9 Step Guide to Reverse Leptin Resistance & Thyroid Resistance

Are you having trouble losing weight?

Or, better yet... do any of these sound familiar? 

  • You can't lose weight no matter how much you exercise
  • You are constantly gaining weight even though you haven't changed your exercise or diet routine
  • You feel like your metabolism is unusually slow or damaged
  • You've tried 4+ different calorie-restricted diets in your life (weight watchers, HCG diet, etc.)
  • You used to be able to lose weight by dieting but you can't anymore
  • You think you have thyroid problems but the Doctor keeps telling you everything is "normal"

​If you fall into any of these categories you may be suffering from something known as Leptin resistance and/or Thyroid resistance. 

​Chances are this may be your first time hearing about Leptin resistance or Thyroid Resistance...

But don't worry:

I'm going to explain everything - including how to diagnose, treat and manage both conditions.

Stay tuned...​

More...

The Powerful Connection between Weight gain and Leptin Levels

So what is Leptin (1) anyway?

Leptin is a hormone that is pumped out by your fat cells (Yes, they do more than just give you cellulite).

Leptin has a specific action in the brain (it works on your hypothalamus) to control your metabolism and your appetite (2).

You see:

We evolved with leptin as a way for our fat cells to communicate with our brain. And we want this to happen (when it works correctly).

When we have a lot of food to eat (and fat stores are high), our body is supposed to tell our brain to increase the metabolism of our body to start burning up that extra fuel.

So by now, you may be asking yourself...

If that’s the case, why does it feel like my metabolism is so low despite having a lot of excess fat in my body?

Shouldn't my metabolism be high so that I can burn up this extra fat?

The truth is that you SHOULD be doing that and if you aren't, then you may have the condition known as Leptin Resistance. 

So let's find out how that happens...​

How do we get Leptin Resistance?

Leptin resistance is what happens when the entire system goes haywire, and it leads to some pretty unfavorable changes in the body.

As you gain more and more fat cells, your leptin levels continue to increase in the blood.

This is your body attempting to tell your brain to increase metabolism and slow down your appetite to help burn that extra fat. ​

Leptin resistance and hypothyroidism

Eventually, your brain becomes “numb” to the signal and starts to tune out the leptin that it sees. Over time your brain completely blocks out any leptin in the system.

This process is similar to what occurs in the condition known as insulin resistance and type II diabetes. ​

And that’s when the symptoms kick in…

Once your brain tunes out the leptin it starts to think your body is in a state of starvation. So your brain slows down the metabolism of your entire body and increases your appetite to try and compensate.

So instead of burning the extra calories you just ate, your body stores it all as fat and INCREASES your appetite in the process (3).

This ultimately leads to more weight gain and higher leptin levels making the cycle even worse. ​

Signs and Symptoms of Leptin Resistance

Most people who suffer from Leptin Resistance know that something is wrong inside their body.

They watch other people eating food, not exercising or living an unhealthy life without gaining weight or changing their body type.

Meanwhile, patients with Leptin Resistance will gain weight if they don't follow a STRICT diet. 

Many patients with leptin resistance eat a calorie restricted diet simply to maintain their weight (this has to do with the metabolic damage that accompanies leptin resistance which we will discuss later). ​

Even eating something like potatoes or white rice can cause weight gain in these individuals. ​

Now we know what it is, we need to talk about how to diagnose it.

Patients with leptin resistance tend to experience at least 2 of the following symptoms: 

  • Inability to lose weight despite eating a calorie restricted diet and exercising regularly
  • Constant weight gain usually accompanied by a ravenous appetite
  • Constant food cravings, even after eating a large meal
  • Constant fatigue, low energy or feeling "sluggish"
  • Cold body temperature (defined as less than 98.0 degrees F)
  • Low resting heart rate (defined as 50-60 first thing in the morning assuming that you are both overweight and not aerobically conditioned)
  • Worsening symptoms of hypothyroidism (Hypothyroidism frequently accompanies leptin resistance)

​These are what I call the "warning" signs of Leptin resistance. 

They don't necessarily mean you have it, but if you are suffering from more than 2 of the symptoms above then there is a high chance you might be.

The presence of these symptoms should trigger the next step, which is serum blood testing. 

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

How to Calculate "Optimal" Free T4, Free T3, & Reverse T3 Ratio: 

Calculating these ratios is important because it can help you determine if your efforts are on the right track and whether or not your medications are working. 

Download more free resources on this page

How to Diagnose Leptin Resistance​

If you want a definitive answer, then you’re going to have to get some lab tests (and you will have to ask your Doctor to order these or order them yourself online).

The absolute best way to diagnose Leptin Resistance is by checking a fasting serum Leptin Level.

Your Serum Leptin level should be less than 10-12.

If your fasting serum leptin level is greater than 10-12 and you are at least 20 pounds overweight this is an indication that you have leptin resistance. 

Why?

Because the fact that leptin levels remain elevated in the face of obesity is a clear signal that the normal feedback loop is dysregulated. 

You can see an example of a patient with leptin resistance and her labs below: 

Leptin resistance kathy

In this result, her fasting leptin level is 48.2 (note that there is no reference range for leptin levels). 

​It's important to realize that most physicians don't understand the significance or importance of leptin levels as they related to weight gain and weight loss. 

As a result, you may need to be asking for these tests and reading posts like this to evaluate your lab result.

Please also note that the lab will try to give you an approximate range for leptin level based off of your BMI.

This may erroneously lead you to believe that your leptin level is somehow "normal" because it falls within the specified range.

Believe me, this is not the case.

The lab makes observations about lab tests and notes that, for instance, patients with a BMI over 40 tend to have a leptin level > 30.

But this does NOT mean that it is normal, it just means that there are many others out there with leptin resistance. ​

Other lab tests to evaluate leptin and metabolism​

In addition to checking serum leptin levels, I also recommend checking serum uric acid levels (4).

Uric acid levels act as a proxy for determining how well your body is metabolizing fructose. And fructose combined with a high-fat diet (5) can make leptin resistance worse. 

Fructose makes leptin resistance worse

So it's worth looking at your liver to see how well you are metabolizing fructose.

If Uric acid levels are > 5 then you know you are consuming too much fructose for your body or your liver is having difficulty metabolizing the fructose. (This is also my secret weapon for determining if my patients are telling me the truth about their diet). 

​I like to see uric acid levels < 5 and Leptin levels < 12. 

The last test I like to order is Reverse T3.

As leptin increases and your metabolism slows, your Reverse T3 level will increase.

This is a compensatory reaction. 

Thyroid hormone is responsible for a large portion of your metabolism at baseline.

So as leptin levels rise and you develop leptin resistance, your hypothalamus lowers your basal metabolic rate.

Reverse T3 acts as a brake for your metabolism, so as leptin levels rise your reverse T3 will also rise - thus damaging and further slowing your metabolism. ​

This connection is explained further in this study (6).

I use 15 as a cut-off for Reverse T3. Anything higher than that indicates to me that there is a problem with thyroid conversion and likely metabolism. 

It's not uncommon for me to see patients with Reverse T3 levels in the mid 20's, especially if they have a history of yo-yo dieting or calorie restricted dieting (like the HCG diet). 

If your levels are out of range then you are suffering from Leptin resistance and most likely Thyroid resistance (which we will talk about below). ​

  • Bottom line: To evaluate your body for leptin resistance make sure to check these lab tests: Fasting serum leptin level, serum uric acid and reverse T3. You will have to ask your doctor for these tests. 

Leptin Resistance causes Thyroid Resistance

Aside from the fact that Leptin Resistance makes it almost impossible to lose weight, it also causes further issues with your thyroid gland.

As Leptin levels increase and your brain slows down your metabolism, your body will start to convert Free T4 into Reverse T3 (7).

Reverse T3 actually competes on your cells for binding with the free and Active T3 hormone.

Leptin resistance and increased TSH

The higher your reverse T3 levels, the lower your metabolism and the more likely you are to suffer from hypothyroidism (8).

This increase in Reverse T3 is known as "Reverse T3 pooling".

It's also clinically seen as euthyroid sick syndrome or Low T3 syndrome. ​(I've outlined the connection between these conditions in the other blog posts)

Treating these high levels of reverse T3 can be a tricky process and requires a physician who is knowledgeable in both leptin resistance and reverse T3. 

Often times the best treatment for patients with this condition is T3 only medication. 

In addition, you may require a total reduction in your T4 thyroid medication to reduce the conversion of T4 to reverse T3. 

This connection between leptin, obesity, and thyroid hormone is very powerful. 

In many cases, it's hard to determine which condition came first considering that they all can worsen each other.

Because of this, it's best to start with a comprehensive lab panel that includes testing beyond the leptin levels mentioned above. ​

If you think you might be suffering from Hypothyroidism get your levels checked.

I recommend testing for the following thyroid tests (at baseline):

  • TSH: This test is highly inaccurate the higher your leptin levels get. But in general healthy levels (assuming you aren't already on medication) are less than 1.0. 
  • Free T3: Should be in the upper 1/2 of the reference range (assuming you aren't taking thyroid medication)
  • Free T4: Less important than T3, but gives you an idea about T4 to T3 conversion.
  • Reverse T3: Should be less than 15. 
  • Total T3: Should be in the upper 1/2 of the reference range. 
  • Antithyroid antibodies: As low as possible. 
  • Sex hormone binding globulin: 20-30 in men and 60-70 in women (assuming you aren't on birth control or other oral estrogens). This gives you an estimation of tissue levels of thyroid hormone in the liver. 

(Make sure that you evaluate your levels with the “optimal range” and not just the “normal range” in mind - please see the link above for further details.)

