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Is TSH Enough

Is a TSH Enough to Test Your Thyroid?

​Most medical providers have been trained to only check the TSH when monitoring thyroid function.

​But is th​e TSH enough to ​test your thyroid?  Is it enough to monitor whether you are on the right dose or right type of thyroid medication?

The answer is a definite “no” and I will explain why in this article…

​What is TSH?

Let’s quickly review what the TSH is and what it indicates:

Thyroid cascade

​All thyroid activity actually begins in the hypothalamus of the brain​.  The hypothalamus secretes a hormone called Thyroid Releasing Hormone (TRH) which then stimulates the pituitary gland to secrete TSH.

​TSH ​an acronym for Thyroid Stimulating Hormone.  ​It’s purpose is to stimulate the thyroid gland to produce thyroid hormone.

The pituitary gland measures the level of T4 and T3 in the blood ​of the pituitary and secretes TSH in order to keep the levels of thyroid hormone in the optimal ranges.

When the body is healthy and working normally, this feedback loop works seamlessly to regulate thyroid function in the body.

As a reminder, if there are low levels of T4 and T3 in the pituitary gland, it will increase TSH secretion to try to stimulate the thyroid to produce more thyroid hormone, so the TSH level will rise.  Conversely, if there is an excess of T4 or T3, the pituitary will decrease TSH production.  The TSH level will drop or sometimes even go to zero.

The result is the TSH moves in the opposite direction of the thyroid hormone level.  If you are low in thyroid hormone, your TSH will usually go high, and vice versa.

​Remember, the TSH is ​an indicator of blood levels of T4 and T3 in the pituitary gland, which may not be the same as in the rest of the body.  This is because the pituitary has a different deoidinase enzyme than the rest of the body.

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​Thyroid Lab Tests

Prior to the 1970s, the history and physical exam were the primary tools used to diagnose hypothyroidism, Grave’s Disease, Hashimoto’s Thyroiditis, and other thyroid conditions.

​The TSH lab test was developed in 1975 and has been considered the gold standard for diagnosing and managing thyroid diseases ever since.  

​The vast majority of medical providers (doctors, PAs, NPs) are taught in their training to just use the TSH lab test to test for thyroid disorders and to monitor thyroid medications. 

If you ask ​them to do a complete thyroid​ workup to see if you have thyroid disease, they will order a TSH and ​sometimes a T4 level or TPO antibody level.  The other tests are rarely ordered, and even if they are, most providers don’t really know how to interpret them correctly.

​Conventional medicine doctors are taught this simple rule – If the TSH is high, you have hypothyroidism.  If it is low, you have Grave’s disease or you are on too much thyroid medication.  

Sounds simple, doesn’t it?  Unfortunately, evaluating the thyroid is much more complex than that.

​I personally believe that in order to truly evaluate ​someone’s thyroid health, you need to order a complete thyroid panel.  Those tests include:

​If you want more information on each of these tests, what the levels are indicating, and optimal ranges for each, read my article here.

The sex hormone binding globulin (SHBG) can also be very helpful in assessing thyroid levels in the body, especially if you are on thyroid medication.  Read more about it here.

​Common Causes of a Suppressed TSH

So ​is checking the TSH enough to diagnose and manage thyroid disorders?  No, because there are many situations in which the TSH will be falsely suppressed or at least lowered from what it really is.

Suppressing (lowering) the TSH level makes it look like the person has more thyroid hormone in their body than they really have.  As a result, this may make it look like they are on too much thyroid medication when the opposite is actually true.

Also, if they haven’t been diagnosed with hypothyroidism, this may mask their true levels and prevent the diagnosis from being made because the TSH is “normal.”

Now let’s discuss some of the situations where the TSH may be falsely low:

​1.  Pregnancy –

​The TSH can be transiently low or even undetectable in up to 20% of normal pregnant women with no other signs or symptoms of hyperthyroidism.

​2.  Medications –

​Several classes of drugs ​can suppress the TSH.  The most common ones include:

  • check​Glucocorticoids – These include oral, topical, inhaled, and injectible steroids such as prednisone, triamcinolone, dexamethasone, betamethasone, etc.
  • checkDopamine Agonists – These drugs are used primarily for the treatment of Parkinson’s Disease and Restless Leg Syndrome (RLS).  They include ropinirole (Requip), pramipexole (Mirapex), and many others.
  • checkCancer Chemotherapy –  ​Many chemotherapy drugs such as somatostatin analogs and rexinoids ​cause hypothalamic dysfunction which reduces TRH secretion ​and thus lowers the TSH.

​3.  Autoimmune Thyroid Disease (Hashimoto’s) –

​It is common practice to give Hashimoto’s patients thyroid hormone medication as a treatment for their autoimmune disease.

This is because studies show that thyroid hormone medication can reduce thyroid antibody levels even if the TSH is normal.  ​Click here, here, here, here​,  and here​ for even more studies.

This will obviously result in​ the TSH being suppressed a large percentage of the time in patients with Hashimoto’s.  However,​ it brings the T4 and T3 levels ​into the optimal range.

Which is more important?  Keeping the TSH “normal” or getting the T4 and T3 levels normal?  I believe there is a strong argument that it is more important to optimize the T4 and T3.

​4.  Chronic Fatigue Syndrome/ Fibromyalgia –

The hypothalamic-pituitary-adrenal axis is a complex system that controls many of the hormone systems of our body.  Research shows that when that system does not function correctly, it can have a major impact on the body.  That is called HPA dysfunction.

​​HPA dysfunction is ​relatively common.   ​When this system isn’t working properly, many of the hormone glands in our body – adrenal, thyroid, ovaries, and testicles – do not work normally.  This results in reduced production of cortisol, thyroid hormone, and sex hormones.

People that have HPA dysfunction ​often have low TSH levels (because of reduced production of TRH), which makes it appear on lab tests that they have adequate or even high thyroid levels in the body.  In reality, the majority of them have LOW thyroid levels, even though their TSH is in the low or normal range.

​HPA dysfunction is commonly found in people with conditions such as Chronic Fatigue Syndrome and Fibromyalgia.

If you suffer from one of these conditions or know someone who does, you may realize that many of the symptoms appear the same as hypothyroidism:

  • checkFatigue
  • checkConstipation
  • checkMuscle pain
  • checkMood swings
  • checkCold intolerance
  • checkBrain fog

​This has led some experts to believe that ​hypothyroidism at the cellular level may be one of the primary causes of fibromyalgia and chronic fatigue syndrome.

In this study, researchers gave liothyronine (T3) to patients with fibromyalgia, even though their TSH was in the normal range.  It resulted in the patients having a suppressed TSH consistent with what most doctors would call hyperthyroidism.  

However, their fibromyalgia symptoms were greatly improved, and there were no significant side effects from taking the high doses of thyroid medication.

In a follow up study, the T3 medication was discontinued, resulting in the patient’s symptoms returning. When the medication was restarted, the symptoms improved again.

​Could fibromyalgia and chronic fatigue syndrome be at least partly caused by undiagnosed hypothyroidism?  It is something that should be considered.

​5.  Mutation of the Thyroid Receptor (Peripheral Thyroid Resistance) –

​This sounds way more complicated than it really is.

​To put it simply, some people are born with a defect in the receptors in their cells where thyroid hormone attaches.  Receptors are like ​locks on the cell wall.  If the right key fits into those ​locks, it will trigger whatever function in the cell that the receptor was designed to do.

Below is a diagram of how this is supposed to work:

​However, if the lock is defective in some way, it may not work right even when the right key fits into it.

This is what happens when there is a mutation in the thyroid receptor.  The thyroid hormone may attach to it, but it may not trigger the function of that receptor like it was designed to do, at least not as efficiently as it would normally.

As a result, the cells will not be as responsive to thyroid hormone as they should be.  ​This is called peripheral thyroid resistance.

​Patients with peripheral thyroid resistance may have normal or even low levels of TSH, but their free T4 and free T3 levels will be low.  The​ amount of thyroid hormone required to normalize their free T4 and free T3 ​will often result in a suppressed TSH.

​Here is an example from a recent patient in my family practice office.

This ​ 32 year old female with a history of Hashimoto’s thyroiditis ​came to my office complaining of persistent fatigue ​despite taking Armour Thyroid 120mg daily, selenium 200mcg daily, turmeric daily, and B12 supplements.  She eats a whole food diet, exercises regularly, and gets good sleep.

Here complete thyroid panel is listed below:

​As you can see, her TSH is in the normal range.  If that was the only lab checked, you might think her thyroid level was normal.  However, both her free T4 and free T3 are very low and her reverse T3 is <15 (which we want).  Her TPO antibodies are slightly elevated.

This is typical of someone that has peripheral thyroid resistance.  It will take more thyroid medication than usual to get adequate amounts of it into her cells, most likely because she has a mutation of her thyroid receptors.

​I therefore increased her Armour Thyroid to 150mg in hopes of getting her free T4 and free T3 levels into the optimal range.  That will ​most likely​ cause her TSH to be suppressed below the “normal range,” but it will be necessary to help relieve her fatigue and other hypothyroid symptoms.

​Summary

​Only checking a TSH level is not enough to monitor the thyroid activity and function in the body.

​That is because the TSH is really only a measurement of thyroid hormone levels in the pituitary gland, which may be different than thyroid levels in the rest of the body.

Many things can cause the TSH level to be inaccurate, including some medications, autoimmune thyroid disease, chronic fatigue syndrome, fibromyalgia, thyroid receptor mutations, and even pregnancy.

In order to get a true ​assessment of thyroid activity in the body, it is important to get a complete thyroid panel and take a thorough history and physical exam.

Now it’s your turn…

​Do you have symptoms of thyroid disease but have been told that your TSH is normal?

Have you had experience treating your thyroid issue even though your TSH is normal?

Leave your questions and comments below.​

Is a Low TSH Level Dangerous?

​Is it dangerous to have a suppressed TSH level lower than the “normal” range?

Does a low TSH increase the risk for osteoporosis or heart problems?

Are there situations when having a suppressed TSH is not only safe but helpful?

Are there things that can be done to avoid the potential negative side effects of a low TSH?

I will try to answer these questions and others in this article…

​What is TSH?

Let’s have a quick reminder of what exactly the TSH is and what it indicates.

​TSH ​is short for Thyroid Stimulating Hormone.  This hormone is produced by the pituitary gland in the brain.  It’s purpose is to stimulate the thyroid gland to produce thyroid hormone.

The pituitary gland measures the level of T4 and T3 in the blood ​of the pituitary and secretes TSH in order to keep the levels of thyroid hormone in the optimal ranges.

When the body is healthy and working normally, this feedback loop works seamlessly to regulate thyroid function in the body.

As a reminder, if there are low levels of T4 and T3 in the pituitary gland, it will increase TSH secretion to try to stimulate the thyroid to produce more thyroid hormone, so the TSH level will rise.  Conversely, if there is an excess of T4 or T3, the pituitary will decrease TSH production.  The TSH level will drop or sometimes even go to zero.

The result is the TSH moves in the opposite direction of the thyroid hormone level.  If you are low in thyroid hormone, your TSH will usually go high, and vice versa.

​What is a Normal TSH Level?

​When looking at a characteristic found in a large population of people, the results will follow a predictable distribution across a graph.

For example, if you ​graph the heights of everyone in the ​world, the results w​ill range from as little as 21.5 inches to as tall as 97 inches ​with the average being about 68 inches.  The majority of people in the world will be close to the average height.  The further away from the average you go, the fewer people will be that height.

The result is what is commonly called a Bell Curve:

​This is also how reference ranges for lab tests are determined.

However, a Bell Curve also assumes that all people included in the graph are equivalent – meaning none are on medication, have different diets, genetic history, etc. which could affect the results.

ZRT is a well-known national laboratory.  Their website explains it like this:

Reference ranges do not always reflect a “normal” healthy population free of medications. Most laboratories establish their reference ranges from a large population of people where detailed information on health status, stage of life (premenopausal vs. postmenopausal), and medications and hormones used is unknown, and therefore not taken into account. Couple this with differences in lifestyles, physiology, dietary habits, and genetic heredity, and it’s even more difficult to define, let alone find, a normal population.  

​This is what happened when the “normal” reference range for TSH was ​first established.  It has since been determined that ​up to 30% of the people​ who have a TSH > 3.0 have undiagnosed ​autoimmune thyroid disease, which skews the TSH results higher than what they would be in a population with no thyroid issues.

​So instead of a normal range of TSH ranging from about 0.4-​5.0 which it is for most labs, it should instead be about 0.4-2.0.

​In other words, even if a patient’s TSH comes back at something like 3.5, even before I look at the other lab tests, that signals to me that there is most likely some degree of thyroid dysfunction in that person.

Is a Low TSH Level Dangerous?

​​The TSH is ​an indicator of blood levels of T4 and T3 in the pituitary, which may not be the same as in the rest of the body.  This is because the pituitary has a different deoidinase enzyme than the rest of the body.

In ​this article, I discussed why I believe that the free T3 and reverse T3 levels are much better indicators of thyroid activity at the cellular level than is the TSH.

I recommend ​trying to get the free T3 > 3.5 and the reverse T3 < 15 if possible.  In my experience, that is sometimes very difficult to do in many patients without suppressing the TSH to < 0.4.

So is lowering the TSH < 0.4 dangerous?  What if the patient has none of the symptoms of an overactive thyroid (thyrotoxicosis) such as palpitations, tachycardia, insomnia, anxiety, etc.?

What if the free T4 and free T3 levels are in the optimal range even if the TSH is suppressed?  Is the low TSH a concern?

​The majority of concern about the dangers of lowering the TSH come from studying patients with Grave’s Disease.  Grave’s is an autoimmune disease which results in the overproduction of thyroid hormone which results in a suppressed TSH.

Grave’s disease has been shown to result in an elevated serum calcium level due to excessive bone turnover.  Untreated, this could ultimately result in significant bone loss and osteoporosis.

​Another study, however, showed that in order to get the free T4 level in the optimal range in patients with hypothyroidism, it required them to take a dose of levothyroxine that ​resulted in a TSH level suppressed below the reference range in over 48% of the patients.

​Potential ​Side Effects of a Suppressed TSH Level

There are actually 2 different instances where suppressing the TSH is not only acceptable but considered the standard of care in conventional medicine:

  • checkAfter thyroidectomy in thyroid cancer patients
  • checkIn patients with thyroid nodules

Both of those groups are good to study to see if any dangerous side effects occurred with long term TSH suppression.

​So what does the literature say?  Does lowering the TSH with thyroid medication result in the same potentially dangerous side effects that Grave’s disease can cause?

Let’s look at it further…

​Bone Loss

In this study, there was no significant bone loss in thyroid cancer patients treated with suppressive doses of thyroid hormone.

​This study showed no decrease in bone mass after 1 year in patients receiving suppressive doses of thyroid hormone for treatment of thyroid nodules.

However, this meta-analysisdid show a reduction in bone mass in postmenopausal women who received suppressive doses of thyroid hormone for over 9 years.  Of note, it did not show the same result in premenopausal women.  But this study did not show an increase in bone loss in women with low TSH levels.

​This study also showed an increased risk of hip and vertebral fractures in women over age 65 that had a TSH of 0.1.  But this study showed there was no increase in fracture risk in women < age 65.

In this study, any bone loss associated with prolonged use of thyroid hormone therapy was ​prevented by the use of ​estrogen replacement.  The use of calcium ​has also been shown to negate any bone loss caused by thyroid hormone.

Bottom Line?  Prolonged suppression of the TSH for years may cause bone loss in postmenopausal women.  The amount of bone loss appears to depend on how long they TSH is suppressed and how much it is suppressed.  The risk seems to be minimal in premenopausal women.

It also appears that the bone loss can be prevented by using bioidentical hormone replacement and nutrients such as calcium and vitamin D.

So what if the only way you can get your free T3 and free T4 levels to the optimal range is by lowering your TSH < 0.4?

First of all, you need to discuss the pros and cons with your doctor before a decision is made.  If you decide to take suppressive doses of thyroid hormone, then the bone loss risk can probably be minimized by also taking ​bioidentical estrogen, calcium, and vitamin D.

​Cardiac Issues

​Thyroid hormone definitely has an impact on cardiac function.  It helps regulate heart rate, the size of the heart, and the pressure inside the chambers of the heart.

​Conditions such as Grave’s Disease that cause large increases in thyroid hormone levels have been shown to increase the risk for things such as atrial fibrillation, heart enlargement and heart failure.

So the question becomes, does taking excessive amounts of thyroid hormone result in the same risks as Grave’s Disease?  At this point, there is not enough data to say yes or no.

So how does thyroid hormone affect the heart?

The heart appears to only respond to T3, yet it is unable to convert T4 to T3 in the cardiac tissues.

It therefore only makes sense that thyroid medications that contain T3 (Cytomel, liothyronine, natural dessicated thyroid) may have more of a cardiac effect than thyroid medications that only contain T4 (Synthroid. Tyrosint, levothyroxine).

If someone has a very healthy T4 to T3 conversion system, they may still get cardiac symptoms from a T4 only medication, but many people have a defect in that conversion.

The risk of excessive thyroid hormone on the heart appears to depend on both how long the TSH is suppressed and how much it is suppressed.

For example, people with a slightly suppressed TSH (subclinical hyperthyroidism) have only mild cardiac issues when compared to Grave’s patients.

Fortunately, studies also show that the cardiac abnormalities return to normal once the thyroid level in the body is normalized.

There is also evidence that using beta blockers can prevent and reverse the cardiac changes seen in hyperthyroidism.

Bottom Line?  Based on the studies, it appears that suppressing the TSH temporarily will not lead to long term cardiac complications.

Also, if you are taking suppressive doses of thyroid hormone, taking a beta blocker at the same time may actually prevent any cardiac complications from occurring.

​There may therefore be situations where taking suppressive doses of thyroid medication for a short time may be beneficial with minimal risk.  However, it should only be considered ​after consulting with a doctor with experience​ in thyroid management.

​Should We Even Monitor the TSH?

