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Keto Diet Pros and Cons

​Chances are you have heard about the Keto Diet ​​a lot from friends, coworkers, or family members.  It is also all over the news and social media.

​The popularity of the Keto Diet has soared over the past few years via marketing campaigns and word-of-mouth.

So what is the Keto Diet?  Is it safe?  Does it work?  What foods do you eat ​and what do you avoid?  What are the ​keto diet pros and cons?  What does the research show about it?  When should you consider using it?

I will answer these questions and many more in this article…​

​History of the Keto Diet

​Versions of the ketogenic (Keto) diet have been around for over 100 years.  It was used in the 1800s to help control blood sugar levels in patients with diabetes.  It was introduced as a treatment for epilepsy in children in the 1920s.  It has since been used as a treatment for various conditions, including cancer, dementia, and other neurological disorders.

Over the past 30 to 40 years, its popularity as a weight loss diet has skyrocketed.  It began with the Adkins Diet, which promoted a mostly protein (meat) based diet with moderate fat intake and low carbohydrates.  ​Other diets ​have since been developed such as the South Beach Diet, Whole 30, Paleo, and many others.  

The primary progression of these diets has been in the percentage of fat that is recommended.

​What is the Keto Diet?

​While Adkins, South Beach and other diets ​have a high amount of protein, the Keto Diet gets the majority of its calories from fats.  Protein levels are moderate, while carbs are extremely low (~5% on the traditional Keto).

The concept of the keto diet is to make your body burn fat for fuel instead of glucose.

The preferred fuel for our cells is glucose (sugar).  Glucose is derived from eating foods that contain sugar and carbohydrates.  That glucose is either used immediately for fuel or stored in the liver or muscles as glycogen.

With the keto diet, the body is deprived of the majority of food sources of sugar and carbs.  After 3-4 days, all stores of glucose in the body are used up.  The liver will then begin burning fat for fuel.  A bi-product of this process is the production of ketones (thus the name ketosis).

​Keto Diet vs Low Fat Diet

​Many of the major health organizations (AHA, ADA, etc) still hold the position that too much fat in the diet is a major cause of health issues.  In fact, most still recommend keeping fat intake to no more than 30% of the total calories.

However, many studies over the past decade have called this into question.  Many experts now recommend reducing the carbohydrate intake rather than fat.

So which is better a helping with weight loss?  Low car or low fat?

One study showed no weight loss difference between a low fat and a low carb diet.

Several other studies, however, show that low carb diets result in more weight loss than low fat diets, especially early.  Click here, here, here and here for examples.

​A big problem with most low fat diets is participants tend to replace the fat content in the diet with simple or processed carbs, which is much worse than eating fat.

​Benefits of the Keto Diet

​Potential Negatives of the Keto Diet

  • The keto diet can be hard for some people to follow.
  • The first 5-14 days on the keto diet may cause flu-like symptoms as your body converts to burning fat for fuel.  This is sometime called the “keto flu.”  The best way to manage this is to increase fluid intake.
  • Keto may cause low blood sugar, especially initially.  Be especially careful if you are diabetic and taking a medication that lower glucose levels (such as sulfonylureas).
  • It may cause in increased risk for kidney stones.  This is typically more common in the high protein diets like Adkins.
  • Staying on the keto diet for a prolonged period of time can possibly lower bone density.  Another study, however, showed no significant change.
  • It may increase uric acid which can trigger a gout attack.  This is the highest risk within the first few days of starting the diet.  Reducing inflammation in the body will eventually lower the risk for gout.
  • The source of fat and protein in a keto diet is very important.  One study showed an increased death risk from people eating a keto diet that was using animal sources for the fat and protein vs plant-based fat and protein.
  • The keto diet is not recommended during time of rapid growth – pregnancy and breast-feeding.  Children must be closely monitored if on it.
  • It may cause constipation.  Push the vegetables.
  • After stopping the keto diet, ghrelin levels may rise which can increase the appetite temporarily.
  • ​It could potentially lower free thyroid hormone levels.  Monitor your thyroid levels regularly while on the diet, especially if you have know thyroid issues.

​How Long Should You Stay on the Keto Diet?

​The short answer is, it depends.  Some people feel great on the keto diet, while other people can feel fatigued or moody while on it.

Some experts feel that the true benefit of the keto diet would be to go in and out of ketosis, not necessarily stay in ketosis indefinitely.

I typically recommend giving the diet a good 4-6 weeks.  At that time, assess how you feel and monitor your labwork – blood sugar, insulin, thyroid, kidney function, and liver function.

If you feel good, you can continue on it for longer.  If you feel bad, consider slowly adding back some good whole food carbs (fruit, veggies, legumes) until you feel better.

Another option to consider is eating a strict keto diet for about 1 month every 3-4 months, then going back to a whole food, organic diet with more carbs during the other months.

Every body and every system is unique.  You may have to do trial and error until you find what eating plan best fits you.

​​How Do You Get Off of the Keto Diet?

  • Go slow.  Don’t just go back to the way you used to eat.
  • Slowly increase complex carbs (fruit, veggies, beans) one meal per day.  If you are tolerating it, you can gradually add them to other meals.  Watch for bloating or gas and slow down adding them if it occurs.
  • Avoid simple carbs and sugars.  Remember, that’s probably what got you to the point of needing to start the keto diet in the first place!
  • You might feel more hungry at first and might even have some blood sugar variations.  Watch your blood sugar and avoid the munchies.

Will You Gain Weight After Stopping the Keto Diet?

​The answer is maybe.  If you go right back to your previous poor eating habits, you will likely gain most if not all of the weight that you lost on the diet.

That is why it is so important to transition off of the keto diet slowly and carefully, preferably to a primarily whole food, organic diet.  Continue to avoid sugar and processed carbs (pasta, bread, doughnuts, etc).

If you do this right, your weight will most likely maintain at your goal weight that your worked so hard to achieve while on the keto diet.

​My Guidelines for Using the Keto Diet

  • The keto diet is a great choice for patients with seizure disorder or other neurological or cognitive conditions.
  • Great choice for patients with insulin resistance/type 2 diabetes.  If on diabetes medication, closely monitor your glucose levels and consult with your medical provider before starting the diet.  The medications may need to be reduced rapidly or even stopped.
  • ​Be careful of the sources of fats and proteins.  Plant sources are better than animal sources.
  • Eat plenty of whole, green vegetables.  You need the fiber and it is a healthier source of protein and fat.
  • Hydrate, hydrate, hydrate!  Most of us are dehydrated which will worsen potential side effects of the diet.
  • Consider doing keto for a limited time several times per year.  Eat a whole food, organic, primarily plant-based diet the other times.

​Summary

​The keto diet is an extremely popular diet that works by reducing the amount of sugar and carbs consumed.  The majority of calories come from healthy fats, while protein intake is moderate.

After a few days, the lack of sugar in the diet forces the body to burn fat for fuel.  This results in the production of ketones.

The keto diet can cause significant weight loss and help reduce appetite.  It has been shown to help treat neurological and cognitive disorders.  It can also help reduce insulin resistance and lower cholesterol levels.