One of the most frustrating parts of diagnosing and managing Thyroid resistance with Leptin resistance is that your thyroid lab tests may always show up as "normal". 

In fact, your Doctor isn't likely to even order the tests that you need to diagnose the condition unless you ask for them.

But there's more:

​When reverse T3 levels increase in the blood, your body will naturally have higher levels of Free T3 as well

This can fool you into thinking that your thyroid function is "normal" or that your body is converting Free T4 into Free T3 - but that is NOT the case.

The pattern I typically see in leptin resistance and thyroid resistance looks like this:

Even Doctors who order the right tests can be fooled by those numbers, but the reality is that patients with this lab pattern need more thyroid hormone (preferably T3) not LESS. 

Don't assume that just by ordering these tests that you will get proper treatment either, your physician must understand the importance of these hormones and lab tests in order for you to get the right treatment (elaboration below). ​

How to treat and Reverse both Leptin Resistance and Thyroid Resistance

So now comes the most important part:

If you have Leptin Resistance what are you supposed to do about it?

Treating and reversing leptin resistance can be tricky, but it's not impossible.

In my experience, most patients will need to do a combination of therapies to get the best results possible.

Doing just one thing at a time isn't likely to produce results.

​This philosophy runs counter to the current treatment paradigm that most patients and physicians like to follow - treat one variable at a time and evaluate. 

It took various insults to get you to where you are now (diet, stress, lifestyle, hormone imbalances, etc.) and it will require multiple therapies to reverse the process. ​

Note: these tips are not necessarily in order of importance or efficacy.​

#1. Get on the right type and dose of thyroid hormone

​This step is very important for treating and reversing leptin resistance. 

Many patients stand to benefit from the addition of ​T3 thyroid hormone in the form of Cytomel, liothyronine or sustained release T3. 

The reason T3 is so effective is that part of the problem with leptin resistance is that it causes T4 to reverse T3 conversion.

It's important to under this point:

T4 is required for conversion to reverse T3.

If you remove T4 from the body then you won't have the substrate to produce reverse T3 from.

Make sense?

And this is exactly what taking T3 does.

thyroid metabolism reset poster for side bar

You can bypass this conversion step so you "force" your T3 levels higher while simultaneously reducing your reverse T3 levels.

​If you are already taking T4 medication this might mean a reduction in your T4 dose. 

This can sometimes, paradoxically, ​improve your thyroid function by reducing the T4 substrate. 

This is also true of patients taking Natural Desiccated Thyroid hormone. 

Even though NDT does contain some T3, it's still mostly T4 thyroid hormone.

So reducing your dose of NDT may be necessary to reduce reverse T3 levels and help reduce leptin levels. 

  • Bottom line: Adding T3 thyroid hormone in the form of Liothyronine or Cytomel can help reduce your reverse T3 levels, increase your metabolism and improve energy levels. This is a critical component of reversing leptin resistance. 

#2. Optimize your exercise routine and do the right kind of exercises

When it comes to exercising, not all exercises are created equal. 

In addition, many patients are actually overtraining and may be making it more difficult to lose weight. 

Over-training leads to higher than normal cortisol levels which may alter insulin levels and ultimately make weight loss more difficult. 

If you have known leptin resistance then you will find the most benefit in doing high-intensity interval training.

HIIT has been shown to help reduce leptin levels (9) long term (note this effect may take months). 

But there's a catch:​

You need to make sure that you are doing enough to help lower the leptin levels, but not enough to cause issues with cortisol.

​It may also be difficult to add in exercise due to the fatigue that often accompanies leptin resistance from reduced mitochondrial energy production. 

With these variables in mind, it's best to start off slow with 1 session of 10-30 minutes per week and increase up your exercise frequency and intensity as tolerated. 

  • Bottom line: Adding high-intensity exercise can help reduce insulin and leptin levels and help with weight loss. Just make sure you aren't over exercising which can make weight loss more difficult. 

#3. Optimize your diet

​Changing your diet is critical for lowering leptin levels. 

There are multiple considerations (we will go over the others below) but for this section, we want to focus on reducing inflammation with your diet.

We know that the standard American diet (10) is full of industrial seed oils and inflammatory omega 6 fatty acids (the hallmark of processed food). 

The addition of these foods can promote inflammation which further increases leptin levels (11) and adds fuel to the fire. 

Leptin resistance mechanism

​With this in mind is very important to remove all sources of processed foods, all sources containing industrial seed oils and to eat a whole food diet. 

True - this change in your diet by itself will be necessary for reducing your leptin level, but it will not be enough by itself to reverse the condition. ​

If you have no idea where to start remember that changing your diet is easy as adding in real sources of whole food.

I call this the one ingredient diet.

Meaning you only eat foods with one ingredient (apples, bananas, almonds, etc.).

This is a very simple and clear way to dramatically improve your health.

You can also find more resources here:

  • Bottom line: Changing your diet will be necessary to reduce leptin levels but often will not be enough by itself for significant weight loss. Focus on natural whole food, anti-inflammatory diets. 

#4. Optimize your sleep (very important)

​Sleep is one of the most overlooked factors when it comes to weight loss. 

Lack of sleep is associated with an increase in insulin/blood sugar levels, inflammation (12) and may increase leptin levels and leptin resistance (13).

While improving your sleep may not help you lose weight by itself, what it does is still very powerful. 

Getting at least 8 hours of sleep will help increase the velocity of your weight loss over time.

Opposite to that, lack of sleep can also reduce how much weight you lose.

For instance:

Let's say you would have lost 10 pounds in a month following my weight loss recommendations, however, if you don't manage your sleep well you may only lose 5 pounds. 

This is generally how sleep interacts with weight loss.

Fortunately, improving your sleep isn't very difficult and you can start with some basic recommendations and ramp up the intensity as necessary. ​

Start with these supplements: ​

  • 5 HTP: 5-HTP is a serotonin precursor and can naturally help calm you down before bedtime. This is especially helpful if you are also suffering from depression or other mood disorders. Use 50-100mg per night (1 hour prior to bedtime). 
  • Melatonin: Melatonin can help promote a regular circadian rhythm. Start with dosing between 1-3mg and take it approximately 30-60 minutes prior to be time. 
  • GABA + Serotonin potentiators: These supplements help promote natural neurotransmitters in the brain (GABA + serotonin) which help calm down the brain and induce regular sleep patterns. Take 1 capsule each night 30-60 minutes prior to bedtime. 
  • Bottom line: Improving your sleep will be necessary to lower your leptin levels if you are sleeping less than 8 hours per night. The addition of supplements can help to improve both the depth and quality of your sleep. 

#5. Reduce your protein consumption

​If you have leptin resistance you will also need to make some dietary changes beyond what we've already discussed. 

It turns out that protein stimulates the release of leptin.

In the case of protein, this occurs primarily through signaling pathways with mTOR.

This is very important because the "standard" and "conventional" weight loss advice often includes copious amounts of lean protein.

Eating lean protein with every meal (or adding protein powder) can influence your leptin levels through this interaction with mTOR (14).

mTOR is involved in cellular signaling and it sends the signal of growth. 

That means growth for your fat tissues, obviously something you don't want if you have leptin resistance.

For more detail on how to incorporate this style of eating into your diet, you can check out this article about the leptin diet

  • Bottom line: Reducing both fructose and your overall protein intake can help reduce leptin levels and should be incorporated into your dietary strategy. 

#6. Stop limiting your calories and/or stop calorie restricted dieting

This is both a very important step and also a tough step for many patients. 

Naturally many patients with leptin resistance find that by reducing their calorie count they are able to maintain their current weight.

Unfortunately, this cycle of calorie restriction leads to a metabolic adaptation that results in a lower metabolism, high reverse T3 levels, and even higher leptin levels.

Put another way you are making the problem even worse.

This can be difficult for many patients because they know that increasing their food consumption will result in some weight gain, but it WILL be necessary to heal your metabolism long term.

It has been clearly shown (15) that calorie restriction plus constant exercise results in a severely damaged metabolism long term. 

calorie restriction leads to a damaged metabolism study

The image above shows the metabolism of the biggest loser contestants both during the program and 6 years after. 

You can see that during the program their metabolism is damaged to the point that they are burning on average less than 600 calories than normal EACH day.

And, what's even worse, is that this metabolic damage persists for 6+ years.

You can also see that 6 years later on average their metabolism is still damaged and they are burning on average ​700 calories less than what is "normal". 

Imagine you would burn 2,000 calories normally but because of your dieting, you now burn 1,300 calories per day on average due to your damaged metabolism. 

Naturally, you would eat 1,300 calories per match your energy expenditure just to AVOID weight gain.

These changes are real and clearly outlined, but unfortunately, many physicians and Doctors either don't know about them or don't appreciate them. 

As a result, when you go to the doctor and tell them you're eating 1,300 calories each day and you're still overweight - they don't believe you. ​

In order to break this cycle, you must slowly increase your food intake to heal your metabolism (but note this may take a very long time). 

  • Bottom line: Calorie restriction (defined as anything less than 1,500 calories per day) or any diet that is considered a "low calorie" diet will ultimately make your leptin resistance worse over time. In order to fix this problem, you must slowly fix your metabolism and increase your calorie consumption to match your energy output. 

#7. Optimize T4 to T3 conversion

As you might recall it is very important to improve your T3 levels when treating leptin resistance. 

One of the ways that you can do this naturally is by increasing your T4 to T3 conversion (which will necessarily reduce your T4 to reverse T3 conversion). 

You can do this in many ways, but one of the best ways is by introducing certain supplements that have been shown to increase this conversion.