​I had a patient ask me recently, “If the TSH is not an accurate measure of thyroid levels in the cells of the body, why even check it?”

That is a ​fair question, but the fact is, monitoring the TSH is still considered standard of care for managing the thyroid.  The TSH should therefore be monitored, just not by itself.

The whole picture of the thyroid should be evaluated by monitoring the complete thyroid panel which also includes the free T4, free T3, reverse T3, and thyroid antibody levels.

​If your doctor is not checking all of these labs when testing or monitoring your thyroid function, you are not getting a complete picture of what is going on with your thyroid.

​Read this article if you want to know more about each of these lab tests, what they mean, and optimal ranges of each.

​Summary

​It is important to monitor your TSH level as part of your thyroid hormone management, but it is even more important to monitor ​all of the tests in a complete thyroid panel.

Taking enough thyroid hormone to lower your TSH level below the normal reference range may have some potential long term consequences.  Fortunately, most of those can be avoided if your thyroid levels are closely monitored and managed properly.

​It may require taking suppressive doses of thyroid hormone temporarily in some patients in order to get their free T4 and free T3 levels into the optimal ranges.  In those instances, it is extremely important to monitor bone density and cardiac health.

​In many cases, the bone loss may be prevented by also taking bio-identical estrogen and calcium.

Many of the cardiac issues may be prevented by also taking a beta-blocker.

​As a general rule, taking enough thyroid hormone to suppress the TSH should be avoided in postmenopausal women, whereas the risk does not appear to be as high in premenopausal women and in men.

Now it’s your turn…

Have you even taking enough thyroid hormone to suppress your TSH?

Did you have any negative side effects?

Do you currently have a TSH in the normal range, yet you still have symptoms of low thyroid?

Leave your questions or comments below.

The Best Natural Treatments for Weight Loss

​A visit to a health food store can be overwhelming when you are looking for something to help you lose weight.

How do you know what works and what doesn’t?  What is safe and what is potentially dangerous?

In this article, I will discuss some of the most popular weight loss supplements and show what can be effective and what probably isn’t.

I will also discuss some nutrient supplements that can be beneficial for weight loss and even some ​food options that can help you drop some weight.

​Here we go…

More…

Identify the Root Causes of Your Weight Gain First

If you have read any of my previous articles, you know that I follow a functional medicine approach when looking at medical issues.

What is functional medicine?  Dr. Mark Hyman, the president of the Institute of Functional Medicine, defines it this way:

“Functional medicine seeks to identify and address the root causes of disease, and views the body as one integrated system, not a collection of independent organs divided up by medical specialties. It treats the whole system, not just the symptoms.”

In the case of this article, it is important that you identify the root causes of your weight gain.  Do you have a hormonal imbalance, are you too sedentary, are you eating the standard American diet, are you stressed out, etc?

I discuss many of these potential root causes in this article.

Every person is different and every person will have different root causes that they need to address in order to lose weight.

If you are simply looking for a pill or supplement that will cause you to lose weight but allows you to continue to live the way you have been living, you will be terribly disappointed.  

Even if you lose weight after taking a supplement, if you don’t change the behavior or address the hormonal issues that caused you to gain weight in the first place, the weight will just return.

These supplements or foods are only a single tool in your tool shed.  You must attack each component of your root causes in order to have long term success in your weight loss journey.

Use Only High Quality Supplements

Please also keep in mind that not all supplements are created equal.  Since there is minimal regulation over the supplement market, a lot of it is garbage.

That is why I always recommend only purchasing supplements that are produced by companies that follow the same current good manufacturing practices (cGMP) that are required of the pharmaceutical companies.

You can no doubt get a supplement for a cheaper price from an unknown brand, but you just can’t guarantee its quality.  

At the very least, look for certification labels from the following companies on the bottles before purchasing them – US Pharmocopeia, NSF International, and ConsumerLab.com are the most common certification companies.

If you notice, most of the supplements that I recommend are from some of the most well known companies that I know follow strict production standards.  These include Pure Encapsulations, Ortho Molecular Products, NeuroScience, Integrative Therapeutics, and a few others.

It is not worth risking your health in order to save a little money.

The Best Natural Treatments for Weight Loss

So let’s dive into some natural supplements that may help you on your weight loss journey.  Many popular weight loss supplements are not listed here.  Instead, I have focused only on the ones that I have experience using or that I feel have a least some preliminary studies to back up their claims.

None of the supplements or foods listed will receive high scores.  None should be taken for the sole purpose of weight loss.  However, many have other benefits such as reducing insulin resistance, reducing systemic inflammation, etc.  They can therefore be an important addition to your goal of improved health. The weight loss benefits that occur from each can potentially be additive to diet, exercise, stress management, and other components of your weight loss plan.

Berberine

How does it work?  Berberine helps with weight loss by decreasing insulin resistance, increasing mitochondria in muscle cells, and increasing the brown fat (good fat) in our bodies.  Studies show that it is as effective as metformin in lowering blood glucose.

How do you take it?  1,000-2,000mg per day with food for about 3 months.  May be taken longer if weight loss continues.  Make sure you take it at least 4 hours apart from your thyroid medication if you are hypothyroid.  

Where do you get it?  Get my recommended brand here.

Potential Side Effects – Minimal.  It may cause nausea if taken on an empty stomach.

Effectiveness –  Extremely effective at lowering insulin resistance which will ultimately help with weight loss.  May lose up to 4% of body weight in 12 weeks.

Who Should Consider Taking It? – Patients with insulin resistance who also need to lose weight.

Score – 5/10 for weight loss.  Excellent for reducing insulin resistance.

CLA

How does it work?  Conjugated linoleic acid (CLA) is a group of fats.  This supplement can help with weight loss by increasing metabolism, reducing the production of fat cells, reducing inflammation, increasing insulin sensitivity, and suppressing the appetite.

How do you take it?  4,000mg daily for at least 12 weeks.

Where do you get it?  Get my recommended brand here.

Potential Side Effects – Generally mild nausea or diarrhea that is self-limited

Effectiveness – Up to 4% of your body weight in 12 weeks.

Who Should Consider Using it?  Anyone that needs a boost in their weight loss plan.

Score – 5/10

Curcumin

How does it work?  Curcumin is the chemical compound found in the spice turmeric.  Curcumin helps with weight loss by reducing inflammation, increasing thermogenesis, reducing blood sugar, and reducing depression symptoms.

How do you take it?  Use the spice tumeric in your foods as much as tolerated.  As a supplement, take 250-500mg 3 times daily.

Where do you get it?  Get my recommended supplement brand here.

Potential Side Effects – Minimal

Effectiveness – Mildly effective for weight loss.  Used primarily as an anti-inflammatory agent.

Who Should Consider Taking it?  Those with high levels of inflammation who also want to lose some weight.

Score – 3/10 for weight loss.  Excellent for reducing inflammation.

Dietary Fiber

How does it work?  Fiber increases the sensation of fullness after a meal and reduces subsequent hunger.  

How do you take it?  Try to eat about 30gm of fiber per day (most people eat less than half that).  When making a conscious effort to increase your fiber intake, you may have to increase it slowly to avoid side effects.  

Where do you get it?  The best form of fiber is from whole foods such as green vegetables, oats, flax seeds, and some legumes.

Potential side effects – Gas, bloating, abdominal cramps

Effectiveness – Moderately effective at reducing appetite

Who should consider using it?  A good fiber intake is important with just about any weight loss program.

Score – 3/10

Probiotics

How does it work?  Probiotics may inhibit the absorption of dietary fat.

Probiotics also seem to increase the release of GLP-1, which is our satiety hormone.  They also increase the levels of ANGPLT4 which reduces fat storage.

Probiotics also reduce the level of gut inflammation, which has been associated with obesity.

One study showed a reduction in food cravings, depression symptoms, and improved self image in participants who took probiotic supplements.

Studies have also shown effectiveness in treating inflammatory bowel disease with high dose probiotics.

How do you take it?  The more bacterial species the better, and higher the CFU count the better.  Most come in either packets or capsules.

Where do you get it?  Get one of my recommended brands here. 

Potential side effects –  Nausea, bloating, loose stools.  Typically well tolerated.

Effectiveness –  Decent when combined with a whole food diet and exercise program.

Who should consider using it?  Anyone that has been on the standard American diet that wants to lose weight and improve gut health.  May be helpful if you have an inflammatory bowel disease such as ulcerative colitis or Crohns disease.

Score –  3/10 for weight loss, but important for gut health.

Green Coffee Beans

How does it work?  Green coffee contains caffeine and chlorogenic acid.  Caffeine can increase metabolism by up to 3-11%.  Chlorogenic acid reduces the absorption of carbohydrates in the intestines.

How do you take it?  1 capsule 30 minutes before each meal

Where do you get it?  Get my recommended brand here.

Potential side effects – anxiety, jitteriness, palpitations, diarrhea

Effectiveness –  Mixed in studies, but average weight loss was 6-7 pounds

Who should consider using it?  Anyone that needs a slight boost in weight loss that is not sensitive to the effects of caffeine.

Score – 3/10

Alpha Lipoic Acid

How does it work?  ALA is a powerful anti-inflammatory agent.  It works by reducing inflammation, reducing insulin resistance, and increasing mitochondria.

How do you take it?  600-1200mg daily

Where do you get it?  Get my recommended brand here.

Potential Side Effects –  Minimal

Effectiveness – Average of 3 pounds in 12 weeks.

Who Should Consider Taking It? – Those with high levels of inflammation – autoimmunity, arthritis, etc. Works best when paired with berberine.

Score – 2/10 for weight loss.  Excellent for reducing inflammation.

Vitamin D

How does it work?  Vitamin D reduces the production and storage of fat cells.  It also increases the levels of serotonin and testosterone, both of which can result in weight loss.

A recent study showed that vitamin D supplementation combined with a weight loss program significantly improved insulin sensitivity.

How do you take it? Regular daily sunlight is always the best way of increasing your vitamin D level. Vitamin D3 is the preferred supplement form, especially when taken with vitamin K2.  Blood levels should be monitored with your goal of having the 25-OH-vitamin D level between 50-80 mg/dl.  Most people do well taking 5000u daily.  

Where do you get it?  Get my recommended brand here.

Potential side effects –  Minimal as long as levels are in the therapeutic range.

Effectiveness –  Up to 7 pounds.  It also seems to help prevent gaining weight.

Who should consider using it?  Everyone should monitor their vitamin D levels and supplement as needed, especially those with little sunlight exposure.

Score – 2/10 for weight loss, but important for overall health.

Garcinia Cambogia

How does it work?  Garcinia contains hydroxycitric acid, which may reduce appetite and increase fat burning.  It may also reduce blood sugar and cholesterol levels.

How do you take it? 1 capsule twice daily before meals.

Where do you get it?  The best brand can be found here.

Potential side effects – liver toxicity

Effectiveness –  3 pounds more weight loss than patients on placebo in studies.

Who should consider using it?  Someone who needs a boost in weight loss, especially if you have elevated cholesterol and insulin resistance.

Score – 2/10

Chromium Picolinate

chromium

How does it work?  Chromium is an essential mineral which helps regulate the metabolism of macromolecules in the body.  It appears to be involved in the insulin signalling pathways.

Studies show that people with type II diabetes have 20-40% less blood chromium levels than normal healthy people.

A study also showed that prolonged use of chromium picolinate could result in the production of hydroxyl radicals which could potentially damage DNA.  Therefore, supplementation should only be done for short periods.

How do you take it?  500-1000mcg per day for 3-6 months.  Do not take long term.

Where do you get it?  Get my recommended brand here.

Potential Side Effects – nausea, headache, rash, dizziness

Effectiveness – 2.2 pounds in 24 weeks in one study.  No weight loss in another study.

Who should consider using it?  Someone with insulin resistance, cholesterol issues, neuropathy, depression, or who suffers from food cravings.  Might be a reasonable add on for someone that also needs help with one of these other conditions.  Should not be used purely for weight loss in my opinion.

Score – 1/10

Summary

There are many supplements and foods that can help reduce weight in motivated people.  None are exceptionally effective, but most can be used safely and effectively as a component of a comprehensive weight loss program.

As with any condition, it is important to identify the root issues that may have caused the weight gain so that you can address them directly.

It is always important to buy a high quality supplement from a company that follows strict production standards.

Many of the supplements listed in this article also have benefits in other issues such as inflammation and insulin resistance, which should be the primary reason for using them.

Now it’s your turn…

Have you ever tried any of these supplements for weight loss?  

If so, what worked?  What didn’t work?

Leave your questions and comments below.

Prescription Medications for Weight Loss

​​​​People are always looking for new and effective ways to lose weight.

Weight loss​​ ​has become a multi-billion dollar industry​.  This includes diets, exercise equipment, supplements, and even prescription medications.

How do you know ​which medications work and wh​ich don’t?  Which are safe for you and which should you avoid?

In this article, I will discuss the most commonly prescribed medications available for weight loss.  I will discuss how they work, any potential side effects, and how effective ​they can be.

Here we go…

More…

​​Always Identify the Root Issues First

It is important to take a moment here and discuss something before going any further.

Weight gain and obesity are complicated issues.

There are usually several things going on that have caused you to gain weight.  These include poor diet, lack of physical activity, emotional stress, hormone imbalances, lack of sleep, and others.  Click here to read more.

If you are looking for a pill or shot to solve all of these issues, you are going to be severely disappointed.

A medication ​by itself will fail 100% of the time if the root issues of the weight gain have not been identified and addressed.

That would be like putting a band-aid over a bullet wound.

There is a ton of bad information on the internet about any topic, including medical topics.  You must be smart and have your antenna up to make sure you are getting correct information.

For example, this paragraph is from medlineplus.gov, a respected government resource for medications. In this case, it is discussing Belviq, a commonly prescribed weight loss medication that we will be talking about later in this article:

​I guess they think you can continue to eat how you have been eating and just depend on the medication to do all of the work.

Do you see my point?

If you want to lose weight and keep it off, you are going to need an extensive evaluation from a medical provider who is willing to sit down, listen to you, and work with you.  They will need to take a thorough medical history and order specific lab tests to identify any hormonal and other imbalances in your body.

You would also likely benefit from intensive nutritional instruction from a certified nutritionist with experience and training in helping people lose weight.  You will need a dietary plan that is custom made specifically for you, your food preferences, and your health situation.

Once ​you have completed all of the above, then (and only then) it may be appropriate for you to consider a weight loss medication ​for at least a short period of time.

Now let’s discuss the most commonly prescribed medication for weight loss:

Prescription Weight Loss Medications

I am going to discuss several medications that are used for weight loss in this article.

Keep in mind that I do not normally prescribe the majority of these.  However, you may have heard about many of them, so I want to give you some basic knowledge of how they work as well as their effectiveness and potential side effects.

I list them in decreasing order of effectiveness based on my experience and research.

1.  GLP-1 Agonists

Liraglutide (Victoza) was first FDA approved for treatment of Type 2 diabetes in 2010.  It was approved for weight loss and repackaged as Saxenda in 2014.

– How does it work? – GLP-1 agonists are one of the most potent appetite suppressants.  They act on the glucagon receptors which slows down gastric emptying.  The reduction in gastric emptying sends a signal to your brain that you are full.  It also directly reduces insulin and leptin levels which reduces inflammation and helps maintain weight loss even after stopping the medication.

– Effectiveness – 45-60% of patients lose at least 5% of their body weight, while about 18% lose at least 10% of their body weight.

– How do you take it? – an injection at bedtime.  Start with 0.6mg then increase the dose by 0.6mg each week until you reach the target dose of 3mg daily.

– Side Effects – nausea/vomiting, diarrhea, constipation, hypoglycemia, headache, loss of appetite. Potential increased risk for medullary thyroid tumors and pancreatitis.

– Contraindications – Family history of medullary thyroid tumors, pregnancy, and history of reaction to this class of medication.

– Who should consider taking it? – Excellent choice if you also have insulin and leptin resistance, including type 2 diabetes.

– Score – 10/10 in my experience.  Expensive and may not be covered by insurance.

2.  phentermine-topirimate (Qsymia)

The FDA approved Qsymia for weight loss in 2012.

– How does it work? – Qsymia contains 2 different generic medications, phentermine and topirimate. Phentermine is an appetite suppressant that directly reduces your appetite while simultaneously increasing your basal metabolic rate.  Topirimate is an anti-seizure medication that has also been shown to be extremely effective in reducing the frequency and severity of migraines.  It helps with weight loss by increasing the sensation of feeling full, increases calorie expenditure and also makes food taste less appealing.

– Effectiveness – Studies show that 70% of patients lose at least 5% of their body weight, and 48% lose at least 10% of their body weight.

– How do you take it? – One tablet daily in the morning.

– Side Effects – Racing heart, tingling of hands and feet, constipation, dizziness, dry mouth, mental slowing.  Be very cautious if you have hypertension, anxiety, or frequent palpitations.

– Contraindications – Pregnancy, glaucoma, history of reaction to the medication, hyperthyroidism.

– Who should consider taking it? – Those who struggle controlling their appetite.  May be useful if you also suffer from migraines or seizures.

– Score – 8/10.  It is very effective at weight loss, but side effects are extremely common and it is quite expensive.

​3.  HCG

HCG is the hormone that is produced in massive amounts during pregnancy.

It has been misused for years as part of the HCG diet.  The HCG diet is a bad diet plan and I would never recommend it because it can severely damage your metabolism by putting you on a severely calorie-restricted diet.

The HCG hormone itself, however, has some properties that could be extremely helpful in weight loss.

– How does it work? – HCG can help normalize testosterone levels in men and estrogen/progesterone levels in women.  It also promotes thyroid activity which increases metabolism.  It also decreases appetite and normalizes food cravings.

– Effectiveness –

– How do you take it? – Use injections (not drops) twice weekly on fasting days for 2-3 months.  DO NOT USE with a severely calorie-restricted diet.

– Side Effects – Water retention, headaches, irritability

– Contraindications – pregnancy

– Who should consider using it? – Those with menstrual irregularities, low testosterone (men), hypothyroidism, and problems with food cravings.

