Positive Health Online

Having trouble exercising away the unflattering ‘spare tires’? If you’ve adopted a healthy diet and a disciplined gym regime but see no results, then perhaps it’s time to check your thyroid gland.

Even though weight gain can be dependent upon the foods we chose to eat, it can also be linked to a malfunctioning endocrine gland called the thyroid. The common misconception is that thyroid disorder is due to genetics or old age; but a sluggish thyroid can begin in our early 20s owing to an unhealthy lifestyle, bad diet and environmental influences (such as pollution) that affect this sentinel gland. The vague and hard-to-pin down symptoms, such as fatigue, weight gain, depression, dry skin and hair and heavy periods mimic symptoms typically associated with ageing. Although patients change their diet and exercise daily, sometimes the weight refuses to shift in areas like the thighs, and stomach or the weight continues to pile on, no matter the type of diet adopted.

When the hormones produced by the thyroid are released into the bloodstream, they’re meant to reach the receptors on the cell surface, which sets up a whole host of biochemical actions - one of these is fat burning. If there aren’t enough receptors on the cell, then the fat begins to accumulate. In other words, the thyroid hormones and the cells don’t communicate with each other. Could other facts be interfering in this hormonal interchange?

How does the Thyroid Work?

When you are undergoing thyroidal issues, it is crucial to understand the physiology and purpose of the thyroid in order to get it to function. The thyroid gland is located at the front of the neck, just below the Adam’s apple and is butterflied shaped. The thyroid hormones regulate heart function, brain development, energy levels, bone maintenance and weight gain. The release of thyroid hormones works according to the messages released by the brain: the hypothalamus and the pituitary gland. Two essential hormones called thyroxin (T4) and triiodothyronine (T3) are released into the bloodstream that increases your body’s metabolic rate. Thyroid hormones make cells use more energy and in turn, heat is released. When the hypothalamus senses that the levels of T3 and T4 are low, it releases thyrotropin releasing hormone (TRH); TRH travels to the pituitary via the connecting blood vessels that stimulates the pituitary to secrete thyroid-stimulating hormone (TSH). TSH is released into the bloodstream and travels to the thyroid gland, instructing the cells within the thyroid to produce T4 and T3. In turn, they increase the metabolic activity.

What Causes the Weight Gain?

Over the past two decades, Dr Elizabeth Lyster MD and specialist in thyroid abnormalities and hormone specialist in USA, has treated over 1000 patients and found that apart from nutrition, stress knocks thyroid production:

“There are a number of factors involved, but I think the main issue is that under physiologic stress, T4 - instead of converting as it should to the active form T3 - converts to Reverse T3, which acts as an anti-thyroid hormone molecule. Physiologic stress in my opinion is ‘life as we know it’, but in particular includes things like calorie restriction, depression, excessive exercise, and illness. This is why most diets don't work - the body ‘protects’ itself by slowing down the metabolism to help us ‘survive’ what is perceived as starvation. The reverse T3 blocks the activity of the T3 molecule, slowing down the metabolism.”

In August 2006, the Journal of Endocrinology and Metabolism initiated a study on how calorie reduction (CR) can produces low amounts of T3, the active form of thyroid. The purpose of the study was to evaluate the thyroid hormonal profile in healthy lean and weight-stable volunteers who were consuming CR diets, containing adequate protein and micronutrients for years. The study was done on 28 men and women who were on a CR diet between 3–15 years: both sexes revealed reduced levels of T3.

The thyroid is a sensitive and fussy gland that reacts easily to the ‘wrong’ foods. Nutritional Therapist Emma Vanlint (FdScm Dip ION mBANT NTCC CNHC) who runs her clinic from No.1 Harley Street, highlights the foods to ban:

“For all types of hypothyroidism it is beneficial to avoid foods known as goitrogens; these foods are thought to block the uptake of iodine, which is essential for healthy thyroid function. They are known as the cruciferous vegetables including turnips, cabbage, kale, cauliflower, broccoli, Brussels sprout, kohlrabi, rutabaga and mustard greens. Soy products should be avoided completely with the exception of a little cooked tofu. I would always recommend cutting goitrogens out of the diet initially until the thyroid has been stabilized and the client is feeling better. Trans fatty acids should also be avoided; these are found in processed foods and ready meals as they can impair the conversion of T4 to T3 - this is the process of converting thyroid hormones from inactive to their active form. MSG found in processed food and Chinese food can deteriorate the thyroid gland.”

Nutrients for Optimal Thyroid Function

Modern day food has been stripped of the essential nutrients, which encourage healthy hormone production. The thyroid is heavily dependent upon a whole host of nutrients such as iodine, selenium and zinc. Time, stress, work and other daily responsibilities have diverted our attention away from eating healthily, with the only options of eating sandwiches, salads, tinned soups and other fill-me-up-quickly meals. Another effect on thyroid hormones are the winter months: the thyroid gland is responsible for regulating the body’s thermostat and when it doesn’t function properly we crave carbohydrates, sugary snacks and several cups of tea, which encourage warmth. Ironically, this drastically reduces thyroid function and ultimately leads to weight gain. “Bad nutrition has a huge hormonal impact in general, and that includes on thyroid hormone activity. Foods we eat influence the adrenal gland function, which directly affects thyroid hormone activity. Sugar, wheat and starches have the most negative impact,” says Dr Lyster.