You can see all of the steps involved (and nutrients required) for proper thyroid hormone production, signaling and conversion in this post here. ​

Here we will go over only those supplements that help ​conversion (which many people also happen to be deficient in): 

  • Zinc: Zinc helps to reduce inflammation, acts as a powerful anti-inflammatory agent and can increase T4 to T3 conversion. Many people are deficient in zinc which makes supplementing a great option.
  • Selenium: Selenium helps balance the immune system, reduces inflammation and boosts T4 to T3 conversion naturally. Doses range from 75mcg to 150mcg per day. 
  • Bottom line: Using supplements to boost your thyroid conversion can help improve energy production, reduce leptin and increase thyroid function in the body. 

#8. Reduce and treat high insulin levels if present

As you may already be aware your weight is a direct result of the hormone balance in your body.

This should be differentiated from the generic calorie in/calorie out model of weight loss.

Calories are important, but only in how they impact your hormones - not their caloric value necessarily.

high fasting insulin

For instance:

A diet high in refined carbs, sugars, breads, pastas, etc. will necessarily result in weight gain due to insulin resistance that develops as a result of this type of diet.

What you may not realize is that patients with leptin resistance generally have multiple hormone imbalances by the time they develop leptin resistance.

What this means for you is that you probably have leptin resistance in addition to other hormone imbalances in your body that need to be treated as well.

Leptin resistance and insulin resistance frequently come together as a package pair.

So if you have leptin resistance you should evaluate and treat insulin resistance if it is also present.

If you follow all of the steps outlined above (and below in the medication section) you will most likely be improving insulin resistance as well.

Having said that there are other things you can add to boost your weight loss results and lower both insulin and leptin levels.

You have insulin and blood sugar related issues if your fasting insulin is greater than 5 (12 hour) and/or if your fasting blood sugar is greater than 90 (12 hour). 

Both conditions represent abnormal glucose homeostasis.

And with a prevalence of about 50% of the US population, there is a good chance you are dealing with insulin resistance.

Consider these supplements to help lower your insulin and blood sugar levels:​

  • Sustained release Alpha lipoic acid: ALA is a powerful antioxidant and helps reverse insulin resistance at the cellular level. For weight loss and a reduction in insulin levels, you will need doses as high as 1,800-2,400mg per day. 
  • Berberine: Berberine is another very powerful medication that can help reverse insulin resistance, help build muscle mass and improve energy production. Berberine has been shown to be as powerful as metformin in terms of reducing blood sugar and insulin levels but doses as high as 2,000mg per day may be necessary for this benefit. 
  • Sustained release Curcumin: SR Curcumin has been shown to delay the onset of pre-diabetes to diabetes for at least 9 months. This powerful supplement helps reverse cellular inflammation and improves insulin sensitivity. Doses as high as 1,000mg per day may be necessary for this benefit. 
  • Bottom line: Insulin resistance contributes to obesity and often accompanies leptin resistance. Treating insulin and leptin often go hand in hand and must be treated concurrently. 

#9. Consider the use of medications to manage insulin + leptin levels

This is where things get really interesting.

Leptin resistance is largely unknown to the medical community (even endocrinologists and many bariatric physicians), but this doesn't mean that its incidence is growing. 

Unfortunately, this means that getting help for your condition from your doctor may be difficult.

Having said that, there are a few medications that have been shown to dramatically reduce leptin levels and lead to significant weight loss on their own.

The best part about these medications is that they can be used to augment your results and don't necessarily need to be maintained long term.

​They should, however, not be used alone. 

Do not make this mistake.

The combination of medications + hormones + supplements + all of the other steps above will lead to the BEST results. ​

The medication referenced above includes the class known as GLP-1 agonists

GLP-1 agonists have been shown to do several things ALL of which are beneficial to the patient with insulin and leptin resistance.

First:

They directly reduce leptin levels (16).

GLP1 agonists and leptin resistance

Second:

These medications help with weight loss if used by themselves in patients without diabetes or pre-diabetes (17).

These medications are approved for the treatment of type II diabetes, but they have special effects for patients without this condition.

Studies have shown that non-diabetic patients can benefit from the weight loss effects of these medications. 

Third:

GLP-1 agonists REDUCE the rise in leptin levels (18) that often accompany rapid weight loss preventing weight gain long term. 

One of the main reasons that patients gain weight after losing weight (besides from their damaged metabolism) is due to the rise in leptin that occurs as a result of the unhealthy weight loss.

The GLP-1 agonist medications can help reduce that rise in leptin and have been shown to help patients keep off their lost weight. 

Fourth: 

This group of medication also reduces insulin resistance and blood sugar (19).

As I mentioned previously, many of these therapies target both insulin and leptin resistance.

These medications do the same thing. ​

The fact that they target both leptin and insulin makes them very powerful when used in conjunction with the other recommendations listed above. ​

The trick in using GLP-1 agonists has to do with dosing. The standard recommended dosing doesn't work very well and the medication must be adjusted to each individual in order to achieve optimal results. 

I discuss how to adjust the various medications and how I use them in my  weight loss guide. 

  • Bottom line: Some targeted medications can dramatically reduce leptin levels and help with weight loss. Many patients with leptin resistance will benefit from the addition of these medications. 

Take home message

Leptin Resistance and Thyroid resistance are both serious conditions that can make losing weight almost impossible.

It’s a vicious cycle that results in a hormonal imbalance where your body thinks it’s starving leading to constant weight gain and a voracious appetite.

Unfortunately, it can be hard to diagnose and is missed by most Doctors.

Because of this, you will need to be your own advocate, check your symptoms, and start taking action with the steps provided at home.

Remember balancing Leptin, the “master hormone” of your body fat, is required if you want to ever have long-lasting weight loss.

If you have any of the symptoms listed above make sure to get your leptin levels (and other hormones) evaluated and use these tips to help with weight loss. ​

Now it’s your turn: 

Have you been diagnosed with Leptin resistance or Thyroid resistance?

What has actually helped you to lose weight?

​Have you tried T3 only medications for these conditions? 

Leave a comment below!

References (Click to Expand)

Reverse Leptin resistance with this guide









This post was most recently updated on January 18th, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

163 thoughts on “9 Step Guide to Reverse Leptin Resistance & Thyroid Resistance”

  1. Brilliant article! Thank you.

    Can you recommend a practice round or doctor in the uk to work with who shares your philosophy please?

    Thank you and regards

    Billee

    • Hey Billee,

      I apologize but I don’t know of any Doctors in the UK that practice like me. You may be able to find some help if you can find a local doctor that focuses on functional medicine.

      • One idea could be to ask some nearby compounding pharmacies of which Drs prescribe natural thyroid extracts and T3 only medications. This could give you an indication of the Drs style of treatment.

        • Hi I phoned loads of private U.K. endocrinologists and asked them if they prescribe T3. I found that no NHS endocrinologist will prescribe T3 without ruling out everything else, and even then probably won’t prescribe it. I found an endocrinologist who would consider prescribing T3 once I’d had a few tests done to rule out other things. generally uk endocrinologist get in trouble for prescribing T3 if they haven’t tried everything else first. A possible option is to source it yourself and ask the endocrinologist to advise you on doseage, and monitor your symptoms.

          • Hey TP,

            As I’ve mentioned previously on this blog I do have patients in the UK on T3 and NDT. It is available somehow, but I don’t know the specifics. I do know that most of these patients see private doctors in the UK and it may be expensive. Hope this helps.

      • Hi Dr Westin,

        You have provided me with a wealth of knowledge so thank you this.

        Question, what units are you measuring Insulin in and blood sugars in?

        Thanks

      • Hello, dr. Childs. Thank you for your articles. They explain a lot happening in Hashimoto’s patient’s struggles.
        I want to ask you if ferritin levels to be in the upper half is a must, before start taking T3 medication? I read that otherwise, the T3 would stay on the “surface of the blood” and also won’t make the patient feel better?
        Thanks in advance for your reply.

  2. Very interesting article, I have Hashis and problems keeping weight off even though I do a lot of sport and am in my 30s. I also have high Uric acid levels and get gout attacks.

    • Hey Mark,

      Make sure to cut down fructose consumption as well as alcohol! Both of these foods result in uric acid production in the liver and can trigger unfavorable metabolic effects. Some individuals do have higher than normal uric acid levels, even if they do not consume those foods and it appears to be a genetic issue in these instances.

  3. Confused about the drug study you posted for lepton resistance. Is this drug available? Do you recommend it? I’ve tried the other approved weight loss drugs. Phentermene wielded for a while but made me too nervous and forgetful.. I have gained back all that I lost. The other one didn’t work for me.

    • Hey Robyn,

      Yes these drugs are available, they fall into the drug class of GLP-a agonists and they work by sensitizing your body to both insulin and leptin. I only recommend medications if they are targeted at hormonal imbalances in the body. It’s important to realize that these are not “weight loss” drugs, they are medications targeted at reversing or balancing existing hormonal imbalances and that’s why they work for weight loss.

      I use phentermine in my office for some patients, but only when I put them on fasting regimens. In general phentermine puts a lot of strain on the adrenals and can worsen fatigue over time. It works by increasing your basal metabolic rate (by increasing norepinephrine) and by suppressing your appetite (which is why it’s good for fasting).

      The GLP-1 agonists are FDA approved (in the US) to treat diabetes, but they happen to help non diabetic patients lose weight if they have high levels of leptin.

