Podcast - Maintaining a Healthy Weight When Dealing with Hyperthyroidism

EPISODE 12

Maintaining a Healthy Weight When Dealing with Hyperthyroidism

Although many people with hyperthyroidism lose weight, some people gain weight.  During this episode both scenarios will be addressed, as Dr. Eric will discuss both weight gain and weight loss strategies for people with hyperthyroidism.  So whether you are struggling to gain weight or looking to shed some pounds this episode will benefit you.

During this episode you’ll learn:

  • Weight gaining strategies for those with hyperthyroidism who are losing weight
  • Whether eating nutrient dense foods can help people gain weight
  • Weight loss strategies for those with hyperthyroidism who are gaining weight
  • The role of cortisol, inflammation, and estrogen dominance in weight gain

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Here is the transcript for this episode:

Welcome back to the Save My Thyroid podcast. This is Dr. Eric Osansky, and in this episode, I am going to discuss how to maintain a healthy weight. We are going to start by discussing strategies for gaining weight. The reason for this is because a lot of people with hyperthyroidism lose weight. Not everybody, so we will discuss some strategies for losing weight as well. Let’s start off by discussing why many people with hyperthyroidism lose weight.

This included me back in 2008/2009 when I was dealing with Graves’ Disease. I lost 42 pounds. Not everybody with hyperthyroidism who loses weight loses that many pounds. But in my situation, the weight loss was extreme. For others with hyperthyroidism who are losing weight, it can understandably be very concerning. Many people struggle to gain weight. This is due to the increased metabolism associated with the elevation of thyroid hormone. That sometimes frustrates people who are gaining weight.

Obviously, you want to lower the thyroid hormone levels because the elevated thyroid hormone level is the main reason for the increased metabolism, which leads to excessive weight loss in many people. So how can you lower thyroid hormone levels? Antithyroid medication is the most common method given by endocrinologists. Of course, I am in favor of natural methods although I will say that many of my patients do take antithyroid medication such as methimazole or PTU, or carbimazole for those who live overseas.

I took bugleweed, which is an herb that has antithyroid properties, and it worked well for me. Many of my patients have also taken bugleweed. L-carnitine is also a natural agent that in higher amounts can lower thyroid hormone levels.

There is also low-dose naltrexone or LDN that calms down the immune system. This is a medication that doesn’t come with the side effects of antithyroid medication although some people do experience sleep disturbances. When LDN works, it can work well, especially with Graves’ disease. If someone has a condition like toxic multinodular goiter, assuming you don’t also have an autoimmune component as well, this probably wouldn’t work for you. But if someone has any autoimmune condition, LDN can calm down the immune system, modulate that immune system response, and for those with hyperthyroidism, it can lower those thyroid hormone levels by calming down the immune system.

The problem with LDN is it is hit or miss. It doesn’t work for everybody, whereas antithyroid medication is effective in most people. The problem with antithyroid medication is that side effects are common. Bugleweed is not as effective as antithyroid medication, but in my opinion and my experience, it is more effective than LDN and doesn’t require a prescription.

You want to address the cause of the problem. Whether you take antithyroid medication or bugleweed or LDN, you want to address the cause of the problem.

Another thing I should mention is cholestyramine. It is used not specifically for hyperthyroidism; it is used in other conditions such as chronic diarrhea or toxic mold (it can bind to mycotoxins). I have had a couple of patients who took cholestyramine, so it’s not a large sample size, but it is in the research. For those who are unable to take antithyroid medication, and maybe the bugleweed doesn’t work, cholestyramine is another option to consider.

When it comes to diet, that is a common question for people with hyperthyroidism who are losing a lot of weight. Besides lowering thyroid hormone levels, they wonder what they could eat. Of course, you want to try to eat nutrient-dense foods, regardless if you are losing or gaining weight. This is the purpose of an autoimmune Paleo diet, which I commonly recommend to my patients with Graves’ Disease. Or even a standard Paleo diet. The purpose of both of these diets is to eat nutrient-dense foods. You want to eat healthy fats. Not necessarily a ketogenic diet, where you are eating a lot of healthy fats and really a low amount of carbs, usually 50g of carbs or less per day. With an AIP or Paleo diet, the carbs will be not as restrictive as a ketogenic diet.

Definitely you want to eat plenty of healthy fats, such as avocados or coconut oil. I think it’s great to cook with coconut oil, but I probably wouldn’t load your smoothies with coconut oil. In the past, I wouldn’t say I loaded my smoothies with coconut oil, but I added a tablespoon of coconut oil. If you do this it’s probably okay, but I don’t think it’s necessary. I am not scared of saturated fat like many people are, but you still don’t want to overdo it. I would say cook with coconut oil, but don’t eat a lot of coconut oil. But avocados definitely. If you are not a vegan or vegetarian, healthy meats or fish. If you are following a standard Paleo diet, then you could also eat nuts, which are a good source of fats as well.

