It’s a very odd thing—As odd as can be—That whatever Miss T. eats Turns into Miss T.
—WALTER DE LA MARE
The endocrine system maintains a delicate balance in the body, and when there is a dysfunction in your thyroid, it can set into motion a host of other imbalances, sensitivities, and abnormalities that all contribute to weight-gain or weight-loss difficulties. This chapter looks at some of the challenges that are more common in thyroid patients.
BLOOD SUGAR IRREGULARITIES
One thing you should consider is getting your blood sugar tested. At a minimum, you can get a glucose level from a home test kit, but preferably get a fasting glucose and even a glucose tolerance test to evaluate whether your blood sugar is low, normal, high normal, or elevated. If it is high normal or elevated, this can in part contribute to your difficulty losing weight, and it is also a sign that you are either becoming insulin resistant, are prediabetic, or are already a type 2 diabetic.
In addition to using the blood sugar–balancing herbs (such as Glucosol) discussed in chapter 6, as well as following a low-glycemic diet and an exercise program, your practitioner may wish to give you antidiabetic medication such as metformin, which is known by its brand name Glucophage.
Metformin is an antidiabetic drug that has been available in the United States since 1995. It helps regulate blood glucose levels by reducing the amount of glucose produced by the liver, limiting the amount of glucose absorbed from food, and helping insulin work better to reduce the amount of glucose in the blood. One study found that metformin was associated with weight loss, better glycemic control, and enhanced insulin sensitivity of visceral fat, which is the deep fat surrounding organs. Another study found that insulin-resistant people given metformin had a 31% less chance of developing diabetes than control subjects with insulin resistance. Metformin can help reduce cholesterol and triglyceride levels and does not cause low blood sugar levels as often as some other drugs in its class (like glyburide and glipizide).
On the downside, metformin can have a number of unpleasant side effects including diarrhea, nausea, and vomiting. The most common side effect was diarrhea, which occurred in 53% of metformin-treated subjects involved in a double-blind clinical trial. Nausea/ vomiting occurred in 26% of subjects in the same trial. Other common side effects included flatulence, loss of strength, indigestion, abdominal discomfort, and headache. Less common side effects include abnormal stools, low blood sugar, muscle pain, light-headedness, shortness of breath, nail disorders, rash, increased sweating, taste disorders, chest discomfort, chills, flu symptoms, flushing, and heart palpitations. In very rare circumstances, metformin has caused lactic acidosis, which is a buildup of lactic acid in the cells and bloodstream; it is fatal in 50% of cases. Symptoms of lactic acidosis are subtle at first and include muscle pain, lethargy, a sense of not feeling well, breathing problems, sleepiness, abdominal aches, nausea, vomiting, and severe weakening of muscles in the legs and arms.
Patients with kidney disease, a history of shock, heart attack, liver disease, and septicemia should not take metformin. Also, people with congestive heart failure, a known sensitivity to metformin, or metabolic acidosis should not take metformin. Excessive intake of alcohol must be avoided because it raises the risk of lactic acidosis. The typical monthly cost for metformin ranges from $33 to $45.
ADRENAL IMBALANCES
There is a strong connection between the function of the adrenal glands and the thyroid. A malfunctioning adrenal system can sabotage weight-loss efforts. On one end, being in a situation of adrenal stress means that you produce too much cortisol, which can contribute to weight gain, and a constant release of adrenaline can cause resistance to it, making metabolism less efficient. On the other end, a low-functioning adrenal gland, also called adrenal insufficiency, can slow down overall metabolism and can worsen thyroid problems.
Adrenal fatigue often develops after periods of intense or lengthy physical or emotional stress, when overstimulation of the glands finally leaves them unable to meet the body’s needs. Some other names for this condition include non-Addison’s hypoadrenia, subclinical hypoadrenia, hypoadrenalism, and neurasthenia. Symptoms include:
The adrenals produce hormones that help to balance blood sugar, which helps your body to manage daily ebbs and flows of energy. When blood sugar drops, the adrenals release hormones that cause the blood sugar to rise, increasing energy. The adrenals also release hormones when you’re under stress, releasing energy. It’s the fight-or-flight response from the days when humans needed to run away from wild animals. Today, it kicks in for everyday stressors such as traffic jams, arguments, and work pressures. But being consistently under stress takes a toll on the adrenal glands, and eventually they run out of steam and stop producing sufficient hormones.
