![]() Steps to Choosing the Right Thyroid Hormone. This article is part of a special report on Thyroid Disorders. To see the other articles in this series. My answer is always the same: “It depends.” As much as some practitioners would like to make us believe, there is simply no “one size fits all” approach to thyroid hormone replacement. Statements like “Synthroid is best” or “I prefer to use synthetic T4 with my patients” or “I only use bio- identical hormones” demonstrate a lack of understanding of thyroid pathology. Because, as I’ve explained in this series, the underlying causes of thyroid dysfunction are diverse. ![]() Giving all patients the same thyroid medication without understanding the mechanisms involved is analogous to not checking a patient’s blood type before doing a transfusion. Granted, the consequences may not be as severe, but the underlying principle is the same. Before we continue, let me remind you that I’m not a doctor and I’m not offering you medical advice. My intent is to educate you about the various considerations that should be made when choosing a thyroid medication, so you can discuss them with your doctor. Let’s move on. Choosing the right thyroid medication requires answering the following three questions: What’s the mechanism that led to the need for medication in the first place? Are there any mechanisms that may interfere with the actions of the medication? Does the patient have sensitivities to the fillers used in the medications? Let’s look at each of these in turn. What’s the mechanism that led to the need for medication in the first place? If you’ve been following this series, you know that there’s no single cause for low thyroid function. Do you have an autoimmune disease (Hashimoto’s) causing destruction of your thyroid gland? Do you have high levels of estrogen causing an increase in thyroid binding proteins and a decrease in free thyroid hormone? Do you have a systemic inflammatory condition affecting your ability to convert T4 to T3, or decreasing the sensitivity of the cells in your body to thyroid hormone? In order to choose the right hormone, you have to know what the underlying mechanism causing the dysfunction is. Let’s look at an example. Say you have a problem converting T4 to T3. ![]()
Mem: Thank you for the kind words! I'm of two minds about posting our personal stories. On the one hand, I think it helps writers if they are honest and open about. ![]() In this situation, your TSH may or may not be slightly elevated, but let’s say it is, and your doctor prescribes Synthroid. Synthroid is a synthetic T4 hormone. Will this help you? No. It won’t help because your problem in this example isn’t a lack of T4, it’s an inability to convert T4 to the active T3 form. You could take T4 all day long, and it won’t do a thing unless your body can convert it. The first step in this case would be to address the causes of the conversion problem (i. ![]() If that doesn’t work, though, what you’d need in this situation is either a so- called bio- identical hormone that has a combination of T4 and T3, or a synthetic T3 hormone (like Cytomel). These will deliver the T3 you need directly, bypassing the conversion problem. Are there any mechanisms that may interfere with the actions of the medication? The vast majority of long- term hypothyroid patients that haven’t been properly managed find that they constantly need to increase the dose of their medication, or switch to new medications, to get the same effect. There are several reasons for this. First, inflammation (which is characteristic of all autoimmune diseases, and Hashimoto’s is no exception) causes a decrease in thyroid receptor site sensitivity. This means that even though you may be taking a substantial dose of replacement hormone, your cells aren’t able to utilize it properly. ![]() Malnutrition or malnourishment is a condition that results from eating a diet in which nutrients are either not enough or are too much such that the diet causes. Who knew that eating MORE carbs was just the ticket to help raise my body temperature and help my thyroid? How I Raised My Body Temperature with Carbs. Ayurveda Research Papers (CCA Student papers) The selected papers published on our website have been written by students of the California College of Ayurveda as a. A quick look at the history or fasting, both for spiritual and for health reasons. I would like to be fit and trim annd most. Second, elevations in either testosterone or estrogen (extremely common in hypothyroid patients) affect the levels of circulating free thyroid hormone. For example, high levels of estrogen will increase levels of thyroid binding protein. Thyroid hormone is inactive as long as it’s bound to this protein. If you take thyroid replacement, but you have too much binding protein, there won’t be enough of the active form to produce the desired effect. Third, there are several medications that alter the absorption or activity of T4. These include commonly prescribed drugs like antibiotics & antifungals (i. Many popular thyroid medications contain common allergens such as cornstarch, lactose and even gluten. As I explained in a previous post, most hypothyroid patients have sensitivities to gluten, and many of them also react to corn and dairy (which contains lactose). Synthroid, which is one of the most popular medications prescribed for hypothyroidism, has both cornstarch and lactose as a filler. Cytomel, which is a popular synthetic T3 hormone, has modified food starch – which contains gluten – as a filler. Even the natural porcine products like Armour suffer from issues with fillers. In 2. 