When it comes to carbohydrates, it’s okay to eat healthy carbs in the form of vegetables. So definitely eat plenty of vegetables. Sweet potatoes, plantains, winter squash are all examples of vegetables that are higher in carbohydrates than green leafy vegetables or cruciferous vegetables such as broccoli and kale. You definitely don’t want to overdo it with those types of starchy vegetables. If you eat three or four sweet potatoes per day, that is probably overdoing it, at least in my opinion.

As far as other weight-gaining strategies besides lowering thyroid hormone levels and eating nutrient-dense foods, you also want to make sure that your gut is in a healthy state. If you have a compromised gut, you want to do things to heal the gut. A lot of people have a leaky gut. There is something called the triad of autoimmunity. According to that triad, everyone with an autoimmune condition has a leaky gut. You would want to heal the leaky gut.

Infections can be a big factor. Really anything that causes malabsorption. Also, SIBO (small intestinal bacterial overgrowth). This isn’t an infection; this is when you have too much bacteria in the small intestine. Most of the bacteria should be in the large intestine. I also should mention conditions such as Celiac disease, which is an autoimmune condition where you definitely want to avoid gluten. Inflammatory bowel disease, including Crohn’s and ulcerative colitis can all cause malabsorption. Any type of gut problem, you want to address.

Also, some weight-bearing exercises. At least some light weightlifting. Depends on your situation. Some people might be able to do more moderate weightlifting. If you’re new to this, start with light weightlifting, and that will at least put on more muscle mass, which is a big problem with a lot of people losing muscle mass with hyperthyroidism.

Let’s discuss some strategies for losing weight, for those who are gaining weight. Antithyroid medication is probably the #1 cause of weight gain in those with hyperthyroidism. It is very affective in lowering thyroid hormone levels. But by lowering thyroid hormone levels it can also cause someone to gain weight.

You want to do an updated thyroid panel. If you start out hyperthyroid, so you took antithyroid medication, you might feel that you’re hypo, but you still want to do an updated panel. And if TSH is on the higher side, again with hyperthyroidism, TSH will typically be low or depressed. If you’re becoming more hypo, TSH will be on the higher side or elevated. The thyroid hormone levels, T3 and T4, they might not be overtly low, meaning they might still be within the lab reference rate, but you might notice them on the lower side. A lot of endocrinologists will just pay attention to TSH. If TSH is elevated, then that will be sufficient for them to decrease the dose of the antithyroid medication. For many people, that can make a big difference, as far as causing them to gain unwanted weight. Decreasing that antithyroid medication can cause them to lose weight.

Carbohydrate intake. You want to limit the carbohydrate intake. You don’t want to reduce the consumption of vegetables. When we’re losing too much weight, you might want to eat more carbs. I mentioned earlier that when you’re losing weight, you still don’t want to go too crazy though. That is especially true if you are trying to lose weight. If you are trying to gain weight, you can maybe justify eating more than a single sweet potato or plantain, but when it comes to losing weight, you want to limit carb intake. That doesn’t include most vegetables as far as green, leafy vegetables or cruciferous vegetables.

But definitely when it comes to other foods that you probably shouldn’t be eating in either situation, like pasta, chips, French fries, grains such as rice or oats. I’m not saying these are foods you can never eat again. There are healthier versions of these foods. For example, some people might eat sweet potato fries and bake them, and you can use healthier oils for example. For the most part, you want to try to at least minimize these foods. Even if someone is eating a healthier form of French fries or sweet potato chips, you could still overdo it. You can still eat too many healthier carbohydrates which can cause weight gain.

I should talk about intermittent fasting. This could be a great method of helping someone to lose weight. Intermittent fasting, you would want to go at least 12 hours between meals. Many people go longer. For example, I do intermittent fasting. I can’t say I did intermittent fasting when I was dealing with hyperthyroidism because I was losing a lot of weight. If someone is losing a lot of weight, they probably don’t want to do this. Now I do it to maintain a healthy weight. I don’t do intermittent fasting to lose weight. Let’s say I might stop eating dinner between 6 and 7. My first meal might not be until 10 or 11, sometimes later. That’s 16 hours in between meals. That is an example of intermittent fasting. Some people will go 18 hours. Some people will do a 24-hour fast, or a full fast. If you’re losing a lot of weight, be cautious about this. On the other hand, if you have problems losing weight, intermittent fasting might be something to consider doing.

If someone has adrenal problems, you might want to be cautious. If someone has hypoglycemia, then you also might want to be cautious. So intermittent fasting can be great to lose weight, but there are times you want to be cautious. This might be a situation where it’s a good idea to work with a health care practitioner on this.

Cortisol. A lot of people have high cortisol levels. This could be a factor when it comes to gaining weight. For people who struggle to lose weight, it could be high cortisol. You might want to do an adrenal saliva test. While it’s true you could do a blood test, you really should look at the Circadian rhythm of cortisol. When I measure cortisol in my patients, I will do either saliva testing or dried urine testing. This will allow me to look at cortisol throughout the day and not just a single cortisol sample.