Conventional endocrinologists and conventional tests cannot diagnose adrenal fatigue, because they are only prepared to diagnose extreme dysfunction in the adrenals, such as Addison’s disease, a potentially fatal condition where the adrenals essentially shut down, or Cushing’s syndrome, when too much cortisol is produced. A holistic or complementary practitioner can do a saliva cortisol test to evaluate your adrenal function and diagnose more subtle dysfunctions.
If you are suffering from adrenal fatigue, here are a few tips:
OTHER HORMONAL IMBALANCES AND DEFICIENCIES
Imbalances of progesterone and estrogen—either too much or too little, or an improper ratio of one to the other—can slow down your digestion or make you more efficient at fat storage. Not enough melatonin, pregnenolone, or DHEA can also interfere with weight loss.
But the answer is not to start self-treating with over-the-counter progesterone creams or order estradiol creams, or to hit the vitamin store for bottles of melatonin, pregnenolone, and DHEA. Whether or not they require a prescription, these are all hormones, and hormones can have powerful effects and side effects. So you need to have your levels tested and deficiencies and imbalances assessed before you start adding hormones to the mix. For a thyroid patient who is already taking a hormone supplement, it is particularly essential to find a practitioner who can work with the patient to help determine the best possible mix of supplements. It’s an art and a science not particularly suited to our own amateur efforts at diagnosis and treatment.
Dr. David Brownstein, author of The Miracle of Natural Hormones, believes that balancing the entire hormonal system may be a key to weight loss for some people.
In order to achieve the best results, I feel it is necessary to balance out the entire hormonal system. This can include the use of the adrenal hormones (i.e., DHEA and pregnenolone), ovarian hormones (i.e., using natural progesterone and natural estrogens and natural testosterone), growth hormone, melatonin, and others. I find using small amounts of each of these hormones in combination much more effective than using one hormone individually. Sometimes, patients need a combination of treatments to help them achieve their optimum health.
FOOD ALLERGIES AND SENSITIVITIES
Sensitivities or full-scale allergies to particular foods or pathogens can cause inflammation in your intestinal system, making weight loss difficult, if not impossible. Food sensitivities and intolerances are quite common, but full-scale food allergies are less so. One report found that while 1 in 3 people think they have a food allergy, only 1 in 50 actually do. An allergy is defined as a reaction to a food or substance that could potentially trigger a life-threatening response such as anaphalactic shock, airway swelling, or difficulty breathing. A food sensitivity is more likely to cause migraine headaches, fatigue, bloating, skin rashes, or diarrhea.
The most common allergenic foods include
I’m fairly allergic to tree fruits (like apples, pears, cherries, peaches, plums) and certain nuts such as walnuts, pecans, and cashews (but not the common allergen peanuts). I also have seasonal hay fever, and these fruit/nut allergies are apparently more common in people who have hay fever. Interestingly, applesauce and baked or canned fruits are fine for me, because the allergen is apparently destroyed by cooking.
Inflammation occurs when you have a food allergy or sensitivity. This sort of inflammation gradually wears away the ability of your intestinal surface to filter out pathogens and toxins. Eventually, like a window screen that has developed holes, bigger particles can pass through your stomach and intestinal lining directly into the bloodstream, which triggers inflammation and irritation, interfering with your body’s ability to optimally absorb nutrients.
If you suspect food sensitivities or allergies, you don’t need to head off for expensive allergy testing. One of the primary ways to assess them is to try an elimination/rotation diet. Stop eating a particular food for about a week, then reintroduce it in a larger quantity. Keep track of any symptoms you have over the next several days including aches, pains, headache, fatigue, stomach upset, skin eruptions, itching, mood swings, and other strong reactions.
If you’re going to do an elimination test diet, start with some of the most common allergens for people with thyroid problems: wheat, dairy, corn, soy, and fish. Check the ingredients list of supplements and processed foods to make sure you’re avoiding all sources of the allergen being tested. Sometimes it seems as if flour, corn oil, hydrogenated soy derivatives, and soy proteins are in everything from power bars to breakfast cereals.