00. 8, the manufacturers of Armour reformulated the product, reducing the amount of dextrose & increasing the amount of methylcellulose in the filler. This may explain the explosion of reports by patients on internet forums and in doctor’s offices that the new form of Armour was either “miraculous” or “horrible”. Those that had sensitivities to dextrose were reacting less to the new form, and experiencing better results, while those that had sensitivities to methylcellulose were reacting more, and experiencing worse results. The best choice in these situations is to ask your doctor to have a compounding pharmacy fill the prescription using fillers you aren’t sensitive to. Unfortunately, insurance companies sometimes refuse to cover this. Other considerations. Another common question that is hotly debated is whether bio- identical or synthetic hormones are best. Once again, the answer is: “It depends.” In general I think bio- identical hormones are the best choice. A frequently perpetuated myth (in Synthroid marketing, for example) is that the dosages and ratio of T4: T3 in Armour aren’t consistent. Studies have shown this to be false. Armour contains a consistent dose of 3. T4 and 9 mcg T3 in a ratio of 4. However, in some cases patients do feel better with synthetic hormones. One reason for this is that a small subset of people with Hashimoto’s produce antibodies not only to their thyroid tissue (TPO and TG), but also to their own thyroid hormones (T4 and T3). These patients do worse with bio- identical sources because they increased the source of the autoimmune attack. Another issue is the use of T3 hormones. As we’ve discussed, T3 is the active form and has the greatest metabolic effects. The flip side of this, however, is that it’s far easier to “overdose” on T3 than on T4. Patients with trouble converting T4 to T3 do well on synthetic T3 or bio- identical combination T4: T3 products. But for many patients with Hashimoto’s, which is can present with alternating hypo- and hyperthyroid symptoms, T3 can push them over the edge. They are generally better off with T4 based drugs. As you can see, the best thyroid hormone for each patient can only be determined by a full thyroid work- up and exam, followed by trial and error of different types of replacement medications. Such a work- up would include not just an isolated TSH test, but also a more complete thyroid panel (including antibodies), other important blood markers (glucose, lipids, CBC with diff, urinary DPD, etc.) and possibly a hormone panel. A history must be taken with particular attention paid to the patient’s subjective response to replacement hormones they may have tried in the past. Unfortunately, this rarely happens in the conventional model, where the standard of care is to test only for TSH. If it’s elevated, the patient will get whatever hormone that particular practitioner is fond of using without any further investigation. And all too often, as many of you can attest, this simplified and incomplete approach is doomed to failure. Like what you’ve read? Sign up for FREE updates delivered to your inbox. I hate spam too. Your email is safe with me. How to raise your basal body temperature. And slap you upside the head with it. If you would like to find out more about the basis of why the following information works so well (and I have 3. There are other factors involved, most of them hereditary in nature (but can still be overcome with the right approach). In a world in which we have developed serious calorie phobia, carbohydrate phobia, fat phobia, couch potato phobia, saturated fat and cholesterol phobia, and more . It is counterproductive and worsens the underlying disorder. Dr. Atkins perhaps said it best when he wrote. This is usually not a problem with the thyroid gland (therefore blood tests are likely to be normal) but with the liver, which fails to convert T4 into the more active thyroid principle, T3. The diagnosis is made on clinical ground with the presence of fatigue, sluggishness, dry skin, coarse or falling hair, an elevation in cholesterol, or a low body temperature. I ask my patients to take four temperature readings daily before the three meals and near bedtime. If the average of all these temperatures, taken for at least three days, is below 9. F (3. 6. 5 C), that is usually low enough to point to this form of thyroid problem; lower readings than that are even more convincing. When metabolism increases, your chances of conception and a successful pregnancy skyrocket. I highly recommend going through the following steps to anyone looking to get pregnant . Having a high metabolism going into pregnancy, and producing abundant progesterone has all kinds of benefits to the offspring . Progesterone increases the elasticity of cervical tissues! Making childbirth a LOT less painful. Alright, so we. If you consistently have a body temperature below 9. F when you wake up in the morning (rectal temps being the most reliable), you can fix this. It is not hard, unless you consider being on vacation and spa days hard. It is very common for people of all ages, male and female, to see increases in body temperature from as low as 9. F to 9. 