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Overcoming Unwanted Weight Gain in Hyperthyroidism & Hashimoto’s

Recently I interviewed Dr. Westin Childs, as he discussed how to overcome unwanted weight gain if you have hyperthyroidism or Hashimoto’s thyroiditis. If you would prefer to listen the interview you can access it by Clicking Here [1].

Dr. Eric Osansky:

With me, I have Dr. Westin Childs. We are going to be discussing unwanted weight gain in both hyperthyroidism and Hashimoto’s. I’m going to give Dr. Childs’ bio, and we will dive into the content. Dr. Westin Childs is a former osteopathic physician that focuses on helping people with thyroid problems, weight gain, hormone imbalances. He takes a functional medicine approach to these systems and believes that everyone regardless of their hormone status can get back to 100% through using a combination of natural and medical therapies. It’s great to chat with you again, Dr. Childs.

Dr. Westin Childs:

It’s good to be here, Dr. Osansky. Thanks for having me on again.

Dr. Eric:

Yep, we have already had you on my podcast. It’s great to talk with you again. This time, we will be talking about weight gain and problems losing weight. I’m sure there are some people with hyperthyroidism viewing this and thinking, “Hey, I’m losing weight,” which is also common. When I dealt with hyperthyroidism, I lost 42 pounds. There are some people with hyperthyroidism where it’s the opposite problem. When some people become hyper, they’re hoping to lose weight because most people with hyperthyroidism are women, not that men don’t want to lose weight. Either way, whether you’re male or female, a lot of people want to lose weight when they realize they are hyper, yet they are gaining weight. “What’s the deal with this? I see weight loss is a classic symptom.” Of course, with Hashimoto’s, it’s also common for people to gain weight. Either way, we know that weight gain is a common symptom. Why is that? What are some of the reasons some people with hyperthyroidism gain weight instead of losing it?

Dr. Westin:

That’s a great question. In order to talk about this, we have to get clarity on what we mean by hyperthyroidism and hypothyroidism. I want to talk about the way that I was seeing patients, the way you are, too. It will make more sense as we dive into this. Traditionally, we think of hyperthyroidism as having too much thyroid hormone. Someone is producing too much thyroid hormone, and it’s overstimulating their body in various ways. It’s causing increased heart rate, their hair follicles and cycles to rapidly turn over so they are losing hair, revving up the metabolism so they are losing weight, having more gastrointestinal function so they are having looser stools or even diarrhea.

Hypothyroid means low thyroid, so it’s the exact opposite. Traditionally, we think about people with hyperthyroidism as those people losing weight, and those with hypothyroidism are gaining weight. That is theway we think about it.

The problem is it doesn’t quite add up all the way. We still have hyperthyroid patients gaining weight, as you mentioned. First and foremost, it depends on where you’re at in this treatment, if you’re going natural or doing the conventional medical route. Let’s just assume you’re somebody who is diagnosed with hyperthyroidism, doesn’t matter if it’s Graves’ or toxic multinodular goiter. If you have hyperthyroidism, and you go see your doctor, what is your doctor going to do? They are going to reduce your thyroid function. They are taking you from a high thyroid level to a lower thyroid level; they are trying to bring you to a normal thyroid level. All of the treatments you are going to receive are going to slow down your thyroid.

Imagine if you have a level of 100. 100 is a normal thyroid function. Let’s say that when you’re hyperthyroid, that level is 200. If you go to the doctor, your doctor’s goal is to take you from 200 to 100, using methimazole in this case (it could be PTU), some sort of thyroid-blocking medication. Your doctor tries to get you to 100 from 200, but they take you to 50. In this case, they took you from hyperthyroidism down past your normal thyroid function down to low thyroid function. They effectively turned you from hyperthyroidism to hypothyroidism with the use of antithyroid medication.

Most of these medications that doctors use, in fact, all therapies for hyperthyroidism, do result in hypothyroidism. We can go through these if you want. We have antithyroid medication, beta blockers (to reduce symptoms, but those can cause problems with thyroid function as well), thyroid surgery (either hemi-thyroidectomy or complete thyroidectomy), and radioactive iodine ablation. All of these therapies that hyperthyroid patients undergo result in low thyroid function. That’s #1. We will talk about the importance of thyroid function as it relates to metabolism and controlling various aspects of your body.

Hyperthyroidism is an abnormal physiologic state. There are problems that are underlying that issue which are then manifested in the thyroid. For instance, inflammation, gut dysfunction, insulin resistance, and leptin resistance may all have preceded your diagnosis of hyperthyroidism. When you get hyperthyroid, you have these underlying issues that still exist. They can cause weight gain by themselves.

Another one I would add in there would be medication such as beta blockers. We talked about methimazole and antithyroid medications. Other medications including SSRIs, antidepressants, narcotics can all impact thyroid function as well. If you are a hyperthyroid patient taking some of these medications, these can also slow down your thyroid beyond which would be normal for you and lead to weight gain or at least conditions that exacerbate weight gain.

