Common perception implies that hypothyroidism causes excess body weight. But which comes first, excess weight or hypothyroidism? Is your weight loss challenge because of hypothyroidism? Some of you have hypothyroidism , obesity and Polycystic Ovarian Syndrome (PCOS) , all three together. Is that a coincidence? But your hypothyroidism has been treated and you still can’t lose weight! What is going on?
How Much of Your Weight is Influenced by Hypothyroidism?
Massive weight gain is rarely associated with hypothyroidism. In general, 5-10 pounds (2.2-4.5 kgs) of body weight may be attributable to the thyroid, depending on the severity of the hypothyroidism. Finally, if weight gain is the only symptom of hypothyroidism that is present, it is less likely that the weight gain is solely due to the thyroid.
Once hypothyroidism has been treated and thyroid hormone levels have returned to the normal range of thyroid hormone, the ability to gain or lose weight is the same as in individuals who do not have thyroid problems.
Obesity And Hypothyroidism: Chicken And Egg?
Obesity or hypothyroidism,which comes first? It turns out that people who have excess body fat often have sluggish thyroid function and those who have sluggish thyroid function have more body fat. While the chicken and egg question may not be answered yet, what is definitely known is that FAT LOSS IMPROVES BOTH!
Why Can’t You Lose Weight?
Weight loss or more importantly, maintaining your weight loss is a challenge for many of you. In fact, studies show that weight regain occurs even in those who have had weight-loss surgery. (2) 2 ( Though I use the terms weight loss and fat loss interchangeably, there is a distinction between the two. Your weight includes your body fat, muscles, organs, fluids, and bones. Therefore, when you say weight loss, I assume that you mean fat loss. You definitely DO NOT want to lose your muscles, bones, organs or fluid! 🙂
As you can see in the image below, obesity is a very complex problem and therefore simplistic solutions like “eat-less-move-more”, “eat fewer calories than you spend” , “eat 6 meals plus snacks” do not work. You already knew that, right?
Carbohydrate-Insulin Model of Weight Gain.
In this model, it is proposed that you gain excess weight because you are insulin resistant. Insulin resistance is a condition where your pancreas makes insulin, in fact sometimes copious amounts, but the insulin does not function optimally. All of you are aware of insulin as the hormone that controls blood sugar but insulin has a very important growth-promoting effect too!
In fact in the words of Dr. David Ludwig, an Endocrinologist from Harvard,
“Insulin is your fat fertiliser hormone.”
Insulin reminds me of an old Hindi movie dialogue “yeh marney nahi deta aur jeena bhi nahi deta hai” (Translation: Insulin will not let you die, but it will not let you live either).
What do I mean by that? One can die in the absence of insulin (for example in the autoimmune destruction of insulin-producing cells in the pancreas in Type 1 diabetes). But insulin resistance can be a killer too!
Initially, your insulin levels in the blood may rise to counter this problem, but it may reach a point where it does not work anymore. At that point, your blood glucose (sugar) levels go up and you develop diabetes.
However, you may be in a pre-diabetic or insulin-resistant state many years before you develop diabetes. Insulin resistance by itself, even without causing diabetes, is a very serious condition. Your risk for diabetes, heart disease, stroke, high blood pressure, and some cancers and mood disorders go up dramatically.
Insulin resistance develops at different levels. The problem may start at the level of
- Skeletal Muscles
- Fat (Adipose) Tissue
Interestingly, thyroid hormones influence all the above tissues as well.
How Will You Know If You Have Insulin Resistance?
If you have the conditions listed on this infographic, you are very likely insulin resistant.
If you are of South Asian (India, Bangladesh, Pakistan, Srilanka ) ancestry, your chances of being insulin resistant are extremely high! In fact, the dictum I follow is“All South Asians are insulin resistant unless proven otherwise.” And rarely is it proven otherwise!
Energy Homeostasis In Obesity
This model explains obesity as a problem of how your body partitions energy. You eat food (calories) and your body utilizes this energy in different processes like digestion, brain function, exercise, etc. Therefore, if you eat more calories than you spend, you end up gaining weight. This is a highly simplistic explanation of very complex neurohormonal processes.
Unfortunately, based on this concept, many people still think of obesity as a problem of personal shortcomings. If only you could use your willpower to eat less and move more and stop being lazy ………………you would lose all the excess weight AND keep it off! Really?? If you read obesity research and talk to people who have spent their entire lives in this field, you will never find them agreeing with that.
Homeostasis is defined as the tendency of a system to maintain internal stability, owing to the coordinated response of its parts to any situation or stimulus that would tend to disturb its normal condition or function. (3) 3What does it mean?
Your body has the inherent ability to sense and control the complex mechanisms involved in maintaining your body weight at a certain level—-the body weight set point. This is true for people with and without obesity. You probably have friends and relatives who eat the same way as you do, but they do not have a weight challenge. (They may have other health issues. Very often people may not “look overweight” but they may be metabolically unhealthy).