– Score – 7/10 when used correctly.

​4.  naltrexone-bupropion (Contrave)

​Contrave has been FDA approved for weight loss since 2014.

– How does it work? – Contrave is a combination of 2 medications:  naltrexone and bupropion (Wellbutrin). Bupropion is an antidepressant that blocks the reuptake of dopamine and norepinephrine which reduces appetite and food cravings.  It has been shown to reduce binge eating.  Naltrexone is an opioid antagonist that also reduces appetite and reduces inflammation.

– Effectiveness – About 40% of users lose at least 5% of their body weight in 1 year, about 20% lose at least 10%.

​- How do you take it? – A titrating schedule as follows:  1 every morning for 1 week, then 1 twice daily for 1 week, then 2 in the morning and 1 in the evening for 1 week, then 2 twice daily thereafter.

– Side Effects – nausea, constipation, headache, dizziness, insomnia, dry mouth, diarrhea, anxiety, and palpitations are common.  I​t may ​trigger seizures if you have a seizure disorder.

– Contraindications – ​Uncontrolled hypertension, history of seizures, and pregnancy.  Also do not take if you are on chronic opioid pain medications.

– Who should consider taking it? – May be a good option if you also suffer from Hashimoto’s or another autoimmune disease.  Especially helpful if you also have chronic pain, depression, or if you deal with food cravings.

– Score – 7/10.  May be expensive.

5.  Appetite Suppressants (phentermine, phendimetrazine, benzphetamin, diethylpropion) –

These appetite suppressants have been around for a long time.  I have never prescribed most of them, but I list them because they are commonly used by some providers, especially in weight loss clinics.

– How do they work? – These medications have a pharmacology similar to amphetamines.  They directly reduce your appetite while simultaneously increasing your metabolic rate.

– Effectiveness – Quite effective at reducing appetite when used correctly and for a short time.  The weight typically returns quickly after stopping the medication.

– How do you take them? – Typically 1 pill every morning.

– Side Effects – anxiety, jitteriness, palpitations, increased blood pressure, insomnia.

– Contraindications – history of amphetamine addiction, uncontrolled hypertension, chronic insomnia.

– Who should consider taking them? – May be helpful to reduce appetite at the beginning of a diet program.  Best if not used every day.  The body becomes tolerant to the effects very quickly, so I will only prescribe it for a month or 2.

– Score – 5/10.  Very effective to reduce appetite, but side effects are common.  Inexpensive.

6.  lorcaserin (Belviq)

Belviq has been available since 2012 for weight loss.

– How does it work? – Belviq activates serotonin receptors in the brain that cause a sense of fullness (satiety).

– Effectiveness – When combined with a diet and exercise program, studies showed about half of the people who took it lost about 5% of their weight (an average of 12 pounds) in the first year.

– How do you take it?  – 1 pill twice daily with or without food.  If substantial weight has not been lost in the first 12 weeks, it is probably not an effective medication for you and should be stopped.

– Side Effects – headache, dizziness, fatigue, nausea, dry mouth, and constipation.  There are concerns about the possibility of heart valve issues with it, but that has not been the case as of yet.  It also caused tumors in animals in some studies.

– Contraindications – Pregnancy or history of reaction to the medication.

– Who should consider taking it? – This drug could be considered if you deal with food cravings and portion control.

– Score – I give it a score of 3/10.  If someone is serious about losing weight, most can lose 5% of their weight with just changing their diet and beginning an exercise program without the risk of taking a medication.  May be expensive.

7.  atemoxetine (Strattera)

Atemoxetine (Strattera) has been FDA approved for treatment of ADHD since 2002.  It has recently been used off label for weight loss.

– How doe it work? – Strattera is a norepinephrine reuptake inhibitor which results in a reduction in appetite and improved cognitive function.  It may also increase energy.

– Effectiveness – No official studies on using it for weight loss.  There is anecdotal evidence of mild to moderate weight loss in the first few months of using it.

– How do you take it? – Typically 1 capsule once or twice daily, usually 40mg daily then increase as needed to a maximum of 100mg daily.

– Side Effects – Nausea, vomiting, diarrhea

– Contraindications – Glaucoma, history of severe cardiac disease, history of sensitivity to the medication.

– Who should consider using it? – Those who need weight loss that also deal with attention and depression issues.

– Score – 2/10 – Patients that take it for ADHD may lose some weight, but it should not be used for the sole  purpose of weight loss in my opinion.

​​8.  orlistat (Xenical or Alli)

​Xenical has been approved by the FDA since 1999 for weight loss.  It is now available over the counter under the name Alli.

– How does it work? – ​orlistat blocks the enzyme that breaks down fats in your diet.  That undigested fat is then eliminated in your stool.

​- Effectiveness – Studies show a weight loss of about 6 pounds in a year.

– How do you take it? – 1 pill 3 times per day with a fat-containing meal.  If you aren’t eating fat in that meal, there is not need to take the medication.

– Side Effects – Since it increases the fat in your stool, you can predict the side effects:  abdominal cramps, diarrhea, greasy rectal discharge.  In other words, “Don’t trust your farts!”  It may also block the absorption of fat soluble vitamins (A,D,E and K) so they will need to be supplemented.

– Contraindications – Chronic diarrhea or other GI issues.  History of low levels of fat soluble vitamins.

– Who should consider taking it? – No one in my opinion.

​- ​Score – 1/10.  6 pounds in a year is pathetic, especially in light of the common side effects that come with taking it.  Most research has shown that we need good, healthy fats, so taking this medication would be counterproductive.  Carbohydrate reduction is what most of us need, not fat reduction.

​Summary

There are multiple medications available by prescription to help with weight loss.  Some are quite effective when used appropriately, some are not.

It is important that you study any medication that you may be considering to help with weight loss to make sure that you can use it safely and effectively.

It is critical that you identify the root issues that have led to your weight gain before starting any weight loss medication.  Without addressing those issues, you will not be successful in your weight loss journey.

Now it’s your turn…

Have you ever taken one of these weight loss medications?

What was your experience?  Did you lose weight?  Did you have any side effects?

Leave your questions and comments below.

How to Use Liothyronine (T3) in Hypothyroidism

​Liothyronine (T3) is ​the most potent thyroid hormone that you can take.

It is rarely prescribed by most doctors, which is unfortunate, because it can significantly improve your hypothyroid symptoms and overall quality of life.

The symptom improvements can include ​improved energy, weight loss, and even a reduction in depression.

​Learn who could benefit from using liothyronine, how to use it safely, and lots more in this article…

More…

What is Liothyronine?

​In order to understand liothyronine, it is important that you ​understand the basic physiology of the thyroid. You can read more in depth about it by clicking here.

Liothyronine is T3.  T3 is one of the 2 main circulating thyroid hormones in your bloodstream.

T4 is the inactive thyroid hormone.  The vast majority of hormone made by the thyroid gland is T4.

T4 itself ​has no activity in the body.  In order for it to be​come an active hormone, it must be converted into T3​.  An iodine molecule is cleaved off of the T4 by an enzyme called a deiodinase, which ​results in the production of T3.

T4 can be looked at as the storage reservoir for thyroid hormone in ​your body.  When your body needs more active thyroid hormone, it can convert the T4 that is circulating in the blood into active T3.

​By understanding that T4 is the inactive form of thyroid and T3 is the active form, it then makes sense why ​oral T3 medication is much more potent than oral T4 medication.  In fact, it is about 3-4 times more potent.

Liothyronine vs. Levothyroxine

​If Liothyronine is so powerful, then why don’t more doctors prescribe it?

​Most doctors simply were not taught how to prescribe T3 medication and manage patients that are taking it.  They ​were also not taught which labs need to be monitored and how to interpret those test results.

I ​was personally NEVER taught about T3 medications in my many years of training.  I have had to learn about it myself through attending multiple medical conferences, reading tons of literature, and asking doctors with experience ​prescribing it how they use it.

It is simply assumed by most doctors that all patients have no issues with converting T4 to T3.  If that was the case, every patient could just take a T4 only medication such as Synthroid, levothyroxine, or Tyrosint and it would seamlessly be converted to T3 when the body needed it.

Wouldn’t that be easy?

However, most people with thyroid issues have a reduced ability to convert T4 to T3.  Instead, much of the T4 is converted into the anti-thyroid metabolite reverse T3 which results in a condition called reverse T3 dominance.  This is usually due to chronic inflammation in the body and/or a deficiency of nutrients such as iodine, selenium, or zinc.

​That is why you may be on a ​good dose of a T4 only medication which results in a normal ​TSH and T4 level, yet you still have symptoms of hypothyroidism.

In those situations, when used and monitored properly, liothyronine can be a safe and extremely effective medication to treat your hypothyroidism and improve your symptoms.

One study showed that replacing T4 with T3 resulted in weight loss and greater thyroid action on lipid metabolism, without an increase in side effects.

Who Should Use Liothyronine?

​Not everyone who takes thyroid medication necessarily needs to take liothyronine.

​Besides having hypothyroidism, if you are otherwise healthy, energetic, and feel great, your conversion of T4 to T3 is probably adequate and you may not need to change from your T4 only medication.

Now, for the other 99% of you (ha!), you may want to get a complete thyroid panel so that you can truly assess the T4 and T3 levels in your body:

​You should also consider getting a sex hormone binding globulin level (SHBG), which can also help give you an idea of the thyroid levels in your body (if you are on oral birth control pills or estrogen or if you smoke, this test will not be helpful).

​If your reverse T3 level is >15, your free T3 level is ​<3.5, and/​or your SHBG level is <20 in men or <60 in women (who aren’t taking oral estrogen), then your T3 level is inadequate and you ​may want to consider adding T3 in some form to your regimen.

Below is a general list of people who may need to add T3 to their thyroid medication regimen:

  • checkPatients with low serum levels of free T3 (<3.5)
  • checkPatients with high levels of reverse T3 (>15)
  • checkPatients with “normal” TSH and T4 levels but still remain symptomatic despite taking T4 only thyroid medication
  • checkPatients with chronic inflammatory conditions such as an autoimmune disease, insulin resistance, and leptin resistance
  • checkPatients that have persistent difficulty with weight loss
  • checkPatients with treatment resistant depression and treatment resistant bipolar disorder

​This is by no means an exhaustive list, but it includes the majority of patients that m​ay benefit from taking T3.

​What about Natural Dessicated Thyroid (NDT)?

​If you are currently taking a T4 only medication (Synthroid, levothyroxine, or Tyrosint), changing to an NDT medication such as Armour Thyroid, NP Thyroid, or Nature-throid may be the easiest ​thing to try to increase your T3 level.  In fact, that is usually the first thing I will do for patients.

NDT is about 80% T4 and 20% T3.  While that is certainly better than a ​medication with 100% T4, that may still be too much T4 which ​could result in a high level of reverse T3.

If​ you are taking an NDT medication and your reverse T3 levels are too high and your free T3 levels are too low, you may need to reduce your NDT dose (at least temporarily) and add a small dose of liothyronine in order to “flush out” the reverse T3 which will allow the T3 ​levels to rise to optimal levels.

Liothyronine for Weight Loss

​Liothyronine may cause weight loss but it should NOT be used as a weight loss medication.

​If used for weight loss in patients without thyroid dysfunction, it could cause some unpleasant and even dangerous side effects.

However, liothyronine may help with weight loss in patients with hypothyroidism.

T3 may cause more weight loss than T4 because of how it interacts with fat cells and other hormones in the body.

T3 directly increases mitochondrial energy production and increases thermogenesis and fat burning potential.

Liothyronine for Depression

​Liothyronine can also reduce symptoms of depression.

Low thyroid levels (hypothyroidism) are known to commonly result in symptoms of depression.

What you may not know is that adding liothyronine to an antidepressant ​can improve mood and cognitive function even when the thyroid function is normal.

The exact mechanism is not fully understood, but it is believed that some patients with depression may have subclinical hypothyroidism that is not bad enough to be detected on standard lab tests but still causes typical symptoms of depression.

Therefore, by treating those patients with liothyronine, it may correct those subtle thyroid abnormalities in the brain which will help resolve the depression symptoms.

T3 has also be shown to increase the receptor sensitivity to serotonin and increase the synaptic concentrations of serotonin.

Since the most commonly used antidepressants are only successful in treating depression in about 50% of cases, the addition of liothyronine ​is a viable option to consider, especially in “treatment resistant” cases.

If you are on a T4 only thyroid medication and are still suffering from depression, adding liothyroinine to your T4 medication may significantly improve mood and neuro​psychological function.

​How to Raise T3 Levels

​The whole point of even ​discussing liothyronine is because we want to raise the ​active thyroid levels (T3) in the body to optimal levels.

​Taking T3 medication (liothyronine) will obviously accomplish that goal.  There are ​also some natural things that should be considered that will result in increased levels of T3.  Let’s discuss those ​as well as how to take ​liothyronine…

​1. Naturally Increase T4 to T3 Conversion

​The conversion of T4 to T3 is dependent on a few nutrients.

​It is common for people to be deficient in these nutrients because they may be lacking in their diet or they may have gut issues such as leaky gut that reduce the absorption of the nutrients.

Some of the most important nutrients include:

  • checkZinc – Zinc has been shown to improve conversion of T4 to T3, acts and a strong anti-inflammatory, and reduce oxidative stress.  Zinc deficiency is VERY common in the US. Standard zinc supplementation is also inadequate because it does not have zinc bound to picolinic acid (which is the most absorbable form of zinc).  Doses of 30-60mg per day are recommended.  It is important to take it with selenium.
  • checkSeleniumSelenium can improve thyroid conversion, act as an anti-inflammatory, and help balance the immune system.  It is also very helpful if you have an autoimmune thyroid issue such as Hashimoto’s.  Doses of 200-400mcg per day are recommended. Best if taken with zinc.

​2. Naturally Lower Reverse T3 Levels

​Another way that you can raise T3 levels and improve its function is to lower reverse T3 levels.

Remember, reverse T3 is the anti-thyroid metabolite that binds to thyroid receptors on the cells but blocks their function.

By reducing the amount of reverse T3, it will in effect improve T3 function.

So how do you do it?  Address the issue that is causing the reverse T3 level to be increased in the first place.

Easier said than done, but below is a list of common issues that result in elevated reverse T3 levels:

  • checkReduce Inflammation – Inflammation from any cause will increase reverse T3 levels and reduce thyroid function.  Checking ESR and CRP lab tests will indicate how much inflammation is present.  If those test are elevated, consider taking anti-inflammatory supplements such as tumeric, fish oil, and quercetin+bromelain.
  • checkFix Your Gut – ​Treating conditions such as leaky gut or SIBO are essential to improve your thyroid function.  Up to 20% of thyroid conversion occurs in the gut, plus absorption of nutrients that are vital to normal thyroid function may be impaired.  About 50% of thyroid patients have SIBO/SIFO and don’t even know it.  Read more about it here.
  • check​Lower Your Insulin Level – High insulin and sugar levels inhibit the ​T4 to T3 conversion process and ​contribute to weight gain.  If your fasting insulin is >5, you most likely have insulin resistance which much be addressed.  Supplements that help reduce insulin resistance include alpha-lipoic acid, berberine, and chromium.
  • checkLower Your Leptin Level – Leptin is another hormone that is usually involved with weight loss resistance.  It also reduces thyroid function by increasing inflammation in the body which impairs the T4 to T3 conversion process.  ​Read more about how to reduce it here.
  • checkStop Extreme Dieting – If you are eating less than 1500 calories per day just to maintain your weight, you are damaging your metabolism and lowering your T3.

​3. Short-acting Liothyronine (Cytomel)

​Cytomel is the brand name for liothyronine, but over the past few years generic versions have become available that are less expensive.  ​

Liothyronine is available in 3 strengths – 5mcg, 25mcg, and 50mcg.  I personally have never prescribed the 50mcg dose.

​Typically, the 5mcg dose is prescribed first, then it may be increased to 10mcg (2 tablets) depending on the patient response and labs.  If more is needed, usually 1/2 pill of 25mcg is given, then possibly a full 25mcg tablet.

– Liothyronine/levothyroxine in Combination

​This is by far the most common way that liothyronine is used.  Fortunately, medical providers are becoming more comfortable using it so its use is expanding.

Liothyronine is added to the patient’s current dose of T4 medication (levothyroxine).

Remember, liothyronine is 3-4 times more potent than levothyroxine, so you will need to be aware of any side effects and your labs will need to be monitored closely.

If your TSH is suppressed excessively, it may be necessary to reduce your dose of levothyroxine.

– Liothyronine only

​Most physicians will not be comfortable prescribing liothyronine by itself.

​This is because most medical committees recommend using a T4 thyroid medication as first-line treatment of thyroid issues.

However, many patients ​with weight loss resistance, leptin resistance, and other hormone imbalances may benefit from using T3 by itself.

T3 medication can be used temporarily to boost the body back into action or it can also be used long-term.

As long as it is used correctly and monitored closely there should not be any long-term consequences in using it.

If you are interested in using it, you must find a doctor with experience in prescribing it, and you must be willing to get regular lab tests and follow-ups with your doctor.

4. Sustained-Release (SR) T3

​Occasionally patients may be extremely sensitive to T3 medication.  In those situations, it may be necessary to have a compounding pharmacy ​make a sustained-release ​form of T3.

The sustained-release formulation will ​allow the T3 to be released ​gradually over a longer period of time which will reduce the side effects that the T3 may cause.

Liothyronine Side Effects

​Some patients tend to be very sensitive to T3 medication.  This usually causes them to feel jittery or anxious when they start the medication.

If you have a history of being sensitive to other medications, you need to let your doctor know before starting T3.  You can probably still take it, but you will need to go “low and slow” with it.

As a general rule, I have found that women tend to be more sensitive to T3 than men, although there are certainly exceptions with both.