I would say those are the three or four main ways that hyperthyroid patients can start gaining weight. Actually, I would say this is very common. Another thing that is worth mentioning, if I could take a couple seconds here, is explaining the difference between the people that would probably be going to see their conventional doctor versus the people seeing you.

Let’s say you were diagnosed with Graves’, the most common cause of hyperthyroidism. You have one of two options. You can go the natural route and try to avoid the antithyroid medications, using supplements, diet, and lifestyle, which would probably lead you to someone like Dr. Osansky. Or you can go to your doctor, which is what most people do. Then they go down that path of taking antithyroid medications.

Depending on which path you take, the outcome is going to be a little bit different. If you’re going down the path where you are trying to do things more naturally, you will be using supplements perhaps instead of medications. Maybe you’re using motherwort or bugleweed instead of antithyroid medication. They aren’t necessarily as powerful as the medications, which means the thyroid function won’t go from 200 down to 50. Instead, it might go down from 200 to 125. You’re still borderline hyper in that case, which means you are more likely going to lose weight on that route versus taking the more aggressive route of using medications.

The distinction between which path you’re taking, where you’re at in the life cycle of treatment (Did you get your thyroid removed? Ablated? What type of underlying issues do you have?). It’s a complicated scenario, and it depends on the individual and where they’re at. That’s a long-winded answer, but that’s how I think about it.

Dr. Eric:

I do see a lot of patients on the medications. Usually it’s the methimazole, becoming hypothyroid. Sometimes it is extreme. As you said with the beta blocker, propranolol could affect conversion of T4 or T3 and some others as well. Very interesting as far as you mentioned that they could have underlying conditions like insulin resistance or leptin resistance before they developed hyperthyroidism. They may not be aware of that condition because when they go to see the endocrinologist, they are focusing on the hyperthyroidism, doing the thyroid panel. They might do a comprehensive metabolic panel, looking for glucose, but that doesn’t always tell if someone has insulin resistance. They might do a CBC with differential.

Let’s talk a little bit about insulin resistance and leptin resistance with both hyperthyroidism and Hashimoto’s. How do those impact weight loss? How do those lead to problems losing weight?

Dr. Westin:

That’s a good question. The relationship is such that insulin resistance can cause weight gain. Also, thyroid dysfunction can lead to insulin resistance. It’s an underlying cause, which may precipitate weight gain. Once you have the thyroid problem, that is also going to make worse insulin resistance.

Those of you listening probably have some awareness of insulin and leptin. Insulin is a hormone secreted by the pancreas. Its job is to control blood sugar levels. What happens as a result of lifestyle, chronic stress, the overconsumption of sugars and carbohydrates, your body becomes resistant to the effects of insulin inside the body. It’s very common. Statistics put it as high as 50% of all people in the United States have some degree of insulin resistance. You can think of it existing on a spectrum. Some people have very severe insulin resistance, and some people have it less severely.

Just discussing my experience in looking at and treating people, most people who end up with thyroid problems already had some level of insulin resistance before their diagnosis of their thyroid problem. The problem with insulin resistance is it can stir up inflammation inside of the body. It can cause various conditions, including metabolic syndrome and cholesterol problems.It’s impacting how well your body is able to utilize sugars inside the body and where they go. When insulin resistance is present, it’s sending the signal to your body to push more of the foods that you eat inside of your fat cells. The way I think about it is when insulin resistance is present, losing weight will be very difficult for that reason.

In the case of hyperthyroidism, we have a double whammy thing going on here. Hyperthyroid states do result in insulin resistance. At the same time, hyperthyroid states, if left untreated, also usually result in weight loss. You have this ebb and flow wherein the hyperthyroidism, if causing weight loss, is sensitizing the body to insulin while simultaneously causing insulin resistance. There is probably some teeter-tottering that occurs there. Depending on where you are at in the treatment, with antithyroid medication, that may tip you more over into the insulin resistance side of things as opposed to the insulin sensitizing side of the equation. It’s a seesaw effect.

Leptin is another story. I would consider that to be a fat-storing hormone as well. Leptin is also a hormone secreted by fat cells instead of the pancreas in this case. It’s probably the most important and underappreciated hormone as it relates to your ability to lose weight, especially if you are a thyroid patient.

The way it works physiologically speaking is that as you gain more weight in your body, as your fat cells accumulate in size, they start to secrete more leptin. The goal of that is for your fat cells to communicate with your brain. They don’t have a direct messaging system built in, so they start secreting leptin out. It floats up to the brain, triggers the hypothalamus, and is supposed to be the communication between the fat cells and the brain, when fat cells are high, to tell the brain, “Hey, we need to change whatever we’re doing. We need to increase metabolism. We need to alter our appetite. We need to alter enzymes and protein production,” such that we start burning off fat so we can lower these leptin levels. That is the communication between leptin, your fat cells, and your brain.