Importance of Energy Expenditure In Weight Loss
Resting Metabolic Rate comprises the largest proportion of daily energy expenditure -60–70% and represents the basal energy requirements of your brain, gut, kidneys, heart, liver, muscle to function.
Thermic Effect of Food: This is the energy expenditure associated with digestion, absorption, and assimilation of food and accounts for 10 % of daily energy expenditure. This percentage is almost the same in obese and lean people.
Exercise and NEAT together account for 20-30% of total daily energy expenditure.
Resting Energy Expenditure With Change In Thyroid Hormone Dosage
In a small study (5) 5 on 9 people with hypothyroidism, who were taking T4, the dosage of T4 was changed over a period of time. Resting Energy Expenditure (along with other tests) was measured during this period.
Findings: A change of 5–10% in REE was seen with a change in dosage of T4, even within normal TSH range. In Fig 3 above you can see that this change is definitely relevant.
Thyroid And Energy Metabolism
Thyroid hormones play a significant role in energy metabolism and in maintaining core body temperature. This is why cold hands and feet or complaining that the air-conditioning is too cold are common symptoms of hypothyroidism. In severe hypothyroidism, your total body energy expenditure can reduce by half. This is mostly through a reduction in Resting Metabolic Rate (in green in Figure 3 above).
As you can see in the image above, thyroid hormones work through their actions on
- Skeletal Muscle
- Brown Fat (BAT)
- White Fat (WAT)
Liver And Thyroid
It has been known for a long time that thyroid hormones have effects on liver fatty acid and cholesterol metabolism. Hypothyroidism has been associated with increased levels of triglycerides and cholesterol as well as non-alcoholic fatty liver disease (NAFLD). (Refer Fig 2 above, NAFLD and high triglycerides are both markers of insulin resistance).Thyroid hormones stimulate the breakdown of fat from fat stores and from food to generate circulating free fatty acids (FFAs), which are the major source of lipids for the liver.
In a large population-based study (6) 6, higher free T4 levels were associated with a lower risk of fatty liver. Higher TSH levels and hypothyroidism were associated with an increased risk of having worse NAFLD.
Skeletal Muscles And Thyroid
Skeletal muscle is a major target of thyroid hormones. In fact, fatigue and generalized weakness along with poor exercise capacity are common symptoms of hypothyroidism.
However, the important question is whether muscle function can be improved with treatment of hypothyroidism. In a study of people with subclinical (High TSH, normal T3, T4) hypothyroidism those who received thyroxine (T4) and maintained normal TSH for 6 months had better exercise capacity on a treadmill (7) 8
Brown And White Adipose Tissue (BAT and WAT)
All fat in your body is not created equal. In fact, body fat is not like lumps of lard lying around doing nothing. Fat (or adipose tissue) is an important endocrine organ, producing substances like adiponectin and leptin, ghrelin which play important roles in maintaining blood glucose levels, lipid metabolism, and feeling of satiety.
White Adipose Tissue (WAT) is so-called because of how it looks under the microscope.WAT contains excess fat as triglycerides and releases fatty acids during fasting. (High triglyceride is a marker of insulin resistance. Ref Figure 2 above).
WAT packed around internal organs (visceral fat) is metabolically much more active than the fat below the skin (subcutaneous fat like”bat wings”).
Brown Adipose Tissue (BAT) are smaller than WAT and are tightly packed with mitochondria, which gives them a distinctive color. Mitochondria are the energy storehouse of cells. BAT are responsible for thermogenesis (maintaining body temperature).
WAT stores energy and BAT releases energy. WAT and BAT function antagonistic to each other. For many years BAT was considered important only in babies. But recent studies have shown that BAT is functional in adults as well as babies. Importantly, WAT can undergo “browning” to produce beige or “brown in white” adipose tissue.
Browning is responsible for a significant increase in total energy expenditure. The stimulation of browning has the potential to promote fat loss. However, though the search is on, no drug has been discovered yet which promotes browning of WAT. There are few animal studies on using supplements like berberine (9) 10 to promote browning, but we need more studies in humans.
How Can You Induce BAT?
- Cold temperature
- Thyroid hormones
Exposure to cold temperatures has shown an increase in amounts of BAT. In a study from Japan, where lean healthy volunteers were exposed to temperatures of 19 degrees C for 2 hours. Measures of BAT increased during cold exposure versus exposure to temperatures of 27 degrees C. However, the response was lesser in older individuals (10) 11
A long holiday in cold temperatures for fat loss? Before you book your tickets, it is important to remember that your ethnicity may decide how much BAT your body has. A study from the Netherlands, where they compared BAT volume in South Asians with Caucasians, total BAT volume was lower in South Asians than it was in Caucasians. (11) 12Additionally, total BAT volume was directly proportional to resting energy expenditure.