Alexandra Nairn, 38, didn’t take her thyroid diet seriously until she gained 8kgs within 2 months:

“I’ve struggled with weight gain since my early 30s. I was initiated on a strict thyroid diet where I had to cut out junk food, reduce carbohydrates and eat freshly prepared meals. Initially, I took it seriously but then started to feel relaxed about it. I thought to myself ‘a few a cakes, biscuits and sandwiches won’t harm me’, but I couldn’t have been further from the truth. It was when I realized by weight jumped from 56 kg (and I’m 5’5 in height) to 64 kg in 8 weeks that I decided to stick to my diet once and for all. I’m not saying it’s easy but it’s definitely worth it - I’ve now safely returned to 54 kg.”

These are Some of the Specific Nutrients that your Thyroid Relies On:

Iodine: the T3 and T4 hormones are produced from this mineral. It can be found in oysters, clams and cockles. Try seaweed or natural sea salt to encourage iodine production. Note that too much iodine can block the thyroid gland so take it only if instructed;

Selenium: this mineral is critical for healthy thyroid function. It is hardly found in food these days so the best option is to opt for a daily supplement;

Zinc, Iron and Copper: these metals are essential for thyroid efficiency;

Essential Fatty Acids: good fats from fish oils can improve a sluggish thyroid.

The T4/T3 Controversy

Diagnosing and treating thyroid disease is not a cut-and-dry matter: thousands of patients who get thyroid tests done are predominantly borderline, meaning GPs face the decision to treat or not treat. In the UK, TSH levels must be over 2mIU/l to be diagnosed with hypothyroidism, meaning the tests dictate whether a patient will be diagnosed or not. And this is where the conflict lies: what could be perceived as ‘normal’ results by medics doesn’t always reflect the patient’s wellbeing. Dr Lyster, MD believes that “most doctors follow practice patterns that they are taught. The expectation is that T4, which is the inactive form of thyroid hormone, will convert in the body to T3, the active form. However, this doesn’t happen in many people.”

In the case of Rachel Haroon, age 45, from Colchester, she felt the immediate benefits of T4/T3 medication: “I was happy on T4 medication but felt it wasn’t enough. I had done my research about a separate T3 medication, and time and time again I urged my GP to prescribe me something; however, he was insistent on keeping me on T4 medication. I finally tracked down a private doctor in Belgium who understood my problem and initiated me on T3 medication. I feel so much better with this medication and no longer suffer with weight gain problems.”

In 2005 the Journal of Endocrinology and Metabolism found that patients preferred thyroid treatment that included a combination of T4 and T3 medication rather than the usual T4 treatment. The double-blind, randomized and controlled clinical trial looked at 141 patients with primary autoimmune hypothyroidism, who were broken into groups who were treated with T4/T3 in a ratio of 5:1, 10:1; as well as a group that continued with their previous T4-only treatment. After 15 weeks, the study showed patients preferred the combination treatments and in particular, the 5:1 group, with a decrease in weight loss.

Another study in The New England Journal of Medicine (February 1999) confirmed the beneficial effects of T4/T3 combination medication for hypothyroidism. The study compared the effects of thyroxin alone with those on thyroxin plus triiodothyronine (liothyronine) in 33 patients with hypothyroidism; each patient was studied for 10 weeks. Sixteen patients stated that they felt there was an improvement in mood.

On the flip side, research conducted by the British Thyroid Association (BTA) in 2007 T4/T3 medication revealed patient’s indifference on the combined medication. Since 1999 the BTA have done 7 rigorous randomized, double-blind and controlled studies on 900 hypothyroid patients that “none showed a beneficial effect of combined T4/T3 therapy”.

Evidently, the T4/T3 controversy can confuse patients about the correct and beneficial medication for them. Dr Lyster believes “doctors steer away from things which they are unfamiliar with”. Also because of the touted benefits of T4, much more research is churned out and circulated in medical circles - leaving the question of T3 (most of the time) unanswered.

If you suspect a thyroid problem is behind your weight gain, notify your doctor immediately and ask him to do a full thyroid check, including TSH, T4 and T3 for a full picture. Remember, a healthy thyroid function goes beyond taking a pill; it requires a commitment on your side to feed your hormones, exercise moderately and manage stress levels.

Scientific References

Fontana Luigi, Klein Samuel, Holloszy O. John, Premachandra, Bhartuer, Effect of Long-Term Calorie Restriction with Adequate Protein and Micronutrients on Thyroid Hormones, The Journal of Endocrinology and Metabolism May 23, 2006. http://jcem.endojournals.org/content/91/8/3232.short

Appelhof BC, Fliers E, Wekking EM, Schene AH, Huyser J, Tijssen JG, Endert E, van Weert HC, Wiersinga WM, Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial, The Journal of Endocrinology and Medicine May 2005. http://thyroid.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=thyroid&cdn=health&tm=441603&gps=287_27_1441_612&f=22&su=p284.13.342.ip_&tt=2&bt=1&bts=2&zu=http%3A//www.ncbi.nlm.nih.gov/entrez/query.fcgi%3Fcmd%3DRetrieve%26db%3Dpubmed%26dopt%3DAbstract%26list_uids%3D15705921%26query_hl%3D1

Bunevicus Robertas, Kazanavious Gintautas, Zalinkkevicius Rimas, Prange Arthur, Effects of Thyroxin as Compared with Thyroxin plus Triiodothyronine in Patients with Hypothyroidism, The New England Journal of Medicine, February 11, 1999. www.nejm.org/doi/full/10.1056/NEJM199902113400603

The British Thyroid Association, Patient Guidelines, November 2007. www.british-thyroid-association.org/Guidelines/

For more information on Dr Elizabeth Lyster, MD www.drlizmd.com

For more information on Emma www.nutritionaltherapyclinic.co.uk