The keto diet can cause significant side effects early in its use.  It may also increase uric acid, worsen constipation, and may have an effect on thyroid levels.

It is important to eat from good sources of fat and protein, especially plants.

Make sure you hydrate well while on the keto diet.

​Now it’s your turn…

Have you tried the keto diet?  What results did you have?

Di you have any side effects or other problems?

Leave any comments or questions in the comments section 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.

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.

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.

Low Dose Naltrexone for Hashimoto’s and Weight Loss

Research has shown the benefit of using low dose naltrexone for Hashimoto’s thyroiditis and other autoimmune conditions.

​If you have ​an autoimmune condition such as Hashimoto’s thyroiditis, reducing the inflammation in your body is crucial to help you feel better and lower your antibody levels.

​If you don’t lower the inflammation, it will be next to impossible to lose weight or feel as good as you can.

Lose dose naltrexone has been shown to substantially lower inflammation.  It also helps to raise endorphin levels which makes you feel better overall.

There is ​also a lot of anecdotal evidence that LDN can help ​some people lose weight.

​In this article, I will discuss LDN and what some of the research is showing about it.  I will explain how ​it can be used to potentially lower antibody levels, help with chronic pain, and ​maybe even help ​people with ​Hashimoto’s to lose weight.

Let’s get started…

More…

​What is LDN?

​LDN is short for low dose naltrexone.

Naltrexone was developed in the 1980s to treat patients with opioid withdrawal.  It is a sister drug to the well-know Narcan (naloxone).

​It is an opioid antagonist, which means it blocks opioid receptors in the brain.

When taken in doses of 50-100mg, it completely saturates the opioid receptors which prevents the person from experiencing the “high” that they normally would get from taking opioid (narcotic) medications.

It is therefore used by people in drug or alcohol rehab to help them stay off of their drug of abuse.

Dr. Bernard Bihari performed research ​in which he discovered that naltrexone in low doses helped reduce symptoms and inflammatory markers in patients with autoimmunity, cancer, and HIV.

How does LDN work?

Endorphins are our “feel good” chemicals.  They are associated with feelings of pleasure, sexuality/sensually, euphoria and pain relief. Essentially, endorphins make us feel good and give us a sense of well-being. 

Endorphins are what cause the “runners high” when ​we exercise.

Low levels of endorphins are associated with the opposite effects: physical and emotional pain (including chronic pain found in disorders such as fibromyalgia), and addiction.

Low doses of naltrexone (from here on I will refer to it as LDN) appears to increase the level of endorphins in the brain by only partially blocking the opioid receptors when the endorphin levels are at their highest (3-4am).

This signals to the body that the levels are low, so it temporarily increases endorphin production.

Endorphins appear to modulate the immune system.  Therefore, raising the endorphin levels (like LDN does), impacts the immune system in a positive way.  

LDN has also been shown to decrease inflammation in chronic pain conditions, which is why the people that have the most success using LDN typically have chronic pain as one of their main symptoms.

​Low Dose Naltrexone for Autoimmune Conditions

​People with autoimmune conditions typically have lower levels of endorphins than people without autoimmunity.

So it makes sense that if LDN raises endorphin levels, it would help someone with an autoimmune condition feel better.

​Also, autoimmune conditions are associated with an increased level of inflammation.  So the anti-inflammatory effects of LDN would obviously also help ​lower the overall inflammation in the body.

​In addition to the benefits listed above some studies have shown that the use of LDN can help to improve the immune system and reduce auto antibodies in some autoimmune conditions.

​The m​ajority of research regarding LDN that I found ​​dealt with how it can impact multiple sclerosis (MS), Crohn’s disease, and fibromyalgia.  However, it has also been used to in many other conditions.

​​Now let’s see what impact LDN has on thyroid disease (particularly Hashimoto’s).

​Low Dose Naltrexone for Hashimoto’s

To learn more about Hashimoto’s thyroiditis, read my article here.

I discuss natural treatments for Hashimoto’s in this article.

​LDN appears to improve Hashimoto’s (and all hypothyroidism for that matter) by:

​Much of the evidence of LDN impacting Hashimoto’s is anecdotal, meaning doctors and patients give their personal experiences using it.  To this point, the number of research studies are small and sporadic.

However, a quick Google search will take you to websites such as http://www.lowdosenaltrexone.org/ that will show you much of the research and patient testimonials about LDN.

I myself have had several patients that reported feeling much better when taking LDN.  Some even showed a reduction in their antibody levels.

​Does LDN Help with Weight Loss?

​The answer is yes in some studies, no in others.

​LDN should never be prescribed for the sole purpose of weight loss, but some patients have had some significant weight loss while taking it.

​It appears that LDN helps with weight loss by affecting the following:

  • Reduces Insulin Resistance – Insulin resistance is a common cause of weight gain, so it makes sense that reducing it will result in weight loss.
  • Increases Growth Hormone – Growth hormone increases lean muscle mass and increases fat burning, both of which help with weight loss.
  • ​​Modulates Appetite – LDN may help to normalize the appetite in people with a damaged metabolism which helps to match their appetite with the amount of energy they burn. https://www.ncbi.nlm.nih.gov/pubmed/9226337
  • Decreases Inflammation – High levels of inflammation cause several hormonal changes including insulin resistance, leptin resistance, poor T4 to T3 conversion, high estrogen and low testosterone.  All of these lead to weight gain.
  • Improves Sleep – Lack of sleep has been shown to increase inflammation and weight gain.  Studies show that LDN ​improves sleep in patients with sleep apnea and chronic pain syndromes

​Naltrexone can be found in a currently marketed drug for weight loss – Contrave.  However, the doses in this pharmaceutical drug are higher than the ones I recommend in this article.

​How to Take LDN

LDN is a prescription medication, so it must be prescribed by a medical professional – doctor, nurse practitioner, or physician assistant.

The vast majority of doctors have little to no experience writing it.  You may have to do your own research to find a doctor that is knowledgeable about LDN and willing to prescribe it for you.

Naltrexone is not available in most retail pharmacies in the low doses we are discussing in this article.  You will have to purchase it from a compounding pharmacy.

Insurance will not cover it.  Fortunately, it is usually less than $50 per month, so it is still affordable.

​How to Dose LDN –

​I have had the most success with LDN by starting on a low dose then stepping up the dose every 2 weeks until we get to the target dose.

My typical prescription looks like this:

Take 1.5mg daily at bedtime for 2 weeks, then 3.0mg daily at bedtime for 2 weeks, then 4.5mg at bedtime thereafter.

​Side Effects of LDN –

​LDN has virtually no side effects, which makes it a great medication to try in people with autoimmune conditions, especially those with chronic pain.

Rarely, patients may complain of vivid dreams or muscle spasms when taking the 4.5mg dose.  If that happens, reducing to 3mg usually resolves the problem.  

The patient can try to go back up to 4.5mg a few weeks later if the 3mg is not adequate to resolve their symptoms.

Remember, LDN partially blocks opioid receptors.  So if you are taking a opioid (narcotic) medication regularly, it could block the effects of your pain medication.