Exercise has numerous benefits for health. One of the possible ways in which exercise affects your metabolism is through browning of WAT. In a study from Mexico, sedentary adults were enrolled in a 12-week bicycle-training program (3 times per week). Without any significant change in body composition, exercise improved insulin resistance and brown and beige gene expression of WAT (12) 13
We know that thyroid hormones affect energy expenditure. A 2016 paper showed that the levels of T4 are related to the expression of browning genes in WAT (13) 14 Browning of WAT by thyroid hormones is regulated through effects on energy balance.
However, using thyroid hormones for weight loss, in the absence of hypothyroidism is not a recommended practice.
Thyroid Tests Within “Normal” Range And Body Weight
The title of this paper says it all! Small Differences in Thyroid Function May Be Important for Body Mass Index and the Occurrence of Obesity in the Population.
In this population-based study the authors looked at BMI and thyroid function in a group of people WITHOUT hypothyroidism. What did they find?
Serum TSH, free T4 , free T3 ,and Anti-TPO antibodies were tested, (besides history and physicals). Normal TSH was considered in the range of 0.4–3.6 mU/liter.
- People with higher TSH (>3.6 mU/L) had higher body weight.
- How much of the weight was affected by thyroid function? The difference in weight between women with the lowest TSH and highest TSH was about 5.5 kilograms (12.12 lbs). Though that seems rather modest, thyroid function had about the same impact on weight as smoking and physical activity (14) 15
Podcast: Diet And Weight Loss In Hypothyroidism
SDK: (00:00) Hi Michal.
MO: (00:02) Good afternoon, Dr. Kar Welcome everybody who is listening to another edition of the MDS podcast. As always. I’m Michal a Functional Nutritionist and I am joined by my very favorite partner in crime Functional Medicine specialist and integrative physician Dr. Shabnam Das Kar. Dr. Kar as always, really excited to talk to you about the subject today.
SDK: (00:27) Hypothyroidism in India. Thank you. Michal and as always, it’s a pleasure talking to you and honor too. So one of the commonest questions that Michal and I get a lot off is about hypothyroidism. So just a little basic for at the beginning because most of you, if you’re dealing with that, you already know you have the problem. So, uh, most of my patients are from India and Michal believe it or not, one in 10 people have hypothyroidism in India. Oh my goodness. Yeah. And it’s, it’s fairly common amongst our clinic population here as well. Dr. Iyer’s s patients, you’ve seen them, but one in 10 in a country of 1.2 billion people is a lot of people with hypothyroidism. So most of the time, sometimes people will say, I have thyroid. What they mean is they have hypothyroidism. So I’m just uh, differentiating a little bit.
SDK: (01:20) Hashimoto’s the commonest form of hypothyroidism. Thyroid and PCOS. I have some blog posts on my, on my website on that. Uh, so one thing is the commonest form of hypothyroidism is what we call Hashimoto’s thyroiditis. So Hashimoto’s is an autoimmune process and an autoimmune process, as most of you know, is an abnormal immune reaction where your own body’s immune system is trying to destroy the thyroid tissue as a result of which you are making less of thyroid hormones. So that is the commonest thyroid problem, the commonest hormone problem in the world. And particularly in India. India also has the dubious distinction of having a lot of people who have Polycystic Ovarian Syndrome. Without going into all the complex details because it turns out the thyroid and PCOS are related. I related some more on that later on. So hyperthyroidism is a less common condition. Again, autoimmune where your thyroid hormones are functioning. And that is again, an autoimmune process where it’s a different problem altogether.
SDK: (02:30) Testing for thyroid function. So the symptoms are different. Of the two, but on our podcast and some of my blog posts, I am talking about the commoner problem of hypothyroidism. So many of you say I have a thyroid problem. What you mean is hypothyroidism, not hyperthyroidism. And another very important distinction is some of you probably don’t know you have Hashimoto’s thyroiditis because you have never been tested for thyroid antibodies and a standard thyroid function tests in particularly in India is a TSH, T3, T4. Some people these days at least do TSH, Free T3, Free T4 versus and Michal this is interesting in Canada I find if not in our office, of course, a lot of people only have a TSH test so I’m not going to discuss whether TSH is the best test in short. In short, my reply is doing only a TSH doesn’t tell us anything but doing only TSH, Free T3 Free T4 also doesn’t give us a complete picture because we are not testing the thyroid antibodies.
