Weight loss is by far the number one question asked by readers. Thank you Marc Ryan from Hashimoto’s Healing for writing a guest blog post on this topic for Hypothyroid Mom. Marc recently invited me to be part of his video blog. I had a great time with Marc discussing Hashimoto’s, hypothyroidism and pregnancy! For those of you who wish to become members of Marc’s video blog and view our interview, here is the link: Hashimoto’s Healing Video Blog
Written by Marc Ryan, Founder of Hashimoto’s Healing
One of the most common concerns for people with hypothyroidism is maintaining proper body weight.
For people with Hashimoto’s (the most common cause of hypothyroidism) this comes in 2 varieties. They gain weight and can’t lose it or they have trouble keeping it on.
In this post we will examine the many reasons why a lot of people with hypothyroidism have such difficulty losing weight.
The Thyroid Influences Metabolism
One of the obvious things that people think about with hypothyroidism and weight gain is the fact that the thyroid has an impact on the body’s metabolic rate.
What does this actually mean? In technical terms, metabolism is the amount of oxygen used by the body over a particular amount of time. When this measurement is made at rest, it is called the basal metabolic rate or BMR.
Testing BMR was, once upon a time, used to assess a patient’s thyroid status. If you had a low BMR, your thyroid was underactive, and if you had a high BMR your thyroid was overactive.
Later studies showed that low thyroid hormone levels were linked to low BMRs. Then, most physicians decided to scrap testing BMR in favor of simply testing thyroid hormone levels because it is easier and it was found that the thyroid was not the only thing to influence metabolism.
Not So Fast
High or low BMRs are associated with changes in energy balance. Energy balance comes down to the difference between how many calories one eats and how many calories one’s body burns.
Things that create a high BMR, like amphetamines, for example, often cause a negative energy balance which results in weight loss. (This is one reason why you tend not to see many overweight speed freaks.)
Based on this, many people originally assumed that changes in thyroid hormone levels which can lead to changes in BMR should lead to the same changes and the same weight losses (Minus the lost teeth and paranoia).
Well, as with most things related to the body, it turns out that it’s more complicated than that.
Other hormones, proteins and neurotransmitters have also been found to be part of the mix and these all also have influence on energy, food intake and body weight.
Some of them that are worth taking a look at and dealing with are leptin, insulin, neuropeptide Y, serotonin and inflammatory proteins like interleukin 6 (IL-6).
Fat, Literally, Has a Mind of Its Own
Physiologically, evolution takes quite a long time (relative to our sweet, short lives). And our ancestors evolved in a calorie poor environment where fat was pretty hard to come by.
As a hunter gatherer on the open plains of Africa, our forefathers (and foremothers) had to expend a lot of energy to get food and there wasn’t a whole lot of fat around.
Most prey was pretty lean and grass fed and there weren’t too many fast food joints (The fossil record has yet to reveal a single Mickey D’s).
As a result, our bodies developed a natural tendency to store whatever fat was available. And that fat got programmed with some pretty ingenious innate intelligence.
One of those ingenious adaptations from the clever mind of fat is the hormone leptin.
Leptin, The Body’s Fat Programmer
Leptin is a hormone that is made in your fat cells and it is involved in maintaining body weight. Interestingly enough, it also has influence on the thyroid.
Leptin acts as an important control system that communicates to other organs about the state of your fat balance and whether to eat more or stay in low-metabolism survival state. (Where, oh where, have all the wildebeest gone?)
When you have more fat cells, you get higher leptin levels.
The high leptin lets your hypothalamus (a kind of master endocrine gland in your brain) know that you don’t need to eat as much.
So your metabolism slows (and this signals you to make more Thyrotropin-releasing hormone (TRH), and this raises Thyroid Stimulating Hormone (TSH) and the TSH tells your thyroid to make more thyroid hormone.
This is what happens when everything is working properly. But with Hashimoto’s and hypothyroidism, lots of things are often not working properly and many people develop leptin resistance.
Leptin Resistance, Not Unlike Insulin Resistance
You may have heard of insulin resistance (if you haven’t, read about it here: http://www.hashimotoshealing.com/hashimotos-blood-sugar-blues/). Well, leptin resistance is similar and often co-exists. In fact, both are consequences of obesity.