The side effects of liothyronine seem to mirror those caused by hyperthyroidism.  These include:

  • checkJitteriness – usually dose-dependent and from taking too much
  • checkPalpitations – usually a sign that the dose is too high
  • checkNausea 
  • checkHair Loss – usually temporary and resolves in 3-6 months
  • checkHeadache – usually an indicator that the dose is too high
  • checkTremor – usually dose-dependent
  • checkSensitivity to Heat – and indicator that the dose is too high
  • checkAnxiety – an indicator that the dose is too high

​If you develop any of these symptoms you should notify your prescribing doctor and discuss treatment options.

Summary

​Liothyronine is a T3 only medication.

It is the most potent thyroid medication available.

When used correctly and closely monitored, liothyronine is extremely effective in treating hypothyroidism and reducing symptoms.  It typically causes some weight loss as well.

It can also be used to treat resistant depression.

​Now it’s your turn…

Have you ever taken liothyronine?  If so, what were the results?

Leave any questions or comments below.

Why Am I So Tired All the Time?

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​Why am I so tired all the time?  I am asked that question multiple times EVERY DAY.

​​Our society is exhausted, and it’s only getting worse.

​Do you ever wake up refreshed, make it through the day ​easily, then still have energy in the evening for home activities and family time?

​If you do, consider yourself fortunate.  Most of us don’t​.  Not by a long shot.

In this article, I will discuss the most common ​reasons why you may be tired and give you some pointers on how to regain some energy and quality of life.

Let’s get started…

More…

​What Does It Mean To Be Tired?

What do people mean when they say they are tired?

Sometimes they may be frustrated – “I am so sick and tired of this traffic.”

Others may mean they are emotionally spent – “I am so tired of fighting with my husband.”

Still others may mean they are physically worn out – “I am so tired from that ​workout.”  Or “I am so ​exhausted.  The baby kept me up all night.”

For the purpose of this article, when I talk about being tired, I am primarily referring to a lack of energy.

​In my online hormone practice, I always start the first appointment with a new patient this​ way:  “Give me 3 goals that you have in meeting with me.”  95% of the time, the first 2 things that people list are:

1.  Lose weight​

2.  More Energy

​People are simply exhausted​, both physically and emotionally.

Let’s dive into the most common causes​ of fatigue that I see in people and discuss some solutions to this national epidemic…

​Common Causes of Being Tired

​Fatigue may be occassionally due to a single obvious reason, but most of the time it is because of several things, not just one.

Like most health issues, what you eat and your ​level of activity play a ​huge role in your energy level.​

There ​may also be some hormonal issues​ as well as other things going on in your body that you need to consider.

Let’s break these down further…

​1. Adrenal Issues

​As you know, we live in a very high stress society.  Most of us are on the move constantly, then we wonder why we feel so tired!

This type of lifestyle plays havoc on our adrenal system.

​One of the major functions of our adrenal glands is to produce cortisol, DHEA and epinephrine in response to stress (physical and mental).

These hormones help regulate our immune system, heart rate, and energy storage.

Under normal situations, a stressful event will trigger the adrenals to release a surge of cortisol which then signals the mitochondria in our cells to temporarily increase energy production​.

That increase in energy helps us to get through the physical or emotional stress we are experiencing.

When the stress passes, the cortisol levels then drop back to the normal range.

When the body is under CONSTANT physical stress, such as a chronic infection, inflammation from obesity, insulin resistance, an autoimmune condition, etc., the adrenals are under pressure to continuously secrete large amounts of cortisol.

The same is true for constant emotional or mental stress.

High cortisol levels promote hypothyroidism.

It also worsens insulin resistance and leptin resistance.

​With all of these conditions, ​fatigue is a common symptom.

Eventually, the adrenals will no longer able to produce adequate amounts of cortisol, so the levels in the body begin to drop. Adrenal fatigue results.

When this situation occurs, constant fatigue is a hallmark symptom.

​Even normal day-to-day activities become exhausting.  Exercise ​may make you feel wiped out for days.

To test for adrenal or cortisol issues, I usually start with an 8am serum cortisol level.

​If your levels are <11 or >18, you have adrenal issues that should be addressed.

That may require getting salivary or urine cortisol levels 4 times throughout the day.  You should discuss this with your doctor.

What What Can You Do About It?

To learn more in detail about management of adrenal issues, read my article here.

As a quick summary, here are my recommendations that you can do even without a doctor if your serum cortisol levels are abnormal.

If your morning cortisol level is >20​, consider these supplements:

  • checkPhosphatidylserine:  Phosphatidylserine has been shown to reduce cortisol levels if taken in doses up to 600mg per day.  Use 4-6 capsules at night (each capsule is 100mg) and recheck cortisol levels in 2-3 months.
  • checkAshwagandha:  Ashwagandha is an adaptogen that can actually help to lower cortisol levels when they are high and raise them when they are low.  It also can boost libido and may help with weight loss. It can also reduce anxiety symptoms caused by chronic stress.  Doses vary from 500-2000mg per day depending on tolerance and severity of symptoms.
  • checkMelatonin:  Melatonin has been show to reduce cortisol levels and may actually help improve your sleep at night.  Even if you are sleeping well, melatonin can still help reduce cortisol levels and should be considered.  It can also help with depression symptoms.  Doses vary from 1-3mg, but most people tolerate 3mg well.

​If your morning serum cortisol is < 11​, consider these supplements:

  • checkAdrenal glandulars:  These work best for patients with very low cortisol levels.  They also tend to provide an immediate boost to energy levels.  Using glandulars in combination with other supplements listed below may be necessary.  Should be used for 6+ months.
  • checkAdrenal Adaptogens:  Adaptogens can actually help to lower cortisol levels when they are high and some can even raise cortisol levels when they are low.  There are many types of adaptogens but I find that blends of multiple adaptogens tends to work best.  These can be combined with glandulars as well for more benefit.  Should be used for at least 3 months.
  • checkCoQ10:  This coenzyme is involved in proper mitochondrial energy production and can help increase energy levels, which can be very helpful in adrenal-related issues.  Use 2 capsules (240mg) per day for several months.
  • checkAlpha Lipoic Acid:  ALA helps increase mitochondrial energy production, acts as a powerful antioxidant, reduces peripheral neuropathy, and lowers inflammation.  ALA can also help with weight loss due to its effects on insulin.  Start at 600mg daily and increase up to 1800mg daily as tolerated.
  • checkVitamin B6:  Vitamin B6 is used in several pathways in the creation of adrenal hormones and many patients are deficient in it.  Taking higher doses of B6 during the acute phase of treatment may be necessary for a short period of time.

If your levels are either extremely high or low, it is critical that you see your doctor for further testing.  You could have undiagnosed Addison’s Disease or Cushing’s Disease.

​Besides supplements, learning some stress management techniques is also critical for optimizing your adrenals and improving your fatigue.

These include things such as yoga, daily meditation, prayer, and even just going outside for 15-30 minutes every day.

​2. Thyroid Issues

​If you are more tired than you think you should be, checking your thyroid should be high on your list.

Since the thyroid is your “metabolism” gland, any conditions affecting it will affect your energy level.

​Besides feeling tired, thyroid issues can cause these common symptoms:

  • checkWeight gain or inability to lose weight
  • checkFeeling cold all the time
  • checkBrittle nails
  • checkThinning hair or hair loss
  • checkConstipation
  • checkLow body temperature
  • checkMood changes, such as anxiety or depression
  • checkBrain fog
  • checkHormone imbalances – irregular periods, PMS

​If you are having some of these symptoms, you should ask your doctor to run a complete thyroid panel:

​Only checking ​the TSH level could miss up to 80% of patients with a thyroid condition.

​Ideal levels for your thyroid tests include:

  • TSH – ideal range ​is 0.5-2.0
  • search​free T4 – ideal range is in the upper 1/3 of the testing range
  • free T3 – ideal range ​is >3.5
  • searchreverse T3 – should be < 15
  • searchTPO antibody – >35 is diagnostic for Hashimoto’s thyroiditis
  • searchThyroglobulin antibody – >35 is diagnostic for Hashimoto’s thyroiditis

So What Can You Do About It?

​If any of your labs are out of these optimal ranges, you should talk to a doctor that is knowledgeable about the thyroid.  Supplements and prescription medication made be needed to boost your thyroid function.

If your doctor isn’t willing to work with you, consider finding a certified functional medicine doctor from the Institute of Functional Medicine.

​To learn more about the thyroid, click here to read my article on hypothyroidism and click here for my article on Hashimoto’s thyroiditis.

​3. Blood Sugar Imbalance

​Blood sugar fluctuations are a common cause of feeling tired.  You may be experiencing this especially if you ​have any “crashes” during the day when you feel weak, tired, and dizzy.

​Most ​people are on a constant roller coaster – they eat a diet high in sugar or processed carbohydrates. This causes their blood sugar to rise rapidly.

The rise in blood sugar triggers their pancreas to release insulin to carry the sugar into the cells to be used as fuel.

​The blood sugar then drops, sometimes rapidly, which makes them feel tired, moody, and even dizzy.

​It also triggers their hunger, so they eat more sweets or high carb foods and the cycle starts all over again.

​This situation is made even worse by:

​- Insulin Resistance

Half of Americans already have insulin resistance and most have no clue.

​When we constantly eat a diet high in sugar and/or processed carbs, our insulin levels remain high to try to manage the sugar load.

Our body responds to anything that is present in excess by learning to ignore it.  That is what happens with insulin when we have insulin resistance.

​We respond to the persistently high insulin levels by down-regulating the insulin receptors in our cells. This protects the cells from getting overloaded with glucose.

This causes the insulin and glucose levels to gradually increase.  Eventually, pre-diabetes and type 2 diabetes occurs.

I bet you don’t know many if any diabetic patients that feel energetic, do you?

​- Poor Diet

​We eat way too much sugar and processed carbs.  Most of us know that intuitively.

In a little over 100 years, the average consumption of sugar has increased from about 40 pounds per person per year to well over 100 pounds per person per year!

​We have also increased our consumption of grains (wheat, corn, etc) by almost 50% over the past 40 years.

I was raised ​in a small town.  Growing up, my diet was full of poor food choices.  Every breakfast had some form of grain and sugar – cereal, pastry, etc.  Every other meal did not seem complete unless it included some form of bread and a sweet dessert.

​With the changes that have been made to wheat and the continued increased processing of our food, we are learning that we have to make some conscious changes to our diets in order to improve our long-term health.

So What Can You Do About It?

Try to eat a whole food, nutrient-dense, high quality diet which is high in lean meats and organic vegetables.

If you need more help, a great starting point would be starting the Whole 30 diet or ketogenic diet.

​I would also suggest hiring a certified nutritionist that is knowledgable about functional medicine.

​4. Sedentary Lifestyle

​When someone ​spends the entire day either sitting or laying down, should they be surprised that they feel tired?

Our bodies were made to move!  Lack of movement with cause atrophy of our muscles and a general ​decline in our fitness level.

One study showed that regular, low-intensity exercise can reduce the feeling of fatigue by 65% and increase energy by 20%.  12 population-based studies showed similar results.

This study showed it specifically in women.

Have you ever been on an exercise program, then because of life events, had to stop for a few days?  Isn’t it amazing how quickly you lose your level of fitness and feel tired?

Now multiply that times 100 and you can get an idea of what a sedentary lifestyle will do to you and your energy level.

So What Can You Do About It?

Simply put, start moving!  Anything that you start doing now will be more than you ​were doing before.

If you aren’t currently exercising, start with a brisk walk at least 3 times per week. ​

Listen to your body.  If it exhausts you, you may need to back off of the intensity.  This is especially true if you are having some adrenal issues.  Increase the time and intensity as tolerated.

Eventually, you will want to incorporate some simple weight training and high intensity interval training (HIIT).

If you are struggling with knowing exactly what to do and how much, I would strongly recommend hiring a personal trainer who can design a workout schedule just for you.

They will also serve as a form of accountability for you and make sure you are doing everything safely.

I highly recommend realfitness.net.  Jessica is a world-class trainer as well as a certified nutritionist.  She has helped many of my patients (including myself).

If you have significant health issues – heart problems, uncontrolled blood pressure, etc. – discuss it with your doctor before starting.

​5. Poor Sleep

​Sleep is our body’s way of recharging itself and giving it the energy to function the next day.  ​When we don’t sleep enough or the quality of sleep is poor, we are going to feel tired.

If you are chronically tired, you need to take a long hard look at your sleep habits and sleep quality.  Your energy will not improve if you are sleeping poorly.

– Poor Sleep Hygiene

​Many people have developed horrible sleep habits over time.

This can include drinking caffeine throughout the day (including the evenings), sleeping in uncomfortable beds, sleeping in a bedroom that ​is too light or too hot, and staring a some sort of electronic screen the entire evening right up until bedtime.

The excessive use of electronic devices has become an epidemic in children and adolescents.  In fact, this use has a direct effect on their quality of sleep.  It has also been linked to the increase in depression in adolescents.

​Normally, around 9pm at night, the pineal gland in our brain begins secreting melatonin.  Melatonin helps our body to relax and prepares it for the night of sleep.

Excessive light, especially blue light, has been shown to suppress the secretion of melatonin in our brains.

I also see tons of patients that try to function on as little as 4 hours of sleep per night.  That simply isn’t enough.  You body will eventually start breaking down.

– Obstructive Sleep Apnea

​It is estimated that 22 million Americans suffer from obstructive sleep apnea.  What’s worse, up to 80% of those are undiagnosed!

Ask yourself these questions.  Ask your spouse to answer them about you as well:

1. Do people complain that you snore like a freight train?

2. Has anyone ever noticed that you frequently gasp or even stop breathing while you are asleep?

3. Do you wake up exhausted in the morning, even if you have ​slept for 7-8 hours or more?

4. Do you find yourself dozing off during the day if you sit still for more than a few minutes?

If you answered yes to one or more of these questions, you should make an appointment to talk to your doctor about it.

​Obstructive sleep apnea is a condition where the tongue falls back against the soft palate and the soft palate collapses against the back of the throat.

​The ​result is the airway closes.  You have to wake up out of deep sleep enough for your body to overcome the obstruction.  This can happen multiple times every hour.

Since you don’t stay in the restful deep stages of sleep, you don’t truly get good rest.

Untreated obstructive sleep apnea has been associated with an increased risk of​ heart disease, congestive heart failure, and stroke.

Obesity is a risk factor for obstructive sleep apnea, but obstructive sleep apnea also worsens obesity, thus creating a vicious cycle.

​It has also been shown to worsen insulin resistance and fatty liver disease.

So What Can You Do About It?

​If you have sleep apnea, fortunately, all of these risk factors can be reversed with the use of a continous positive airway pressure (CPAP) device.

Your doctor can order an overnight sleep study which will determine whether you have sleep apnea or not.

Everyone should follow these common sense sleep habits:

  • checkTry to sleep a minimum of 7-8 hours every night
  • checkReserve the bed for sleep and sexual relations only
  • checkConsider installing blackout curtains in your bedroom
  • checkReduce your thermostat to keep your bedroom cool at night
  • checkMake sure you have a comfortable, supportive bed and pillow
  • checkTurn off all electronic screens at least 2 hours before bedtime
  • checkAt the very least, install a blue light filter on your smart phone, tablet and computer to use after dinner

​6. Digestive Issues

​Gut issues are often the root cause of many conditions of the body.  The gut can also be playing a major role in your fatigue.

Here are some gut issues to consider:

– Leaky Gut

​Leaky gut (intestinal permeability) occurs when the inflammation in the intestines causes gaps between the cells.  These gaps allow foreign ​substances such as bacteria and other proteins to be absorbed that wouldn’t be normally.

Those foreign substances trigger a strong immune response which further increases inflammation.  That inflammation results in symptoms such as fatigue, mood swings, abdominal bloating and pain, achiness, headaches, and others.

The inflammation also prevents the absorption of many nutrients from what we eat, such as iron and vitamin B12.  A deficiency of these nutrients worsens feelings of fatigue.

Leaky gut can be caused by a poor diet of processed foods, prescription medication, thyroid disorders and autoimmune disorders.

What Can You Do About It?

​Remove processed foods from your diet, especially gluten and sugar.

Replace it with natural, organic whole foods.  I also recommend fermented foods that are full of healthy bacteria that our body needs.

Fermented foods include sauerkraut, kumbucha, kefir, kimchi and yogurt.

There are also several gut-healing supplements that can help.  These include:

  • checkProbiotics – I recommend that it have at least 10 bacterial strains and at least 50 billion cfu.
  • checkL-glutamine – this amino acid helps repair damage in the GI tract.  Take 1000-3000mg daily in divided doses between meals.
  • checkDigestive Enzymes – these enzymes help breakdown the fats and proteins in our meals. Take 1-2 with each meal.
  • checkQuercetin – this product has bioflavanoids which help to balance histamine levels and helps with digestion and allergies.  Take 2-4 capsules per day.
  • checkBetaine Hcl with Pepcin – these are vital components of gastric acid secretion.  It assists with digestion of food and absorption of nutrients.  Take 1 with each meal.  You may increase by 1 capsule per meal as needed.  If you develop burning in your stomach, reduce the dose by 1 capsule with each meal.

– Food Intolerances

​Many people are sensitive to certain foods and may not even know it.  Although they may not be truly “allergic,” consuming those foods still triggers inflammation and a reaction from the body.  Again, a common feature of inflammation is fatigue.

What Can You Do About It?

There is not a good lab test for food sensitivities.  The gold standard for determining them is the Elimination diet.

With the elimination diet, you remove the most common foods that cause food sensitivities for 3-4 weeks.  ​If your symptoms improve during that time, you know that you are most likely sensitive to at least one of the foods.

You then re-introduce the foods one at a time and see if you react.  If you don’t, you are most likely not sensitive.  If you do react, then you need to avoid that food as much as possible in the future.

The most common food sensitivities include:

  • checkGluten
  • checkDairy
  • checkSoy
  • checkProcessed or refined sugar
  • checkPeanuts
  • checkEggs
  • checkCorn

– Dehydration

​Water constitutes up to 75% of the body weight of infants and up to 55% of the body weight of adults.