​Therefore, if you are on regular narcotic pain medications, ​you should ​​NOT take LDN at least until you reduce or stop your pain medications.  At the very least, you will want to take your pain medications at a different time to try to prevent the interaction.

​If you take your pain medication at the same time (or close to it) as you take LDN, it could block the effect of ​the ​narcotic medication on the opioid receptors which would in effect reverse its action.

This could result in a​ sudden increase in your pain level.  While it is not life-threatening, you could experience a lot of pain until the LDN wore off and you were able to take more pain medication.

If you are interested in trying LDN, it is critical that you give your doctor a complete list of all of your current medications.  This will help him or her to know if you can safely try LDN.

​If you have Hashimoto’s and you decide to try LDN,. it is important that you watch your thyroid levels closely.  LDN may decrease your thyroid antibody levels which could cause your thyroid hormone level to increase and cause symptoms of hyperthyroidism.

That would be a great thing ultimately, but it could be potentially dangerous at first.  You may therefore need to lower your thyroid medication dose.  

​Summary

​Low dose naltrexone is a seldom used, yet potentially helpful medication in people with Hashimoto’s and other autoimmune conditions.

Studies show that it can lower inflammation in autoimmune conditions.  It also raises endorphin levels in the brain which makes the person feel better.

​It is especially helpful in people who suffer from chronic pain, although it should not be taken at the same time as an opioid pain medication because it can block the effect of the pain medicine.

​If you are interested in trying it, you will need to find a medical provider with experience in prescribing it.  It will need to be purchased from a compounding pharmacy and insurance will not cover it.

Now it’s your turn…

Have you ever tried LDN?

If so, what was your experience with it?

Leave your comments below.

The Best Natural Treatments for PCOS

​If you have PCOS (polycystic ovarian syndrome), you know how hard it is to treat.

​You were probably told to “lose weight.”  Easier said than done.  You were probably also told to cut back on your sweets and carbs.

You may have even been prescribed metformin, which is a medication for diabetes.  Or perhaps a birth control pill or an antidepressant.

​Like most health problems, if you truly want to have success at reducing or eliminating your PCOS symptoms, you must get to the root causes instead of just treating symptoms.

​In this article I will discuss PCOS, what causes it, common symptoms associated with it, how to diagnose it, and several natural treatments that can help you manage it.

Here we go…

More…

​What is PCOS?

​PCOS (polycystic ovarian syndrome) is a combination of several hormonal imbalances in women​.  The symptoms that you have depend on which hormones are out of balance and to what degree.

Most PCOS patients have the following hormonal imbalances:

Not all women will have all of these hormone imbalances, but most PCOS patients will have 1 or more of them.

​The primary culprit of all of these hormone imbalances is insulin.  

Insulin resistance develops which starts a chain reaction that results in all of these hormonal issues – high testosterone, high estrogen, low progesterone, and ​leptin resistance.  The symptoms of PCOS then follow.

These imbalances commonly result in the development of metabolic syndrome, which is a group of risk factors that increase your risk for heart disease, diabetes and stroke.

These hormonal imbalances prevent the normal ovulation cycle.  ​As a result, multiple immature follicles or cysts develop in ​the ovaries which can be seen on ultrasound, which is where the name polycystic ovarian syndrome ​originated.

​Common PCOS Signs and Symptoms

​​If you have PCOS, the symptoms you have will depend on ​WHICH hormones are out of balance and how ​MUCH they are out of balance.

​Some of the more common PCOS symptoms include:

  • Excessive Hair growth – Caused by excess testosterone and insulin resistance
  • Weight Gain (even when eating well and reducing calorie intake) – Caused by a combination of leptin resistance, insulin resistance, and hypothyroidism
  • Menstrual Irregularities – Caused by an imbalance in estrogen and progesterone
  • searchMultiple Ovarian Cysts – Caused by an imbalance in estrogen and progesterone
  • searchHair Loss – Caused by hypothyroidism, nutrient deficiencies, and androgen/testosterone excess
  • searchDepression and Mood Changes – Caused by hypothyroidism and sex hormone imbalances
  • searchFibrocystic Breast Disease, endometriosis, PMS – Caused by excess estrogen and/or low progesterone
  • searchInfertility – Caused by hypothyroidism and low progesterone

​How to Diagnose PCOS

PCOS is diagnosed if you have at least 2 of the 3 conditions:

1.  Absence of ovulation, which leads to irregular menstrual periods or no periods at all.

2.  High levels of androgens, or signs of high androgens, such as excessive body or facial hair.

3.  Cysts on one or both ovaries.

​If you are having some of the symptoms that we have discussed, it is reasonable to assume you either have PCOS or are in the process of developing it.

​Natural Treatments for PCOS

The conventional approach to treating PCOS is to mask the symptoms.

This may make you feel better in the short term, but it does not result in long term improvement.

My conventional training taught me to treat PCOS patients with oral birth control pills, metformin, and anti-depressant medications.

While none of those treatments are bad in and of themselves, most of them don’t get to the root cause of the issues.

Birth control pills ​artificially regulate the estrogen and progesterone levels, but ​they don’t address the ​cause of the imbalance that is preventing you from having a period in the first place.

Anti-depressants may help you sleep better and will help control your mood swings, but it doesn’t address the hormonal imbalances that ​are the cause of the moodiness.

Metformin has some practical use ​for treating insulin resistance.

If you decide to t​ake these medications for a short time to control your symptoms while you make the other changes I discuss, that is reasonable.  

However, PLEASE don’t let these symptomatic treatments be the ONLY thing you do for your PCOS.

​The sooner you can begin reversing the hormonal imbalances in your body, the sooner you can begin feeling better and avoid the future complications brought on by the imbalances.

If you remember anything from this article, please remember this:

All women that are diagnosed with PCOS should be treated for insulin resistance.

To read more about insulin resistance, please read my article here.

Every treatment that I discuss below focuses on reducing the insulin resistance in your body.

You will need to aggressively do ALL of the things discussed.  Doing only 1 or 2 of them will most likely not be enough to give you the improvement you are seeking.

​1.  Change Your Diet

​Changing your diet will not by itself completely reverse the symptoms of your PCOS, but nothing else will ​work if you don’t address your diet.

​So what dietary things can you do to treat your PCOS?

Let’s start with some basic guidelines that are helpful for almost any health condition:

  • Eat whole organic-based foods
  • Avoid ALL processed foods
  • Eliminate sugar from your diet
  • Avoid most gluten and dairy-containing foods (some people can eat more than others)
  • Not ALL carbs are bad (but most people eat way too many)
  • There are times you should eat and times that you SHOULDN’T

​These guidelines can be applied to whatever diet you choose.

All of these diets should be looked at as a starting point only.

Every person is different and may require slight modifications for their particular situation.

For example, someone with severe adrenal fatigue many need a higher ratio of healthy carbs than the diet suggests.

With that in mind, the following diets are approved for patients with PCOS:

​I would strongly suggest hiring a nutritionist or health coach to help with your diet.

It can be very difficult and confusing to monitor your macromolecule ratios and make appropriate adjustments depending on your particular situation and symptoms.