With insulin resistance your body’s insulin receptors get fatigued because they have to deal with so much sugar. (They just give up and say “Uncle”). A lot of people in the US, today, have some degree of this.
With hypothyroidism, people can become overweight and they tend to use less energy. The increased amounts of fat and the lower energy use can result in leptin resistance and you wind up with a vicious cycle where leptin stops doing its job.
It stops telling you when to eat and it stops signaling your thyroid.
Dieting Can Make This All Worse
Of course, many people’s natural inclination when they gain weight is to go on a diet to try and lose it. Often these people will keep dieting and fail and then diet again and get all stressed out about it because it’s not working.
And guess what? Chronic dieting and/or major stress are common causes of leptin resistance. As a result, leptin no longer signals your hypothalamus and your metabolism slows down.
Leptin resistance makes the hypothalamus believe that you are in starvation mode, and you make more fat, and slow down thyroid hormone production.
So, TSH goes down, you don’t convert as much T3 from T4, and your reverse T3 goes up.
And, in what can only be described as unfair and cruel, your appetite actually increases, you become insulin resistant, and fat breakdown (lipolysis) slows down.
So a vicious cycle is created in which more fat accumulates, you’re hungrier and your thyroid is slower.
Over time, you gain weight, especially around the mid-section, and it becomes more difficult to lose the weight and accumulated fat.
Leptin Resistance Leads to Inflammation
With Hashimoto’s (and hypothyroidism) one of the most serious problems is inflammation. In fact, a destructive inflammatory process is really what is at the root of all autoimmune diseases (of which Hashimoto’s is one.)
Leptin controls and influences the immune system, too. It is chemically very similar in structure to IL-6, which is an inflammatory cytokine (immune protein) that studies have shown to be significantly elevated in women with Hashimoto’s.
One of the places where you can find high concentrations of IL-6 is in the fat that accumulates around the abdomen. This adipose tissue is highly inflammatory and can, itself, lead to the progression and more aggressive proliferation of many diseases.
Low vitamin D has also been associated with both insulin and leptin resistance. And vitamin D is an important anti-inflammatory that is often low in people with hypothyroidism.
This Is Your Brain on Leptin
Your perception of hunger is intimately linked to your brain chemistry. Normally, when things are working properly, your hypothalamus gets signals that you need energy and a brain neurotransmitter called neuropeptide Y (NPY- not to be confused with NYPD) is released.
It makes you want to eat more carbohydrates (think overwhelming urge to finish that can of Pringles). That surge is what makes you feel cravings and hunger.
Once your body has had enough carbohydrates, the brain releases serotonin which is your brain’s way of saying, “Put down the bag and step away from the counter.”
Studies have shown that NPY is an important go between of leptin in the central nervous system and the hypothalamus. And that giving people NPY suppressed circulating levels of thyroid hormone (T(3) and T(4)) and resulted in an inappropriately normal or low TSH.
So, high levels of NPY can actually lead to functional hypothyroidism. And leptin’s job is to suppress NPY. So once again, we have the makings of another vicious cycle.
This also may be yet another reason why TSH testing can be unreliable in circumstances involving leptin and insulin resistance and weight gain due to hypothyroidism. (A set of circumstances that is ridiculously common.)
Et Tu, Serotonin?
Another neurotransmitter that is impacted by hypothyroidism is serotonin. As we saw above, one of the many roles of serotonin is to tell you to stop eating those crazy carbohydrates.
Thyroid hormone and serotonin have an intimate relationship and many studies have shown that thyroid hormones impact virtually all neurotransmitters in the brain.
So, with hypothyroidism you also may have less serotonin production and all the accompanying emotional and physiological problems related to that, like depression and minimized signaling that tells you to stop eating.
The cravings don’t go away, they intensify with weight gain and hypothyroidism. And this is all accompanied by emotional discomfort that makes you want to reach for that high carb comfort food.
Help! What Do We Do?
Naturally, we can’t leave you there, depressed and jonesing for comfort food. Let’s talk about what to do about all of this.