The problem is the communication is between the fat cells and your brain in the hypothalamus. That is the same area that the thyroid is being regulated. We have the hypothalamic pituitary access that is then involved with the thyroid gland. Leptin and thyroid hormone are connected to each other such that when you have problems with thyroid hormone or leptin, you have problems with the other. It’s a bidirectional relationship there. When there is an issue with leptin, there is an issue with thyroid hormone. When there is an issue with thyroid hormone, there is an issue with leptin.

Leptin is one of those that we’re not looking for. We know the importance of insulin because people have diabetes or metabolic syndrome, etc. I was ordering it a lot. Are you ordering a fair amount? Where do you sit on the leptin thing?

Dr. Eric:

I can’t say I order leptin in a lot of patients. After our first interview, I started doing it more with some patients, mainly if they are gaining weight and having problems losing weight. I do commonly recommend insulin testing, doing a fasting insulin along with hemoglobin A1C. I don’t know where you stand on those markers. With leptin, a few months ago, I started, depending on the person. I can’t say everyone with hyperthyroidism or Hashimoto’s, maybe I should, I don’t know.

Dr. Westin:

It depends on their symptoms. If weight is in the equation, if it’s a problem for them, I would always recommend getting it. In order to test for leptin, you need to be in a fasted state. Typically, I will test for leptin and insulin because you want to be in a fasted state for insulin, too. You can check your cortisol and thyroid function at the same time. You can get a good idea of what’s happening in the body by checking all of these hormones at the exact same time.

Leptin is one of the most important fat/weight loss hormones, however you want to describe it. If it’s dysregulated, weight loss is going to be very difficult. I can talk a little bit about leptin resistance if you don’t mind.

Dr. Eric:

Sure.

Dr. Westin:

Leptin resistance, and its diagnosis, is something a lot of doctors are unfamiliar with. If you are going to a conventional doctor and saying, “Hey, can I check my leptin? I heard that it’s important for losing weight. I’m not losing weight. What’s the deal?” Leptin plays a big role in this obviously. The problem is a lot of doctors are not familiar with the physiology we just described. Let me explain what happens with leptin resistance.

Similar to insulin resistance, if you have leptin resistance, your body becomes desensitized to the leptin that’s there. Remember, under normal physiologic conditions, as fat cells increase, leptin levels will increase, too. That leptin is supposed to go to the brain and tell the brain to make some changes. We need to do something to lower fat cells.

When you become resistant to leptin, either because your fat cells are inflamed, or you have some underlying issue like a thyroid problem, which people here will likely have a combination of both, especially if you have an autoimmune-related issue, that system becomes dysregulated, and the brain is no longer sensing it. What ends up happening is that leptin levels increase, and your body, instead of getting the signal that there is too much there, it ends up getting the exact opposite signal. It thinks there isn’t enough leptin to go around because it’s resistant to it. What does that do? That triggers more appetite. That triggers a decrease in metabolism.

Now you have the exact opposite of what should be occurring actually happening inside of your body. This is where people who have thyroid conditions get ravenous appetites, where they are already overweight. Maybe they are reducing their calories already to 1,500 per day, but they are still gaining weight. Their metabolism is the highest it can possibly be. You have this mismatch between appetite and metabolism even though you are already overweight, and it should be changing. But a lot of that is driven by the mechanism of leptin resistance.

Dr. Eric:

Makes sense. Similar with insulin resistance, that’s what you’re looking for on a test. You’re looking for the leptin to be high, and the person is going to have an increased appetite and still going to want to eat. That won’t help. Is it safe to say that even in cases where they are restraining themselves from eating, it still might not be enough? If someone just changes their diet with leptin resistance- I find that with insulin resistance, it’s usually an inflammatory component. The person could be following a ketogenic diet, and they might lose weight. Depends on the person. Some people, still following keto, might struggle with making the dietary changes alone, or in combination with exercise. I don’t know if you found that when you were seeing patients.

Dr. Westin:

Definitely. If you werein a position like ours where you get to see a lot of different patients, you get to see how they react to different diets and protocols, it becomes easy to look at it from a different angle than most people do. If you are looking at it from the perspective of if you want to lose weight, all you need to do is reduce your calories and exercise more, and if you’re not losing weight, then you’re not doing that, there is something wrong with that model. It doesn’t apply to everyone, especially those with thyroid situations.

I can recount numerous examples of patients who are eating 1,000 calories per day. I have no reason to suspect they are lying. I believe they are telling the truth when they say that. Most people will say, “They are eating more than they say they are.” That may happen in some instances, but I believe most of the time, people are pretty accurate, plus or minus 10-15% of their caloric intake, if they are tracking it pretty rigorously. The problem is you have a lot of these thyroid patients who are consuming 1,000 calories per day but still gaining weight. What gives? I put them on the ketogenic diet, elimination diet, AIP, carnivore diet, all sorts of types of diets with these people, and they still don’t lose weight. This tells me that there’s something more to this idea that weight gain is primarily driven purely by calories.