​Your diet will require some adjustments along the way that would best be monitored by a professional.

​2.  Exercise the Right Way

​Exercise is critical to help reverse the hormonal imbalances of PCOS.

However, not all exercise is created equal.

Doing the right ​KIND of exercise and the right ​AMOUNT of it is vital.

Some forms of exercise such as walking on a treadmill for an hour may have very little impact on weight loss and hormone changes that are needed in PCOS.

​There are 2 ​things regarding exercise that you should focus on when trying to reverse your PCOS:

1.  Shorter and more intense exercises

2.  Building up more lean muscle mass

​I have mentioned high intensity internal training (HIIT) in several of my articles.  It is an outstanding treatment for PCOS.

Why?

Because it helps reduce insulin resistance.

​As a reminder, insulin resistance is the primary root cause of PCOS.  If you want to reverse your PCOS, you must address the insulin resistance.

Increasing your lean muscle mass is also very helpful for PCOS because it increases your resting metabolic rate.

When exercising, it’s important to match your level of exercise with your level of energy.

Over-exercising can be as harmful as not exercising because of its impact on cortisol levels.

3.  Manage Your Stress

​Stress may be the most overlooked cause of health issues that we have, yet it is one of the most important to address.

​I’m not just talking about the severe forms of stress – divorce, loss of a loved one, severe sickness or injury, etc.

The daily stresses also take a toll on your body – traffic jams, family conflict, job issues, kid issues, and others.

These stresses affect our cortisol levels which can cause bad things to happen in our body.

Stress has been found to be associated with the following:

Weight gain

​- Hormonal imbalances

Autoimmune diseases

Premature death

Most people think stress is just “a way of life” and there isn’t much they can do about it.

That just isn’t true.  We can do a lot to reduce the negative effects stress can have on our lives.

Here are some things that you can do to help you better manage your stress:

  • ​Listen to music that activates delta waves prior to sleephttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374921/
  • Get 8 hours of quality sleep EACH night
  • Eliminate toxic relationships from your life
  • 20-30 minutes of yoga or meditation every day
  • 1-3 days of quality exercise each week
  • 30 minutes per day of activities that you enjoy and relax you
  • Mentally change how you manage stress and how you internalize it
  • Consider hiring a life coach or health coach

Pick at least 1 or 2 of the things above and start doing them each and every day.

You won’t get healthy until you address your stress and improve how you manage it.

That is true for any health issue, not just PCOS.

​4.  Decrease Inflammation

​Inflammation in the body is the root issue of almost all diseases.

That is true for PCOS as well. ​

Inflammation leads to insulin resistance, leptin resistance and weight gain.

It also worsens hypothyroidism by increasing the production of reverse T3.

​As I have already discussed, PCOS is caused by inflammatory conditions such as insulin resistance and leptin resistance.

To make matters worse, PCOS leads to increased inflammation which will itself worsen the hormonal imbalances, thus creating a vicious cycle.

So what can you do about it?

Check your inflammatory markers (CRP and ESR).  If they are elevated, begin looking for possible sources of the inflammation.

If you can find the source, you can work on eliminating it which will help to balance your hormones.

Some common sources of hidden inflammation in the body include:

1.  Undiagnosed low grade food sensitivities

2.  SIBO or other intestinal overgrowth issues

3.  Chronic infections -EBV, CMV, H. pylori and others

4.  Standard American Diet – high in processed foods

5.  Autoimmune Conditions – Hashimoto’s and others

6.  Hormonal Imbalances – these alone can be bad enough to raise the inflammatory markers

​5.  Use the Right Supplements

​Supplements should be a cornerstone in the treatment of PCOS.

Be very careful and selective with which supplements you consider using.

Make sure you get them from a reputable source.  Not all supplements are created equal.

Supplement manufacturers are not under as strict of regulation as pharmaceutical companies.  That’s why it’s critical that you buy only from good companies that self-regulate themselves.

​Make sure you focus on the following areas when choosing your supplements:

  • Reducing and reversing insulin levels
  • Reducing inflammation
  • Reducing leptin levels
  • Reducing androgen and testosterone levels
  • Improving the metabolism of estrogen

​I will quickly go through each of these and give you my recommended brands for each supplement.

Supplements that Help Lower Insulin Levels:

  • Alpha Lipoic AcidALA helps reduce insulin resistance and lower blood sugar levels.  Use up to 1800mg per day in a sustained release form for best results.  Use up to 6 months.
  • Berberine Berberine can lower the A1c as much as metformin.  It also helps with weight loss in patients with insulin resistance.  Use up to 2000mg per day for up to 3 months for best results.
  • GlucomannanThis is a viscous fiber that reduces carbohydrate absorption and helps you fill up faster with results in weight loss.  Use 4 tablets 15 minutes before a meal for best results.
  • Krill oil + Astaxanthin Fish oil can reduce insulin resistance by lowering inflammation and leading to weight loss.  It can also increase lean muscle mass.  You will need 2-4 grams per day to get this benefit.

​Supplements that Help Lower Estrogen and Estrogen Metabolites:

  • DIMhelps reduce the conversion of testosterone into estrogen, plus it helps the body metabolize estrogen through the least estrogenic pathway.  Use up to 300mg per day for up to 3 months.
  • Calcium D Glucarate – increases liver metabolism of estrogen and androgens.  It can also increase the elimination of endocrine disruptors.  Use up to 3000mg per day.  

Supplements to help lower testosterone:

  • Zinc + Saw Palmetto – Zinc and saw palmetto help reduce the conversion of testosterone into its active metabolite DHT.  This can help reduce acne, hair loss and mood swings.  Use 60mg of zinc and 600mg of saw palmetto together daily for best results.

​6.  ​Monitor All of Your Hormones

​Remember, PCOS is usually caused from several hormones becoming imbalanced in the body.

Don’t get stuck on just thinking about the sex hormones (estrogen and progesterone), since they seem to cause the majority of symptoms.

Consider monitoring these hormones as well:

  • Leptin ResistanceCheck your fasting leptin level.  If you are overweight and your leptin level is above 12, you have leptin resistance.
  • Insulin Resistance a fasting total insulin level > 5 is indicative of insulin resistance.  This should be your primary focus when treating your PCOS.  Lowering your insulin will help to normalize all of the other hormone levels.  
  • High Testosterone – check the free and total testosterone levels.  Most PCOS patients have high free testosterone and often normal or slightly high total testosterone levels.
  • Cortisol check your am cortisol level.  Normal ranges are 14-16.  Any level above or below this indicate adrenal issues and could be affecting your energy levels.
  • Hypothyroidism  Hypothyroidism and PCOS are closely linked.  Make sure you get a complete thyroid panel (TSH, free T4, free T3, reverse T3, TPO antibodies, thyroglobulin antibodies) plus a sex hormone binding globulin level. 
  • Low Progesterone – PCOS patients commonly have very low progesterone levels which should be addressed.  

​7.  ​Consider Prescription Medications

​I am all for doing as much as we can naturally to keep our bodies running smoothly.

However, there is a time and a place when prescription medication may be necessary.