You can also pursue more formalized testing with an integrative or functional medicine expert or an allergist. A specialized blood test known as enzyme-linked immunosorbent assay (ELISA) is considered a state-of-the-art way to diagnose food sensitivities.
Obviously, if you discover a food to which you have a sensitivity or allergy, one of the key things you can do is eliminate it from your diet, or at least cut back significantly on consumption of the food to see if it aids you in your weight-loss efforts and helps alleviate other symptoms.
CANDIDIASIS
Thyroid patients seem to be more susceptible to candidiasis—a chronic overgrowth of the fungus candida—also known as chronic yeast infection. The condition was brought to the public’s attention by the late Dr. William Crook in his 1983 book, The Yeast Connection, and is considered to be the cause of—or is more common in people with—many hard-to-diagnose chronic illnesses.
If you have been on long-term antibiotic therapy, have a diet high in sugars, have used steroids, or have a suppressed immune system, you are at higher risk for developing candidiasis. There are a number of other risk factors. They are outlined at length in Dr. Crook’s several definitive books on the topic.
The symptoms of candidiasis are fairly wide-ranging, and include
These are just a few of the dozens of other symptoms attributed to candida overgrowth.
Detecting candida involves one or more tests, including:
Treating candidiasis can be a complex process and may require monitoring by a good nutritionally oriented doctor or practitioner. Treatment is typically multifaceted and may include the following tactics.
Changes to Diet
Dietary changes depend on the severity of symptoms. Some of the most extreme candida diets suggest eliminating the foods that “feed” yeast, including anything with yeast itself (such as breads), plus sugar, flour, fruits, dairy, certain meats, mushrooms, and fermented products like vinegars and alcoholic drinks. Other suggestions include eliminating only those foods that are particularly troublesome. (Again, Dr. Crook’s books cover the entire yeast issue and provide specific guidelines on the diets.)
Supplements
Antiyeast supplements are sometimes recommended, including garlic, biotin, caprylic acid, pau d’arco, and others that are thought to help combat yeast.
Probiotics
Probiotics are supplements that contain live bacteria—the “good” bacteria found in fermented foods such as miso and dairy products such as yogurt and some cheeses—that we are meant to have in sufficient quantities in our intestinal system. One of the more well-known bacterium in this category is acidophilus, the live cultures found in yogurt. A Finnish study found that giving probiotic supplements to pregnant women close to delivery and then to their newborns could help prevent childhood allergies in the babies. Allergy experts say this is evidence that probiotic bacteria can train the immune system to resist allergic reactions, including candidiasis.
Antifungal Drugs
Prescription antifungal drugs may be necessary in order to completely eliminate the candida infection. Some of the drugs your doctor can prescribe include
CELIAC DISEASE/GLUTEN SENSITIVITY
Celiac disease, also known as celiac sprue, celiac sprue-dermatitis, or gluten intolerance, is a chronic disease of the digestive system that prevents absorption of nutrients from food. People who have celiac disease have an allergic sensitivity to gluten, a protein that is found in grains such as wheat, rye, barley, and possibly oats. Eating these foods causes damage to the mucosal lining of the intestine, which leads to an inability to properly digest and absorb nutrients.
According to a study by the University of Maryland Center for Celiac Research, nearly 1 out of every 150 Americans suffers from celiac disease, meaning that several million people in the United States currently have this disease. It can affect both men and women, but is slightly more common in women.
Celiac disease can first appear in infants when they begin to eat gluten products. However, it may not be diagnosed at that time, and symptoms flare and diminish through adolescence and into adulthood, when symptoms reappear again. Most cases are diagnosed in people in their 30s and 40s.
Symptoms of celiac disease and gluten sensitivity include
The main way to diagnose celiac disease is with a blood test to measure circulating antibodies to gluten—antigliadin, antiendomysium, and antireticulin. A home or office finger-prick test that does an analysis known as an IgA tissue transglutaminase (tTG) autoantibody assay can be done to help diagnose celiac disease. In some cases, endoscopic examination of the small bowel or a biopsy is necessary to make a diagnosis.