8F and above in less than 3. It really is that simple and reliable. The hard part is getting people to try it because it sounds so strange in contrast to the exercise more/eat less, . Emphasize the more calorie- dense unrefined carbohydrates like root vegetables, fruit, and grains in particular, but also eat a satisfying amount of meat, fat, dairy products (milk is incredible for body temperature), and whatever else that you find enjoyable. But keep it as nutritious and unprocessed as possible. Eating more than you want to eat is what forces your body to get out of its low metabolism rut. Go at least 1. 2 hours straight per day without food . So if you eat dinner at 7pm, have breakfast at 7am. I believe this practice can make the body more responsive to the hormone leptin, probably the most important hormone in fertility (because it raises thyroid and progesterone). Get as much sleep as possible. Sleep is an incredibly powerful tool for raising metabolism. Avoid vigorous exercise. This is not a permanent recommendation obviously. You can resume getting more vigorous exercise once your body temperature is fully restored. Emphasize saturated fats over unsaturated fats. Dairy products, red meat, and coconut products are the best source of dietary saturated fats. You should eat these preferentially over nuts, seeds, vegetable oils, avocado, and other plant fats . While eating a lot, sleeping a lot, and avoiding excessive exercise is inherently de- stressing, it also pays to spend time doing something that you find leisurely or enjoyable and mentally and physically relaxing, which is highly individual. Massage and sunbathing would be my two personal favorites! And, well. Those are not bad signs, but signs of deep physiological relaxation and/or signs of adjustment to the new transition. Give it a full 3. Matt Stone, author of 7 books, is an independent health researcher who emphasizes the dangers of dieting and restricted and restrained eating of many varieties, and raising metabolism naturally. He is the voice of www. Note from Donielle – I use the i. Basal* for checking daily basal temperatures and love that it also keeps track of my cycle and fertile days for me. Matt uses this thermometer*. Some links in our posts might be affiliate links. This means that, at no additional cost to you, earn affiliate marketing commission if you make a purchase. Thanks for your support! Share this post with your friends! Not only does fat oxidation itself increase, but your body starts producing enough ketones that they can be used as a significant source of fuel as well. Ketones are derived from partially metabolized fat, and they can be used in many of the same tissues of the body as glucose can, including much of the brain. The benefits of using fat and ketones rather than glucose for fuel are many, and are the main subject of this site. However, it takes time for the metabolism to adjust to producing and using ketones at a significant rate. Even though changes are evident within days of carbohydrate restriction, improvements continue for weeks. In brief: Carbohydrate- based fueling is a self- perpetuating cycle: it runs out quickly, and every time you eat more carbs you delay adaptation to fat- burning. Fat- based fueling is sustainable, because it allows access to a very large store of energy without you frequently stopping to refuel. About 1. 00 grams can be stored in the liver, and about 4. Muscle glycogen can only be used by the muscle it is stored in — it can't go back to the bloodstream — so the liver glycogen is the only source that can be used to keep blood sugar stable, and provide fuel for the brain. If you are not making use of ketones for fuel, then this is not enough glucose to get through a typical day, let alone a day when you are doing something strenuous. If you depend on glucose metabolism, then you have to frequently replenish your glycogen stores or you will begin to feel tired, physically and mentally. There are basically two ways to get the necessary glucose, and only one of them involves eating it. The first is to eat carbohydrate. Unfortunately, every time you ingest more than a small amount of carbohydrate, it stops all progression toward keto- adaptation. So this strategy is a Catch- 2. It makes you continually dependent on dietary carbohydrate. It locks you in, because supply is limited, but restocking prevents other fuels from becoming available. The other way to get glucose is to let the body make its own on demand out of protein. This process is called gluconeogenesis. Gluconeogenesis is the reason that eating carbohydrate is not necessary, even though some amount of glucose is manufactured and used internally. This is analogous to any other internally produced nutrient, such as vitamin D, which we don't need to ingest, because the body makes it in response to sun exposure, or to a hormone, like adrenaline, that we make and use every day, but don't need to get from food. One of the benefits that comes directly from this physiological mechanism is that on a keto diet you will no longer need to eat so often. Skipping a meal does not become an emergency, or even a problem. What exactly happens during keto- adaptation? In the first few days of a keto diet, your body is still running on glycogen stores. This is the toughest part of the process, because in order to break the vicious cycle of glucose- based metabolism, you have to avoid eating carbohydrates, even though your glycogen stores are dwindling. Fat metabolism is still not optimized, and ketone production hasn't become significant. These combined effects are the origin of the claim that the weight lost on keto diets is due to water loss. This is easy to measure, and some keto dieters use it to know if they are hitting a low enough level