Most of us are mildly dehydrated on an almost constant basis.  That results in symptoms of fatigue, headache, brain fog, and mood swings.

Studies show that even mild dehydration can affect our mood, energy level and mental functioning.  Here is another study.

Thirst is one of the last symptoms that you may feel when you are dehydrated.  Fatigue and the other symptoms may already be present by the time you feel thirsty.

So What Can You Do About It?

​Simply drinking more water may be the simplest yet most effective thing that you can do to increase your energy level.

As a general rule, I tell my patients that they should have to urinate at least every 2 hours.  If you are going longer than that, chances are you are dehydrated.

A simple way to determine your daily water needs is to take your weight in pounds and divide that in half. That number will be the approximate amount of water in ounces that you should drink daily.

For example, if you weight 140 pounds, you should be drinking about 70 ounces of water per day.

By the way, that amount is just for your baseline water needs.  If you are exercising, you need an additional 8 ounces for every 30 minutes of exercise.​

Eating a diet high in moist vegetables such as celery, cucumber and carrots is another way of increasing your water intake.

​7. Other Causes to Rule Out

​Although feeling tired is a common symptom that all of us have at times, it can also be a sign of something more serious going on in your body.

If your fatigue is more severe and lasts longer than it typically does, it is extremely important that you see a doctor for a complete history, physical exam, and blood work.

Some of the more serious potential causes of your fatigue include:

​- Anemia

​Anemia is a condition where you have lower levels of red blood cells.  Red blood cells carry oxygen in the blood to be used by the cells in the body.

Anemia is actually a symptom and not a diagnosis.  Something is causing the anemia.  That cause needs to be investigated thoroughly.

As a general rule, if someone is anemic, either the red blood cells are not being produced adequately by the bone marrow, or ​there is either blood being lost somewhere or the red blood cells are being destroyed somewhere.

Not only does anemia cause fatigue, it can also cause symptoms of weakness, dizziness, shortness of breath, pale skin, and an irregular heart beat.

​Some causes of anemia include:

  • checkHeavy menstrual periods
  • check​Iron, vitamin B12 or folic acid deficiency
  • checkGI bleeding – ulcer, gastritis, hemorrhoids, colon polyp, GI malignancy
  • checkAnemia of chronic disease – cancer, autoimmune disease, and other inflammatory conditions can suppression bone marrow production
  • checkBone marrow suppression – leukemia, multiple myeloma
  • checkAplastic Anemia – the bone marrow stops making red blood cells.  Can be caused by autoimmunity, infections, medications, and toxic exposures
  • checkHemolytic anemia– a condition where the body destroys the red blood cells faster than they can be made.
  • checkSickle Cell Anemia – a genetic condition caused by a defective form of hemoglobin

​Many of these causes of anemia are life-threatening and should be worked up by a medical professional.

​If you are anemic, don’t just assume it is from something like heavy periods or a bleeding hemorrhoid. Have it evaluated!

– Autoimmunity

​Inflammation in general taxes our bodies and will usually cause us to have significant fatigue.

If your fatigue is persistent or progressive, you should see your doctor.  Make sure that you request that your blood work include inflammatory markers, including the following:

– Complete Blood Count (CBC)

​- Erythrocyte Sedimentation Rate (ESR)

– C-reactive Protein – (CRP)

If any of these tests are abnormal it indicates an increase in inflammation and further workup is required. Several autoimmune conditions could be the cause including Hashimoto’s thyroiditis, rheumatoid arthritis, lupus, and many others.

– Malignancy

​As stated above, various different malignancies may have fatigue as one of the​ primary symptoms.  This could include cancers of the blood, gastrointestinal system, reproductive system, and lungs.

It is critical that you see a doctor for evaluation if your fatigue is persistent and an obvious source has not been found.

​Summary

​If you are tired, there are probably several reasons that you should consider.

You may have some hormonal issues such as insulin resistance and thyroid dysfunction.

Your diet and activity level ​are also probably playing a role.

You should also look into your stress, sleep habits, gut function, and level of hydration.

​There are also many potentially serious causes that need to be considered.  Therefore, it you are excessively fatigued, see your doctor!

Now it’s your turn…

​Are you tired?

​What ​did you ​find that cause​d your fatigue?

Any advice you would have for others?

Leave your questions and comments below.​

What is MTHFR?

​What i​s MTHFR?  Is that a curse word?

​​Science and medicine are ​in the ​early stages of understanding ​genes and gene mutations and the potential of gene therapy to treat disease.

The MTHFR gene mutation​s are probably the best known of the​ gene mutations, but ​relatively little is truly known about them by most people.

Having one of these gene mutations may increase your risk of developing heart disease, stroke, depression, neurological disorders, birth defects, developmental disorders, and possibly even cancer.

In this article, I will discuss ​the MTHFR gene mutation, explain how you can be tested for it, and show what it may mean if you are positive for one of ​its common variants.

Here we go…

More…

What is a Gene?

Even though this is not a hormone issue, I am frequently asked about MTHFR in my practice.  ​Since is could potentially impact your health it deserves a blog post in order to help ​you stay informed.

In order to understand MTHFR and the concept of a gene mutation, we need to do a quick primer on genetics.  

Every person in the world has the same approximately 20,000 genes (​NOT jeans for you shopaholics reading this!).

The differences between us come from the slight variations in those genes.

Almost every cell in your body contains the complete set of instructions on how to make you.  These instructions are coded in your DNA.

Deoxyribonucleic acid (DNA) is a long, ladder-shaped molecule.  Each rung of that ladder is made up of a pair of bases called units. Those units are either adenine (A), thymine (T),  guanine (G) or cytosine (C).  A and T are always paired together, and G and C are always paired together.

The DNA strands are then organized into larger pieces called chromosomes.  Humans have 23 pairs of chromosomes for a total of 46.  Other animals and plants have a different number of chromosomes. 

For example, a dog has 39 chromosomes, a rice plant 12, and a fruit fly only 4.

Chromosomes are further organized into short segments of DNA called genes.  A gene has a set of instructions that tells your cells how to function and what traits to express.

The cells use the instructions given by the genes to make proteins.  Proteins do much of the work in the cells of your body.  Some give the cell its shape and structure, while other proteins help the cells carry out certain biological processes, such as carrying oxygen to the body.

Proteins can be further organized into larger molecules called enzymes.  Enzymes serve as catalysts to bring about ​certain biochemical reactions.

In the situation we are discussing in this article, an enzyme causes a reaction that allows nutrients from food that were eaten to be metabolized so that they can be used by the body.

The body typically metabolizes substances by triggering an enzymatic reaction that attaches a molecule to the substance.

If an oxygen molecule is attached in the reaction, ​i​t’s called oxidation.  If a sulfate group is attached, it’s called sulfation.  If a methyl group is attached, it’s called methylation. And so on.

So if every cell contains all of the same DNA, how does one cell know to make a finger while another makes a heart?  The answer lies in the intricate system of genetic switches.  

Master genes turn other genes on and off, ensuring that the right proteins are produced at the right time in the right cells.

​I hope I haven’t overwhelmed you.

​Now that you have an overview, let’s get into the specific situation of MTHFR…

​What is​ MTHFR?

The MTHFR gene is found on the short arm of chromosome 1.

​MTHFR stands for methylenetetrahydrofolate reductase.  The MTHFR gene contains instructions for making the MTHFR enzyme.

The MTHFR enzyme has 2 primary functions:

1.  It metabolizes folic acid (also called folate or vitamin B9) by converting it to methylfolate.  Remember, it adds a methyl group to it.

​2.  ​​It helps to keep homocysteine levels low because methylfolate converts homocysteine back into methionine, which ​is then recycled​.

Methionine is used to make other important proteins in the body.  These include SamE, which ​plays a major role in serotonin production, and glutathione, which helps with detoxification of heavy metals and environmental toxins.

​Up to 60% of the population has been shown to have a defect in the MTHFR gene (also called a polymorphism or SNP).  The defects can impair the ability of the MTHFR enzyme to methylate folic acid and convert homocysteine to methionine.

​Remember, you have 2 copies of every gene in your body (one from mom, one from dad).

If only one of the two genes contains the defect, ​it is called a heterozygous defect.  If both genes have the defect, it is called a homozygous defect.  “Hetero” means different, “Homo” mean the same.

If the defect is on both genes (homozygous), it results in a more severe impairment of the function of the enzyme compared to a heterozygous defect.

With the MTHFR gene, the defect usually occurs in 2 locations – C677T and A1298C. ​

People can also be heterozygous for both – meaning they have a defect at the C677T location on one gene and a defect at the A1298C location on the other gene.  This is called compound heterozygous.

​Studies have shown that the above genetic defects may impair the ​efficiency of the MTHFR enzyme by the following percentages:

  • checkHomozygous  C677T – up to 70% impairment
  • checkHeterozygous C677T – up to 35% impairment
  • checkHomozygous A1298C – up to 35% impairment
  • checkHeterozygous A1298C – Minimal impairment
  • checkCompound Heterozygous – Possibly >70% impairment

​Symptoms of an MTHFR Mutation

​The gene mutations themselves do not directly cause any health problems.  However, they may cause an exaggerated response to a poor diet or poor lifestyle choices.

​Any signs or symptoms caused by the MTHFR gene mutation will be the result of having an elevated homocysteine level, a low folic acid level, or low SamE and glutathione levels.

​Central Nervous System –

These include

depression

fatigue

– headaches

– memory loss

– dementia

– bipolar disorder

– schizophrenia

These conditions seem to be more common with the A1298C mutation.

Studies have shown that using methylfolate is as effective as traditional anti-depressant drugs in the treatment of depression, even in patients that did not respond to the anti-depressant drugs.

This probably occurs because the methylfolate increases levels of SamE which then raises serotonin levels.

​Cardiovascular System –

​MTHFR gene mutations, particularly the homozygous C677T and compound heterozygous mutations, have been shown to be a risk factor for the following:  

heart disease

– stroke

blood clots

peripheral neuropathy

recurrent miscarriages

congenital birth defects

​The increase in incidence is most likely due to the elevation of homocysteine levels caused by the gene defect.

​Toxic Exposures –

With the MTHFR defect, less methionine is produced which results in lower levels of glutathione.

Glutathione is one of the primary detox molecules in our body.  It helps to clear heavy metals, BPA, and other environmental toxins from our body.

​Symptoms that can occur if we have an excess of these toxins can include nausea, diarrhea, abdominal pain, asthma, hair loss, rashes, and others.

​Other Systems –

An MTHFR mutation has been possibly linked to autism, fibromyalgia, chronic fatigue syndrome and chronic lyme disease.

In one study, ​there was a 3-fold increase in the risk of autism in children with the C677T defect.  If they also had the A1298C defect, their risk rose by 8-fold.

In another study, mothers with an MTHFR mutation who didn’t take folic acid during their pregnancy were found to be 7 times more likely to have a child with autism.

​Folic acid and B12 supplementation has been shown to reduce the symptoms of fibromyalgia.

MTHFR mutations have also been possibly linked to colon and gastric cancers.

​Pregnancy –

MTHFR mutations have been linked to an increase risk of premature delivery​ as well as birth defects.

​Diagnosing an MTHFR Defect

There is a blood test available to test for an MTHFR defect.  It can also be tested through buccal (cheek) swabs.

​Testing for MTHFR is not routinely ordered in most doctors offices unless the patient has an elevated homocysteine level or a positive family history of having an MTHFR defect.

In fact, there are many experts that believe there is not enough data to support or recommend routine testing at all for the defects.

If you want to have it tested “just so you will know,” then there is a strong possibility that your insurance will not cover it and it could cost a few hundred dollars.

A cheaper option may be to order a home testing kit from an online source such as livinggenes.com. Most cost about $150.  Another option would be to get a full genetic testing kit through 23andme.com.

If you have a family history of an MTHFR defect, and/or if you have a personal or family history of an elevated homocysteine level, I would recommend that you get tested.  This is especially true if there is also a strong family history of heart disease, stroke, or one of the other conditions that have been linked to a genetic defect in the MTHFR gene.

Some experts recommend also testing for S-adenosylhomocysteine and methymalomic acid (MMA) if you are positive for a homozygous MTHFR mutation or compound heterozygous.  S-adenosylhomocysteine appears to be a more sensitive indicator of cardiovascular disease than homocysteine.

​Treatment of an MTHFR Gene Defect

​Since the core issue with an MTHFR gene defect is inadequate methylation of ​B vitamins (particularly foic acid), taking a B complex vitamin that​ has methylated forms of folic acid, B12 and B6 is a mainstay of treatment.

It is important to stay away from vitamins that have synthetic folic acid​ and synthetic B12 (cyanocobalamin) if you have an MTHFR defect. Since your ability to methylate it is already impaired, it could actually make things worse.

You can buy my methylated B vitamin of choice by clicking here.

​There is inadequate data at this time​ that eating a diet low in folic acid has any significant impact.

​Helping your body to detox naturally is also key.  This includes:

  • checkEat a diet of whole, natural, unprocessed foods
  • checkSweat​! – regular exercise, sauna, etc.
  • checkAvoid environmental toxins – Avoid cleansers, pesticides, plastic bottles
  • checkMaintain good gut health – Regular, consistent BMs, take a daily probiotic
  • checkStress Management – Yoga, good sleep, meditation

​On a personal note, my homocysteine level was ​16.3 on labwork from a year ago.  Further testing showed that I was heterozygous for one of the MTHFR mutations.  Since cleaning up my diet, detoxing better, and taking a methylated B vitamin, my most recent labwork showed my homocysteine level at 4.5!

​Summary

​The MTHFR gene carries the instructions for making the MTHFR enzyme.  That enzyme is responsible for methylating folic acid which allows it to be metabolized in the body.

There are several known genetic defects in the MTHFR gene that can reduce its ability to methylate.

The lack of methylation can lead to low levels of folic acid and high levels of homocysteine, which can increase cardiovascular risk and multiple other medical conditions.

This can be managed by taking a methylated B vitamin, eating a whole, natural food diet, managing stress, and detoxing adequately.

Now it’s your turn…

Have you or someone you know been diagnosed with an MTHFR defect?

If so, how are you managing it?

Leave any questions or comments below.

Intermittent Fasting for Weight Loss – Yes It Is Safe and Yes You Can Do it!

​The thought of purposely not eating may sound unrealistic and even terrible to you.

However, our bodies were not designed to eat constantly.

Until the last century or so, most people lived a “feast or famine” lifestyle.  It was not uncommon for them to go ​a day or more between meals until they could afford to buy more food or until they could find another animal or plant to eat.

Eating multiple meals per day has resulted in a ton of health issues, including diabetes, obesity, hypertension, heart disease, and many others.

In this article, I will discuss the history of fasting and some false information we have been taught about dieting.

I will also discuss the medical benefits of fasting, some popular ways of fasting that have been shown to help with weight loss, and I will answer some common questions that people have about fasting.

Here we go…

More…

​Diet ​​Beliefs That Are Wrong

​Before we discuss fasting and its benefits, we need to understand why we gain weight in the first place.

Society is riddled with false information.  We have been sold a bill of goods when it comes to understanding nutrition and how ​and when we should eat.

Even doctors get minimal training and education on diet and nutrition.  Even some nutritionists in my experience are still teaching information from 20 or more years ago that has since been debunked.

Much of this false information comes from the food industry.  The more we eat, the more their business prospers.  They want us to eat as much as possible!

As a result,​ some ideas have spread through advertising and other means that are patently false, yet they have nonetheless become ingrained into our way of thinking.

These include:

– You must always eat breakfast.

– Never miss a meal.  It will cause you to overeat when you do eat.

​- You should eat multiple times a day, including snacks.

For those of you that were born in the 1970s or earlier, think about your childhood.

You probably only ate 3 meals a day and that was usually it.  If you tried to eat a snack when you got home from school, your mother probably said, “Stop that!  You’ll ruin your dinner!”

Sound familiar?

By the way, the incidence of obesity in those days was MUCH lower than today.

Compare that to today:  The average American now eats 5 to 6 times per day.  That means you are eating in a 16-18 hour window and only fasting for 6-8 hours a day, the reverse of what it was ​30-40 years ago.

Should we be surprised then that obesity is such an epidemic?

To look into this further, let’s discuss some of the common ​beliefs that most of us have about diets and why they are wrong:

​1.  Calorie In, Calorie Out –

​Most of us have been taught this theory and ​it is core to our beliefs on weight loss and obesity.  

We ​look at our body like a large container with a hole in the top and a hole in the bottom.

As long as the container is draining more out from the bottom than is ​being poured into the top, we will lose weight.

If someone is obese, then obviously they must be consuming more energy than they are burning everyday.  Right?

​What is the first thought that comes to your mind when you see an obese person in public?  Most likely it is something like this – “If they would just quit eating so much they would lose weight.”

​Haven’t we all thought this before?

If this were true, then why do up to 99% of people fail long term when they try a low calorie diet?

​Even if you do lose weight on one of those diets, why do you always seem to plateau after a few weeks and the weight loss slows and ​even stops?

There has to be more going on, doesn’t there?

​2.  Eat Less, ​Move More –

​Over the past decade or so, many people in our society have evolved their thinking into more of this concept.

If you put on a few pounds over the holidays, what thought comes to your mind?  Probably something like this – “I need to quit eating so much and get my rear back in the gym.”

Yes, if you are consuming massive amounts of food, you need to back off.  If you are a total couch potato, you need to start doing some exercise.

However, it’s just not that easy, is it?  How many of you feel like you are eating very little and exercising as much as you can, yet your weight doesn’t budge?

The fact is, there is no correlation between obesity and calories.

A study from 1997 showed that between 1980 and 1990, Americans consumed about 4% fewer calories than previously, yet the incidence of obesity increased by 31%.  They called it the “American Paradox.”

​Losing weight just isn’t as simple as reducing the number of calories you eat and burning more by exercising.

A United Kingdom review from 2015 showed that the probability of achieving a normal weight by just reducing calories was 0.8% in women and 0.47% in men.  In other words, losing weight by using the conventional calorie-counting methods had a failure rate of 99.2%!