  4. If I use a GLP 1 agonist to lose weight, when I stop using it how do I keep Leptin resistance from coming back? I eat very healthy and exercise and cannot lose weight. I do not have a lot of extra weight to lose just maybe 10 lbs but it is absolutely impossible to get it off. My labs were checked this week. TSH- 0.005 (which most Drs would say I’m hyperthyroid) I’m not having symtoms. Free 3 was 3.60 and free T4 was at the high end of normal. I think 1.50. Reverse T3 has not come back yet, nor antibodies.

    • Hey Kim,

      Once you reverse leptin resistance it’s like going back in time and resetting the clock back 10 years or more. If you don’t change your habits, or don’t reverse other hormonal imbalances then yes it may come back – but it will likely take years.

      It’s the same as insulin resistance. Under normal circumstances it may take 10+ years to develop, and maybe 2-3 months to reverse it. Once you’ve reversed it your body has a tendency to come back to where you were quicker than before, so instead of taking 10 + years it may take 1-2 years. I’ve found the same to be true with Leptin resistance.

      If you haven’t checked your leptin level, then you don’t know if you have leptin resistance or not. I don’t recommend taking this medication for “weight loss” I only recommend taking it to restore hormonal balance to leptin. Your first step is to check ALL of your hormones.

  5. For me my pooling was caused by lack of cortisol, at least for Hashis patients adrenal/cortisol issues are the root problem, all other cofactors come from this, once I was supplemented with hydrocortisone I was able to convert properly and in turn weight started coming off, but I think Lepin resistance happens after other things become out of wack.

    • Hey Karla,

      Thanks for the comment. I’ve seen leptin resistance in patients with “normal” adrenal function, but I’m sure in some patients it does contribute. I’d be curious to know what your leptin levels were? I find that almost every hypothyroid patient has trouble losing weight (at least 80-90% of them), but leptin resistance is not the *primary problem in the majority of cases – just the really tough ones.

      Reverse T3 pooling can be caused by leptin resistance, but other inflammatory states can cause it as well. That’s why in order to figure out what is going on you really need to look at all of the major hormones.

  6. Hello Dr. Child’s,

    My 16 year old daughter has continued to gain weight since being diagnosed at 12 with Hashimotos. She has been gluten-free since 1week after diagnosis, and grain-free for 3 years. We limit fruit and use green bananas for smoothies with blueberries. We are now on AIP. She does not have a ravenous appetite. Maybe that is the high protein content of her meals. I am fairly thin and have lost weight in the 45 days since starting AIP and she has not. She is currently on a levothyroxin and Armour combination. We went to a functional dr for 3 years before she stopped taking insurance, so my daughter has been tested for several infections and viruses, all which were negative. Could Leptin resistance happen in teens? Are there any other tests that you would recommend besides the ones listed above? I’m currently looking for a new dr (closer, as we drove 2 1/2 hrs to the last one), and will get her labs done and need your advice. Any other suggestion you have would be very helpful. She is about 40 lbs overweight.

    Thank you!!!!

    • Hey Nicole,

      Yes, leptin resistance can happen at any age. To get started I would check out these posts: https://www.restartmed.com/lose-weight-hypothyroidism/ and https://www.restartmed.com/lose-weight-hashimotos/

      Both should give you ideas on where to look. I’d be cautious when using AIP, I don’t like putting my patients on it for prolonged periods of time and I wouldn’t recommend it for the sole purpose of weight loss. If your daughter has been sticking to the diet and not losing weight, then her weight issue is more likely related to hormonal imbalance – not diet.

      I would also check her basal body temperature daily to see how her thyroid is functioning, this will also give you an idea if she is ovulating or not (and give you insight about her estrogen/progesterone balance).

      Good luck!

      • Hello Dr. Childs,

        Just got some labs back and we certainly have a significant case of Reverse T3 pooling. Her numbers are:

        TSH: .08
        Fr. T4: 1.66
        Fr T3: 5.19
        Reverse T3: 35
        Ferritin: 41.3
        Iron: 117
        Folate: 9.7
        Selenium: 156
        B12: 873
        Zinc: .93

        I had requested serum leptin levels and when I received the results, the lab said that they weren’t in there. Maybe they have not come back yet.

        Any ideas? As I mentioned in the previous post, we have chased so many rabbits down holes with our previous Functional doctor and never got anywhere besides “she has leaky gut” and now I believe we are that much closer to having an idea of what is causing this very rapid weight gain. Can we get some assistance through your club membership? Unfortunately, in Mississippi there are not many functional doctors.
        We would be so grateful for your advice.

        Thank you,
        Nicole

        • Hey Nicole,

          Yeah, she definitely has very high reverse T3 levels! And that’s why her free T3 looks inappropriately “normal”. She still needs the other hormone levels evaluated like insulin and leptin but the thyroid is certainly contributing.

          I can help you guys with supplements on the membership program, for sure.

      • Can you please tell me why you do not suggest the AIP diet to your patients ? What diet do you suggest Paleo , whole 30 ?

        Thanks

        • Hey Robert,

          It’s not that I don’t suggest AIP to my patients, I do when I think it’s necessary. I don’t have a “generic” diet that I suggest to patients because each person needs something slightly different. So I spend time trying to find out what that is, and adapt it to their specific needs.

  7. I am 83, Canadian & on Thyroid Hormone, 30mg/day(AM)& take Iodine 2 – 4 drops(PM)& feel pretty good, but do have to watch my weight. Did a diet cleanse & lost 12 lbs., so still do some of that diet, limit carbs & have increased fiber, don’t worry about the fat. All other tests(cholesterol, etc.)come back normal. Dr., wants to increase Thyroid Hormone to 2/day but I worry that this may not be the answer.
    You didn’t cover symptoms & wonder if my getting really cold late afternoon & then take my Iodine. After I have supper or after I go to bed I can get overly warm, which wakes me up, MAY this be a symptom?
    In the past I had been put on Synthroid which didn’t agree with me(but is an acceptable drug in Alberta)
    I eat healthy, cook own food, rarely eat ANY junk/canned/cured meats but from what you said, maybe I don’t eat enough. Best meal is breakfast, snack for lunch then dinner with bigger portion of vegetables.

    • Hey Barbara,

      Symptoms of leptin resistance? There aren’t necessarily symptoms but there are warning signs:

      Inability to lose weight no matter what you do
      Constant weight gain
      Constant food cravings, even after eating a large meal
      Constant fatigue, low energy or feeling “sluggish”
      Worsening symptoms of hypothyroidism…

      I would recommend getting an extensive set of lab work and checking out other hormones in your body. Increasing your thyroid hormone may not necessarily be the right answer if other hormones are also out of balance. More info here: https://www.restartmed.com/lose-weight-hashimotos/

  8. When you mention that your Serum Leptin level should be < 12, then in which unit is this measured? I have received my leptin lab tests back and the number shows in microgram per liter. Thank you.

  9. Hello –

    I am in my early 20s and I was told I have hypothyroidism last year and was put on levothyroxine 50mg for about 8 months and switched over to 75mg. I still feel really tired, dizzy, and all the other symptoms someone who has hypothyroidism would get. I hired a personal trainer and I see him 3 times a week and do intense training with weight circuits and I still do not loose any weight.. super frustrating. I eat pretty healthy but snack throughout the day because I am always feeling like I am hungry. I saw my doctor last month to run blood work and he kept me at 75mg and said everything was normal. I do not feel normal. After reading this article, I feel like my issue is Leptin. I made an appointment to run more blood work. What levels do you suggest I ask him to check? Do you have any other advice for me.

    Thank you!

    • Hey Lydia,

      You may very well have leptin resistance but I can almost guarantee that your doctor won’t know how to treat it. It’s usually not helpful for me to give you a list of lab tests to run because if your doctor knew what to do with them, they would have ordered them already. In your situation you’d want to check leptin, cortisol, insulin, sex hormones and a complete thyroid panel – but just realize that ordering the tests is just the very beginning, it’s the treatment that matters.

      • Thank you for the quick response. You say that its the treatment that matters.. is there supplements available that my doctor can prescribe me to or will I just have to go off the tips and ticks to reverse Leptin that you share above?

        • Hey Lyd,

          There aren’t many supplements that I’ve seen consistently work, but there are some medications that can help. Unfortunately, these medications are used off-label so many doctors may not feel comfortable prescribing them.

  10. I had Leptin tested in January and it was 10.7. RT3 was 22.2. I asked my Dr at the time if I could reduce my Levothyroxine and add 25mcg cytomel. He agreed, and the next time my RT3 decreased to 16.9. In the meantime, I’ve started working with a trainer, increased the quantity and quality of calories I’m eating, started resistance training and cut out most sugar, dairy and grains. Still have only managed to lose like 5 pounds in 5 months. I only have like 40 more to go. Sooooo. Frustrating. Would you recommend lowering T4 a bit more to try? I’m still at 175mcg Levothyroxine, which is a lot. I was thinking about trying to cut that in half to see what happens? I think the 10+years of T4 medication is causing most of my issues… Thoughts?

    • Hey Jennie,

      You would be the perfect patient! 🙂 A couple of thoughts:

      1. Your reverse T3 is still too high for my liking and likely contributing to a lower than normal metabolism. If you were my patient I would “flush” out the system by dramatically reducing T4 and increase T3 for a short period. The 175 mcg of T4 is a LOT and though 25mcg is a lot for most endo’s and PCP’s you may need up to 50mcg or more (especially if you are post total thyroidectomy?)

      2. Check other hormone levels like fasting insulin and 2 hour post prandial insulin. If your insulin is > 5 after 12 hours you have a problem. To completely heal your metabolism you will likely need a combination of higher doses of liothyronine + a fasting protocol. Fasting as opposed to calorie restriction actually INCREASES metabolism and helps your body burn fat.