Many adults spend years being misdiagnosed and are commonly told they have irritable bowel syndrome, which is a far less serious condition not treated with a gluten-free diet. It’s particularly important to get a diagnosis of celiac disease as early as possible, because the more delayed the diagnosis, the more risky the disease can be.
People with celiac disease must stay on a gluten-free diet for the rest of their lives or risk damaging their small intestine and further losing the ability to absorb nutrients. The gluten-free diet means total avoidance of all wheat, rye, and barley and products made from them. There is some disagreement as to whether oats are also to be avoided. Be careful to avoid hidden glutens such as vegetable protein and malt, modified food starch, some soy sauces, and distilled vinegars, among other food items. A good support group can help you learn how to eat gluten-free among today’s variety of food options. It’s essential to stay on the gluten-free diet for life. One Italian study found that the death rate for those who failed to stick to a gluten-free diet was six times higher than for those adhering to the diet.
The incidence of celiac disease in various autoimmune disorders is 10 to 30 times higher compared to the general population. Even a sensitivity to gluten (and not full celiac disease) may contribute to the development of an autoimmune disease, so it’s important to be aware of the connection. Some patients have found that independent of any testing and diagnosis, they have been able to reduce symptoms and more effectively lose weight on a gluten-free diet.
PARASITES
There are a variety of parasitic infections ranging from microscopic parasites like giardia, amoeba, cryptosporidium, and blastocystishominis to larger parasites such as various worms, flukes, and parasitic insects. You can pick up these parasites from a variety of sources, including improperly cooked foods, water, poor sanitation or hygiene, travel to tropical climates, exposure to animals or their feces, insect bites, and other means.
The symptoms of various parasitic infections vary but often include intestinal problems and can include difficulty losing weight. Diagnosis depends on the suspected parasite and may include a physical exam, stool samples, urine samples, blood tests, biopsies, ultrasound, x-ray, and tape tests (applying tape around the anal region to examine for microscopic worms).
Treatments depend on the type of infection and can include antiparasitic drugs, steroids, pain relievers, antiinflammatories, antihistamines, and antibiotics for relief of symptoms or to treat various infections. Some herbal remedies are fig, andrographis root, garlic, wormseed, turmeric, and pumpkin seeds, among others. There are also a number of parasite cleansing systems and herbal combination remedies available.
Parasites are a complex issue, so you should not self-diagnose or self-treat. If you suspect that you may have any risk factors or symptoms of parasites—and many of us don’t realize how pervasive parasitic infections are—you should start by reading one of the definitive books on the topic, such as Guess What Came to Dinner? Parasites and Your Health by Ann Louise Gittleman, then consulting with a practitioner who can help you diagnose and treat the infection.
COPPER/ZINC BALANCE
One overlooked but important consideration for thyroid patients is copper overload. Dr. Gittleman, in another key book, Why Am I Always So Tired? explores this issue.
Copper and zinc tend to work in a seesaw relationship with each other in the body. When the levels of one of these minerals rise in the blood and tissues, the levels of its counterpart tend to fall. Ideally, copper and zinc should be in a 1:8 ratio in favor of zinc in the tissues. But stress, overexposure to copper, or a low intake of zinc can throw the critical copper-zinc balance off, upsetting normal body functioning.
Gittleman believes that a copper-zinc imbalance can slow weight loss and impede conversion of T4 to T3 even in people whose thyroid hormone levels are normal.
To determine whether you have excess copper or a copper-zinc imbalance, you should have your doctor or practitioner run a trace elements analysis (TEA). This test uses a small hair sample to assess your nutritional levels of various minerals and metals. Laboratories that perform TEA testing are included in appendix A.
Gittleman recommends that if you are found to have high copper levels, you should avoid foods that have high copper levels, including soy products, yeast, wheat bran/wheat germ, chocolate, mushrooms, nuts, seeds (except pumpkin), shellfish, organ meats, and tea. She also recommends avoiding foods and drinks that deplete zinc, including alcohol, coffee, sugar, and excessive carbohydrates, while emphasizing zinc-rich foods such as eggs, chicken, turkey, red meats, game, and pumpkin seeds. Gittleman’s book includes specific guidelines on copper-zinc balances.