In fact, ​eating too few of calories for an extended period of time can actually be harmful.  

If you reduce your calorie input too much for too long, it can damage your metabolism for years!  

This was shown in the Biggest Loser Study.  14 contestants from the 2009 show were studied.  All but one of them had regained most or all of the weight they had lost while on the show plus sometimes more six years after the show.

The severe calorie-restricted diets that they were on during the show had severely damaged their metabolism.  The damage was still present 6 years later.

In other words, instead of burning the typical ​~2000 calories per day that the​y burned before being on the show, their resting metabolic rate had dropped by about 1000 calories per day.

Dr. Jason Fung, widely considered one of the world’s foremost experts on fasting, brilliantly discusses why these concepts of weight loss are wrong​ in this video plus he also explains the importance of fasting:

The Real Reason for Weight Gain and Obesity

So if these 2 concepts are wrong, what is the real ​reason that we gain weight?

The underlying cause of obesity is ​an imbalance of your hormones, not an imbalance of your calories!

The ​real root issue is insulin resistance!

If you want to lose weight, you HAVE to lower your insulin (you must also reduce leptin resistance).

The body responds to excessive amounts of anything by developing resistance to it.

​Have you ever seen anyone that takes pain medication on a regular basis​?  ​Typically, after a period of time, it ​begins to require more of it to get the same effect.  That is true for alcohol and other medications as well.

The same thing happens with insulin.  

When we eat a diet high is sugar or processed carbs, ​our pancreas is signaled to release insulin.  The insulin attaches to the sugar in our blood and transports it into the cells where it is used immediately for energy.

​The insulin also carries the sugar into the liver which links it into long chains called glycogen.  The glycogen is stored in the liver where it can be accessed as a source of glucose when needed.

When the storage limit of glycogen is reached in the liver, the glucose is then converted into fat (called lipogenesis).  That fat is stored in the liver and around the body to be used for energy in the future.

​When this process occurs in excess, we gain weight.

It only makes sense that if we want to reverse this process, we have to lower insulin.

So ​what is the best way to lower your insulin level?

​Anything that reduces your intake of sugar and carbs (and protein, actually) will re​sult in less insulin being secreted by the body.

​No diet will do this as well as not eating anything at all.

Yes, fasting is by far the most potent tool we have to lower the insulin levels in our body.

Let’s discuss ​it ​further…

​History of Fasting

​Fasting has been practiced by virtually every religion and culture on earth.  It is considered a vital part of Christianity, Judaism, Islam, Hinduism, and Buddhism.

​The ancient Greeks noticed that both animals and humans avoided eating when they became sick.  They realized that fasting is a natural treatment for illness.  

They also realized that fasting improved their mental capabilities.  These times of fasting were called “purification” or “cleansing.”

The father of modern medicine, Hippocrates, recognized the benefit of fasting as a treatment for obesity over 2000 years ago.

Benjamin Franklin was a strong believer in the power of fasting, as his quote above shows.

Mark Twain, one of America’s foremost philosphers and writers, wrote “A little starvation can really do more for the average sick man than can the best medicines and the best doctors.”

​Fasting began to appear in medical literature in the early 1900s.  There was a renewed interest in it in the 1950s when Dr. W.L. Bloom began recommending it, but that interest faded by the late 1960s.

​Fasting was rarely if ever mentioned again until the last ​few years when people such as Dr. Jason Fung ​reignited interest.

​Benefits of Intermittent Fasting

​Fasting has been shown to:

  • checkImprove concentration and mental clarity
  • checkReduce weight
  • checkLower blood sugar
  • checkReduce Insulin
  • checkIncrease energy
  • checkLower cholesterol
  • checkDecrease inflammation
  • checkReduce the risk of Alzheimer’s Disease

​Fasting also has many practical benefits:

​It is free to fast.  It will not add any expenses to your budget.

​Fasting increases your amount of free time.  No food preparation or running to the grocery store or a restaurant is needed when you fast.

​Fasting is also very flexible.  Depending on your work schedule or other activities, fasting can be modified to be used however and whenever you need it.

You can also incorporate fasting with any diet​.   I believe that combining fasting with a whole food, low carb diet is one of the single most effect ways for someone to lose weight, but it can be used with any diet you choose.

​Types of Fasting

​Fasting refers to abstaining from something.  In this article, I am referring specifically to abstaining from food for a period of time.

A true fast would mean that no food was consumed during the time of the fast.  However, there are some types of fasting that I will discuss that allow a small amount of food at times.  Even though they are technically not a true fast, I will consider them a fast for the sake of this article.

​With all of these fasts, ​the fluid consumed should be water, tea or coffee.  I am also okay with drinking kumbucha and bone broth, both of which can provide some nutrition without increasing caloric intake substantially or raising insulin levels.

Soft drinks or artificial sweeteners should be avoided because they can raise insulin levels.

Fasts are primarily differentiated by the amount of time involved when food is withheld or at least reduced.

Let’s discuss the various fasts that are commonly used and in what situations they are helpful:

1.  Daily 12 Hour Fast –

This was how most Americans ate prior to the 1970s.  In this fast, all meals (usually 3) are eaten typically between 7am and 7pm.

This balances the time of fasting and feasting​ to 12 hours for each.

Who Benefits From This Diet? – Anyone trying to maintain their current weight and prevent insulin resistance.

This type of fasting is most likely not powerful enough to cause weight loss or to reverse insulin resistance that is already present but is a good maintenance diet.

2.  Daily 16 Hour Fast (16:8) –

In this diet, ​the window when you eat is reduced to only 8 hours of the day.  Basically, you skip the breakfast time of eating.  

A typical person will eat dinner at 8 pm and not eat again until noon the following day.  Typically either 2 or 3 meals are consumed during the 8 hour window.

This diet is commonly called the 8-Hour Diet.

​It has also been called the LeanGains method.

Who Benefits from This Diet? – Anyone that needs a simple way of fasting to incorporate into their life.

It works best when combined with a low carb diet.

Weight loss occurs, but it is slow and gradual.

​3.  Daily 20 Hour Fast (The Warrior Diet) –

Ori Hofmekler popularized this diet in the early 2000s.  He ​argued that knowing when to eat is just as important as knowing what to eat.

This diet is inspired by ancient warrior tribes such as the Spartans and Romans, who typically battled all day then would feast in the evenings.

​With this diet, all meals are eaten in the evening in a 4 hour window of time.  It also stresses the importance of eating whole, natural foods and perfoming high-intensity interval training.

Who Benefits From This Diet? – Anyone wishing to lose weight that is willing to incorporate ​a longer time of fasting with a whole food diet and intense exercise.

4.  24 Hour Fast

With this fast, eating is limited to only once per day.  You can fast from morning to morning, evening to evening, or mid day to mid day.

This is helpful for people that take medication that should be taken with food (iron, aspirin, etc).

This diet is also easy to incorporate into daily routines.  You can still plan on eating whichever meal is important in your life – dinner with the family, lunch at work, etc.

Nutrient deficiencies are rare since food is still being consumed daily.

​The fast was popularized by the book “Eat, Stop, Eat.”  The author, Brad Pilon, recommends doing a 24 hour fast twice a week.

​You could do ​this fast up to 3 days per week, but I would not recommend any more than that for fear of damaging your metabolism.  Doing it 2 days consecutively is particularly effective in my experience.

Who Benefits From This Diet? – Anyone needing powerful weight loss and reduction of insulin resistance.  Also, anyone that is ​on medication that ​needs to be taken with food.

​Diabetics ​should ​consult with their physician ​before attempting this diet.

5.  The 5:2 Diet –

This is really not a true fast.  With this diet, calories are just reduced for a period of time.

It consists of 5 normal eating days.  On the other 2 days, women may eat up to 500 calories and men may eat up to 600 calories.  The “fasting” days can either be done consecutively or split up during the week.

The calories can either be consumed in a single meal or spread out over the entire “fasting” day.  The diet is continued indefinitely, even after your target weight is reached.

Who Benefits From This Diet? – Anyone that is hesitant to try fasting.  This diet can be a good starting point, then you can transition to a stricter fast if needed.

6.  Alternate Day Fasting –

This diet is similar to the 5:2 diet, except the “fasting” days occur every other day.  Therefore, there are 3-4 days that are low calorie ​every week rather than just 2.

On the “fasting” days, women are allowed to eat 500 calories and men 600 calories.

The diet should be continued until your target weight is reached.  The fasting days can then be reduced as long as you are maintaining your desired weight.

The effectiveness of this protocol has been shown in several studies to be effective for weight loss.

Who Benefits From This Diet? – Anyone that has had success with the 5:2 diet but needs a slightly more aggressive approach.  Also, anyone that struggles with fasting completely and feels they need to eat at least some food daily.

​7.  36 Hour Fast –

With this diet, you do not eat for an entire day.

​You eat dinner at 7pm, eat nothing the next day, then eat breakfast on the NEXT day at 7am.

​You ​typically do this fast ​2-3 times per week.

The diet is continued until the desired results are achieved – weight loss and/or reversal of insulin resistance and diabetes.  The longer you have had diabetes, the longer you will need to do be on this fasting protocol to reach your goals.

The frequency of the fasting is then reduced to allow for maintenance.

This is the diet of choice for Dr. Jason Fung and his Intensive Dietary Management (IDM) program.

Who Benefits From This Diet? – Type 2 diabetes and other patients with severe insulin resistance.

Blood sugar should be closely monitored multiple times per day.  Diabetic medications will need to be reduced or stopped under the supervision of your doctor.

8.  42 Hour Fast –

This fast is similar to the 36 hour fast except the first meal at the end of the fast is not until lunch instead of breakfast.

This makes it easier for you to follow ​a 16:8 fast and diet on the regular days.

This fast is done twice per week.

Who Benefits From This Diet? – Type 2 diabetics and others with severe metabolic syndrome and insulin resistance.

Again, this must ​ONLY be done under the close supervision of a physician.

9.  Extended Fasts –

There are ample historical records of people surviving and even doing well ​during extended day fasts.

The longest recorded fast in history is 382 days!  A Scottish man started at 456 pounds.  His only intake was noncaloric fluids, a daily multivitamin, and various supplements.

At the end of the 382 days, he weighed 180 pounds.  He had no significant medical issues during the fast. Five years later he still only weighed 196 pounds.

​Several experts, including Dr. Fung, routinely start patients with severe type 2 diabetes on 7-14 day fasts. They typically see rapid improvement and re​versal of insulin resistance with only rare medical complications.

​Some oncologists are also beginning to recommend a 7 day fast once per year because it is ​appears to help lower cancer risk.

​I personally have never tried an extended fast.   I would also be hesitant to prescribe it to a patient, although I admit that my experience is extremely limited.

If you decide to embark on an extended fast for either health or religious reasons, it is critical that you involve your physician and monitor your glucose and other lab tests closely.  Medications may need to be reduced or even stopped during the fast.

I would also recommend consuming bone broth throughout the fast, perhaps even with sea salt added to ​it.

I have concerns about the possibility of damaging your metabolism if fasting is done to excess.   Like most things in this world, moderation is usually best.

​People Who Should Avoid Intermittent Fasting

​Fasting isn’t for everyone.

There are certain minerals, vitamins, and other nutrients that are obviously not ingested when you fast.

Most people can tolerate the lack of those nutrients for a period of time, but there are some people that should never attempt fasting.  They include:

  • checkPregnant Women
  • checkBreastfeeding Women
  • checkChildren under the age of 18
  • check​People who are underweight or malnourished​

​People who should not attempt fasting without first consulting with their doctor include:

  • checkType 1 or Type 2 Diabetics
  • checkPeople with Gout
  • checkPeople on any prescription medications

​This caution is especially true for diabetics.  Fasting is so potent at lowering insulin that it can cause a rapid decrease in the blood sugar which can be very dangerous, particularly if the person is on diabetic medications.

​Those people can still consider fasting, but it is crucial that they discuss it with their doctor beforehand and closely monitor their blood sugar throughout the fasting period.  It may be necessary to reduce or even stop their diabetes medications during that time.

​Common Questions About Fasting

​When I suggest fasting to patients, I usually initially get a shocked stare followed by a nervous giggle and a bunch of questions.

​I have answered the most common ones below:

Is Intermittent Fasting Safe?

​When used correctly, fasting is very safe.  

Remember, our bodies were designed to have periods of time when we eat and periods of time when food is not available.  There are mechanisms in place that will maintain our energy, electrolytes, and other vital bodily functions during times without food.

The biggest risk is dehydration.  Most of us do not drink enough fluids and exist in a state of mild dehydration on a daily basis.

Many times our brains will confuse our thirst with hunger.  The next time you feel hungry, try drinking a glass of water instead.  You may be surprised ​that the hunger resolves.

It is therefore important to drink a lot of fluids when you fast.  Water is great, kumbucha or bone broth are even better because of the nutrients they contain.

​Again, special precautions should be made if you are taking prescription medication (particularly diabetic meds).  Do not fast without discussing it with your doctor first.

I have also found that fasting can be difficult for people that are dealing with low cortisol levels (adrenal fatigue).  Those folks should get their cortisol levels normalized first before attempting fasting or else it could exhaust them.

​Won’t Fasting Make Me Feel Tired?

​No!  In fact, most people feel more energized.

How in the world does that happen?

​Norepinephrine (adrenaline) is ​secreted when you fast.  Its job is to release the glycogen stores in the liver.  It also increases your metabolism.

After a 4 day fast, one study showed that the resting energy expenditure of ​the people in the study increased by 12%.

​It makes sense if you think about it.

​This is a survival response that has developed in our bodies ​over thousands of years to help us ​survive times when food is scarce.

If someone hasn’t eaten for a few days, t​hat increase in energy ​is critical to help them get up and find some food.  Otherwise, if the lack of food continued to ​drop their energy levels, ​they would eventually just lay down and die.

​Will Fasting Make My Body Burn Muscle?

​No.  Studies show no significant loss in muscle mass even when people fast for prolonged periods of time.

​The primary reason for this is fasting causes huge surges in human growth hormone (HGH) ​secretion.

​The elevated HGH maintains muscle mass by raising the levels of lipoprotein lipase and hepatic lipase which trigger release of fat to be used for fuel.

​In one study, HGH secretion doubled after a 5 day fast.

In another study, HGH secretion increased ​5 fold after a 2 day fast.

During a religious 40 day fast, ​one man showed an increase of HGH secretion of 1250%!

And the opposite is true as well.

Overeating has been shown to suppress HGH secretion by up to 80%.  If you eat all day long, you will almost completely shut down your HGH secretion.

​Does Fasting Damage Your Metabolism Like a Severe Low Calorie Diet?

​Just like with anything else is life, fasting can be overdone.  However, when used correctly, fasting can actually repair our metabolism, not damage it.

​The body will adjust to a ​constant low calorie diet by reducing ​the amount of calories we burn (our metabolic rate).  Remember, our body is designed to maintain itself whenever possible, including our weight (even when that weight is excessive).

A prolonged exposure to a low calorie diet will trigger this downward adjustment in our metabolism.

Since intermittent fasting is done intermittently, the body never has a chance to make that adjustment.  As a result, the ​metabolism isn’t ​reduced.  If anything, it goes up!

That is why it is good to change up your fasting routine.  On one week you might want to have two consecutive 24 hour fasts, while on the next week you might try three 16-18 hour fasts.

Avoid developing a routine that your body has an opportunity to detect and ​make adjustments.

​Can I Exercise If I Fast?

​Yes.  In fact, many experts suggest that the best time for you to exercise is at the end of a period of fasting.

Exercising during fasting trains your muscle to burn fat.  Instead of relying on the limited glycogen stores, you can teach your body to use an almost unlimited supply of fat stores.

Remember, fasting triggers an increase in norepinephrine which increases energy.   Also, the increase in HGH will help you build muscle faster.

In one study, ​fasting had no negative impact on strength, aerobic capacity or endurance.

Another showed that fasting before exercise improves insulin sensitivity.

​At first, some people may notice a decline in their athletic performance until their body adjusts to burning fat instead of glycogen.  That will typically resolve within a couple of weeks.

​Won’t Fasting Make It Hard For Me To Focus?

​No.  Studies have shown that fasting has no negative impact on brain function.  

Another study showed no effect from fasting on attention, focus or memory.

In fact, one study showed that memory improved in elderly patients when their calories were restricted.  This was felt to be secondary to the reduction in insulin and inflammation.

In my personal experience, ​fasting seems to improve focus and concentration in myself and in my patients.

​Have you ever had a hard time focusing at work after eating a large meal?  Food worsens​, not improves, our brain function.

​References

​1.  “The Complete Guide to Fasting” – Jason Fung MD.  Copyright 2016.

2.  “Eat, Stop, Eat” – Brad Pilon.  Copyright 2007.

3.  The 8-Hour Diet – David Zenczenko and Peter Moore.  Copyright 2015.

4.  www.leangains.com

5.  “The ​5:2 Diet – Feast for Five Days, Fast for 2 Days to Lose Weight and Revitalize Your Health” – Kate Harrison.  Copyright 2013.

​Summary

​Fasting may seem scary or even ridiculous, but it has been around for thousands of years.

When done correctly, fasting is the single most effective tool available to lose weight and reduce insulin resistance.

Severe low calorie diets can damage the metabolism, whereas intermittent fasting does not and is even more effective.

Fasting should be started with caution, especially if you have health issues such as type 2 diabetes. Consulting with your physician is essential before starting and while on the fast.

There are many different ways to fast.  While some are more potent than others, all can be helpful and should be considered as part of a healthy lifestyle.

Now its your turn…

Have you tried fasting?

If so, how did you feel during the fast?

What were the results of the fast?

Any advice that you would give for others considering fasting?

Leave your questions and comments below.

Why Am I So Fat? 9 Reasons to Consider

​That may seem like a harsh title, but I am asked that question almost daily in my medical practice.  ​People that struggle with their weight are desperate for answers.