      • See? This is why I wish you were in Wisconsin or did consulting! I’d love to be your patient. It’s hard to get traditional Dr’s to go along with things like this. My Dr gives me some leeway now because he recognizes what he’s doing isn’t helping. Ha. I may try cutting Levothyroxine on my own, but not sure he’d approve a T3 increase? I’ll ask him about the insulin tests. I have NOT had a thyroidectomy. No one has ever even scanned my thyroid. I was just told I had hashimoto’s and before I knew it over the course of 10 years I was on 225mcg Levothyroxine and had gained 70 pounds…early menopause at 35. (which I think is directly related to the T4 personally)…
        I would LOVE to be the first to know if you’re ever able to do out of state consulting! Thank you for your info!

          • Hey Jennie,

            I will have to write a blog post about it for more clarification, it’s a little complicated for a message here. I also have a 28 day program that should be coming out soon designed specifically for weight loss for people with hypothyroidism and fasting is built into this program.

  11. How much Zinc and Selenium do you recommend per day? I have been Hypo for over 15 years, I continue to gain weight despite the fact that I run 2 miles a day, and bike 10 miles a couple of times a week. I don’t eat a lot of sweets but do enjoy fruit and my biggest downfall is salt, I seem to always crave salt. My Dr recently said she can add some T3 to my .88 of Synthroid, but I was afraid to mess with anything, since my only symptom at this point is my weight. When my thyroid was off before I experienced a lot of anxiety so now I am very afraid to try anything, in fear of messing it up. Will adding T3 change how much Synthroid I will need?

    Thank you for all this wonderful information. I so desperately want to feel human again and lose this extra weight, this has given me hope that it is possible. I now know I am not crazy that there are others who struggle to lose weight and do so much exercise and nothing works. It really is not as simple as calories in vs calories out, if so I would be a size 0, ha ha.

    • Hey Audrey,

      You’re welcome!

      60mg of Zinc at most and 400mcg of selenium at most. It’s definitely not as simple as calories in vs calories out. Make sure to get your other hormone levels checked and treated if they are abnormal otherwise it will be impossible to lose weight.

    • I’m sorry, I did not manage to write my own comment so I hope it’s ok to answer someone else’s comment.

      This is one of the most interesting articles I’ve ever read!!! I have all the symptoms of leptin resistance (diagnosed with Hashimoto’s 20 years ago). I have been on NDT for quite some time but did not get the results I expected. I keep raising the dosage slowly but don’t feel better, and I still have many signs of low metabolism despite a suppressed TSH (<0.01).

      I was recently told my uric acid levels were slightly above the upper normal limit but, as long as I did not display any signs of gout, there was no need to do anything about it.

      My appetite is ravenous and I crave fast carbs. In a short time I've put on 28 pounds while exercising and following a low carb, high protein/high fat diet. While other people lose 2-4 pounds a week on that diet, I keep gaining weight…which is why I find it so interesting to read about the need to eat less protein when leptin resistant. So far, I was under the impression protein would make me feel full longer and increase fat burning.

      If anyone here has managed to cure leptin resistance with T3, I'd be very interested in finding out exactly how you did it – did you take T3 only, or was it enough to decrease the NDT and some T3 to the mix? If so, by how much did you cut your NDT dosage and how much T3 did you add?

      Any input would be much appreciated!

      Anna

  12. I know that you treat out of state patients, but what about out of country patients? I’m American but live in London. Do you do Skype appointments?

    Thanks in advance!

    Marianna

    • Hey Marianna,

      I can work with out of country patients but I’m limited in terms of ordering tests and prescribing medications.

      • Ok, I’m interested in getting in touch. I can get tests over here if you advise me on what to get. Basically I’d like to tell you my background and what issues I have and ask for your feedback. I know for certain that I have insulin resistance but I don’t know about the leptins. So, how do I go about setting up a ‘consultation’ with you? Thanks!

  13. Thank you so much for all this valuable information. My leptin blood test result returned with 39.9 ug/l and my RT3 is 0.55 nmol/L, FT3 4.23 pmol/L. My doctor offers no solution for the high leptin level. He prescribed 125mg of T4 and 20mg of T3 medication. After more than 10 years of struggle, I do not give up and keep digging, specifically thanks to your help Dr Childs.

    • Hey Nicole,

      Keep up the good work! Most doctors don’t know how to treat leptin levels so they just avoid ordering the test, unfortunately.

  14. My leptin level is 84 !!! What the heck needs to be done I already eat low carb high fat and am on higher dose of T3 .

    Have already lowered my NAturethyroid and added T3 , my RT3 is now 10

    Is this leptin level dangerous , I would think I need meds for that high of leptin level , what meds are GLP-1 Agonists?

  15. Hi my leptin came back at 84 !! No wonder I can’t lose weight , what meds are used to get this down ?

    My RT3 is around 10 and I am on T3 ,

    What are some GLP- 1 meds ?

  16. Looked up the info on Byetta and Victoza and they have some serious side effects , like pancretisis , thyroid cancer ….. Do you feel it is still safe to use ?

    Why not just increase metformin dose ?

    • Hey Jo,

      For leptin resistance I only recommend using it for a short period of time so the risks are mitigated. The conventional approach is to put a patient on the medication and leave them on it which leads to the side effects you listed. Getting on the medication is the first step, but using it correctly is the important part.

      Increasing metformin will have little effect on leptin levels. In terms of other medications there aren’t many options.

  17. Dr. Childs want to say because of this article I found out what I hope is my last major problem to this puzzle I have been trying to fix for 20 years !

    My doctor has started me on Byetta 5 mcg twice a day for my extremely high leptin issue . Is the 5 mcgs Byetta twice a day for 3 months the proper way to use it ? ?

  18. Dr. Childs
    I have my lab results back for Leptin Serum but the range is based on my BMI and if I read your article correctly, you don’t consider that.

    My result is 26.5 per ng/ml, not good!

      • Dr Childs,

        I’m not diabetic but I am taking Metiformin to keep my glucose under 99, should I stop taking Metiformin if she prescribes the other medication?

        Since I started taking Armour Thyroid (4 months ago) my Blood Pressure and Glucose (126 prior to that 91) have risen drastically AND it did nothing for my T3 or T4. So she prescribe 25 mg of Liothyronine and told me to stop taking Armour Thyroid, as of yesterday 6/21/16.

        I’m not sure which medication EXACTLY to ask my doctor to write me a prescription for to reduce my Leptin levels. I tried to access the website but for some reason it will not let me sign up. I see another poster indicated Byetta and Victoza, but they are injectable, is there something in pill form? I’m not good with needles!

        I purchased Zinc and Selenium and will start those tonight.

  19. I am desperate… My problem is that I no longer want to eat any food at all. I was in-patient for 12 days last week, and no one could help me besides prescribing klonopin and hydroxyzine for anxiety and high stress levels as I cannot sleep anymore. I have not eaten processed foods for years, and in the last month have cut out bread.. only eating fresh foods, boiled eggs, broth, etc. so much so that I no longer want to eat at all. Today I had one boiled egg, coffee with coconut oil and a few bites of watermelon. My GP is at a loss .. and I will not go to an endocrinologist as they will only want to re-start me on synthroid. I have been on NP Acella for a couple of months now, with additional T3 (liothyronine) started at 25 now cut in half. Just decided to get the selenium and zinc you suggested, but other than that.. any ideas? Thanks

    • Hey Janel,

      I would consider a comprehensive panel looking for autoimmune disease, chronic hidden infections, mold toxicity and inflammatory markers.

  20. Thank you so much for your informative site and for taking the time to answer questions. It’s greatly appreciated. I have all your nominated symptoms of leptin resistance with leptin levels of +50 since 2007 (testing available then but suspect +levels lot longer).

    I’m desperate. I follow a very strict regime of paleo diet and HIIT exercise 6 days per week and not only cannot shift the weight but can put on 5kgs in a WEEK if I dn’t stick to the strict regime. Off paleo, it’s even worse.

    Medications:

    90mcg T3
    100mg 7 keto DHEA
    100mcg pregnenalone

    Byetta and Symlin (90 day cycles) x 3 each. Absolutely NO change to leptin levels.

    I don’t know where to turn. I’ve been to endos on 3 continents trying to find out why I have chronic leptin levels and apart from “lifestyle factors”, which I believe I’ve never had, they have no answers.

    Blood tests: I keep

    Free T3, Free T4, DHEAS, Preg mid range
    TSH <4
    RT3 – moves around between high (I water fast a lot as the only means to stop galloping weight gain) and normal

    Supplements. I take anything that has any chance of treating leptin resistance the main suspects are:

    Phosphatidylcholine
    N Acetyl Cysteine
    Curcurmin
    Cpd Choline
    Selenium Complex
    PQQ Caps
    Resveratrol
    Magnesium L-Threonate
    Ubiquinol CoQ10
    L Carnitine
    D-Ribose Tablets
    D3

    plus all the usual vitamin and mineral suspects

    Anything that has any cited research that might possibly kinda treat leptin resistance I take and yet………..

    I would be so grateful for any idea where to go from here. I've been chronically water fasting for more than a decade as it's the only thing that prevents extraordinary weight gain but I do find it a chore. Without it, I've continued with paleo and HIIT exercise (I can leg press 170kg!!) and gained 20kgs in a month.

    Any ideas would be so gratefully appreciated.