Think of PCOS as a spectrum.  On one end the hormonal imbalances are relatively mild.  Making the lifestyle changes and using the supplements I have discussed may be enough to reverse the condition and improve symptoms.

On the other end of the spectrum, the hormonal disruptions are severe.  

Lifestyle intervention​s and natural treatments may improve symptoms to some degree, but they may not be enough to fully reverse the condition.

In those cases, it may be necessary to consider medications to treat the insulin resistance, leptin resistance, and sex hormone imbalances.

You will need the guidance of a knowledgeable doctor to walk you through these treatment options.

​Summary

​Polycystic Ovarian Syndrome (PCOS) is a syndrome ​caused by several hormonal imbalances in the body.

These include elevated androgens, insulin resistance, low progesterone, and leptin resistance.

Rather than just treating the symptoms, it is important to identify the root causes and address each specifically.

All PCOS patients should be treated for insulin resistance.

Like most conditions, diet, exercise, stress reduction and proper supplementation are foundational to treatment.  Medications are sometimes needed as well.

​Now it’s your turn…

Have you been diagnosed with PCOS?

What treatments have you tried?

What has helped?  What hasn’t?

Leave your comments below.

How to Treat Insulin Resistance

​Have you been diagnosed with insulin resistance, pre-diabetes, or even diabetes?

​Even if you haven’t been diagnosed with insulin resistance, there is a good chance that you have it and don’t even know it.

Insulin resistance is primarily a dietary disease – what you have been eating has played a major role in causing you to have this condition.

The good news is that by changing what you eat and how you live, you can ​make major strides in reversing this condition.

​In this article I’m going to discuss a comprehensive approach on how to treat insulin resistance.  

This will include a proper diet, activity level, supplements, medications, and much more…

​What Is Insulin Resistance?

​In order to understand insulin resistance, it’s important to understand what insulin is and what is does NORMALLY in the body.

​Insulin is a hormone that is secreted by the pancreas.

When we eat a meal that contains glucose (sugar), the pancreas is signaled to secrete insulin​ into the bloodstream.

The insulin will attach to the sugar and move it into the cells where the sugar can be used as fuel for energy.

It also moves the sugar into fat and liver cells where it is stored to be used for fuel at a later time.

That is how things should work.

​With insulin resistance, things get messed up.

​When we eat too much sugar (which is most people in the US), the cells get bombarded with so much sugar that it can be toxic to the cells.

To protect the cells from this toxic load of sugar, the cells downregulate the insulin receptors.

In other words, they reduce the number of channels that the insulin ​can use to enter the cells, kind of like locking several of the doors that ​go into your house.

The results?  Insulin is not as effective, so the pancreas releases even more of it and the blood sugar level gradually increases.

The process gradually worsens over time.  Your insulin and blood sugar levels continue to rise until someone checks your blood sugar and diagnoses you with pre-diabetes or diabetes.

Has this happened to you or someone you know?

The shocking part is this process is occurring right now in about 50% of the people in the United States.

​This is an epidemic that must be addressed.

By the way, when discussing diabetes in this article, I am referring to Type II diabetes.

Type I diabetes is an autoimmune condition where the body’s immune system attacks and kills the cells in the pancreas that produce insulin.  Those folks therefore don’t make enough insulin and must take insulin shots for the rest of their lives.

​Insulin also does a lot of other really bad things​ as well.

It is one of the most inflammatory substances in our body.

​Insulin causes cancer.

​Insulin causes us to gain weight by increasing the size of our fat cells.

Insulin increases our risk for heart disease​ and Alzheimer’s Dementia​ as well.

​Are you beginning to see why it is so important to keep your insulin level as low as possible?

​How Do You Know If You Have Insulin Resistance?

​There are a few symptoms that can indicate that you may have insulin resistance.  

They include:

  • checkBelly fat
  • checkFrequent cravings for sugary foods
  • checkIrritability when going long periods without eating
  • checkDizziness and lightheadedness between meals
  • checkInability to lose weight

​There are also a few lab tests that are very helpful in diagnosing insulin resistance.

​Ask your doctor to order these tests:

1.  Fasting ​insulin level – should be < 5

2.  Hemoglobin A1c – should be < 5.3

3.  Fasting blood sugar – should be < 85

4.  Possibly a 2 hour post-meal glucose level – should be < 120

If any of these labs are higher than these optimal levels, you have evidence of insulin resistance and you need to incorporate the treatment recommendations that I will discuss below.

It is critical to your long term health!

​How To Treat Insulin Resistance

​Now that we have identified that you have insulin resistance, let’s discuss treatment options.

One of the biggest issues with treating ​diabetes is that the current treatment recommendations of ​many conventional medicine organizations ​focus purely on lowering blood sugar and do little to address insulin resistance.

​A large part of their recommendations, especially in regards to diet, ​are obsolete.  New research has shown that a lot of what we thought was true isn’t anymore.

​For example, the American Diabetes Association still recommends multiple portions of carbs from grains and other sources daily, then using insulin to keep the blood sugar levels low.

This is recommended despite that fact that studies show that simply​ lowering blood sugar levels has no benefit in reducing mortality.  In fact, adverse events are actually INCREASED due to increased episodes of low blood sugar (hypoglycemia).

That is unfortunate because by the time the blood sugar is high enough to get the attention of most doctors, the insulin resistance has probably been around for quite awhile and has been causing problems.

Diabetes is really just advanced insulin resistance.

In my own practice, I had a patient that presented to my office complaining of uncontrolled diabetes with glucose levels running in the high 200s.

​I put him on a whole food, low carb diet.  However, he really didn’t ​want to change his diet, so he requested that I send him to a certified nutritionist at a local hospital.

​The nutritionist actually told him that he wasn’t eating ENOUGH carbs and increased his carb intake substantially!

A month later, he called back to my office complaining that his blood sugar had gone up into the 400s!

That is why it is important that you do your homework and learn as much as you can about insulin resistance and how to reduce it.

You are in charge of you!

Insulin Resistance and Weight Loss

​You will never lose weight unless you get your insulin resistance under control.

That is because when your insulin levels are high, your body is unable to burn your fat cells as a fuel source.

The burning of fat cells in the body is controlled by an enzyme known as hormone sensitive lipase.

​This enzyme is inhibited by insulin.  

Therefore, you MUST reduce your insulin level if you ever want to get the weight off.

Insulin resistance is also closely associated with leptin resistance which I discuss in this article.

If your leptin levels are elevated, it will be almost impossible to drop any significant weight.

​Diet

​Changing your diet may be the single more important thing that you can do when treating insulin resistance.

You will not have success if you don’t change what you eat.

​However,​ keep in mind that diet alone may not be enough to lower your insulin levels.

​It is going to require a comprehensive approach involving everything we discuss in this article.

​- Foods to Eat

​When deciding on what food to eat, ask yourself this simple question – Did God make this food or did man make it?

In other words, eat only whole, natural foods and avoid processed food.

Most vegetables are good.  Try to stay away from starchy ones such as potatoes except on occasion.

When eating fruit, stick primarily with the berries and cherries.  Also kiwi, lemon and limes.