​As most people would guess, diet and exercise ​​play a huge role in your ability to lose weight, but​ there are​ multiple other things ​also going on that are making ​it ​difficult for you to drop the pounds.

In this article, I will discuss 9​ commonly ignored reasons that anyone should consider if ​they are ​failing in their weight loss attempts.

These include thyroid issues, stress, poor sleep habits, insulin resistance, and many others…

More…

​9 Reasons That May Be Making Weight Loss ​Difficult

​Most Americans need to lose weight.  The latest statistics show that 7 out of 10 people are overweight or obese.  ​Interestingly,  only 36% of people think they need to lose weight.

If you are reading this article, ​I suspect that you need to lose weight but you don’t know how.

I’m going to discuss 9 reasons that may be a hurdle in your weight loss journey.  All of them may not apply to you and your specific situation, but chances are most of them do.

​1.  Standard American Diet

​Let’s start with the obvious.  ​What we are eating in America is slowly killing us.

If you don’t get your diet under control, nothing else that I discuss in this article will be enough to help you lose weight.  What you eat is the cornerstone for everything else.

As the percentage of Americans that are considered obese continues to skyrocket, so are conditions such as heart disease, cancer, and Type 2 diabetes.

A big reason why is obviously our diets.  Many people have chosen convenience over health.  Eating out has replaced cooking at home for a large portion of Americans.  This includes fast-food restaurants.

​Even if you choose “healthy” options from a good restaurant, you have no input on the quality of food that is served (for instance, grass-fed beef vs corn-fed), what kinds of oils are used, how much sodium and other chemicals are added, etc.

Our priorities are totally out of whack.

According to the USDA, almost 1000 calories per day in the Standard American Diet (SAD) come from saturated fats and sweeteners.  Fruits and vegetables account for only about 200 calories!

​The biggest source of calories comes from grains, which is a 45% increase ​from 50 years ago.  Not only that, the quality of the grains consumed has changed.  Read “Wheat Belly” by Dr. William Davis if you want to learn more.

Even more concerning is the fact that sugar consumption has gone from about ​40 pounds per person per year in 1900 to ​​over 100 pounds per person per year today!

Source: http://wholehealthsource.blogspot.com/2012/02/by-2606-us-diet-will-be-100-percent.html

Last but not least, about 2/3 of the calories in the standard American diet (SAD) come from food-like substances and processed food.  It’s not even real food!

http://wholehealthsource.blogspot.com/2012/02/by-2606-us-diet-will-be-100-percent.html

​Note that the typical SAD diet consists of about 2500 calories per day.  

Depending on your metabolic rate, most people burn about 1800-2000 calories per day.

While I don’t prescribe to or recommend the “calorie in, calorie out” model of weight loss, it ​only makes sense that if you continue to consume more calories than you burn each day, you aren’t going to lose weight.

This is especially true if you have some of the other issues going on that I will discuss in this article.

​So What is the Solution? –

You should immediately change to a nutrient-dense, high quality, real whole food diet.

As a general rule, I recommend the ratio of the macromolecules in your diet to be in these ranges:

  • check50-70% good, healthy fats
  • check20% protein
  • check10-20% carbohydrates

​A good starting point would be to start with one of these diets.  There is a ton of online information and recipes for each:

Whole 30 Diet

Ketogenic Diet

Paleo Diet

All these diets have been shown in studies to help with weight loss and reduce insulin resistance.

– Intermittent Fasting

​Another tool that can be extremely helpful with weight loss is intermittent fasting.  Learning when NOT to eat is just as important as learning WHAT to eat.

When used appropriately, intermittent fasting can actually INCREASE your resting energy expenditure.

I typically recommend 2 types of fasting:

14-16 hour fast – Eat an early dinner, then don’t eat again until lunch the next day. 

2 consecutive 24 hour fasts – For example, eat a good dinner on Friday night, then don’t eat again until Saturday night​.  You have 30 minutes to eat at that time.  Then don’t eat again until Sunday night.

Fasting is ​so effective that you need to be careful if you have severe adrenal fatigue or if you are diabetic and are on certain medications that increase insulin.  In these situations it can cause ​your blood sugar to drop to dangerous levels.  Talk to your doctor first and monitor your blood glucose closely.

​If you want to learn more about intermittent fasting, read my article here.

You may ultimately need the help of a knowledgeable nutritionist if you are having difficulty.

​2.  Lack of Exercise

​While there is no amount of exercise that by itself will get you to your goal weight, it can be an invaluable tool to help ​with your journey.

​Exercise has been shown to directly help ​reduce weight.  ​It has also been shown to increase growth hormone levels which increases lean body mass and ​results in weight loss.

Exercise not only helps with weight loss, it has been shown to increase cognitive function and overall quality of life.  It also reduces symptoms of anxiety and depression.

​It is important to know what ​KIND of exercise and how ​MUCH of it to do.  Too little of it will not have enough of an effect while too much exercise can actually be harmful.

If you have adrenal issues, even light exercise may exhaust you.  Get your adrenals functioning well first.

​If you are currently not exercising at all, then start doing ​SOMETHING.  A brisk walk for 15-30 minutes 4-5 days per week is a great start.  Let your fatigue level guide you on how much you can progress.

Ultimately, you will want to​ add high intensity interval training (HIIT).  HIIT has been shown to reduce abdominal and total body fat.

HIIT consists of doing all-out, maximum bursts of exercise followed by 30-60 seconds of recovery time then repeating the cycle 5-6 times.​

This can be done with any equipment you have (elliptical, treadmill, bike, rowing machine, etc), or even by jogging/walking or using a jump rope.

HIIT training only needs to be done 1-3 times per week for 10-15 minutes.  Yes, you have time for that!

If you want to lose weight, get started with an exercise program TODAY!.

​3.  Stress

​If you have ever read any of my other articles, you know that I mention stress as a factor in almost all medical conditions.

The fact is, stress undermines our health on multiple levels.  You will never reach your maximum health potential if you don’t learn how to better manage your stress.

When I say stress, I am talking about physical, emotional and mental stress.  This could include an injury or illness, work stress, relationship stress, death of a loved one, and many others.

Stress causes our adrenal glands to secrete cortisol, which signals the mitochondria in our cells to increase energy production to get us through that stressful time.

This is great for acute stresses, but bad when the stresses are chronic and continuous.

Cortisol has been associated with insulin resistance and leptin resistance.  It also promotes hypothyroidism.  All three of these conditions lead to obesity (I will discuss them more shortly).

​So What is the Solution?

Remove ​any stressors in your life that you can.  That may include changing jobs, getting rid of toxic relationships, ​or getting marriage counseling.

If there are major stressors that can’t be removed such as an illness in a family member, kid troubles, etc., you will need to work on improving your coping mechanisms.

​Ways of reducing your stress ​includes:

  • checkYoga or a similar relaxation exercise
  • check20 minutes of prayer or meditation once or twice daily
  • checkStart a hobby that you enjoy
  • checkCount your blessings and write them down
  • checkGo for a walk outside
  • checkDo something nice for someone without expecting anything in return
  • checkMake yourself smile everyday (even when you don’t feel like it)

If you feel you need more help on this subject, read my article on adrenal fatigue.

​4.  Poor Sleep Habits

Lack of sleep has been directly linked to obesity.  It increases inflammation in the body and causes weight gain.

Your quality of sleep directly impacts your melatonin level which increases your cortisol.  Your sleep quality also impacts your metabolism which affects your body weight.

You should be getting at least 7 hours of quality sleep per night.  When you wake up, you should feel refreshed and energized.

If that doesn’t describe you, consider making the following changes:

  • checkGo to bed the same time every night and get up the same time every morning
  • checkNo electronic screens (phone, computer, tv, tablet) for at least 2 hours before going to bed
  • checkKeep your bedroom cool and dark
  • checkAvoid stimulants (coffee, nicotine, decongestants) in the evening
  • check​Reserve your bed for sleep and sexual relations only

​If you are still having sleep issues, you should consider talking to your doctor about ​testing you for obstructive sleep apnea.  In this condition, the muscles in your throat and neck collapse as ​you fall asleep which in effect chokes you, sometimes dozens of times per hour.

Your brain has to wake you in order to overcome the muscle relaxation so that you can breathe.  As a result, you never get into the restful stages 3 and 4 of sleep which are required for you to be refreshed.

This may require you to undergo a sleep study, which will​ consist of sleeping in a sleep lab while you are monitored.  

If you have obstructive sleep apnea, you may need to sleep with a nasal CPAP machine which will keep the air pressure in your airway high enough t​o prevent your airway from collapsing while you sleep.

​If you can lose the weight you ​need to lose, there is a high likelihood that your sleep apnea will resolve and you will no longer need a CPAP machine.

If obstructive sleep apnea has been ruled out but you are still struggling with sleep, supplements may be necessary.  My favorites are below:

How to Supplement to Improve Your Sleep

Why I Like It

May help improve energy levels

May help to decrease levels of inflammation

May help reduce brain fog and mental slowness

Requires lifestyle change for best results

How to Tell if You Need It

    • You should be getting 8 hours of quality sleep every night.
    • If you find yourself waking up exhausted then you should consider checking for sleep apnea or a trial of the following supplements to improve sleep

How to Use

    • Take each supplement as indicated on the bottle or as recommended below
    • In addition to these supplements make sure you practice adequate sleep hygiene, that means: black out curtains for your bedroom, noise cancelling ear plugs, having a consistent sleep schedule, and avoiding all electronics 3 hours prior to your scheduled bed time

My Recommended Brand and Product

For minor sleep issues start with supplements containing 5-HTP which may promote proper melatonin production and induce sleep naturally (take 100mg 30 minutes before your scheduled bed time):

Get 5-HTP Here

For more difficult cases consider the addition of melatonin + 5-HTP, start with 1-3mg of melatonin and don’t be afraid to use melatonin if you need it.

Get 5-HTP and Melatonin Here

For more the most difficult cases consider using serotonin and GABA potentiators. These supplements help enhance GABA and serotonin neurotransmitters in the brain and help induce deep sleep.

Get GABA/Serotonin Potentiators Here

​5.  Thyroid Issues

​The statistics show that over 12% of the population is hypothyroid.  Some experts suggest that it could actually be closer to 40%.

​About 2/3 of people with thyroid issues don’t even know they have it!

Since the thyroid is the ​”metabolism factory” of the body, it only makes sense that people who are struggling with their weight may have an issue with their thyroid.

In my practice, I see people with undiagnosed and untreated or undertreated thyroid conditions several times a day.

The vast majority fit into the following 3 categories:

– Hypothyroidism

​The thyroid should always be one of the first things assessed in someone who is overweight.

That is especially true if the person also has many of the other common symptoms seen in hypothyroidism – fatigue, constipation, cold intolerance, hair loss, brittle nails, etc.

​Only checking the TSH blood test may miss a large percentage of hypothyroid patients.

That is why you need to ask for a complete thyroid panel:

​If your doctor is unwilling to ​run all of these tests, I would STRONGLY suggest you find a doctor who will.  Your thyroid status cannot be fully evaluated without them.

Read more about how to interpret your results in my article here.

– Hashimoto’s Thyroiditis

​Hashimoto’s is the common name given for autoimmune thyroiditis.  

It is estimated that up to 10% of the population has Hashimoto’s.  It is 7 times more common in women than in men.

​Some experts estimate that Hashimoto’s is the cause of up to 90% of hypothyrodism.

That’s why it is important to have your thyroid antibody levels checked if you are hypothyroid.  If either the TPO antibody level or the thyroglobulin antibody level is >35, the diagnosis of Hashimoto’s can be made.

Hashimoto’s can cause the same symptoms that you see in hypothyroidism (including weight gain), but it may have some additional symtoms as well.  These include joint pain, muscle aches, throat swelling, and even low grade fever.

​Click here to learn more about how to treat Hashimoto’s thyroiditis.

– Reverse T3 Dominance

​Reverse T3 is an inert hormone that is made normally by the ​body in small amounts.  

It binds to the thyroid receptors on the cells of the body, but it does ​it has no function.  In effect, it serves as a “brake” for our metabolism.

​It is another way that the body can regulate its own metabolism.

In acute situations (such as an infection or injury), it helps the body to reserve its energy stores by lowering the metabolism.

​However, many people have chronic inflammation in their body due to things such as obesity, insulin resistance, leptin resistance, poor diet, etc.  All of these conditions cause the reverse T3 level to be chronically elevated, which is called reverse T3 dominance.

​When this occurs, the TSH and T4 levels may be normal, but the elevated reverse T3 ​blocks the action of the active T3 on the cells of the body.  Hypothyroidism at the cellular level results.

The above labs are from one of my recent patients.  If you just looked at the TSH, it would show that she has normal thyroid function.  The free T3 and reverse T3 tell the true story.

If your reverse T3 level is >15 or if your free T3 to reverse T3 ratio is ​< 0.2, you have reverse T3 dominance (also called thyroid resistance) that needs to be addressed.​​​

Read my article on Reverse T3 Dominance to learn more.

​6.  Metabolic Damage from Yo-yo Dieting

​Most people that I know ​who struggle with their weight have tried tons of different diets.  Some have worked, some haven’t.

Many of these diets such as the HCG diet require severe calorie restriction (as low as 500-600 calories per day).  

This severe calorie restriction can damage your metabolism for many years and make it impossible to lose weight and keep it off.

The typical story goes like this – the first time they went on the diet they lost 40 pounds, the next time 25 pounds, then next time 10 pounds, then next time none at all.

​The​se diets cause this by​ re-setting your basal metabolic rate.  Instead of burning ​the usual 1800-2000 calories per day, after severe calorie restriction, your body may only burn about 800 calories per day.

That’s why you eat less than anyone else you know but still gain weight.

Never go on a severe calorie-restricted diet or recommend any friends or family to do it.  It can be devastating to your body.

Correcting this can be very difficult and will require the help of a knowledgeable doctor and/or nutritionist. It will most likely take a long time to fix.

​7.  Insulin Resistance

Insulin is a hormone made by the pancreas.

Its function is to bind to ​glucose (sugar) in the bloodstream and carry​ it into the cells where it can be used for energy production.  It also carries the glucose into the fat cells and liver cells where it is stored to be used later.

With insulin resistance, the process doesn’t work like it should.

​When people eat a diet too high in sugar (as in the standard American diet), the cells in the body become so bombarded with the sugar that it can become toxic to the cells.

As a protective measure, the cells down-regulate the insulin receptors, meaning it reduces the number of insulin receptors that are available for the insulin to attach.  As a result, the insulin level in the bloodstream increases (as does the sugar levels).

Eventually, the sugar level increases to the point that it measures high on a blood test.  Pre-diabetes or diabetes is then diagnosed.

In other words, diabetes is really just advanced insulin resistance.

Having high levels of insulin is bad in many ways.

​Insulin causes us to gain weight by increasing the size of our fat cells.

​Insulin is one of the most inflammatory substances in our body​.  That inflammation increases our cancer risk.  ​Insulin resistance has been shown to be directly linked to thyroid disorders which also results in more weight gain.

A hemoglobin A1c level > 5.3 is suggestive of insulin resistance.  A total fasting insulin level >5 also indicates insulin resistance.

Anyone who has the diagnosis of pre-diabetes or type 2 diabetes by definition also has insulin resistance.

To learn more about how to diagnose and treat insulin resistance, read my article here.

8.  Leptin Resistance

What in the world is leptin resistance? 

In order to understand leptin resistance, you need to understand the function of leptin.

Leptin is a hormone made by fat cells.  Yes, they do more than just make ​our clothes to not fit!

Leptin is our “satiety” hormone.  It’s primary function is to signal to our brain that we have plenty of fat stored in our body and we don’t need anymore.

The brain then increases our metabolism and reduces our hunger until the leptin levels drop.

In leptin resistance, something happens that is similar to what happens in insulin resistance.  Our brain becomes desensitized to the high leptin levels and basically ignores the signal.

As a result, our metabolism becomes locked in the “low” setting and our hunger sensation stays locked in the “high” setting, a perfect storm that results in weight gain and obesity.

The weight gain results in more fat cells which results in more leptin production, and the cycle feeds itself (literally!).

Leptin resistance typically occurs simultaneously with insulin resistance.

Leptin resistance also triggers an increase in reverse T3 production (reverse T3 dominance) that also results in weight gain.

Leptin resistance is diagnosed by checking a serum leptin level.  If it is >12, the diagnosis can be made.

​Long term successful weight loss will not be possible until the leptin resistance is treated and eradicated.

Click here to learn more about leptin resistance and its treatment.

​9.  Unresolved Emotional Issues

​If you have ever watched a show where they follow ​people on their weight loss journey, a common theme emerges.

They lose a little weight, then the weight loss stops.  They ​don’t begin losing weight again until they have a “breakthrough” regarding a​ trauma​ from their past.

Emotional, physical, and mental trauma from childhood has been shown to affect eating habits and it is directly linked to obesity in adulthood.

Many of these traumas may have been locked away in your brain.  You may not recall them, but they may be subconsciously sabotaging your life in many ways.

This may or may not be playing a role in your particular situation, but you owe it to yourself to deal with any past trauma if you have any.

I strongly recommend ​that anyone struggling with their weight should see a licensed professional counselor to ​assess if ​they have any past issues that need to be addressed.

Seeing a counselor is a sign of strength, NOT weakness.  It means you love yourself enough to deal with any issues that are impacting your quality of life.

​Summary

​50% of the US population is either overweight or obese.

Many reasons are to blame.  While diet and exercise play a major role, hormonal and metabolic issues are most likely involved as well.

If you can’t lose weight, it is important for you to consider and address your diet, exercise, stress level and your sleep quality.

You should also be tested for any thyroid issues, insulin resistance, and leptin resistance.

If you have a history of severe low calorie dieting, your metabolism may be damaged which will require long term, intensive treatment.

Finally, you need to address any past trauma in your life to finally release its grip on you.

​Now it’s your turn…

​Have you ever asked the question in this article title?

If so, what has helped you with your weight loss?

What have you tried that didn’t work?