  21. I thought for sure I had the pooling issues..But based on what you show, it looks liek my Reverse T3 is not at the level where you consider it an issue?
    Reverse T3- 11.9, Free T4, .91, Free T3 2.8, TSh .479. I take chelated iron as I am trying to get my Ferritin levels up. they are at 57. Vit D is still low, even though I take liquid 5,000 iu every day.
    I take Naturethroid three grains. I split it up too, I take one 97.5 in morning and one 97.5 at night. I wake up tired no matter how much sleep I get. I always get sinus infections. I have had two sinus surgeries… tonsils out as an adult..
    I take raw adrenals by Standard Process, I take zinc and selenium, Magnesium at night.
    I had to start taking bio identical progesterone starting day 10 of cycle and then stop when I menstrate. I thought this may have kept my weight on.. but I went off of it and my next month was awful. I started my period at day 20! . I was first diagnosed with Hashi’s in 2011. My antibodies do not show up anymore. I do have a nodule on my thyroid but its benign. I am tired of going to specialists that dont know what to do etc. I have spent so much money and buy tons of books and just keep on researching.. I have alot of labs that I have already done.. I think the only thing I have not done is saliva test.. but I am sure there are more tests that need to be done.

    • Hey Alyssa,

      Not all fatigue is thyroid related. I see many patients confuse a slow metabolism with persistent hypothyroidism and they focus on thyroid hormone while eating 1000 calories per day. That is a recipe for never feeling better!

  22. Hello I have a thyroid condition that I have not been able to get in control and I have hair loss from it and I also an anemic it seems as though the first set of pills I was on worked for a minute and then she had to up the dose but eventually I switched doctors to see what he can do to help me but not sure of him also I wanted to know we’re are you located

    • Hey Sabika,

      I’m in Gilbert, Arizona.

      Sometimes it takes time to play with the dose before you find what works best for your body.

      • Great info! I’ve been diagnosed with adrenal fatigue, hormonal imbalance, and most recently ehlers danlos syndrome. I just put on about 14 pounds, am always hungry, brain fog, etc, and have started the bio-identical hormones & hope that will help. I also just started LDN – I found your writing on that very interesting. I think the Leptin resistance sounds very interesting as well.

  23. Dr. Childs,

    Your website and information are really helpful, so thank you for what you do! I’ve been seeing a functional medicine physician for several years now and have made some great improvements in many things, including hypothyroidism (I currently take T3 and T4 medication). Weight is still a constant battle for me. A complicating factor is that I’m a Type 1 diabetic and feel that I have less “control” over insulin resistance. I eat a marginally carbohydrate-restricted diet (fewer than 100 carbs a day, usually), and I’m gluten- and dairy-free and obviously have to match the insulin I take to the carbs I eat. How does leptin resistance play into this? I feel like it is all part and parcel of the same root issue, but I can’t seem to untangle it. Are there other things to be mindful of? (I also take Farxiga (off-label), prescribed by my endocrinologist. I find that works better than the Victoza or Symlin did. My A1C is below 7, so my diabetes is in decent control.)

    I will continue reading and searching, but thank you in advance!

    • Hey Jen,

      I have also found that SGLT-2 inhibitors and GLP-1 agonists work well for reducing insulin resistance. Your Hgb A1c looks pretty good, but I would definitely look into leptin/thyroid and I would also consider prolonged and intermittent fasting routines to increase cellular sensitivity to insulin.

  24. Hello,

    I was diagnosed with Hashimoto’s in 2015. I have three benign goiters. I was on Synthroid 88mcg then added Cytomel 10mcg. I then switched to Armour 60 mcg. Can I take Cytomel along with Armour to get extra T3?

    I cannot lose weight. I do feel better on a lower carb process. Carbs do make me feel bloated and heavy. I would like to either increase to Armour 90 mcg or add T3 to current dose.

    Suggestions?
    ~K

  25. My last thyroid labs were:
    TSH .243
    Free T4 1.8
    Free T3 2.8
    Reverse T3. 31
    TPO 45

    I was on 175mcg Synthroid doc pulled back to 112mcg
    He did not prescribe T3 meds

    Would I benefit from T3 meds?

    • Hey Julie,

      You might, but it’s unlikely that your current doctor would give you high enough doses to make a difference.

    • Hey Tyler,

      Truliciy can work, I perfer some of the others but it’s in the same class of drugs as the others that I recommend. I usually don’t recommend using the GLP-1 agonists by themselves for leptin and insulin resistance though – they work better when coupled with other hormones + fasting.

      • Thanks for fast reply ! I am also on T3 meds for my thyroid I already do a 16 hour fast with 8 hour eating window ? Do you like longer fasting ?

  26. I just had my own lab work done and found out that my leptin level is 26 and my reverse T3 is 22.8 with a free T3 of 2.9. Clearly I am in need of help. This has been a 2 year nightmare of trying to figure out what is wrong with me. My question is this: should my leptin resistance be treated first, or should I be treated for both conditions at the same time? I just found out my results today and will begin my search for a doctor that can help me. I have already started on your suggested supplements and diet recommendations. Thank you so much for the information that has put me on what I think will be the road to recovery.

    • Hey Dru,

      No problem and I’m glad you found it helpful.

      Generally I recommend treating both simultaneously, but if you have both of those hormonal issues I’m sure you have some others lurking around in your blood work as well.

  27. Dr. Childs – Thank You for sharing this information. I was surprised that my PCP refused to provide an order for Leptin, Insulin, and Reverse T3. He suggested I find a functional Dr and get the order from him/her. Unreal!!!!

    • Unfortunately that is quite common. You wouldn’t want him to run the tests anyways because he wouldn’t know how to interpret and treat based on the results.

  28. Dr. Childs – my 17 year old daughter has been suffering through weight gain and total inability to lose weight for the past 3 yrs. We’ve seen dozens of Dr’s and the only diagnosis is hypothyroid. She’s on 120 Armour, Yaz birth control to balance estrogen and progesterone along with a multivitamin. She eats gluten free and less than 100 grams of carbs per day. The one functional Dr that tested her rt3 (level was 18) was unsure what to do with it. Not one Dr. has ever checked her leptin. Last fasting tests reflected:
    TSH .5
    Ft4 1.5
    Ft3 3.1
    Rt3 18
    Crp 11
    High morning cortisol 30
    Low vit D, low growth hormone

    Do you think she’d benefit from adding cytomel or byetta?

  29. Hi
    I’ve got low leptin (8) my bmi is 34 my reverse T3 is 24 top end of normal. I’m female 42.. what is going on? I was expecting a high leptin result.. but it’s low ? .. does that mean that my body is in starvation mode and I’m still over weight by 20kg.. of course I can’t loose weight. If I eat carbs I gain 1-2 kg over night. I’m grain, legume, egg, dairy free (5/95 ratio). I don’t snack at night. I often don’t eat till lunch time. My BP is normal.. resting pulse is 67-70bpm. I’m tired all the time, memory issues, foggy head.. I can go on for hours.

      • So having a low leptin score with a high BMI is a good thing?

        My reverse T3 is 24 boarder line high and my ratio T3/RT3 is low .. if it’s not leptin causing this issue.. what are the other possibilities.. the rest of my thyroid test results are within normal range.. my GP thinks I’m making a fuss about nothing.
        But I feel slightly depressed, angry mostly irritated and angry! overwhelmed, unfocused, unmotivated, and other cognitive issues, such as saying words incorrectly or jumbling up their pronunciation, not being able to remember how to spell something I knew how to spell yesterday.

  30. Hi Dr. Childs,

    Thank you so much for this video. I’ve watched it several times before taking my list of labs I asked to be performed by my doctor. He is as stumped as I am as to my weight gain – I look at celery and gain weight (about 30 lbs in the last year, which I attributed to switching to Armour Thyroid and not increasing the dose quickly enough. I was on Synthroid for 16 years) Now having my labs back, I’m stuck as to what to do next.

    TSH: .869
    Free T4: 0.82
    Total T3: 230ng
    Reverse T3: 11.8
    Uric Acid: 3.3mg
    Cortisol: 0.4ug
    Leptin: 21ng (which was said to be normal)

    I’m 5’4, 33 years old, 220lbs.

    I’m on 135 MG of Armour Thyroid but my hypo symptoms are raging. Losing hair, exhausted all of the time, weight gain, foggy. I take vitamin D, have added Zinc, Selenium and B12. My husband and I are also trying to start a family, which isn’t happening – my OB wants to start me on Clomid. Any help is appreciated. I’m at my whits end. Thank you so much for your time!!!

    Lindsay 🙂

  31. Hi dr childs!

    You are a wealth of information and im so glad to have found website.

    I have every single one of the symptoms listed above! Ive suspected that i have hypo for 2 years now but no doctors could help me because my results are normal – although my free t3 is low at 3.0

    The problem is, i am not able to test for free t3 and my leptin levels here in Singapore.

    I am also not able to get the medications that you recommended above.

    Do you suggest I try the medications still, even without a proper bloodtest n doagnosis? And do you think its possible to reverse leptin levels and balance out my hormones without the use of them, but just with a healthier lifestyle and the supplements u suggested?

    • Hey Et,

      Hard to say, by the time people come see me they generally need all of the therapies. I’m sure there are some people out there who can get by on less.

  32. Thank you so much for the time you take to put this information out for people like me who are trying to go it alone because the regular medical Dr.s don’t know how to help or want to help deal with root causes. I’m going to look more into your website as maybe I can do phone or skype consultation with you.
    Blessings to you!

    • Hey Candis,

      You are welcome. I would point out that it can be very difficult to try and figure all of this stuff out yourself, one of the best things you can do is find someone to help guide you to prescribe medications/hormones, etc. as necessary.