​Protein – chicken, turkey, fish (not tilapia), eggs, deli meats

Fat – coconut, avocado, olive oil, nuts and seeds (not peanuts), chia, flax

​- Foods to Avoid

​​If you have insulin resistance, you need to avoid any foods that will be rapidly absorbed and are high in sugar.

These include:

  • flagSugar – Any source of sugar should be avoided.  That includes high fructose corn syrup, honey, cane sugar, and brown sugar.
  • flagRefined Carbohydrates – This includes breads, pastas, tortillas, chips, bagels, pizza crust, etc.
  • flagBeer and Alcohol – These are loaded with carbs and sugar and will increase your insulin levels.

​There ​is a general rule that you should keep in mind:  Eat when you are hungry and stop eating when you are full.  Quit focusing on calorie counts and listen to your body.

One caveat to this rule.  If you also have leptin resistance, it could affect your perception of hunger and you won’t be able to trust what your body is saying to you.

​- Macros

Macros is short for macromolecules.

There are 3 macromolecules we talk about when discussing diet – carbohydrates, proteins and fats.

​The conventional approach to treating insulin resistance is to just go “low carb.”

However, carbs aren’t the only macromolecule that can increase insulin levels.

​​Proteins also increase insulin production, so it is important that your diet be low in both carbs AND proteins.

That means you should eat a diet high in good quality fats.

Your ratios of these macros should be in these ranges:

  • check50-70% fat
  • check20% protein
  • check10-20% carbohydrates

​You may need to adjust these ratios depending on what kind of a lifestyle you live.

If you have more muscle mass you may need more protein.

If you are extremely active, you may need more carbs.

Just make sure that most of your food comes from high quality fats.

​If all of this seems overwhelming, you could consider one of these diets that have lots of online support, recipes and other information:

Whole 30 Diet

Ketogenic Diet

Paleo Diet

​All of these diets have been shown to help with weight loss and reduce insulin levels.

​- Intermittent or Prolonged Fasting

​The one thing that is probably overlooked more than anything else when treating insulin resistance, obesity, and other conditions is fasting.

Going without food is probably the most effective strategy for lowering insulin and blood sugar levels.

​And yes, when done correctly, it is safe and very effective in repairing your metabolism.

Fasting should be done in conjunction with diet, supplements, and even medication to work the best.

It is extremely important for you to know that fasting should ​NOT be done without physician supervision, especially if you are diabetic and are on a diabetes medication or insulin.

Fasting is so effective, it will drop your blood sugar which could potentially cause serious hypoglycemia.

Also, if prolonged fasting is used excessively, it can cause prolonged calorie restriction which can damage your metabolism and make insulin resistance worse.

In other words, fasting can be very effective when used correctly, but can be harmful when done incorrectly.

​How does fasting work?

The longer you go without eating the lower your insulin levels fall.

Once your body uses up the majority of stored glucose in the liver for energy, it switches over to using the triglycerides that are stored in your fat cells.

You then start burning fat for fuel and your body becomes more sensitized to insulin.

There is one other important caveat that you should know:

Your adrenals and thyroid should be working optimally before trying intermittent fasting.

If you try fasting and you develop symptoms of dizziness, lightheadedness, tremors, increased thirst or urination, that may be a sign that your adrenals or thyroid are not working optimally.

​Get them working well then you can try fasting again.

​If you are ready to try fasting, start with this simple program:

– Start with a 14 hour fast

– Eat an early dinner

​- Eat an early lunch around 11am the next day

– Repeat this twice weekly

Click here to read more from my article on intermittent fasting.

​Exercise

​​Exercise is very important in treating insulin resistance.

Now if you aren’t exercising at all, doing anything is better than what you are doing now!

​Simply taking a 15 minute walk will do wonders for your body and metabolism.

However, the best exercise for insulin resistance is High Intensity Interval Training (HIIT).  Studies show that it helps sensitize the body to insulin.

It sounds complicated but it’s not.

HIIT focuses on doing small bursts of all-out, maximum effort for 30 seconds followed by 60-90 seconds of moderate exercise.

This is repeated 5-10 times in a single session at least once per week.

This can be done while walking, on a treadmill, regular or stationary bike, rowing machine, etc.

Doing HIIT training for 10 minutes is more effective than just walking on a treadmill for 30.

Stress Management

​Cortisol plays a big role in insulin resistance.

If you are under ​stress, your body will increase cortisol production.  The cortisol decreases your body’s sensitivity to insulin which makes insulin resistance worse.

This is true for chronic stress but also acute stress.

That is why it is essential for you to develop some healthy stress reduction habits if you want to decrease your insulin resistance.

These can include yoga, prayer time, good sleep, and fun hobbies.

It may also mean changing jobs or avoiding toxic relationships.

​Just think of the word “balance.”  We need balance in every facet of our lives.  Without it, we will start breaking down physically, emotionally, and mentally.

​Supplements

​There are a few supplements that have been shown to improve insulin resistance.

​Only taking these supplements will not get rid of your insulin resistance.

However, they are another tool in your toolshed that when used with the diet and lifestyle changes we have discussed can be very helpful.

The best supplements for reducing insulin resistance include (click on each for my recommended brand):

​Medications

​Unfortunately, many people with insulin resistance may need to consider medication, especially when it is advanced.

The diet, lifestyle changes, and supplements may simply not be enough to lower their insulin levels.

With that in mind, you have to be VERY careful about which medications you should use.

Remember, as a general rule, conventional medicine is more focused on lowering blood sugar levels than reducing insulin levels.

In fact, many prescription medications lower blood sugar by INCREASING insulin levels!

When insulin resistance is the cause of the elevated blood sugar, why would we use a medication that worsens the insulin resistance?

​It makes no sense.

The good news is there are several medications that actually lower BOTH the blood sugar and insulin levels.

As an added bonus, they typically cause some weight loss as well.

Compare that to other medications including insulin that result in significant weight GAIN.

I’m not going to go into great detail about the “good” medications for insulin resistance, but I will list them below.  

If you and your doctor determine that your insulin resistance is bad enough to merit using a medication, you should consider using one of these:

  • checkMetformin
  • checkAcarbose
  • checkSGLT-2 Inhibitors
  • checkGLP-1 Agonists​ – These are especially helpful if you are also dealing with leptin resistance.​​​

Each of these medications have their own set of precautions and contraindications, so make sure that you and your doctor discuss them thoroughly and monitor for any potential side effects or problems.

​Summary

​Insulin resistance is an extremely common and dangerous condition, affecting up to 50% of the US population.

Untreated, it can lead to pre-diabetes and ultimately Type II diabetes.

It will be almost impossible for you to lose weight until you reduce your insulin resistance.

Diet is a crucial part of managing insulin resistance.

Lifestyle interventions such as exercise and stress management are also critical.

Supplementation can help and prescription medication will often be needed, at least for awhile.

Incorporating ​ALL of these modalities will be necessary for you to have success in reducing your insulin resistance.

Now it’s your turn…

​Do you have insulin resistance?

What helped you to lose weight and reduce your insulin levels?

What advice do you have for others in your situation?

Leave your comments below.