In a simple sense the root of all of this can be summed up with one word: inflammation. Being overweight is a problem of inflammation. So is Hashimoto’s, the most common cause of hypothyroidism.
So the most important thing to do is to reduce inflammation. And if you do that you can start to unwind many of these hormonal and neurotransmitter disruptions that are leading you down the road to feeling really crappy a lot of the time.
Paleo to the Rescue
One place to start is with some version of the Paleo diet. There are many versions, with my patients I use a version that is tailored for people with autoimmune disease.
This is also called the elimination diet and is very restrictive. But it is also very effective. Desperate times call for desperate measures.
If you want to unwind all of these vicious cycles and to reset leptin and insulin you can’t mess around and use half measures. When things get bad, half measures do not result in half results. They result in disappointment or, worse, no results.
This diet involves the elimination of virtually everything that is inflammatory in your diet and it removes almost all of the carbohydrates that lead to most of the problems we have described, too.
This allows your body to convert from a sugar burning leptin and insulin resistant machine to a happy fat burning ecosystem. It also reduces systemic inflammation.
This is absolutely essential, but often, the diet is not enough. As we have seen here, many systems are involved (and this is just the tip of the iceberg-click here to learn more: http://www.hashimotoshealing.com/how-the-thyroid-affects-11-different-systems-of-the-body/).
Over time, these various systems start to break down because of the influence of thyroid hormone on virtually every aspect of our physiology. The impact of hypothyroidism is felt everywhere.
This can cause problems in all the other systems of your body including your adrenals, your liver, your heart, your pancreas, your brain, your blood and much more.
Other Important Anti-inflammatories
Other things to add to the mix are natural anti-inflammatories like Vitamin D, turmeric, glutathione and lots of fruits and vegetables high in anti-oxidants.
Also, it should be noted that it is super important to eliminate from your diet other foods that are inflammatory like gluten, dairy products, soy, artificial sweeteners, processed foods and fast food.
Exercise Is Important Too
The other important ingredient is exercise. If you have Hashimoto’s or hypothyroidism this can be a real challenge because many people don’t have the energy to do anything.
But it’s really important that you do and that you do it consistently and at a relatively high intensity. For some people you may only be able to do high intensity for a few minutes a few times a week.
But gradually, as you lose the weight and the inflammation you will have more efficient energy reserves and distribution and you will turn this oppressive trend of downward spirals on its head and create a positive upward momentum towards weight loss and healing.
It can be done. It takes commitment and it takes perseverance. But, the results are well worth the effort. For more information on how to exercise with Hashimoto’s, click here: http://www.hashimotoshealing.com/how-to-exercise-with-hashimotos/.
Marc Ryan, L.Ac. is a licensed acupuncturist and herbalist and a functional medicine practitioner who specializes in treating Hashimoto’s Thyroiditis.
After going through his own trials and tribulation with the disease he decided to devote his life and his practice to helping people with Hashimoto’s and hypothyroidism get the information and the help that they need to understand what is happening to their bodies and to heal.
http://www.ncbi.nlm.nih.gov/pubmed/20205113 – IL-6 and Hashimoto’s
http://www.ncbi.nlm.nih.gov/pubmed/21528812 – low vitamin D and insulin resistance
http://www.ncbi.nlm.nih.gov/pubmed/11356711 -NPY inhibits HPT axis
http://www.ncbi.nlm.nih.gov/pubmed/21914774 – leptin resistance and neuropeptide Y
http://www.nature.com/mp/journal/v7/n2/full/4000963a.html – thyroid hormone and serotonin
http://endo.endojournals.org/content/138/10/4485.short – leptin and thyroid hormone
http://www.eje-online.org/content/149/4/257.full.pdf -leptin and thyroid dysfunction
http://www.ncbi.nlm.nih.gov/pubmed/18840640 -obesity in children and thyroid dysfunction
http://www.ncbi.nlm.nih.gov/pubmed/18852923 – relationship between TSH and BMI
http://articles.mercola.com/sites/articles/archive/2012/10/29/leptin-resistance.aspx – what to do about insulin and leptin resistance