It’s also important to mention that if someone goes to a lab and get a morning cortisol, sometimes, it depends on the person, but cortisol responds to stress. Some people, their cortisol will elevate just getting the blood draw itself. It might create a false elevation. You need to keep that in mind. Of course, if you have cortisol imbalances, you want to do things to reduce stressors, but also do things to reduce stress handling. Many people find it difficult to reduce stressors, but just about everybody can do things to improve stress handling skills.

There are natural agents you can use to reduce cortisol levels. Some examples include phosphatidylserine, Relora, ashwagandha, which is a member of the nightshade family. If you are following a strict autoimmune Paleo diet, you might decide to avoid ashwagandha. I will say that I have had a lot of patients over the years with Graves’ and Hashimoto’s take ashwagandha without a problem. Just something to keep in mind. The only test that looks into cortisol metabolites is dried urine testing.

Getting back to natural agents. That is not a substitute. Taking any of these is not a substitute for working on stress handling.

Balancing the sex hormones could also be a factor when it comes to gaining weight, especially estrogen dominance. Problems with estrogen metabolism. This can cause weight gain in some people. Keep in mind that etrogen dominance doesn’t only mean high estrogen. If someone has low progesterone, that is also considered a form of estrogen dominance.

You could do testing in the blood, saliva, and urine. When looking at estrogen metabolism, the only test that really does this is dried urine testing. But if you are just looking at estradiol or total estrogens, you can do a blood test for total estrogens. You could look at estradiol in the saliva. You could also look at other estrogens, too. Estrone and estriol. You want to do things to support estrogen metabolism if this is what is causing your weight gain issues.Also keep in mind that healthy adrenals are necessary for healthy sex hormones, too.

But getting back to estrogen metabolism, certain foods such as broccoli or other cruciferous vegetables and broccoli sprouts are good for supporting estrogen metabolism. Some people will take a supplement called diindolylmethane or DIM, which is found in cruciferous vegetables, but you can also take it in supplement form. If someone does a dried urine test, and they definitely have problems with estrogen metabolism, you can assume you have problems and just eat broccoli sprouts. But if someone does a test and the test shows that they have a problem with estrogen metabolism, it is probably still a good idea to eat broccoli sprouts, but you might also decide to take a DIM supplement.

Inflammation is huge when it comes to gaining weight. You want to do everything you can to reduce inflammation. Diet plays a big role. Doing things to manage stress. We all know sleep is important, but when it comes to inflammation, if you have a lot of inflammation and are not getting sufficient sleep, it will be very difficult to reduce inflammation. You want to try to get sufficient sleep.

Then of course any inflammatory triggers, whether it’s a food trigger such as gluten, or if you have a certain infection that is causing inflammation you want to find and remove the triggers. Chemicals also. A lot of things can cause inflammation. Even toxic mold.

Vitamin D is more of a pro hormone than a nutrient, but having healthy Vitamin D levels is important in order to have an anti-inflammatory state. Also, omega-3 fatty acids. You could eat fish or take fish oils. Curcumin, drinking some green tea or ginger tea, or adding ginger to your diet in other forms besides tea. These are options to reduce inflammation.

Reducing your toxic load. Of course, we live in a toxic world, and so we are all exposed to environmental toxins that we can’t completely eliminate. But we can do things to reduce our toxic load. You want to focus on your home environment. Once you step outside, there is not a whole lot you can do. But when you are in your own home, there is a lot you can do. Diet-wise, eating organic food is important. As well as the household products, such as cleaners, cosmetics, try to use more natural versions. It doesn’t mean you have to use 100% natural cleaners and cosmetics. You want to keep some chemicals in some situations. For example, spraying the countertops every day. There is no reason in my opinion to use chemicals every single day. Same thing with your cosmetics, things you put on your body. You want them to be as natural as possible.

You also might want to consider infrared sauna therapy. Of course eating certain foods can really help with the detoxification process, so you don’t need to sweat out the toxins. But if you have it in your budget to get an infrared sauna, assuming you don’t have one already, that’s a really good method of reducing your toxic load. That is something I do a few days a week. I also do as much as I can through diet.

Let’s discuss some action steps you can take to maintain a healthy weight. You want balanced thyroid hormone levels. If your thyroid hormone levels are too high, this can potentially lead to weight loss.

Eating nutrient-dense foods. Again, important either way. If you are trying to gain weight, you especially do, but also if you are looking to lose weight.

For those who are losing weight, healing the gut. This is important for everyone as well though.

I mentioned inflammation can be a factor for people trying to lose weight. If someone has an unhealthy gut, this can also be a factor with inflammation. Either way, whether you are trying to lose weight or gain weight, you want to have a healthy gut.

You want to balance adrenals and sex hormones.

Reducing inflammation is important. You need to find the factors causing inflammation to do that. I mentioned doing things like heaving healthy Vitamin D levels, taking omega-3 fatty acids and curcumin, those things can help. But if all you do is take supplements without addressing the cause of inflammation, those supplements will have minimal effect.

Doing everything you can to decrease your toxic load. You won’t completely eliminate your exposure to toxins, but you want to try to minimize your exposure and increase your elimination of toxins.

Hopefully you found this information to be valuable. Thank you for tuning in. I look forward to seeing you in the next episode.