In the case of thyroid patients, including those who have had their thyroid removed, a lot of it is driven by hormones. More important than calories, even though calories are important, is what is happening inside of the body at the level of the hormones? A lot of people know this. This is why the ketogenic diet exists. They will say, yes, calories are somewhat important—how important is debatable—but they believe insulin is the primary driver of weight gain. The whole goal of the dietary recommendations of the ketogenic diet and the carnivore diet to some degree is to reduce as much stimulation of insulin as we possibly can. Therefore, we will sensitize the body to insulin, and we will lose weight. They do that and still don’t lose weight. There is something else involved other than insulin.

I would say insulin is important, but there are other hormones just as important, including thyroid, cortisol, sex hormones, leptin. If you are a thyroid patient struggling with weight, my opinion—and I have had a lot of success in helping people lose weight—is to focus more on the hormones than the calories. Yes, you definitely can and should focus on the quality of the food you’re eating and even the quantity to some degree. We can talk about that if you want.

I’m sure you have shared a similar experience to me, where you see people doing exactly what you say, and I have no reason to believe they are lying about how much food they’re consuming, and they are still gaining weight, or at least not losing it. What do you do at that point? How do you explain this away? My explanation is these hormones are taking a front seat to calories. They’re most important. That’s where I sit on calories versus hormones when it comes to weight gain.

Dr. Eric:

Let’s talk about diet. You mentioned quality versus quantity. What do you typically recommend when it comes to diet?

Dr. Westin:

I think it depends on the type of person we’re talking about here. In this discussion, we’re talking a lot about hyperthyroid patients. I would say the way that you would treat a hyperthyroid patient who is undergoing natural therapies to treat Graves’ is going to be different than the dietary recommendations for someone who had hyperthyroidism who underwent a thyroidectomy or radioactive iodine ablation. You have to stratify what type of patients we’re talking about and what problems we have.

In the case of someone who has active inflammation going on in the body, we are suspicious they have elevated antibodies floating around in their bloodstream. We will use Graves’ as a prototypical example here. They are trying to treat Graves’, maybe with methimazole or not. The goal of their dietary changes should be to reduce inflammation and alter immune function. I would look into diets such as the elimination diet, a whole food-based diet, AIP diet. Anything that is reducing any stimulation from foods that might stir up inflammation inside of the body, leading to worsening thyroid function, weight gain, etc.

That is different from the person who has undergone thyroidectomy or radioactive iodine ablation. That is a person who could be different in their dietary approaches because presumably they don’t have the same immune/inflammation aspect. Yes, they may have some inflammation underlying their condition, but you can treat them differently.

I would recommend focusing more on intermittent fasting, prolonged fasting, water fasting. You still want to be cognizant of the quality and quantity of food you’re eating. Any whole food-based diet would be good in this situation. You could play around with the ketogenic diet, carnivore diet, or whole 30 diet. As long as the quality of the food is high, the actual weight loss will come as you start focusing on those other hormones I mentioned.

That is a different approach than I would take to the person who is hyperthyroid with an active immune dysfunction we mentioned previously. That is someone you don’t want to put on a fasting regimen. Fasting may make them worse or cause more weight gain.

Also, how are you going to make changes to their diet based off of their personal preferences? I am not the type of person who thinks you can apply a broad stroke to everybody with a thyroid condition. This universally is the best diet for hyperthyroidism. This is the best diet for Graves’, etc. I don’t think that works. I try to take a more individualized approach to dietary management of a particular patient. That works the best. I have had people who have lost weight consuming high carbohydrate diets or high potato diets with lots of fiber and everything in between. The one thing I’ve found is that no two thyroid patients are really alike. They can have similarities, but they are not the exact same in terms of what’s going to work for them.

Dr. Eric:

Agreed. There is no diet that fits everyone perfectly. I’m glad you brought up fasting. I agree that when it comes to my hyperthyroid patients, I typically don’t recommend intermittent fasting. Interesting when you mention someone who gets a thyroidectomy or radioactive iodine that you do recommend fasting. With Hashimoto’s, I’m guessing you also don’t recommend fasting since it’s more of an active inflammatory state like Graves’.

Dr. Westin:

Actually, I do recommend frequently fasting with Hashimoto’s. It depends on thyroid function. My hesitancy in recommending fasting in the case of active Graves’ in which you’re being treated naturally is that the fasting state might cause overstimulation of metabolism and lead to worsening weight loss beyond the point that you want.

In the case of Hashimoto’s, you do have some people who have a hyperthyroid state, and they can fluctuate in and out of hyperthyroidism. That is usually uncommon. Usually Hashimoto’s, low thyroid function generally, but it can fluctuate up and down. Hyperthyroidism with Hashimoto’s, that does occur. But in the case of Hashimoto’s, most people are hyperthyroid, and fasting does have benefits in terms of its impact on inflammation and other areas inside of the body.

It is beneficial in the case of autoimmunity. If someone had MS or any sort of lupus or other autoimmune diseases, I still think fasting is highly beneficial for those patients. I would say fasting as a therapy, outside of its impact on weight loss as it relates to thyroid function, is still beneficial. Fasting should be used if possible. In the case of Graves’, I think it can be used, but it should be used cautiously. Hopefully that clarifies my standing on that.