SDK: (03:45) Thyroid antibodies. So what are the two Thyroid antibodies that you should ideally test? One is the Anti-TPO and the Anti Thyroglobulin test. So commonest is again Anti TPO. Some people are positive for both, some people are positive for one and not the other. So commonest thyroid antibody test and is the Anti-TPO. But I like to test for both of them. So without making it sound too complicated, you don’t know whether you have Hashimoto’s thyroiditis if you haven’t tested your thyroid antibodies. Now it gets even more complex because sometimes you might have the antibodies and not have an abnormal thyroid function. So more on all of that. On thyroid, I can probably talk until kingdom come. So, the most important question we want to answer today is, with hypothyroidism, lots of people have a weight loss challenge. No, they may have lost some weight, but very often the weight comes back or they don’t reach the weight loss goals that they have set out to achieve. And that is the most important question I want to answer today because it’s, it’s not very, it’s not a simple answer always as always. And I’m going to try to be as brief as possible. Brevity is something that I have to learn. So Michal, what would you like to like me like us to discuss first of all.
MO: (05:15) Multidisciplinary approach. Not diet alone So we know that treating, um, that treating any condition is a multidisciplinary approach, right? And we know that one of the biggest problems with hypothyroidism is this inability to sustain weight loss. And the two go together because the diet isn’t the only treatment for hypothyroidism and it isn’t a treatment alone, but it does play a huge role in, you know, in the success of management of the, of the problem. So, um, let’s begin, I think maybe with an overview of um, low calorie and low carbohydrate diets and how those impact the thyroid and how they impact specifically people with low thyroid.
SDK: (05:58) Tests.
(05:58) Thank you. Michal so one important point that I want to make, and obviously none of this information is for you to take as medical advice unless you are my patient and I have said that to you on a medical consultation, not on a podcast. So, uh, again, uh, can diet alone, treat your hypothyroidism? So that is a very interesting question and it depends on many factors. Number one, how have you been diagnosed as hypothyroid? Was it only a measurement of TSH, which is not the correct measurement. Was it a measurement of only TSH, free T3 , Free T4 no free t four or were you also measured for the Thyroid antibodies? So number one point is how were you, uh, investigated? Number two is well even after the investigation does every, you know Thyroid hormone dysfunction needs replacement with Thyroid hormones?
SDK: (07:10) Nutrients and thyroid.
(07:10) Again, it’s not an easy question to answer because there are so many other factors that are involved in this. For example, some nutrient deficiencies can make your thyroid function, you know, look abnormal on, on laboratory reports, but you may be having no symptoms at all. One of the commonest ones I come across is low iron. And again, low iron depends on how you’ve been tested. So I am so sorry, I can never give you a simple answer. If you have low iron obviously your thyroid is not going to function well. All of you know about iodine and iodine and thyroid is a 2-hour discussion so low iodine can be a problem, but should you just willy-nilly go and supplement yourself with iodine? No, because if you add more iodine than you actually need that puts you at high risk for getting thyroiditis and causing thyroid problems so iodine is not a supplement you just decide to take willy nilly without actually measuring.
SDK: (08:12) More nutrients.
(08:12) Then comes, zinc then comes vitamin D, they’re all very big ones. Then a whole lot of other factors influence thyroid function as well. As a Functional Medicine doctor. I don’t look at just thyroid function means if it is low thyroid, you have you know hypothyroidism. All you need to do is take some T4. That is Levothyroxine. For those of you in India, it’s the Eltroxin or Thyronorm. In Canada, of course, you have options of T3 T4 combinations and you know glandulars and all that. I’m not going into that discussion today because if you just going to become more complex. The most important question Michal I want to answer today is what is the best diet for you if you have hypothyroidism and a weight loss challenge. So I’m again not going to discuss whether you should eat cruciferous vegetables or not.
SDK: (09:09) Cruciferous vegetables.
(09:09) Just be, I have a blog post on that. No cruciferous vegetables will not make you hypothyroid simple but how does it work and all of that is a different thing. And most importantly, this is something a lot of people forget. If you aren’t taking a Thyronorm or you know any of the Levothyroxine preparations, you have to take it on an empty stomach. So one hour before food or one hour after for like one hour of gap between taking your thyroid hormone and any meal or even other than water, nothing else, one hour before and one-hour after. So that is more important than there is no broccoli and all these wonderful vegetables are not going to get in the way of your thyroid. So that is not what we are discussing to the most important question we you want to answer it. Should you eat a low-fat diet or a low carbohydrate diet if you have hypothyroidism, which is going to give you the best results. So Michalam I right? That is the question are answering today, right?
MO: (10:11) Yes. As in what, you know, how does each of them impact that the person trying to lose some fat when they’re struggling with some thyroid issues and yeah, which one, which one is more effective and not just for fat loss but for health and for as part of your treatment protocol for your thyroid.
SDK: (10:32) Low calorie or low carb diet?