Treatment of Reverse T3 Dominance

Reverse T3 dominance could be the reason why you still have hypothyroid symptoms even though you are taking thyroid medication.

Or why you struggle to lose weight even when your thyroid labs are “normal.”

Never heard of reverse T3 dominance?  Most people haven’t, including most doctors.

High levels of reverse T3 could be slowing down your metabolism, reducing thyroid function at the cellular level, and causing multiple symptoms of hypothyroidism.

The purpose of this article is to inform you about reverse T3 – its purpose in the body, what causes it to get elevated, how to test for it, and how to reduce it back to optimal levels.

Let’s get started…

More…

What is Reverse T3?

The thyroid gland primarily produces T4.  That is thyroglobulin with 4 iodine molecules attached to it.

T4 is the inactive transport form of thyroid hormone.  In order to be used by the body, an enzyme called a deiodinase must cleave off an iodine molecule to convert it to T3.

T3 is the active hormone that can then interact with cells of our body and turn on certain cellular functions.

However, T4 can also be converted into reverse T3.

Reverse T3 will also bind to the cellular thyroid receptors.  However, it doesn’t trigger any cellular reactions.

So basically reverse T3 serves as a “brake” to our thyroid system.

Why Do We Have Reverse T3 in the First Place?

The production of reverse T3 is normally not a bad thing.  It gives our body another way of regulating our energy production and output.

Reverse T3 production will increase during times of extreme stress.

That makes sense if you think about it closely.

For example, if you have an acute infection such as pneumonia, a kidney infection, or you’ve had something like a car accident and have suffered multiple injuries, your body needs to turn down the metabolism to conserve energy so it can be used to fight the infection or injuries.

This system works very well for such acute situations.

There is actually a medical term for this condition – Euthyroid sick syndrome.

However, with the onslaught of chronic conditions and resulting inflammation in our society, it has also become extremely common ​outside of the acute setting of a hospital.

People that are under extreme stress develop this condition which results in a high reverse T3 level, low free T3 level, and a normal TSH and T4 level.

Does this sound familiar?  Do your labs look like that?

In 20+ years of private practice, I have never seen this diagnosis given to a patient that wasn’t in the hospital.

But if you look at studies like this one, ​something as common as a calorie-restricted diet can raise reverse T3 levels and lower free T3 levels and cause other symptoms that “resemble euthyroid sick syndrome.”

So what is going on?​  What causes the reverse T3 levels to increase (reverse T3 dominance)?

Let’s talk about it more…

What Causes Reverse T3 Levels to Increase?

From what we have discussed so far, unless you are acutely ill or have suffered a major injury of some sort, you want your reverse T3 level to be as low as possible.​

​Does an elevated reverse T3 cause any symptoms?

The answer is yes! 

The symptoms will be the same as you would think of with someone with an extremely slow metabolism (which is what reverse T3 dominance causes):

  • Constant weight gain without changing your eating habits
  • Severe fatigue
  • Symptoms of hypothyroidism
  • Depression or anxiety
  • Joint pain

If you have any of these symptoms, it’s important to get your reverse T3 level checked and follow the treatment instructions that I will discuss below.

But first…

What are some of the most common causes of reverse T3 dominance?

    • Chronic physical or emotional stress – This can include job stresses, financial problems, family issues, death of a loved one, and divorce.  It also includes trauma including PTSD or permanent injuries from car wrecks, etc.
    • Chronic illness or infections –  This can include infections such as mono or SIBO, or chronic illness such as cancer, diabetes, heart disease, or even obesity.
    • High or low cortisol (Adrenal fatigue) – Either end of the cortisol spectrum will affect reverse T3 levels.  Read more here.
    • Low ferritin – Suboptimal levels of iron and ferritin have been shown to increase reverse T3 levels.
    • Acute illness or injury – Patients with an acute issue that requires ICU treatment have been shown to have low T3, high reverse T3, and normal TSH levels.
    • Severe calorie restriction – especially HCG diets or very low calorie diets.  These diets have been shown to increase reverse T3, slow metabolism, and make it almost impossible to have permanent weight loss.
    • Chronic inflammationAny inflammation will result in reduced T4 to T3 conversion and an increase in reverse T3 production.  Inflammatory conditions include autoimmune disease, leptin resistance, insulin resistance, intestinal dysbiosis, and cancer.
    • Chronic untreated gut infections or imbalancesUp to 20% of all conversion of T4 to T3 occurs in our gastrointestinal tract.  Any gut imbalance therefore has a huge impact on thyroid function.  Examples of this includes SIBO, GERD, yeast overgrowth, inadequate gut bacteria, overuse of antibiotics, and inflammatory bowel disease.
    • Certain medications – Medications that can increase reverse T3 levels include beta blockers, diabetes medications, anti-seizure medications, depression medications and narcotics.

​If you have one or even more of the above issues, it is important for you to be tested for reverse T3 dominance.

How to Test for Reverse T3 Dominance

Testing for reverse T3 dominance is readily available but may be hard to get ordered.

You will need to see a doctor that has a full understanding of the thyroid and doesn’t just depend on the TSH to determine thyroid health and function.​

It is critical that you get a complete thyroid panel.  I discuss this more in this article.

This will include the TSH, free T4,free T3, reverse T3, TPO antibodies and thyroglobulin antibodies.​

As you can see from this graph, when reverse T3 dominance occurs, the TSH level will remain normal the vast majority of time.  So will the free T4 level, which is the other lab test that most conventional doctors will order.

The lab tests that will show an abnormality the quickest will be the reverse T3 level and the free T3 level.  You can see that as the reverse T3 levels rise, the free T3 levels fall.

Even though your TSH may be normal, your thyroid is not working well at all!​

That is why the reverse T3 and free T3 are absolutely the most important thyroid tests to get when assessing for reverse T3 dominance.​

You will also want to check the ratio of reverse T3 to free T3 to get an idea of what is happening in your cells.

Normally you want your free T3 to be as high as possible and your reverse T3 to be as low as possible.

I consider a reverse T3 > 15 to be abnormal.

It is possible to have a normal free T3 level but still have a very high reverse T3.  That is why the ratio is important.

​To get the ratio, divide your free T3 by your reverse T3.  The ratio should be >0.20.

Any number less than 0.20 indicates that you have too much reverse T3 and you need to take steps to lower it.

How to Lower Reverse T3 Levels

Okay, so you’ve gotten the necessary lab tests, and your reverse T3 level is > 15 and/or your free T3: reverse T3 ratio is < 0.20.

What can you do to decrease your reverse T3 dominance?

The single most important thing is to identify the root cause.​  This is always the primary goal of functional medicine.

If your diabetes is out of control and you don’t change your diet and lifestyle, your reverse T3 will not decrease.

If you are in a toxic job or a toxic relationship, you will never get your cortisol levels in the optimal range which will prevent your reverse T3 level from dropping.

I could give several other hypothetical situations, but I think you get my point.

Focus primarily on the issues that you know you have FIRST.  Then consider some of the other treatment options I will discuss below.

1. T3 Medication

The quickest way to reduce reverse T3 levels is by using pure T3 hormone.