Leave your comments below…

Weight Loss Resistance and Hormones – 8 Tips to Get You Back on Track

​Why can’t you lose weight even though you are trying to eat right and exercise?

Why do diets that worked in the past have little or no benefit now?

Your hormones are probably playing a huge role.  These include cortisol, thyroid, leptin, insulin, testosterone, estrogen, and progesterone.

​Until you get these hormones in balance, it will be almost impossible for you to get to your ideal body weight.

​In this article, I will discuss how these hormones lead to weight loss resistance and give you 8 tips to get you back on track…

More…

​Commonly Overlooked Causes of Weight Loss Resistance

We have all been taught that weight loss should be easy.  

As long as we are consuming fewer calories than we are burning, the weight should just drop off of our bodies.  This is called the “calorie in, calorie out” model.

If we have a friend or relative who is overweight, our first thought is usually “If they would just quit eating so much they wouldn’t have such a weight problem.”

There is no doubt that what we eat and how much we eat impacts our body weight, but it’s way more complex than that.

I suspect that many of you who are reading this article each MUCH less than other people in your family, but you gain weight while they seem to never gain.

It doesn’t seem fair, does it?

Let’s try to break this down further and discuss some common things that can cause weight loss resistance…

​History of Calorie-Restricted Diets

If you learn anything from this article, I hope it’s this:  losing weight requires much more than just eating less.  In fact, eating too little can actually harm you and make losing weight even more difficult.

​Studies are starting to show this phenomenon as well.  

​In 2016, a group of researchers released a study of 14 contestants from the 2009 season of “The Biggest Loser.”  6 years after the show, all but one of the contestants had regained  a substantial amount of weight.  Some even weighed more than they had before being on the show.

The metabolism ​of the contestants had been damaged from the severe calorie-restricted diets.  This damage was still present 6 years later!

It’s not uncommon for me to see patients that have to eat less than 1000 calories per day just to maintain their weight.  If they eat a normal amount of ​1500-2000 calories per day, they will quickly ​start putting on pounds.

If you have tried extremely low calorie diets in the past such as the HCG diet, you very likely have a damaged metabolism and your metabolic set point (​the amount of calories your burn daily) is now too low.

Raising your metabolic set point is possible, but it can take a long time and it can be very difficult.

​Reverse T3 Dominance

​Many doctors think that managing hypothyroidism is easy.  Give the patient a T4 only medication such as Synthroid or levothyroxine, and periodically check the TSH to make sure it is in the “normal” range.

​In my experience, this does not adequately treat the majority of patients with hypothyroidism.  That is because it does not take into account the thyroid conversion process in the body.

​For it to be used by the body, T4 must first be converted into T3, which is the active thyroid hormone.  

T4 can also be converted into reverse T3.  Reverse T3 binds to the thyroid receptors in the cells, but it does n​ot trigger any activity in the cells, which effectively blocks that thyroid receptor.  It therefore functions as a “brake” on our metabolism.

This is helpful in times of acute stress, such as an illness or injury because it allows us to conserve energy would normally be spend on metabolism.  However, it becomes a problem when the reverse T3 levels are chronically elevated.

In effect, it slows our metabolism which can lead to weight loss resistance.

I discuss this issue in much greater detail in ​this article​.

​Gut Dysfunction

​A digestive system that is not working properly can have a big impact on weight loss resistance.

Low stomach acid can result in the inadequate absorption of many essential nutrients such as iron, vitamin B12, and others.  A deficiency of these nutrients can result in ​slowing of the metabolic rate of the body.

​An imbalance in gut bacteria can also have negative effects by secreting chemicals that increase our hunger and cause us to eat more frequently.  It can also cause us to extract more calories from food than we would normally.

​Insulin Resistance

Insulin resistance will make your thyroid worse by inhibiting T4 to T3 conversion.

Insulin resistance also makes your cells more resistant to the thyroid hormone floating around in the blood. 

This is why many people may have “normal” levels of thyroid hormone in the blood but low levels of thyroid hormone in the cells (this phenomenon is known as thyroid resistance). 

​Leptin Resistance

​Leptin is an important hormone, which stimulates metabolism, reduces appetite, and signals the body to burn fat.

Fat cells secrete leptin as weight is gained to signal the brain that we have plenty of energy (fat) stores.  It then turns up our metabolism and reduces our hunger.

Most overweight patients have elevated levels (>12) of leptin because the brain has become desensitized to the leptin and no longer responds to its signal.  This is called leptin resistance.

Leptin resistance results in a chronically depressed metabolic rate and an increased sense of hunger, both of which lead to weight gain.  It also ​increases reverse T3 levels.

​Excessive Stress

​Our bodies were never designed to withstand the daily onslaught of chronic stress that many of us encounter.

The adrenal glands were designed to give us an energy boost during acute stresses, such as running from a wild animal.

When we constantly live under stressful conditions such as working long hours, eating processed food, getting too little sleep, etc., it puts constant pressure on the adrenals to produce cortisol.

Eventually, the adrenal glands can no longer keep up with the demands, and our cortisol levels will drop.

This results in adrenal fatigue.

Adrenal fatigue causes fatigue, weight gain, sugar cravings, mood swings, and numerous other ​negative things.

​Sex Hormone Imbalance

​Low testosterone has been linked to obesity, especially in males.

​Low testosterone, in both men and women, is often caused by stress, which also leads to high cortisol, weight gain, extreme fatigue, and fat accumulation everywhere—especially the belly.

Excessive estrogen (called estrogen dominance) can also lead to many bad things, including weight gain. 

​Estrogen dominance leads to the accumulation of fat, especially in the belly, hips and thighs.

It also causes sex hormone binding globulin (SHBG) levels to increase which binds testosterone and results in even worsening symptoms of low testosterone.

​8 Tips to Help You Reverse Your Weight Loss Resistance

​Now that we have identified some commonly missed causes of weight loss resistance, let’s discuss some things that you can do to help you have success in dropping excess weight.

​1.  Eat the Right Diet for You

​Diets are the most misunderstood part of the weight loss journey.  

With that in mind, lets discuss some basic points that you need to consider regarding what you eat:

  • No more low calorie diets! – As I described earlier, severely limiting the calories you eat can damage your metabolism and make it almost impossible to lose weight.
  • Diets are unique to each individual – what worked for your friend or sister may not work for you.
  • Don’t count calories!  Instead, focus on nutrient dense, high quality, real whole food.
  • Most people should consider avoiding most if not all gluten, dairy and soy.
  • ​Taylor your diet to your specific medical condition.  You need to take into account any thyroid, adrenal, gut, or blood sugar issues.

​When in doubt, most people do great starting on a diet such as the Whole 30 or the Ketogenic diet. Depending on your level of success, your diet can be further modified later if needed.

​2.  Choose the Right Type and Right Amount of Exercise

​You must be very smart about what type of exercise you do and how much of it you do.

This is especially true because so many people have adrenal issues.

If you have constant exhaustion from adrenal fatigue (we will discuss it more below), then doing too much exercise could do more harm than good.

If your overall energy level is pretty good, then starting an exercise program will be helpful for weight loss.

The single best type of exercise for weight loss is High Intensity Interval Training (HIIT).

​HIIT training has been shown to be very effective at burning fat, especially belly fat.  It also helps to sensitize your body to insulin.

In fact, doing HIIT exercise for 10-15 minutes 1-2x per week is more effective than doing typical “cardio” exercises for 45 minutes a day.

In this type of exercise, you perform bursts of maximum effort for about 30 seconds followed by a recovery period.  It can be performed on any gym equipment – treadmill, elliptical, rowing machine, or even by jogging/walking.

If you simply have too much fatigue to begin exercising ​fully, start with walking every day and add HIIT as your energy improves.

​3.  Balance Your Adrenals

​As we discussed earlier, most of us are under increasing amounts of stress.  Stress causes cortisol secretion by the adrenal glands.

If the stress continues, the adrenal glands will eventually not be able to keep up and the cortisol levels will begin dropping.

We will no longer get the cortisol surges when we need them and adrenal fatigue results.

If someone also has low thyroid, it only makes the problem worse.

​You adrenal issues can be managed in this way:

– ​Adrenal Adaptogens – Adaptogens can actually help to lower cortisol levels when they are high and some can even raise cortisol levels when they are low.  There are many types of adaptogens but I find that blends of multiple adaptogens tends to work best.  These can be combined with glandulars as well for more benefit.  Should be used for at least 3 months.

Adrenal Glandulars – These work best for patients with very low cortisol levels.  They also tend to provide an immediate boost to energy levels.  Using glandulars in combination with other supplements listed below may be necessary.  Should be used for 6+ months.

– Improve Your Sleep – Sleep is critical for optimal health.  It is essential that you get at least 7 good hours of sleep per day.  Poor sleep increases inflammation in the body and causes weight gain.  You may need to consider some supplements to help you sleep at least at first.  Read more about this here.

– Consider Daily Meditation and/or yoga – Learning to relax and unwind your mind will help lower cortisol levels.

– Avoid Caffeine – It may be providing your temporary energy but it is also depleting your adrenals.

​4.  Optimize Your Thyroid

​More often than not, people who have weight loss resistance have a thyroid issue. 

It is estimated that up to 40% of the population have some degree of hypothyroidism.

One of the foundational things that you must do in order for you to lose weight will be to optimize your thyroid function.  Here a 3 key aspects for you to investigate:

​- Check a Complete Thyroid Panel – ​

In my experience, most people with a thyroid condition are not on the right kind of thyroid medication and/or the right dose of it.

That is because doctors are taught to treat the lab numbers and not really pay attention to the symptoms that the patient may be having.

​​In my medical training (this applies to almost all doctors) I was taught to only look at the TSH (and maybe the T4) level and base all of my dosing decisions on whether those labs were in the “normal” range.  If they were, then any symptoms that patient may be having must be due to something besides the thyroid.

I have since learned that is flat out wrong.

The fact is, the TSH is really only a measure of the thyroid activity in the pituitary gland.  The pituitary has different deiodinases than any other part of the body, which are the enzymes that convert T4 to active thyroid (T3).​

T​he body will make sure that the pituitary gland has a good supply of thyroid hormone, sometimes at the expense of the rest of the cells in the body.  So the other cells may be starving for thyroid hormone, but the TSH will be in the normal range.

That’s why it’s important to have a complete thyroid panel checked to get a true measurement of thyroid hormone levels in the entire body.  This includes a TSH, free T4, free T3, reverse T3, and thyroid antibody levels.

– Get on the Right Kind of Thyroid Medication –

Thyroid hormone comes in 2 main forms in the body:

T4 – This the transport or carrier form of thyroid hormone.  It has no significant cellular activity.

T3 – This the active form of thyroid.  The  majority of ​T3 in the body comes from the deiodinase enzymes converting it from T4.

Most doctors prescribe T4 only thyroid medication, assuming that the body will have no problems converting it into active T3.

That is a false assumption, however, because most people with thyroid issues have an impaired conversion process because of things such as leptin resistance, insulin resistance, stress, nutrient deficiencies, and environmental toxins.

For this reason, most patients do better and feel better if they ​have some form of T3 in their thyroid medication.

If you are on a T4 only medication (Synthroid, Tyrosint, or levothyroxine) and you still have symptoms of hypothyroidism, you would likely benefit from adding T3 in some form.

Many people respond well to changing to a natural dessicated thyroid (NDT) such as Nature-throid, Armour Thyroid, or NP thyroid.

Some people may need more T3 than what NDT provides.  In those cases, Cytomel, liothyronine, or compounded sustained release T3 can be prescribed either with their T4 medication or even by itself.

The thyroid needs are very unique to each person, so don’t assume what worked well for someone you know will automatically work well for you.  You may need to try more than one option to find the one​ that best controls your symptoms.

– Understand ​Reverse T3 Dominance –

The body can convert T4 to either T3 (active hormone) or inactive reverse T3.

Reverse T3 attaches to the thyroid receptor in the cells, but it blocks it instead of activating it.

When the reverse T3 levels are high, it causes hypothyroidism at the cellular level, even if the blood levels of TSH and T4 are normal.

If the reverse T3 level is >15, and/or if the free T3 level divided by the reverse T3 level is <0.20, then you have too much reverse T3 which will cause thyroid resistance and will ultimately lead to fatigue, weight gain, and other symptoms of hypothyroidism.

You can read more about this in my article here.

This is treated by increasing the T3 in your medication either by changing to an NDT thyroid medication or by adding T3 to take with your T4 only medication.

Convincing your doctor to do this may be very difficult.  If he or she is unwilling to listen to you or consider these changes, you may need to consider looking for a new one.

You might want to call some local pharmacies and ask them for a list of doctors who prescribe NDT thyroid medication and Cytomel.

​You could also log onto the Institute of Functional Medicine website and click on “Find a Practitioner.”

​5.  Reverse Insulin Resistance and Leptin Resistance

​Reversing leptin resistance and insulin resistance are crucial if you want to lose weight and keep it off.

Both will respond to the following – High Intensity Interval Training (HIIT), intermittent fasting, avoiding sugar and grains, and ​optimizing your free T3 levels.  I discuss these and other treatments in this article.

The use of targeted supplements can help reduce insulin resistance.  These include:

Alpha Lipoic Acid – This supplement can help improve insulin sensitivity and reduce inflammation, and can even help treat neuropathy caused by diabetes.

Berberine – This supplements helps lower blood sugar, improves cholesterol levels, and can help with weight loss.  One study showed that it lowers hemoglobin A1c as well as metformin.

Chromium – Chromium helps increase insulin sensitivity and may reduce the risk of cardiovascular disease.

 Curcumin – Curcumin is known as a very potent anti-inflammatory.  It has also been shown to reduce the risk of a pre-diabetic from becoming diabetic.

​Leptin resistance may also require the use of a GLP-1 agonist medication for a few months.  These include Victoza, Byetta, and Bydureon.  

You might also benefit from the addition of low dose naltraxone (LDN).  

All of these medications will require a prescription from a medical provider that is experienced in using them for insulin and leptin resistance.

​6.  Improve Gut Health

​It’s difficult to discuss any medical issue without discussing the gut.

That is because the trillions of bacteria in your digestive tract play a major role in your health.

The gut bacteria can increase metabolism, change how you digest food, impact inflammation, and even produce chemicals that ​impact our behavior and moods.

Studies are also showing that certain bacteria in your gut can help you lose weight, while others cause weight gain.

​That means if you are suffering from: bloating, alternating constipation/diarrhea, upper abdominal pain, ​acid reflux/GERD, IBS, IBD, SIBO, leaky gut, yeast overgrowth or any other gut related problems you HAVE to get your gut fixed if you want to lose weight.

So how do you get your gut more healthy?

Consider taking a high quality, multiple-species probiotic. – I recommend using at least 10+ different species of probiotics and at dosages higher than 100 billion CFU per serving. Most of these will require refrigeration.

Consider taking proteolytic enzymes – These help you digest your food and absorb nutrients.

Consider possible food sensitivities – Many people have sensitivities to commonly-eaten foods which can lead to constant gut inflammation.  Consider removing foods such as gluten, dairy, and soy from your diet to see if your gut function improves.

​7.  Reduce Inflammation

​Chronic low grade inflammation could be a root cause of your weight loss resistance as well as other conditions you may have.

This kinds of inflammation is caused by things such as:

  • Chronic Daily Stress – work, family, financial, social, etc.
  • Lack of Sleep – less than 7 hours per night
  • Standard American Diet
  • Gut Issues – SIBO, GERD, dysbiosis, yeast overgrowth, etc.
  • Visceral Abdominal Fat – belly fat and fat in organs

​If you want to lose weight, you will HAVE to reduce the inflammation in your body.

Once the problems areas are identified, it is usually obvious how to treat them.

In general, most inflammation in the body can be reduced by doing these basics:

– Eat nutrient-dense, real whole foods

– Focus on relaxing and managing your stress – 20 minutes of meditation or yoga twice daily

– Get at least 7 hours of quality sleep per night

– Get your gut healthy as discussed earlier

– Take a probiotic and correct any nutrient deficiencies – usually fish oil, magnesium, zinc and vitamin B12

– Exercise as discussed earlier

​8.  Avoid Endocrine Disruptors

​We are unknowingly exposed to chemicals in the environment that directly interfere with many of the hormone systems in our body on a regular basis.

These are called endocrine disruptors.

​While it is impossible to completely avoid all of these chemicals (because they are everywhere!), there are some things that you can do to lower the level of exposure:

  • Drink out of glass or steel containers – Plastic bottles contain Bisphenol-A which is a know thyroid blocker.  Aluminum containers should also be avoided.
  • ​Avoid touching receipts – These also contain Bisphenol-A which can be absorbed in the skin.
  • Drink only filtered water – Consider getting a reverse osmosis system for your home.  You should also consider adding a shower head filter to each shower.
  • Avoid plastic whenever possible – never reheat or microwave foot stored in plastic.  The heat releases more of the chemicals.
  • Throw away old rubber toys – Rubber toys made before 2009 contain phlalates, another thyroid blocker.
  • ​Eat organic foods and grass fed meats – 
  • ​Check your cosmetics for chemicals – The website Skin Deep will allow you to see how many chemicals your cosmetics contain.

​This is not intended to make you into a paranoid, nervous wreck, but it’s time that many of us take control of our health and realize that there are environmental dangers that impact our health.

​Summary

​​There is more to weight loss than the calorie in, calorie out model that we have all been taught.

Multiple hormones play a direct role in our ability to lose weight and keep it off.

A history of being on severe calorie restricted diets can also damage your metabolism and make it impossible to lose.

In order to have success, you need to be on a good diet and a sensible exercise program.  You must also optimize your gut health and manage any adrenal and thyroid issues.

You  must also test for and address any insulin resistance, leptin resistance, and chronic inflammation that you may be having.

Finally, you should do your best to avoid any environmental exposures that can affect your ​hormone functions.

Now it’s your turn…

Have you struggled with weight loss resistance?

What you have tried that helped?

What didn’t help?

Leave your questions and comments below.