Dr. Eric:

It makes sense. I’m just concerned that it might exacerbate the hyperthyroid state, but to play it safe, you would say probably on average, a person with hyperthyroidism, even if they are gaining weight, maybe not due to intermittent fasting, at least not right now. With Hashimoto’s, you do recommend, as well as those who receive thyroidectomy or radioactive iodine.

Dr. Westin:

Yeah, that’s a good way to think about it. It’s all based on the situation. I do think there are situations in which somebody who has Graves’ could do intermittent fasting or start out with mild fasting. You could do maybe 14-hour eating windows or 16-hour eating windows. When I talk about fasting, I’m generally recommending prolonged fast, water fast, or dry fast of 24 hours or more. That is where you get those therapeutic benefits I was mentioning previously. I’m a big fan of using fasting as a therapy for weight loss but also for treating autoimmunity or balancing immune function.

Just be cautious. The worst thing you can do is if you run out and start doing a two- or three-day fast and are already in a hyperthyroid state, and you start catabolizing some of your muscles, that is not what you want to do. Before you run out and do something like that, touch base with someone that understands this philosophy, so you don’t put yourself in a worsening situation. I don’t ever want to lead anyone down that path.

Dr. Eric:

You briefly mentioned cortisol. How does that play a role when it comes to weight gain? High cortisol will have a greater impact than depressed cortisol levels.

Dr. Westin:

Cortisol is another really important hormone. In fact, I would say in terms of its impact on weight, it’s not as important as insulin or leptin. I would put those up there as 1 and 2. They are the most important hormones as relates to your ability to lose weight. I would put thyroid hormone up there as three. Cortisol is important, but not as important as the other ones we have been discussing.

Just a brief physiology for those who aren’t familiar: Cortisol is the hormone secreted when you are under a lot of stress. Its whole goal is to help you adapt to stress. Normally this is not a problem, and it can be a good thing. Much like these syndromes we have been talking about previously, whenever something becomes overstimulated, that is when it becomes a problem.

We commonly refer to this as adrenal fatigue or adrenal-related issues or even cortisol resistance. When cortisol is becoming overstimulated inside of the body, the body is no longer utilizing it as well as it once was. A lot of people believe that as your body becomes more pressed with stress over a long period of time, cortisol levels tend to increase. Over time, your body loses ability to handle that production, and it peters out and goes down. That cycle of cortisol production has mostly been debunked. I don’t necessarily believe that is the case. I have seen people with weight gain with low cortisol as well as high cortisol and everywhere in between.

My way of looking at cortisol is more of what’s happening at the cellular level. As you mentioned, absolutely, high cortisol tends to be the thing that triggers weight gain. We also have to expand our thinking beyond what is the absolute cortisol level inside the blood? How are the cells able to utilize and manage cortisol? Is it efficient or inefficient? How does that impact weight?

I do think it’s worthwhile checking cortisol. That’s why I mentioned to grab your fasting leptin, fasting insulin, serum 8am cortisol, thyroid hormones, sex hormones. You can grab all these at the same time. But they need to be looked at in context. No single lab test can be looked at in isolation. You can’t just see that your cortisol is 16; therefore, it’s fine. It may be fine, but you also may have some degree of cortisol resistance, in which case cortisol is causing a problem.

Furthermore, this is compounded by the fact there is a close relationship between cortisol function and thyroid function such that usually, especially in the case of hypothyroidism, but also with hyperthyroidism, changes to your thyroid function will impact cortisol levels as well. This has been my experience, and you can chime in here, too. I have yet to meet a thyroid patient who didn’t also have some cortisol-related issue.

How you treat that is up in the air. If someone is hyperthyroid, maybe you want to lay off some of the adaptogens and use a more mild version. I’m a big fan of using adaptogens and glandulars in the hypothyroid patients. That includes people who have had radioactive iodine or thyroidectomy. In the case of active Graves’, you might want to use a different type. You can also do things like meditation, stress reduction, improving your sleep, and mindfulness. There is so many things you cando to improve your stress outside of taking an adaptogen. I am a big fan of using adaptogens in certain cases of thyroid patients.

Dr. Eric:

It sounds like cortisol is a factor, but you would say the top three are leptin, insulin, and thyroid hormone. Cortisol would potentially be a factor, but it would be #4.

Dr. Westin:

This is the helpful way to think about it. I don’t think this is exact. Let’s imagine somebody is 50 pounds overweight. The conventional thought might be, “That weight is because I have gained 50 pounds. I have been eating too many calories.” I would say to scratch that.

When I was treating patients, this worked effectively. Some fraction of that 50 pounds is due to leptin resistance. Some fraction is due to insulin resistance. Some fraction is due to cortisol. Some fraction may be due to sex hormone imbalances. The thyroid regulates all of these things. If you have a thyroid problem, you will have a problem in all of these areas.