This includes short acting T3 such as Cytomel or liothyronine, but also sustained release T3 from compounding pharmacies.

This is so effective because you are able to skip the conversion step required with medications that contain T4 such as Synthroid and levothyroxine.

Your body can’t make reverse T3 unless it has T4.  If you remove the T4, the reverse T3 levels will obviously drop.​

Make sense?

When you give T3 only medication, it will result in the free T3 level rising, T4 level dropping, reverse T3 level dropping, and the TSH level dropping.​

When on this therapy, it is very important to monitor your reverse T3 levels closely, usually every 1-2 months.

Typically the reverse T3 level will drop below 10 within 2 months (assuming you are on enough T3).​

This is by far the fastest way of reducing your reverse T3 dominance, but if you don’t identify and correct the root cause, it will just go back up.​

By the way, natural dessicated thyroid (NDT) medications such as Armour Thyroid, Nature-throid, and others may not be adequate to lower reverse T3 levels.​

They are still about 80% T4, which may still provide too much T4 that can be converted to reverse T3.

If you are on an NDT medication, you may need to reduce the dose for a couple of months and add T3 to lower the reverse T3 levels.​

Again, it will be imperative to identify the root cause of your reverse T3 dominance, or else the reverse T3 levels will go back up once you return to your typical NDT dose.​

2. Increase T4 to T3 Conversion

Every patient with a thyroid issue is going to need one or more supplements.​

Why?​

When you have low thyroid you produce less stomach acid which results in less nutrient absorption.

I discuss many nutrient deficiencies and supplements here, but for this article I will only mention those that help with conversion of T4 to T3.​

​The primary nutrients that have been shown to increase this conversion are zinc and selenium.  Increasing conversion of T4 to T3 means less conversion to reverse T3 which will lower its level.

My preferred supplements are below:

How to Supplement with Selenium

Why I Like It

May reduce antibodies in patients with Hashimoto’s

Also acts as an  anti-inflammatory

May help reduce anxiety symptoms

Helps boost T4 to T3 conversion (helpful in those with high reverse T3)

Who Should Use It

    • Patients with hair loss or hair thinning
    • Patients with a known thyroid disorder and hair loss
    • Patients with other nutrient deficiencies like zinc or iodine
    • Patients who frequently take acid blockers for acid reflux
    • Patients with other GI related issues (IBS, gas/bloating, IBD)
    • Patients also taking zinc

How to Use

    • Take 200-400 mcg per day (do not exceed 400 mcg daily)

My Recommended Brand and Product

Get Selenium Here

How to Supplement with Zinc

Why I Like It

Many people are deficient in zinc

May help with T4 to T3 conversion

May increase cellular sensitivity to thyroid hormone

Has anti-inflammatory effects

How to Tell if You Need It

    • If you have Hashimoto’s and hair loss
    • If alkaline phosphatase is < 70

How to Use

    • Take 30-60 mg daily (do not take more than 60 mg)

My Recommended Brand and Product

Get Zinc Here

3. Manage Leptin Resistance and Insulin Resistance

​Most hormones in the body work together.

When there is a change in one hormone, it will affect other hormones as well.

In fact, hypothyroidism has been linked with leptin resistance as well as insulin resistance.

Hypothyroidism leads to a state where it is easy to develop leptin resistance and insulin resistance.

Conversely, leptin and insulin resistance slow metabolism and increase inflammation which increase reverse T3 production, which makes losing weight almost impossible.

Very high reverse T3 levels are almost always found with elevated insulin and leptin levels.

That’s why you need to request a fasting insulin and leptin level if your reverse T3 is > 15.

You will not be able to get your reverse T3 level down and keep it down if you don’t also address the leptin and insulin resistance.

You can read more about how to do that in my article here.

4. Decrease Inflammation

​Inflammation is a vague concept.

We all know that excessive or prolonged inflammation is bad, but what do we do about it?

It is hard to measure and even harder to treat.

However, it’s important to identify and address because inflammation directly increases conversion of T4 to reverse T3.

The lab tests that we use to measure inflammation in the body are nonspecific, meaning they do not tell us what is causing the inflammation.

If they are elevated, it can still indicate to us that inflammation is high in the body and we need to identify the source of it.

The primary tests that indicate inflammation are:

    • C-reactive Protein (CRP) – Should be as low as possible (<1.0)
    • Erythrocyte Sedimentation Rate (ESR) – Best if this is < 10.

​If you have high levels of inflammation AND high levels of reverse T3, you can safely assume that inflammation if causing or at least worsening your reverse T3 dominance.

The next step is to identify the source of the inflammation.

In hypothyroid patients, the source of inflammation is usually from one of 3 issues:

    • Food Sensitivities -typically gluten and dairy but there may be others.  They promote inflammation, primarily in the gut.
    • Gut imbalances – such as SIBO or yeast overgrowth.  Both also increase inflammation.
    • Hormone imbalances – especially insulin resistance and leptin resistance.

If your CRP or ESR levels are elevated, you should look closely at these 3 common sources and address them.

If you don’t know the source of your inflammation, you can still consider some supplements that help reduce inflammation by improving the detoxification of the body, primarily in the liver:

Just blindly treating inflammation is far from ideal but can be helpful if you can’t identify the source of your inflammation.

5. Lifestyle Changes

​Without getting overly technical, doing 4 basic things can make a huge impact on your health, including your reverse T3 levels:

    • 8 hours of quality sleep per night
    • Reducing and managing your stress
    • Eat a balanced diet of whole, real foods
    • Daily low intensity exercise and episodes of high intensity exercise 1-3 times per week

Just doing these 4 things alone will do more to bring you back to a state of health than anything else we have discussed.

On the other hand, if you do everything else that I recommend in this article but neglect these 4 things, you will not be successful and your reverse T3 dominance will continue.​

I realize these things are easier said than done, but they have to be a primary focus for you to have success.​

​By the way, reverse T3 is an important component of our thyroid hormone system.

Decreasing reverse T3 levels are not harmful in the short term and can in fact be helpful.

However, persistently low levels of reverse T3 increases the risk for hyperthyroidism if left suppressed for a long time.

That’s why the goal will be to “flush” out the elevated reverse T3 levels for only a short period of time and then allow the body to balance out the levels of T3 and reverse T3.

Summary

Reverse T3 dominance is a common problem for many hypothyroid patients. 

It may be the primary reason why some patients have persistent hypothyroid symptoms despite being on thyroid medication and why so many thyroid patients have difficulty losing weight and keeping it off.

In order to diagnose reverse T3 dominance, you need to have your free T3 and reverse T3 levels checked.

A reverse T3 level > 15 is considered abnormal, and a T3:reverse T3 ratio of < 0.20 indicates that you have too much reverse T3.

Treatment includes taking T3 medication for a short period of time, taking supplements to improve T4 to T3 conversion, and making appropriate lifestyle interventions to reduce stress, inflammation, and leptin/insulin resistance.

Doing all of these things can help get your body back and balance and reduce your hypothyroid symptoms and weight loss resistance.

Now it’s your turn:

Do you have reverse T3 dominance?

What treatments have you tried?

What has worked for you?

Leave your comments below.

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