(10:32) Thank you. So, uh, most importantly, as all of you know, if you’re struggling with weight loss, you know that it’s not a simple problem of, you know, just eat less and exercise more. And weight loss is way, way, way more complex than what sometimes if you read some of the stuff on the internet, it’s like gives you an impression that it’s just a question of will power, you know, you just eat less, and make some low-calorie choices. And that is it. What does science say? So most importantly in regards to weight loss, one of the most popular hypotheses is what we call the carbohydrate-insulin hypothesis. That means you are insulin resistant, which means you can tolerate a very little amount of carbohydrate and that is the reason you are insulin resistant and that makes you gain fat. Now that is the commonest problem for my patients in India,.Almost everyone is insulin resistant unless proven otherwise.
SDK: (11:33) How do you know if you have insulin resistance?
(11:33) So if you are insulin resistant and how will you know whether you’re insulin resistant or not Michal has prepared a wonderful infographic and I, this time I show notes are going to be quite exhaustive I think. So I have that on the show notes. So briefly, if you have belly fat, if you have to really exercise a lot to maintain your body weight, if you have high triglycerides, if you have been told you’re pre-diabetic, uh, if you have PCOS these are the common ones, then you know that insulin resistance is a bigger problem for you than anything else. And if you are insulin resistant, your chances of you know the insulin resistance and thyroid are also intimately related. Thyroid and PCOS are intimately related. PCOS is related to insulin resistance. Very complex and thank God our body is so complex Michal right? Otherwise, we would probably have been dead a long time ago.
(12:32) MO: And there is this you know that there’s this strange little cliche out there “if our minds were simple for us to understand, we’d be so simple that we couldn’t. The same thing with our bodies.
SDK: (12:43) Low carb and insulin resistance.
(12:43) Yeah. So yes hypothyroidism, being pre-diabetic, all of these are intimately related. If you have diabetes, of course, insulin resistance, and I’m talking about type two diabetes, the common, not Type 1 not the type of autoimmune diabetes. So if you have insulin resistance, a low carbohydrate diet is a much better option for you than a low-calorie diet. So do we have any scientific information regarding that? Yes, we have a lot of information. Most of all, this was a 2012 study and this is a study in which I will post the link so that none of you are looking around. you know, looking around here and there for it. This was a study that was done by Dr. Kara Ebeling and Dr. David Ludwig. Now, Dr. Ludwig is a very well known endocrinologist from Harvard and all of us respect him a lot for his wonderful research and you know all his videos, he’s written some wonderful books too.
SDK: (13:45) Dr. Ebeling and Dr. Ludwig’s study on energy expenditure during weight-loss maintenance.
(13:45) So what did they do? They decided to find out the effects of dietary composition on energy expenditure during weight-loss maintenance. As most of you know, losing a little bit of weight, 5 to 10 pounds is not always very difficult for many of you, but the biggest challenge is always maintaining weight loss. So that has been a big challenge and many researchers have been looking at it for many years. So we do have a few answers. Now what happens is when we talk about energy expenditure and here it becomes a little complex. So I’ll just explain a little bit in detail. So what they found is your resting energy expenditure is, well, it’s divided in different ways. Number one is 60% of the total energy expenditure. That means the energy your body’s using up in its activities. So 60% of it is in maintaining heart function, lung function, brain function.
SDK: (14:46) Resting energy expenditure. Energy spent in digestion, other bodily processes.
(14:46) Non-resting energy expenditure.
(14:46) In fact, the brain uses up a lot of your energy. Then uh, about 10% comes from what is called the thermic effect of feeding. So that is essentially the energy that is expended in digestion transport and the deposition of nutrients. So that is a very small percentage, 10%. So 60% is your metabolic cost of all these different processes, which are absolutely essential for the body. And 30% is the non-resting energy expenditure, which is again mainly dependent on physical activity, which tells me that the 30%, it’s where is a big area where we can influence a lot by our behavior. And the 60% of the, you know, the resting energy expenditure, what happens is as you lose weight, your energy expenditure goes down. There are enough studies to show that with weight loss, energy expenditure goes down. And the other challenge that comes up at that point is after you’ve lost some weight, your resting energy expenditure has gone down.
SDK: (15:56) Low carb diet and resting energy expenditure.
(15:56) Your thyroid doesn’t function as well at that time. But does it mean that you need more thyroid hormones? No, that may not be. It’s the answer is way more complex than that. So what they found in Dr. Ludwig’s study is they gave a bunch of people, isocaloric feedings. So what does Isocaloric feeding mean? isocaloric means in terms of calorie it, all the three different diets were the same. So they had a low-fat diet, they had an intermediate and low glycemic index diet. The low glycemic index is where the carbohydrates are lesser, but they also had a very low carbohydrate diet. So they compared the effects of three different kinds of diets. And what they found is the energy expenditure, loss in energy expenditure was the least in low carbohydrate diets. So again, I’m trying to simplify it as far as I can. Resting Energy expenditure, will decide your long term fat loss and resting energy expenditure goes down with weight loss. And when it goes down with weight loss, low-calorie diet reduces your resting energy expenditure, uh, the least. So that means it’s not good. Your resting energy expenditure has to remain high for you to maintain the weight loss and a low carbohydrate diet keeps your resting energy expenditure higher so that you can maintain the fat loss. So, Michal, is it sounding very complicated?