What you will see is somebody who comes in, gets treated, starts doing a ketogenic diet. They lose 10 pounds. You have treated the insulin resistance fraction, but you did not address the leptin, sex hormones, or cortisol. It’s not until you address the complete hormone disruption inside of your body that you will lose that complete 50 pounds of weight. Everything is contributing either together or in concert. There is never really a case where someone just has 50 pounds of weight gain related to their insulin level. All they need to do is go on the ketogenic diet and lose weight because they fixed that problem. That does happen, but that’s very rare. Most common is someone does something and loses 2-5 pounds and they plateau.

What’s going on here is you didn’t address those other hormone imbalances we talked about previously. That is how I would wrap my head around it. That is the way I would explain it to patients I would treat in the past. That seemed to work the best. We addressed one problem and then looked at how much is left over. We would see leptin resistance is still here. We just checked your leptin levels again, and it’s still high. Leptin needs to be addressed still. Then they lose 25 pounds and have 25 pounds left to lose. We need to address leptin in order to get that down.

Whenever you are trying to lose weight, a plan should be multifactorial. It should have a lot of different therapies. It should never just be,“I am going to go on the ketogenic diet, and that’s that.” That’s a recipe for losing a couple pounds and maybe damaging your thyroid in the process, especially if you’re eating pro-inflammatory foods. It’s easy to do some of these diets in the wrong way. That is how I would think about that. I hope that’s more clear.

Dr. Eric:

Another hormone I want to throw at you is estrogen. If someone has estrogen dominance, whether it’s too much estrogen or not enough estrogen in relation to progesterone, I’m guessing not as big of a factor as the insulin, leptin, thyroid. Would you say that could also be a factor?

Dr. Westin:

Absolutely. 100%. I would say sex hormones are also heavily neglected by conventional doctors as it relates to their impact on weight. As you mentioned, it’s less important in men. Testosterone is important in both men and women in terms of its impact on immune function and weight loss. Estrogen is important in primarily women. It is important in men as it impacts libido and so on, but for women, it’s much more important.

What’s really important is not your absolute estrogen levels, so much as it is the balance between estrogen and progesterone. This is the way I explain it to people: Imagine we took 100 women, lined them up in a line, and looked at the physique of each of these women. There will be differences in terms of ratios, heights, busts, thighs, weight, everything. Those differences are primarily related to the impact of these sex hormones on their body during development. That is how you can think about what estrogen is doing.

If there is a relative imbalance of estrogen such that estrogen is much higher than progesterone, you will start to develop certain things. You will develop weight gain, usually in the breasts, hips, thighs, and butt. That is what estrogen does. Estrogen is stimulatory to adipose tissue. That is physiology 101. If you have too much stimulation of estrogen, the fat cells in those areas are going to enlarge. It’s as easy as that.

How you get to this state of estrogen dominance, there are a couple ways. You can have an absolute increase in estrogen levels, which means that estrogen can go up, progesterone stays, and the gap between the two widens.

You can have a reduction in progesterone, which is pretty common, especially as women are aging.

You can have a combination of estrogen staying the same, if not falling, but progesterone falling more rapidly than estrogen is falling, so the gap is still widening even though they are both going down.

Then you can also have exposure to endocrine disrupting chemicals or xenoestrogens. These are compounds you come in contact with. Milk and dairy products have a lot of these things. They stimulate the estrogen receptor cells inside the body. They act as if estrogen is there even though it’s not. You can have a relatively normal estrogen and progesterone, but due to overstimulation at the cellular level, it is appearing to the body as if estrogen levels are higher than they really are. That one is more difficult to diagnose because you can’t really test for it. There is no test for EDCs really. At least none that are available to most people.

The other ones are more common. You can check for estrogen and progesterone levels. You can look at the serum levels and see how they are changing. The problem is women have menstrual cycles. Those levels fluctuate over time. If you don’t know how to test estrogen and progesterone levels, and you are not consistent in how you’re testing them or what time of the month you’re testing them, then the levels are going to be whatever. Nobody really knows what to do with them necessarily unless you’re testing consistently at a similar interval.

To answer the question, I think estrogen is very important, especially for women. The way I would think about it in women who are gaining weight is you want to look at where that weight is being placed on your body. Where you are gaining your weight can tell you a lot about what type of hormone imbalances you have inside of the body. For instance, is the weight primarily in the hips and thighs area? Is it primarily in the breast? Is it in the abdomen? Abdomen tells you something different than in those other areas. Think about where the weight is being gained. Think about how it’s presenting on your body and how rapidly it’s occurring. That can tell you a lot about what hormones you should be looking at. Even if the hormone lab tests aren’t 100% indicative of what’s happening, you can look at the patterns on your body, and that can give you a lot of information.

Do you mind if I talk about testosterone as well?

Dr. Eric:

No, not at all.