  33. I’ve been diagnosed with Hypothyroidism again in 2015. I said again cause at the age of 9, I also was diagnosed with Mixed Connective Tissue Disorder…Lupus, Ra Hypothyroidism etc..now I’m 34 and Hypo came back and no one seems to know how to help me get back on track. I keep gaining and even when my levels are normal but my Endo haven’t check rt3 and Leptin just the basic TSH, t3 and t4. My TSH is what keep going up and down. At first it was 11 and now last checked it was 6. Im now taking Armour 90mg the Snythroid 130mg made me swollen and retain alot of fluid. When I was a teenager it didnt take years for them to get my hormones back together…Is there any extra blood test I can tell them to run? My problem is that Lupus ALWAYS get the blame for everything.

    • Hey Shawnta,

      Unfortunately if you have to ask for blood tests then I can almost guarantee you that the physician probably won’t be able to help you much, the reason is simple: if they knew about the tests they would have ordered them to begin with. The single best thing you can do is try to find someone who is knowledgable about hormones to help you further – this will most likely mean looking outside of the insurance model.

  34. Excellent article!!
    Is it absolutely necessary to have serum leptin levels higher than 12 to be leptin resistant? Thank you

    • Hey Gustavo,

      I’m not 100% clear on the answer to that because I have patients who exhibit symptoms of leptin resistance with leptin levels less than 8 and I still treat them as if they have leptin resistance. Some of this might have to do with the daily trends and changes in leptin levels.

  35. I am curious, and would love some feedback from a proffessional in this field. I was diagnosed with hypo 2 years ago by a practistioner. Put on levothyroid. It work amazingly for a month then stopped. But continued to take ot for a year. Got into studying the thyroid myself to help myself and started asking questions. Ask for a full panel and found my reverse were bad! Asked to be put on Armour thyroid and again felt great for a month then it too declined…asked to go see a specialist. She on the first visit was great and ran all sorts of tests. Came back and said I was Hasmoto thyroid, insulin resistant, and had a high testostrone level (i am female). Put me on a higher dose of Armour, and also some metformin, and spiraldactone. I lost 20lbs just like that! I have a good diet to say the least. But then the weight loss stopped. Was put on birth control for PCOS. Have been on all these meds for about 6 months now and nothing! I take omega3, daily vitimins, ginger tabs, coconut oil tabs, and vitimin D as well daily. I asked my doctor once about leptin resistance and she said it does not affect obese people!!! And dropped the subject. I started at 227 now at 185 and cannot for the past 6 months or more lose any weight….its been two years total since diagnosis first started rolling in and 8 years or misery becuase doctors would not listen to me in the first place…what are your sugestions?

    • Hey Trisha,

      Your total weight is a combination of multiple hormone imbalances stacking up in your body. Insulin may be contributing 10 pounds, thyroid may be contributing 15 pounds, leptin may be contributing 20 pounds, etc. If you only treat one or two of these imbalances then you will have some weight loss but you won’t get back to your “ideal” weight. In your case I would keep looking until you find what hasn’t been treated.

  36. Hi,

    I had my thyroid removed 2002. I have been on .125mcg of Synthroid, and was able to keep at my normal weight, sleep, etc. This last year I have been putting on a lot of weight, even though I do HIIT and eat healthy. I have put on 20 lbs. I have a lot of physical and mental fatigue, do not sleep well, crave high fat and sugary foods, and chocolate. I am also finding myself very anxious and depressed. I did undergo to surgeries this last year and was able to fully heal. Unfortunately, I have all of this weight gain, horrible cravings, fatigue, and feel like I have aged 25 years the last 6 months. I am 52 year old and getting fatter by the minute. Please help.

    • Hey Nanette,

      The best thing you can do is find someone local who can help you determine your hormone problems and put together a comprehensive treatment plan. Without the help it will be difficult (or impossible) to feel better and lose weight.

  37. I had a TT IN October due to thyroid cancer. I am currently on synthriod 137mcg. Overall I feel good. I am battling with weight gain. I am on a low carb diet and exersise regularly – I’ve even stepped it up. (Spinning) In December I had a week where my left big toe was hurting and often the bottoms of my feet hurt. I have done some research and think it may have been gout which would mean something’s going on with my uric acid. I got into doctor the next week and here’s my numbers
    – uric acid -7.3,
    TSH – .01
    Free T4 – 1.81
    TG – 0.14
    PTH, intake – 84

    I go back to my endocrinologist at the end of February for another ultra sound and more blood work to determine if radiation is need. I am reading a lot but want to make sure I am as informed as can be. I also want to ask for the correct medication. I know I need something more. I suspect a leptin issue but wanted to get your thoughts as well. Thank you.

  38. Interesting article. I’ve read that alpha lipoid acid is contraindicated in hypothyroidism. Is that true? I’ve also read that berberins can reduce muscle mass. It gets so confusing when there is conflicting information from healthcare providers. You also stated there is a risk of increasing reverse t3 if an individual remains in a calorie deficit or overtrains. Is this true when they are on cytomel? I thought you wrote that being on cytomel decreases the potential of Rt3 because there is less T4 for conversion?
    I look forward to your response.

    • Hey Rhonda,

      Being on a calorie restricted diet will always reduce metabolism over time, usually this is reflected through a number of hormone imbalances including high levels of reverse T3. Being on cytomel will not negate this effect and you will still get metabolic damage if you calorie restrict yourself.

      I never make recommendations unless I’ve used them successfully on my patients so anything you see here has been used successfully on hypothyroid patients.

  39. Hello thank you for all of this information. I asked my Endocrinologist yesterday about my weight loss and how it is extremely hard for me to lose weight. I have hypothyroidism and I also had a pituitary tumor I talk to my endocrinologist about switching to a T3 thyroid medication instead of levothyroxin and he said that this was not OK and it would not be safe. He said that T3 raises your heart rate and is extremely unhealthy. He told me that I am different than everybody else and that I must require way more exercise to lose weight or I should look into bypass surgery which I am extremely against it may work for some but it is not even an option for me I would not do such a thing I do not have a problem watching what I eat or exercising. Last February I started working out and eating healthy and I lost 115 pounds then in October I had to have surgery and I was told by my surgeon not to exercise for six months so that puts me at April since October I have gained back about 20 to 25 pounds and I’ve still been eating extremely healthy and walking since I am not allowed to exercise until April. Oh my endocrinologist says that unless I am working out every single day busting my butt and eating very healthyI will never lose weight. But I don’t agree with him I don’t think that I should gain so much weight back just because I’m not exercising my mother my sister have both I also stopped working out and I have each Max gained 4-5 pounds not 20 to 25 pounds. Neither of them have any thyroid issues or pituitary gland issues . I feel like my metabolism is extremely low and that I’m not on the proper medications which is causing me to gain weight and I don’t know where to go or who to turn to because my endocrinologist doesn’t seem to want to look into anything or help me any further just says that I need to not read articles such as yours that are not FDA approved or from a very good source.

      • I’ve read a lot of your stuff and that’s why I am reaching out to you. I don’t think my doctor is giving me the correct information and wanted to know if you have any suggestions for what I should do?

  40. Hi dr. I sent an email regarding the 1 on 1 program but no one answered my questions yet.
    Are the program still open?

  41. I have been obese for decades and have received absolutely no help from any of the MDs I’ve ever seen. I’ve told them how it is impossible for me to lose weight not matter what I do. I kept getting told eat less/exercise more. I had a friend recommend a local chiropractor who specializes in wellness and nutrition. She’s been running some lab work and one was a cardiometablic test which included leptin. Mine is 132.9 Have you ever seen one that high? She is recommending a ketogenic diet and supplements to help support insulin and my pituitary. Does this sound like the right direction to go?

    • Hi Pam,

      I generally recommend against seeing chiropractors because they lack the expertise and ability to prescribe hormones and medications. The direction you are heading in sounds reasonable, but likely won’t be sufficient by itself to combat that degree of leptin resistance.

  42. You said above Serum Acid Level <5 is to much fructose and then a couples sentences down says you LIKE to see S.A.L. <5 and Leptin <12 ? I am I confused? PS.YOUR GREAT!!!!!!!!!!

    • Hi Ava,

      Fructose increases uric acid levels. You want uric acid to be low and leptin to be low (the ranges you references).

  43. I am so glad I found your article, I could cry. I have been struggling for the pas 10 years with weight gain and fatigue. No matter how much I excercise or starve. I was diagnosed with hypothyroid at age 17 and am 55 years old now, has my Brady developed lepton resistance? Do you recommend adding both the cytomel and the lepton resistance medications?

    • Hi Sujata,

      Each person is different and requires a complete work up including full history and lab panel before you make those kind of choices.

        • I have a huge list I get on every patient at baseline, your best bet is to find someone willing to order these labs without you having to ask for them.

      • Since my last comment I had add 5 mg of Cytomel five days a week to my 100 mg of Synthroid 7 days a week. It’s now been six weeks and I have not lost a single ounce despite exercise and proper diet. Does this mean that cytomel does not work for me what are my other options? My latest results prior to starting the Cytomel . tsh 0.085; and t3 98. I am 5.3 and I weigh 165 pounds

        • Hi Sujata,

          5mcg is a very small dose so it doesn’t necessarily mean that T3 isn’t for you. It might suggest that you have other problems going on simultaneously, or that your T3 dose isn’t high enough.

          • Thank you. I have been to 7 different doctors and no relief. I have no idea what to do next. At this rate I am very scared that my health is going to deteriorate if I don’t find a solution.

  44. Hi, I have commented before. I am just trying to get my head around everything.

    Background: After being given a small amount of radioactive iodine treatment (participated in failed trial to determine right amount to bring thyroid to normal levels) for Graves I soon developed hypothyroidism.