MO: (17:33) It is, but I’m managing to follow along so I’m hoping everybody else is.
SDK: (17:37) So if you were to explain it simpler, what, what else would you add?
MO: (17:43) The whole thing again, that’s a tough one to simplify. What I would do is leave it with where you’re at right now because there’s a lot there and it can, it can take some time to, to digest. I don’t want to add anything and I don’t want to add anything to that. I want to just sit as it is and for you to carry on because this is a story that is unfolding, right? The one thing leads to the next.
SDK: (18:08) Calorie-in-calorie-out.
(18:08) Yeah. And so traditionally we have all that, that includes me even. I used to talk about eating a low-calorie diet because that is where my knowledge level was at. So I talk about my life, uh, you know, before insulin awareness and after insulin awareness, the two lives are very different and it’s a tough one to get the head around. Well absolutely.
MO: (18:35) And I’ve been doing this for many years and as of you and sometimes you’re not on default, you still go back to eat less, exercise more. You still go back to calories in, calories out and you know, and then it’s like, no, no, that’s not, that’s not how, that’s not how it works. So it really does take a real shift in how we’re looking at food, not just as energy but as information.
SDK: (19:00) Best diet for hypothyroidism and weight loss. Low carbohydrate diet.
(19:00) Yeah. So the simple answer to the question is what is the best diet for hypothyroidism and weight loss? It is particularly for those of you who are insulin resistant and which includes almost 90% of people I know and my patients. It is a low carbohydrate diet. Then, of course, the devil is in the details, which we are going to discuss on another podcast, which is how low carbohydrates should you eat and what other modalities can you use to eat in a different way. So a low carbohydrate diet will help you much more than a low-fat diet. So when I say low-fat diet, it is essentially the calorie counting kind of diet because fat is more calories per gram. And this is the sad thing, you know I was talking to somebody that she’s dealing with diabetes and she’s overweight and she’s on insulin, she’s got some heart problem and she says, oh, I was just, you know, frying with little teeny weeny bit of olive oil and I was just trying some stuff in it and eating it.
SDK: (20:06) Rice versus wheat.Low fat versus low carb.
(20:06) I said, why are you eating like with low fat? No, why are you cooking with so little fat? No, my doctor said that is what I should do. And she said: I don’t eat rice. I eat wheat. Ah. Anyway, those were like big flags. So we may not be the best option for you if you think that that’s healthier. No, maybe not. So this is, this is again, years and years of conditioning and I don’t blame anyone because that is where our level of knowledge was at , at that time. And we didn’t have such wonderful ways of disseminating knowledge too. So a lot of my colleagues, I know a lot of my friends who are physicians, they are also still in the low-fat world. And obviously I was in the low-fat world before and, but the fact is it didn’t help us. People are gaining more and more weight than ever before. And I meet so many people, some of our, some of them are my patients, some of them are my relatives who will say, well I cannot lose weight because I have hypothyroidism. I said, who told you? So? So that is the biggest challenge. So forget about resting energy expenditure and all of that. What is the other way of increasing resting energy expenditure other than eating a low-calorie diet? Sorry, a low carbohydrate diet? Michal, would you like to add something to that and other ways of increasing the resting energy expenditure?
MO: (21:31) Other ways to increase Resting Energy Expenditure.
(21:31) Well, there’s a couple. Um, two are really simple and number one is move more. Um, right, because if you and I are not talking about running on a treadmill, I’m talking about simply moving your body and creating some, some movement. Maybe building some muscle. Muscle really helps us increase our resting energy expenditure. Muscle requires more energy then, um, muscle requires more energy than fat does in order to function. And fat does require energy to function and it also demands that we feed it more fat. So fat likes to grow, so moving your body and sleeping, believe it or not, can actually increase your, um, your resting metabolic rate. If we don’t sleep enough, it can actually cause a depletion in another. Why can I not think of the word today? It can cause our resting metabolic rate to get slower, to go, um, to go down. So those are, those are two really simple ones. And then another one when it comes to diet, believe it or not, is to eat protein is to make sure that every single time you eat protein. Why? Because protein metabolically requires us to at rest, just for digestion, just for a simple bodily function to you utilize more energy than carbohydrates or fat. So these are ways to increase, to naturally get our body to burn more, to burn fuel more efficiently, and to burn a larger amount of fuel at rest.
