have seen the repercussions on our body, mediated primarily by our adrenal glands, these little soldiers that sit on top of our kidneys, trying to fight for us.
Fight Or Flight
Your adrenal glands perceive any form of stress, whether it is a physical, emotional, environmental, biochemical, or spiritual stress, and respond the same way: by trying to produce either adrenaline (short-term) or cortisol (long-term). They are responsible for our fight or flight response: when our body assesses its environment and deems it unsafe, it prepares us for battle, getting our blood pumping, shifting our resources away from digestion and into our muscles and brain so that we can run from danger or fight it head on. But if this goes on for a long period of time, we will get exhausted, as it’s just not sustainable.
How Chronic Stress Affected Me
When I graduated from naturopathic medicine, and shortly after writing my licensing exams, my adrenal glands were in rough shape. I had pushed myself through medical school, but once the stressor was over, it was difficult for me to peel myself off the couch or do any exercise at all. I had survived on insufficient sleep, caffeine, deadlines, and willpower, but in the process, my digestion was a mess, and I was constantly battling fatigue throughout the day. Any new stressor made me feel overwhelmed. Luckily, as a new naturopathic doctor, I knew that my adrenal glands were in need of some tender loving care. I was probably near burnout. It took me a good year before I felt a lot better, and a few years more before I felt better than I had years before, during my undergraduate and naturopathic medical school studies.
You don’t need to be near breaking point before realizing that your adrenal glands need some help, and that stress is affecting your body in various ways. It’s best to catch it in the early stages, when it’s easier to shift back to balance.
Adrenal Fatigue Stages
You may have heard of the term “adrenal fatigue” (or adrenal insufficiency, hypoadrenia) from naturopathic doctors and integrative medical doctors. This term really refers to an older concept founded on Dr. Hans Selye’s research (a Canadian endocrinologist), called “General Adaptation Syndrome”. If we are under stress for long enough, we move through the different stages of adaptation to chronic stress, from the alarm stage, to the exhaustion stage. At the end of the exhaustion stage is burnout. You don’t want to get to the exhaustion stage if you can prevent it!
Stage 1 – Alarm
In this initial alarm stage, the body panics a little and tries to mobilize its resources. You might have a temporary decreased resistance to stress as your body starts to produce more cortisol to deal with the chronic stress, and you mobilize your energy sources from fat and muscle. Some people will lose weight in this stage.
Stage 2 – Resistance
In this stage, the adrenal glands actually grow in size as they try and keep producing more cortisol. But the high cortisol will wreak havoc on the body. Symptoms of high cortisol include:
-feeling tired but wired
-anxiety and nervousness; heart palpitations
-depressed mood; irritability; mood swings
-brain fog, confusion; memory problems; decreased concentration
-decreased sex drive
-hot flashes; night sweats
-weight gain around the middle
-more frequent colds and flus
Stage 3 – Exhaustion
In this stage, the adrenal glands can’t keep up with the production of cortisol and eventually cortisol production goes down. Any added stressor will be more difficult to deal with, as your resilience goes down. While cortisol levels fluctuate throughout the day, your highest levels of cortisol should be in the morning. Morning cortisol levels are also the last ones to drop in hypo-functioning adrenals. Cortisol helps keep us alert. So if you are having trouble peeling yourself out of bed, and you have late afternoon energy crashes, you may be in this stage.
At this stage, you may have symptoms of both low and high cortisol all at once. Symptoms of low cortisol include:
-burned out feeling
-cold body temperature; cold extremities
-cravings for sweets and/or salt
-joint pains; muscle pains
-low blood pressure
At the end of naturopathic school, I was definitely into Stage 3. Luckily, there are things we can do to help you deal with the stress and rebuild the health of your adrenal glands.
Do you need to put your glass down?
Do you think you might suffer from adrenal fatigue? In my next blog, I will discuss testing methods for assessing the health of your adrenal glands, so that you can know which stage you’re in and we can treat more specifically based on your needs.
But if you’ve read this and think you’re in the later stages based on your symptoms, don’t wait! Come on in for a visit, and I’d be happy to help you start to feel better. And don’t forget to put your glass down!
Image from 123RF.com, Copyright: https://www.123rf.com/profile_bialasiewicz'>bialasiewicz / 123RF Stock Photo</a>
Selye, H. (1998). A Syndrome Produced By Diverse Nocuous Agents. Journal of Neuropsychiatry, Spring 1998; 10(2): 230-231.
Scott, TD, Speidel, K. (2017). Essential Elements of Prescription Hormone Compounding. LP3 Network. Conference 2017 Apr 29-30.
Many people come to me at my Ottawa practice because they have difficulty losing weight and feel that their metabolism is slowing down. Your master gland for controlling metabolism in the body is your thyroid gland, a butterfly-shaped gland at the base of your neck. It is estimated that thyroid disorders affect 0.5-0.8% of the population, but those estimates may be on the low side. Naturopathic doctors such as myself who have taken additional training are now able to prescribe natural desiccated thyroid to help restore optimal thyroid function.