Dr. Westin:

Testosterone is really important for both women and men, and especially those people who have autoimmune thyroid disease. There is some debate inside the medical community- Let me put it this way. We know women tend to get autoimmune diseases at a higher frequency than men do. No one knows why. Some people thought it might be due to the baseline level of testosterone in men versus women. Men have much higher testosterone levels than women do naturally. Women tend to get autoimmune disease, sometimes 8-10x more commonly than men. They thought it was because of that. In fact, we do have studies that show testosterone is playing a role in the immune system in some ways.

I do think low testosterone is very common in women who have Graves’ or Hashimoto’s because they are both autoimmune diseases. We also know the thyroid is impacting testosterone levels. We also know testosterone impacts your weight through its impact on lean muscle mass, energy levels, libido, and mood.

Testosterone is very important because it can be used as a therapy not only to treat the underlying autoimmune disease, but it can also help with weight loss. That is assuming your testosterone is low. Testosterone is like a secret therapy if you will for treating autoimmune disease because of its impact on weight and autoimmunity.

Treating estrogen is more difficult. You rarely ever want to give a woman an estrogen hormone, like a bioidentical hormone, unless they are in menopause. If you are a premenopausal woman, estrogen is off the table in terms of hormones you should be taking. Progesterone and testosterone can both be used, but not estrogen. That is why I say focusing on testosterone can be beneficial because increasing that can cause a good impact on immune function and weight loss.

There are roundabout ways of increasing testosterone such as using DHEA. I don’t know if you recommend DHEA at all. The problem with DHEA is it is a precursor hormone to the other hormones downstream. Giving someone DHEA and hoping they produce more testosterone doesn’t always work. Someone might take it and use it as a precursor to produce more estrogen instead of the testosterone you want them to produce. In this case, you’re worse off than you were.

There are different things you can do as a patient. You can get testosterone creams and gels. You can use DHEA. Pregnenolone can be a potential option. That can also be used for the treatment of cortisol issues.

The topic of hormone balance can get complex. It’s very nuanced. It depends on the person. It’s hard to give broad statements and recommendations for individuals in this setting.

Dr. Eric:

What I’m sure people are wondering is the action steps they should take, the solutions. If someone has hyperthyroidism or Hashimoto’s, and they are struggling to lose weight, as far as testing goes, the testing as you mentioned does probably depend on the person. Let’s say if someone goes to a functional medicine practitioner or does some testing on their own, these days you can go to a lab and test yourself for insulin, leptin. If someone finds out they have higher insulin and/or leptin and maybe some of these other imbalances, how do you get these hormones in balance? What would you recommend?

Dr. Westin:

There is a lot of things you can do. We could probably spend an hour or more talking about treatments. Let me try to distill it down to this. The first place you want to focus is your thyroid. That is the thing that will have the most impact in this setting. If you are not a thyroid patient, you want to focus on your leptin. In the case of these thyroid patients, they have thyroid problems. The first thing to do is address thyroid function.

Let’s assume you are someone with hyperthyroidism, and you are not taking antithyroid medication. What you want to do is address the autoimmune aspect of it. Try to get thyroid function back to normal as quickly as possible.

If you are taking antithyroid medication, try to get off it. The best thing you can do is get off of methimazole. It is the brakes on your metabolism. If you are taking methimazole and gaining weight, the single best thing you can do is whatever it takes to get off of it. That does not mean to yank yourself off of it. I am talking about doing the natural therapies that balance immune system and function. Take supplements you need. Fix your gut. All those underlying issues we have been talking about. That is where I would start, without getting too depth into those. That is the best thing you could do for that person. Try to get that under control as quickly as you can. That will give you the most bang for your buck in terms of efficiency.

The second thing you would want to do, which goes along with the first, is adjust diet and consider fasting. The reason I say these is because there are other therapies. We have medications, sauna therapy, detox therapy, cryotherapy, and more. Diet and fasting are two things that you are in control over. You may not be in control over what medication your doctor is giving you, but you do have control over what you put inside of your mouth. Focus on the diet as much as you can. On the flip side, with fasting, you can control what you don’t put in your mouth since you are going without food. If you have found you are in a situation where fasting is safe, use that. No matter what, focus on your thyroid and do your diet.

When it comes to people who have undergone thyroidectomy or radioactive iodine ablation, and I’m not sure how many of those people are listening here, that is a different story. The philosophy of addressing your thyroid is still the same. However, in this case, that means you will have to address thyroid medication. In the case of hyperthyroidism, you’re still producing some, in abundance in most cases.

In the case of thyroidectomy or RAI, they no longer produce thyroid hormone, which means they are 100% reliant on thyroid medication as their primary source of thyroid hormone. This means if you are trying to optimize your metabolism, you have to adjust this thyroid medication. That makes it more difficult because that means it’s outside of your hands and in the hands of the doctor.

Thyroid function, no matter where you’re at, is the first thing to focus on. If that means getting off of antithyroid medication, balancing your immune system so your body stops overproducing it, that will go a long way with inflammation. Or on the flip side, if you still need to take thyroid medication, that’s #1. #2 or 3 would be diet or fasting. Fasting for sure in the case of RAI and thyroidectomy. Possibly in the case of active Graves’, where you don’t take antithyroid medication. Is that a decent starting place? We could go into more detail if you want.