SDK: (23:10) Thank you. And when we talk about, uh, you know, hunger, so hunger is a very big thing because a lot of people, a lot of you have experienced this. You go on a calorie-counting diet, your dietician has given you a, Oh, you need to, I have, I’ve even forgotten the maths actually know how many calories are you supposed to reduce to lose one kg of weight? What was it, 3,500 or something like that?
MO: (23:39) Calorie counting.
(23:39) The maths doesn’t add up.Even so, I just need to point this out because it’s kind of funny. They say that a pound of fat is 3,500 calories, but a gram of fat has we know nine calories. The calorimeters have measured that a gram of fat has nine calories and a pound as 454 calories. I mean 454 grams. So technically a pound of fat should be 4,086 calories. I don’t know where they got 3,500 so you need to burn 3,500 more calories, which on a set and a seven-day diet is basically means reducing your calories by 500 calories every single day and then you should lose a pound in a week and sometimes that works and sometimes that doesn’t.
SDK: (24:26) Oh yeah. By that, by that rule, I should have disappeared by now anyway.
MO: (24:31) Biggest Loser TV Show
(24:31) And why does it, a lot of studies right now on participants of a TV show, which I don’t know if they’ve got an India, but you’ve got to called The Biggest Loser was a weight loss competition where these people went to an extremely low calorie, extremely high exercise diets for a certain amount of time and they were very people who had a lot of weight to lose. And the person who lost the most weight at the end of this program, won and over time, all of these people, not all of them, but the vast, vast majority of them because this program, right ran for a few seasons with many different people and most of the people put the weight back on. And it wasn’t because they went back to their old eating ways, they just put the weight there. And this is because eating a low-calorie diet and stressing the body after over-exercise, eventually, the body doesn’t care what you look like in the mirror. The body cares about surviving, to reproduce and in order to survive, to reproduce whether we want to in our brains or not, that’s the purpose of the body. Um, it needed to become more efficient and do just as well and be just as productive on way less calories. So the metabolic rate actually slows down when you continually deprive the body of nutrients.
SDK: (25:45) Hunger on low calorie versus low carb diets.
(25:45) Yeah. And the other, sometimes the other explanation that is given is why do people gain weight after they have lost successfully? Some people say, oh, they just, they feel more hungry so they end up eating more. So this is the interesting observation that we have found in the comparison between a low-calorie diet versus a low carbohydrate diet. Hunger is not something that you, you deal with when you are on a low carbohydrate diet. Hunger is not something that bothers most of you and the, we have seen so many of you know of our participants on our MDS Program who have said that one of the earliest, uh, you know, results they have seen from this and this has happened in sometimes it’s been in one week or two weeks of eating low-carbohydrate food. They realize they could not finish the food on the plate. And I have realized that I cannot eat a lot of food now because I feel full way before that.
SDK: (26:41) Eating adequate protein.
(26:41) So eating a low carbohydrate diet. Then again, the other important thing is as Michal mentioned protein. Obviously you have to add adequate protein and good quality fat. So a low carbohydrate diet. For some people, they get mixed up between a low carbohydrate diet and low carbohydrate, high-fat diet. For most of you in India, you’re not eating a whole lot of saturated fats or any kind of fats. Most of you are eating low fat, low protein, high carbohydrate diets. So you obviously need to incorporate a good quality protein and good quality fat to make you feel full. The satiety is very important because you cannot feel constantly hungry and maintain that fat loss. So again, going back to the low carbohydrate and low-calorie diet, the low-calorie diet makes you hungry. So if you’re hungry, obviously you are going to make, sometimes you end up making poor food choices when you’re hungry. And of course, if you make poor food choices, the ones like processed food and lots of sugar and processed carbohydrates, it is going to get get in the way of your fat loss versus eating a lower carbohydrate than what you’re used to. Hunger is not one of the complaints that most of the participants in our program have. Am I right? Michal
MO: (28:05) Fat-protein combination.
(28:05) That’s true. And you know, by default a low carbohydrate diet or a low-fat diet [inaudible] ends up being a low protein diet, especially if you eat animal protein. Because animal protein generally comes with fat and it’s the protein and the fats that allow your body to feel nourished and satisfied. This is why they also said why that, why they stimulate satiety, why they leave us not hungry. Because without fat, you can’t absorb most of your vitamins, minerals, and nutrients. And without your vitamins, minerals, and nutrients in your body, your body is feeling deprived. And that will demand that you, um, that you replenish those nutrients. And how do we replenish nutrients by eating? So by default it will, if we are not absorbing our nutrients, we will be stimulating our hunger. So that’s, fat-protein combination on many levels is very important.
SDK: (28:59) Fat -free mass.