of carbohydrate restriction. There is an interesting interplay between ketone use in the muscles and the brain. This means that at low levels of ketones, the brain's supply is not much affected, because the muscles intercede, but above some threshold, the brain's supply rapidly becomes much higher. The muscles in turn now rely on fat: they finally have access to a virtually unlimited supply of energy, which is particularly valuable for athletes. Much confusion has been generated by scientists not recognizing one or both stages of keto- adaptation. Be sure to get enough sodium: about 5 grams per day, or 2 teaspoons of table salt, will help prevent these symptoms. Adequate potassium may be necessary to preserve lean mass . We haven't tried this brand, but it's currently a good price. Acta Physiologica Scandinavica, 8. Thereafter they switched to a carbohydrate enriched diet during a 4- day period. The measurements were performed on the 3rd day and then repeated on the 7th day. The glycogen concentration in the thigh and the arm muscles was 4. Body weight increased 2. The total body water increased 2. The amount of glycogen stored was calculated to be at least 5. De. Fronzo (1. 98. The effect of insulin on renal sodium metabolism: A review with clinical implications. Diabetologia Volume 2. Number 3, 1. 65- 1. DOI: 1. 0. 1. 00. BF0. 02. 52. 64. 9. The primary action of insulin on sodium balance is exerted on the kidney. Increases in plasma insulin concentration within the physiological range stimulate sodium reabsorption by the distal nephron segments and this effect is independent of changes in circulating metabolites or other hormones. Several clinical situations are reviewed: sodium wasting in poorly controlled diabetics, natriuresis of starvation, anti- natriuresis of refeeding and hypertension of obesity, in which insulin- mediated changes in sodium balance have been shown to play an important pathophysiological role. The effect of a low- carbohydrate diet on performance, hormonal and metabolic responses to a 3. The aim of this study was to find out whether a low- carbohydrate diet (L- CHO) affects: (1) the capacity for all- out anaerobic exercise, and (2) hormonal and metabolic responses to this type of exercise. To this purpose, eight healthy subjects underwent a 3. Wingate test preceded by either 3 days of a controlled mixed diet (1. J/kg of body mass daily, 5. L- CHO diet (up to 5% carbohydrate, 5. Low- carbohydrate weight- loss diets. Effects on cognition and mood. Feb; 5. 2(1): 9. 6- 1. Epub 2. 00. 8 Aug 2. In the present experiment, cognitive effects of a low- carbohydrate diet were compared to those of another popular weight reduction diet over a 3- week period.. These data suggest that after a week of severe carbohydrate restriction, memory performance, particularly on difficult tasks (e. Comment: This paper is interesting. The low carb dieters experienced memory deficits one week into the diet, and long term memory problems later, but the long term memory experiments were from memories that were formed at that same one week point, and so the problems were likely to be from poor memory formation, not poor recall ability. When carbohydrates were reintroduced, cognition skills returned to normal. Taylor, professor of psychology at Tufts and corresponding author of the study. These impairments were ameliorated after reintroduction of carbohydrates. Low- carbohydrate dieters reported less confusion (POMS) and responded faster during an attention vigilance task (CPT) than ADA dieters. Hunger ratings did not differ between the two diet conditions. The present data show memory impairments during low- carbohydrate diets at a point when available glycogen stores would be at their lowest. A commonly held explanation based on preoccupation with food would not account for these findings. The results also suggest better vigilance attention and reduced self- reported confusion while on the low- carbohydrate diet, although not tied to a specific time point during the diet. Taken together the results suggest that weight- loss diet regimens differentially impact cognitive behavior. Nutrition & Metabolism 2. This was a study designed to evaluate the relative value of . The protein only diet consisted solely of boiled turkey (taken without the broth), whereas the protein plus carbohydrate consisted of an equal number of calories provided as turkey plus grape juice. Monitored for 4 weeks in a metabolic ward, the subjects taking the protein plus carbohydrate did fairly well at maintaining lean body mass (measured by nitrogen balance), whereas those taking the protein only experienced a progressive loss of body nitrogen. A clue to what was happening in this . Normally, nitrogen and potassium gains or losses are closely correlated, as they both are contained in lean tissue. Interestingly, the authors noted that the protein only diet subjects were losing nitrogen but gaining potassium. As noted in a rebuttal letter published soon after this report . Deprived of this potassium (and also limited in their salt intake), these subjects were unable to benefit from the dietary protein provided and lost lean tissue. Also worthy of note, although this study was effectively refuted by a well- designed metabolic ward study published 3 years later . Owen, Philip Felig, Alfred P. Morgan, John Wahren, and George F. Liver and kidney metabolism during prolonged starvation. March; 4. 8(3): 5. The concentration of free fatty acids.
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