Many people have been told that they have normal thyroid function after an initial screening test (TSH), but on further testing, one or both of their thyroid hormones are off. So, I usually screen my patients who experience several low thyroid symptoms with a full thyroid panel to make sure that their thyroid is functioning optimally.
Symptoms of Hypothyroidism
What are low thyroid symptoms? If you think about it, if your metabolism is slowing down, you will see repercussions throughout the body. Digestion will slow down, thinking will slow down, and the pounds will start adding up. Here is a list of common signs and symptoms of hypothyroidism:
-Dry and coarse skin
-Difficulty tolerating cold temperatures
-Sluggish digestion and constipation
-Puffiness (you may notice puffiness in the face)
-Slow heart rate
-Delayed relaxation of ankle reflexes (this is tested during a physical exam)
Having several of these symptoms does not necessarily mean that you have a thyroid issue. Many of these symptoms are non-specific, so they may be due to many other imbalances in the body. That’s why testing is so important.
Testing for Hypothyroidism
I usually do a full thyroid screen when I test for thyroid disorders, which includes:
If you thought you had a thyroid issue or your doctor suspected it, you’ve probably had your TSH (thyroid stimulating hormone) tested. This hormone is secreted by the pituitary gland (at the base of your brain) and acts as a manager to tell the thyroid what to do.
If the thyroid isn’t producing enough thyroid hormones, TSH will typically be high, as the manager is working hard, trying to get the thyroid to do its job. However, there is a huge “normal” range for TSH. If you’re within the normal range but still have symptoms, your levels may be sub-optimal. As a naturopathic doctor, I’m checking to see if you’re actually within the optimal range, which is a smaller sub-section of the normal range.
The next hormone to look at is your free T4 levels. This is a pro-hormone produced by the thyroid which needs to be converted to free T3. It’s the free T3 that is actually active within the tissues, speeding up your metabolism. If you’ve been taking Synthroid or its generic form, levothyroxine, you are getting synthetic T4. This T4 needs to be converted into free T3. However, many people take Synthroid, regain normal TSH and fT4 levels, but still have low thyroid symptoms because they are not converting the fT4 into fT3 properly. That conversion process depends on many things, including stress levels, heavy metal exposure, and minerals such as selenium and zinc.
TPO antibodies are useful for screening for Hashimoto’s thyroiditis, an auto-immune condition where the body misguidedly attacks its own thyroid tissue, leading to hypothyroid symptoms. If you have this, it makes a big difference in how you will be treated from a naturopathic perspective, because our treatments will not only be aimed at getting thyroid function back, but also at decreasing the auto-immune response using diet, lifestyle, and supplementation.
What Affects Conversion of T4 into T3?
The conversion of T4 (inactive) into T3 (active) requires many factors to be in place for it to work optimally. The deiodinase enzyme is the enzyme through which this reaction takes place. This enzyme can be slowed down by (Hui, 2016):
-Lack of progesterone (common as women enter perimenopause)
-Low or high cortisol levels
-Toxins and heavy metals such as mercury
-Inadequate selenium, zinc, and other trace minerals and vitamins
-Stress or many chronic diseases
Why Desiccated Thyroid?
Desiccated thyroid is not for everyone affected with hypothyroidism. However, now that you have a basic knowledge of how the thyroid works, you’ll understand why someone might require desiccated thyroid rather than Synthroid (only T4). Desiccated thyroid in Canada, called Erfa, is a standardized natural extract from a porcine source. Since it contains both T4 and T3, it can be especially useful for those who convert T4 poorly to T3. As well, since it is an extract of the whole thyroid gland, it also contains other nutrients that act as building blocks for the thyroid to function properly. In a randomized, double blind, crossover trial, when patients spent 12 weeks on Synthroid followed by 12 weeks on desiccated thyroid, or the other way around, 43% of patients preferred desiccated thyroid over Synthroid while only 19% preferred Synthroid (Hoang et al., 2013). Those on desiccated thyroid also tended to lose more weight.
As with other drugs, patients on desiccated thyroid must be closely monitored to make sure that they are on an optimal dose for them which does not cause any side-effects.
Is Desiccated Thyroid For You?
If you would want to find out if desiccated thyroid is a good option for you, book an appointment at either of my locations, and I would be happy to help you out! We will do a thorough assessment and see if you would be a good candidate, or if there are other avenues that should be explored first (or in conjunction).
If you think your health issues may be related to your thyroid, just give one of my Ottawa offices a call!
Hoang TD et al. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: A randomized, double-blind, crossover study. J Clin Endo-crinol Metab 2013;98:1982-90. Epub March 28, 2013.
Hui F. Clinical Pearls in Assessing & Treating The Thyroid. Evidence Based Nutrition Module 3: Bio-identical Hormones Conference. February 2016.