(28:59) So again, I’m going back and forth between exercise and food. So what would be the ideal exercise? And Michal mentioned about muscles. So why we, why do we talk about building muscles and building muscles, doesn’t mean you’re going to do, if you’re a woman, they will become a man. You can never develop those kinds of muscles just by doing weight training at the gym. So why are we talking about muscles? Because your fat-free mass, which means that part of your body that is not fat also decides your energy expenditure and muscles is a highly efficient process whatever carbohydrates that you might be eating. So muscles are one of the primary areas of insulin resistance without, you know, going into all the details and remember that having muscles is way better than having fat that you already knew and muscles make you more insulin sensitive, which is the good thing.
SDK: (29:54) More muscles less insulin resistance.
(29:54) The Problem of sitting continuously.
(29:54) So having fewer muscles, will make you more insulin resistant and uh, doing weight training, high intensity and double training. Those are good ways. However, if you feel that, you know, you cannot incorporate a visit to the gym as a bottle for your daily work routine, the other thing to focus on would be avoiding constant sitting. Because again, that messes up everything that messes up your metabolism. And in fact, right now I’m standing and recording this podcast so I have incorporated more standing, but I sh the goal is to incorporate more moving rather than just standing. Standing alone will not do the trick. The problem, the bigger problem is avoiding continuous sitting and some of you are sitting continuously. If it’s in Mumbai traffic, Michal you cannot imagine two to three hours you’re sitting in in the car already know what you are, you’re using and there isn’t a whole lot of stuff you can do in those though.
SDK: (30:48) 10,000 steps a day
(30:48) You know those two to three hours of commute and I sometimes wonder whether someone’s going to come up with some kind of, you know, other than flexing your ankles and knees. I don’t know what else you can do when you’re sitting continuously in a car and yeah, you can keep maybe those stretch bands and things like that and try some of that. Next time I go to Mumbai, I must try some, something like that. So avoiding continuous sitting. So obviously the two hours of commute, if you cannot help it, you can’t help it. But at least focus on the remaining eight to 10 hours you’re spending in the office. Whether you’re interrupting your continuous sitting, that is one thing. And are you doing 10,000 steps a day? How will you know? I would rather you buy even a low cost, you know, a tracker of some kind because your phone may not give you the best information. And particularly a lot of women don’t carry their phones, their mobile phones in their pockets. So it’s not a very accurate measurement. Get a tracker, track your sleep, track your movements. Sleep is so important for fat loss and for thyroid function. So any last comments Michal or I think we’ve kind of, it’s a complex, complex problem. It’s not an easy problem.
MO: (32:02) Summarize.
(32:02) Yes, there’s so much to cover and I think what we’ve done with this series that we’re going to do is to try and break it down into small steps or into small bites so that, um, so that you can get the big picture and make sense of it rather than just being overwhelmed with a whole, with a whole ton of information. But you know to, to summarize, um, you need to get proper testing if your thyroid is um, if you suspect or you have been diagnosed with hypothyroidism, make sure that the test is actually an accurate test. And number two, when you are addressing your diet that a low carbohydrate diet is an effective strategy in the management of hypothyroidism. I think those are the two big takeaways, from that I got from today.
SDK: (32:54) Carbohydrate not an essential nutrient.
(32:54) Oh, thank you. And more importantly, this is again something that comes up so often with when I’m talking to my patients in India and also sometimes my relatives that many people think carbohydrate is an essential nutrient. What a, what do I mean by essential nutrients? That means you’re going to die if you don’t eat carbohydrates. Well, Michal and I want to tell you that it is not true. Carbohydrate is not an essential nutrient. That means your body has the ability do live without carbohydrate and it can even make carbohydrates from other sources. So you do not need to eat carbohydrates for the body to use it. Again, more on that later. We have lots of podcasts and videos on all of those. So remember that you do not need your rice or Roti or any of those or the bread. Oh, the cookies, definitely not. So in India, they call it biscuits. So you don’t need any of that to survive. Okay. So a low carbohydrate diet works fantastically well for thyroid and it will not affect your thyroid function. However, you need some, someone who’s really, you know, well versed in treating someone with hypothyroidism and not only looking at, okay, your thyroid is not functioning well, let me just increase your dosage of T4. Uh, you know, the levothyroxine that you are getting as a prescription medication. There are a lot more nuances to it than that Yay. Bye now. Until next time.
(34:21) MO: Bye.
- 5-10 pounds (2.2-4.5 kgs) of body weight may be attributable to the thyroid.
- If your hypothyroidism is optimally treated and you are still struggling with weight loss, then you need to look for other causes. Insulin resistance is one of the most important ones.
- If you have insulin resistance (Infographic Fig 2) then a low carbohydrate diet (Ref podcast above, from minute 10:32 onwards) is an excellent option for weight loss.
- Even relatively small changes in thyroid numbers can have a huge impact on your health.
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Watch for later posts :
- Thyroid and Insulin Resistance/Diabetes.
- PCOS and Thyroid.
- Thyroid and Endocrine Disrupting Chemicals (EDC)