Dr. Eric:

That’s great. I assume also stress management for cortisol. How about supplementation?

Dr. Westin:

Sure. That is going to depend heavily on the type of hormone imbalances that you have. Preceding the treatment recommendations I mentioned, you want to get testing first because testing will help direct the type of therapies you will be focusing on.

Let’s say you get your insulin checked, and it shows that you have a significant amount of insulin resistance. That means you can now focus your supplementation on treating that problem. You could use dietary fibers, konjac, glucomannan, fish oil, turmeric. In the case of insulin resistance, you can target supplementations to that particular issue.

In the case of leptin, let’s say your leptin is high, there are some things you can do. Glycosaminoglycans, l-glutamine. Those are particularly beneficial. Fish oils is another one beneficial for both leptin resistance and insulin resistance. I will throw berberine on as well even though that is more of an insulin resistance issue.

In the case of thyroid, let’s say you’re trying to balance your immune system. in that case, your supplementation will be directed more toward your immune system: magnesium, Vitamin D, zinc. It depends on what the underlying issue is and how you want to address that.

Universally, some good supplements everyone could benefit from would be a solid multivitamin, Vitamin D, probiotics, magnesium.

Dr. Eric:

You said Omegas.

Dr. Westin:

Fish oils, Omegas. Let’s say somebody doesn’t know what their lab tests are. These would be the things you could start with right away. The goal of these wouldn’t be to help with weight loss, but to level the playing field. Replace lost nutrients to the body, so that it is functioning more optimally and can take care of itself.

I would also add protein powder regardless of whatever situation you’re in. It’s really good for managing appetite, helping build lean muscle mass, and some other benefits. It’s general supplementation for pretty much anybody with thyroid conditions. You’d be safe to use those.

Dr. Eric:

Any specific type of protein powder? Pea protein, whey protein, etc.

Dr. Westin:

In the case of autoimmune disease, generally you want to stay away from whey-based protein powders. Some people can get away with it. The benefit to whey protein is it has a pretty robust increase in glutathione naturally based off the amino acid profile, which is amazing for anybody who has thyroid inflammation, which is all autoimmune disease. If you can, you would want to use whey protein for the pure benefit of getting more glutathione. The problem is it also has an immunogenic component, wherein it can cause worsening inflammation inside the body.

If you can get by with whey, it can be beneficial in some situations. But you’re more safe starting with a pea-based protein or plant-based protein. Avoid the whey for now until you can tolerate things and get your gut function under control. Stick with the more vegan plant-based proteins to start for thyroid patients. Maybe you can dip your toes in whey.

Another one would be egg protein, which is pretty good if you can get it. You can also try bovine-based protein powders as well. Those are good for AIP diets. You can play around with the various types of powders available. If it’s getting into the weeds, focus on the pea-based protein powders. Those are the best places to start.

Do look for fillers, binders, hidden dairy in there. If you are going to the grocery stores and grabbing a vegan protein powder, you never know what’s in it. All sorts of artificial flavors, dyes, fillers, binders, that’s all stuff you want to avoid. Make sure you’re getting a good-quality protein powder that doesn’t have any added ingredients.

Dr. Eric:

I agree. I typically don’t recommend whey. I threw that out because a lot of people do consume whey protein powder. I agree that the pea protein, the hydrolyzed beef for AIP. Even pea protein, I find if someone is following AIP, they can tolerate a good organic pea protein in most cases.

Dr. Westin:

I think so, too. A lot of people will say, “I can’t use this because I’m on AIP.” I don’t see any issue usually. There are 5-10% of people who don’t fit the mold, and they always react. For the most part, I think it’s fine. It sounds like our experience is pretty similar there.

Dr. Eric:

As you mentioned, we could go on probably for another hour. Unfortunately, we gotta wrap things up. Where can people find out more about you?

Dr. Westin:

You can go to my website, RestartMed.com. You can search my name, too. I have a podcast, YouTube, Instagram, Facebook, Pinterest, you name it. I have a bunch of free downloads. My information tends to focus more on hypothyroidism. I do talk about all types of thyroid conditions. Generally, the people who are coming to seek information from me are people with hyperthyroidism who are now hypothyroid. These are people who have undergone radioactive iodine ablation or thyroidectomy. I have some information on hyperthyroidism, but not as much as you, since you primarily focus on it, right?

Dr. Eric:

I would say 80% of my patients are hyperthyroid. I do work with some Hashimoto’s patients though.

Dr. Westin:

It was a flip for me. I still have information on both. Still obviously enjoy helping patients with any type of thyroid problem. Doesn’t matter to me what they have. That’s my passion.

Dr. Eric:

Wonderful. Thanks, Dr. Childs. It was great chatting with you again. Look forward to having yet another conversation in the future, whether it’s about losing weight or some other topic related to thyroid health.

Dr. Westin:

Let’s do it. I think it’ll be good. Pleasure being on here.