Images from 123RF.com
Over the years, I have seen many patients who have been struggling with their weight in my Ottawa practice. Many have tried multiple strategies without lasting success before coming to see a naturopathic doctor. Trying to lose weight can be an emotional roller coaster, and is often not simply a matter of willpower and portion control. The only way to truly make a difference in the long run is to address the underlying cause(s) of weight gain.
I am excited to share with you some of the key points I talked about in my recent “Wellness for Weight Loss” seminars at the Ottawa Public Library. These are my top 5 weight loss sabotagers that I screen for in patients who are having difficulty losing weight.
Top 5 Hidden Causes of Weight Gain
Despite the large amount of food available to us, most North Americans following the Standard American Diet (appropriately referred to as the “SAD” diet) are overfed but undernourished! This diet is low in essential nutrients that are needed for proper metabolism and hormone balance. Without these nutrients, we can experience hunger even while eating larger quantities of food, since the body is still starving for those nutrients. Eating a whole food, varied diet, high in vegetables and omega-3 fatty acids, can help decrease inflammation in the body and help with proper hormone balance.
2. Blood Sugar Imbalances
Some carbohydrates in foods convert to sugar in the bloodstream faster than others. To prevent excessive storage of blood sugar into fat, you want your blood sugar to stay tightly regulated, with no sharp rises or dips. This is because sharp rises in blood sugar triggers the release of insulin, a hormone that controls blood sugar levels and storage into fat. As long as insulin levels are high, you cannot burn fat from adipose tissue because your body is focusing on storing excess blood sugar into triglycerides and then into fat cells. Foods that are high in simple carbohydrates and low in protein and fibre will cause an initial spike in blood sugar, leading to an initial energy boost. However, this is short-lived and is quickly followed by a dip as the sugar is taken up into cells and stored, leading to low blood sugar, low energy, and hunger cravings. And what do we typically reach for when we are hungry and in a hurry? High carbohydrate foods, which just perpetuate the cycle! Keeping your blood sugar more even by eating the right foods can make a big difference.
3. Food Sensitivities
Many people have underlying food sensitivities which are causing inflammation in their body, hindering weight loss. Identifying and eliminating food sensitivities may decrease chronic inflammation which fuels obesity. Food sensitivities are delayed immune-mediated reactions to foods, which can occur anytime from eating the food and up to 72 hours after. The body can produce excessive amounts of a type of antibody called immunoglobulin G, or IgG, which recognizes and attaches to specific proteins in food particles. (This is different from the typical anaphylactic allergic reactions we hear about, which are mediated by a different type of antibody called IgE.) Common symptoms of food sensitivities include digestive issues (gas, bloating, constipation, diarrhea), feeling like food “just sits there”, foggy thinking, migraine headaches, fatigue, difficulty losing weight, or skin issues (acne, eczema, psoriasis). If you suspect that you might have a food sensitivity, a naturopathic doctor can help you identify problematic foods through IgG food sensitivity testing (blood test) or an elimination diet.
4. Chronic Stress
All of us go through stressful periods. Usually, we can recover after a short-term stress and go on with our lives. However, we often don’t realize the detrimental impact of long-term, chronic stress on our bodies. Our body deals with any long-term stress through the adrenal glands (“ad” means “near” and “renal” means “the region of the kidneys”), which produce cortisol. If you tend to gain weight in your mid-section, chances are chronic stress (or sugar imbalances) may be an issue. Over time, high cortisol leads to the breakdown of muscle mass (decreasing metabolic rate), decreased production of active thyroid hormone, depressed mood, cravings for sweets, fats, and salty food, and central weight gain. Learning stress management tools and using the appropriate nutritional supplementation can help you improve your metabolism and help you lose weight around the middle.
5. Thyroid Dysfunction
Optimal thyroid function is very important for anyone who is trying to lose weight. The thyroid controls metabolism and therefore weight. An underactive thyroid, or hypothyroidism, is associated with weight gain, depressed mood, cold intolerance, constipation, and many other symptoms. Think about what would happen in your body if you slowed down how quickly everything worked, and you could explain most symptoms of hypothyroidism. If you have symptoms but your thyroid has been tested and found to be “normal”, there still could be a problem with your thyroid. I look for optimal rather than normal levels in those patients, and often order a complete thyroid panel (TSH, fT3, fT4, TPO) to make sure everything is functioning as well as it could. As mentioned above, chronic stress can also impair the way thyroid hormone is used by the tissues, and may be a reason you could have symptoms when your lab tests appear normal.
So that’s it: 5 underlying causes of weight gain to look out for! Are there any that you think could apply to you? If you have been struggling with weight for some time and want to treat the underlying cause, come on in for a visit at either my Nepean or Orleans clinic!
Dr. Tamar Ferreira is a Naturopathic Doctor in Brampton, Ontario. Her areas of focus include digestive health, hormone balance, and skin conditions.