    Treatment: On Oroxin (T4 only meds) for 20 years gradually putting on weight. TSH; FT3: FT4 and antibodies all completely normal but still had symptoms of hypothyroidism worsening in the last 12 months.

    Dr tested RT3 – it was very high. GP reduced T4 from 125mcg to 75mcg adding compounded slow release T3 (5mcg increasing to 10mcg). While initially felt much worse, gradually I felt great so GP increased T3 to 15mcg but I noticed hair started falling out becoming thin all over. Panicked I thought serious sign of hypothyroidism so increased T4 to usual level with 10mcg T3 per day – continued to feel good and still do.

    Current Situation: Weight loss impossible even with 6 month’s diet and exercise. I don’t eat breakfast as I am not hungry (probably due to morning cortisol levels) so fast up to 17hrs per day and get carb/sugar rush at 3pm. I have typical round hypo face so, as with most hypo patients. So, I asked GP to test Leptin.

    Leptin results very very high. GP said i have leptin resistance. After reading your articles this explains high levels of RT3. By now my GP thinks I am all too hard and just told me to go on a Kenetics diet and come back in three months to have Leptin measured again. I also have high Uric Acid levels (I don’t know if that has anything to do with anything – just thought I would add it in).

    So, after seeing link between leptin and RT3 my plan is to try and eat a high protein breakfast, continue to walk 30mins a day, reduce T4 back to 75mcg again and increase compounded slow release T3 to 15mcg increasing to 20mcg.

    So, I have two questions. Firstly, is this a good plan? Do you think the hair loss I experienced (normal again now) was associated with lowering the dose of T4 or raising T3 even though at the time I was feeling great otherwise? I am in Australia – we don’t seem to have many functional doctors here and I live in a remote location anyway. I am just looking for some direction. Thankyou

  45. HI
    I’ve cleared my reverse T3.. it’s now 11. I’ve been on T3 only for about 6mth. I’ve been using berberine for about 3 months, plus a few (lots) others. I have lost about 2kg .. but it’s very slow. Recently I’ve been diagnosed with a gallstone stuck in my gallbladder duct. Would this new (possibly old) issues be stalling my weight loss. My leptin was 8 last year.. I’ve not redone it. I’m about 25kg over weight, BP, pulse etc are normal. My temperature has risen with the continued T3. Would the gallbladder issues cause cortisol issues.. increasing leptin? I think the T3 will keep the RT3 down.

  46. Is it expensive for people to use the GLP-agonist since their not a diabetic? And do you take any patients out of state and treat by phone or internet? Thank you Debbie Braun. Are there side effects using the diabetic drugs?

    • Hi Deborah,

      Yes, the GLP-1 agonist is quite expensive unless your physician knows how to help you get it cheaper.

  47. Hello,

    Do you take patients at this time? I have a myriad of health concerns and am desperate for guidance and proper testing.

    Thank you

  48. I have recently been prescribed t3 20mcg added to my t4 reduced to 100 mcg
    I have suddenly started dreadful cravings for chocolate and sweet foods
    I have also gained weight
    Prior to this I had been losing weight steadily for a few months then stopped and started oscillating slowly at first then 5lb on 5 lbs off on a weekly basis.
    I have been swimming at least 5 x per week for 90 minutes a time in chlorinated water and I realized it was having an adverse effect on my thyroid but with HOCOM swimming is one of the few exercises I am allowed to do.
    Are the effects I am experiencing likely to continue.
    I fought very hard to have the t3 prescribed and any comments against it will give the doctor a reason to discontinue what is a very expensive medication
    I would really are hate your input on this

    Regards

    Dorothy

  49. Hi Dr Childs,

    I have just done a blood test and discovered I am leptin resistant (although I have not done any of the other tests you have recommended). My naturopath suggested I test for it after having my second child and holding lots of fat around my mid section even though I exercise 1.5 hours a day and eat quite well. I had gestational diabetes and wonder if there is a correlation?

    My first question is – do you recommend any of these medications while breastfeeding?

    Secondly, I have been spending some time researching leptin resistance and most other articles recommend a diet of around 30% protein and to ensure high protein at breakfast. Your approach differs from this and now I wonder if I am having too much protein?

    Thirdly, do you think trying to treat leptin resistance alone without doing all the other tests is a waste of time?

    Thanks in advance, Nikki

  50. Hi Dr Childs,
    Thank you for your articles on Reverse T3. I came across your site while searching high reverse T3. I feel really confused at the moment because I’ve been reading about reverse T3 for many years and it actually took years to find a doctor who would test for it and when I finally got tested 2 years ago it was high at 35. By that time I had been on several different doses of synthroid, tried natural dessicated thyroid – didn’t feel well on any of them – with a lower dose I always had hypothyroid symptoms and when my dose was increased I would get palpitations and inner shaking. I had elevated antibodies at one point although practitioners never told me it was hashimoto’s – I had to ask and they confirmed it was. My antibodies were down on my last few tests. So my confusion now is about the high reverse T3 – when it was tested two years ago I went off T4 meds and went on cytomel only – could only tolerate low doses, anything over 10 mcg gave me palpitations. After switching to cytomel my reverse T3 dropped from 35 to 29 to 22 over about six months. For the past year I’ve been on only 5 mcg of cytomel, my reverse T3 wasn’t tested because I’m seeing a different practitioner. She finally agreed to test it last month and it was high again at 27 on T3 only meds. So now I’m really confused because most of what I’m reading says it has to do with T4 not converting to T3 but I’m on T3 only. Maybe there’s more to the high Reverse T3 issue. I did read on another website that too much T3 without enough T4 could also convert to reverse T3. I really wish there wasn’t so much conflicting information. It really is difficult when someone’s trying to figure things out on their own because many of the practitioners are not up on the latest in thyroid health and are still just checking TSH and prescribing synthroid meanwhile we have to resort to doing our own research on the internet. I’m grateful for your articles. Thank you.

  51. Dr. Westin,

    I’m requesting a leptin test from my doctor tomorrow, but do you have a recommended time of day for the draw?

    Also, I have a sluggish thyroid (T3 is not optimal and TSH is near 6). However, I’ve tried Naturethroid, Synthroid generic, and Tirosint, and all caused painful heart palpitations. Do you have any recommendations or does that mean I’m not ready for treatment?

    Thanks!

  52. Hello,
    I’m 58 years of age and have been struggling with chronic constipation, some depression for no reason, being cold all of the time, thinning hair, weight gain, and terrible brain fog just to name a few for the last 8 years but, no doctor will treat me for Hypothyroidism because all of my blood tests always come back normal. I took my temp under my arm first thing every morning for 5 days and my temp ranged from 96.4 to 97.2. I believe with all of my being that I suffer from Hypothyroidism. How do I get someone to listen to me. What do you suggest?

  53. Dr Childs,

    Another great blog, I would like to know what is fasting + exercise (time of exercise particularly) for someone who is thyroid as well as leptin resistant but not at all insulin resistant or does NOT have any glucose issues?

    I have read from some neurologists blog that they say fasting and exercise on empty stomach in above case specifically, is not good for leptin resistant?

    Thanks in anticipation,

  54. I was diagnosed last year with hypothyroidism…. Tried synthroid, but my body doesn’t convert it to t3… My endocrinologist switched me to cytomel (50mcg 3 times a day) I seem to feel the effects for about 1-2 weeks, but then all the fatigue and weight gain seem to start again. My free t3 was 5.5 a month ago which puts my into the hyper category. I workout and eat healthy… It’s my life…I teach special Ed pe and Pilates. I can’t lose a pound to save my life and now have increased cellulite on my legs/glutes and fat on my stomach that I’ve NEVER had before 🙁 I’m at such a loss….

  55. Where have you been all my life? Pretty sure you hit the nail on the head, question is how to find a Endo to comprehend the above. Do you have any referrals in Austin, TX? I was recently taking Topamax which immediately eliminated my desire to eat (leptin) but I’m pretty sure it’s giving me brain damage and will make me go blind if I continue on it. The sad thing is I know what it feels like to be normal – at least in relation to food while taking it. You described me to a T above, very hopeful to find a Dr that can actually help me to resolve this life long battle once and for all. Thanks in advance! Clarisse

  56. Hi, thanks for all these informative articles. I was thinking leptin resistance might be my problem, but you mention typically you see mid to high free T3 levels, whereas mine is below range. Can you point me in the direction of one of your articles that might best help me? Thank you.

    THYROID STIMULATING HORMONE 1.62 mIU/L. 0.27 -4.20
    FREE THYROXINE 14.9 pmol/L. 12.00 -22.00
    TOTAL THYROXINE(T4) 66.1 nmol/L. 59.00 -154.00
    FREE T3 *2.77 pmol/L. 3.10 -6.80
    REVERSE T3 16 ng/dL. 10.00 -24.00
    REVERSE T3 RATIO *11.27. 15.01 -75.00
    No antibodies to speak of.

  57. Searching for a doctor that is willing to listen and understand the struggle has been difficult. Do you have a suggestion on how to proceed with finding one that will test for and research the information? (FYI: Live in DFW area in Texas)

  58. Good evening Dr. Childs,

    I’ve written before but I’m a 28 year old male, 11 year history of bulimia, mostly in remission now as I’m completely and utterly terrified that I will continue to gain weight. I’m taking 50 mcg cytomel daily but have yet to get to the root of my hypothyroidism, though it seems my whole hormonal milieu is effed up pretty badly. My leptin is “<1" and my ADH is undetectable, which explains why I'm up roughly 6-10 times per night to urinate. As I've mentioned, I'm currently in school to be an APRN and plan to study/practice functional medicine which is my passion. I started working with a naturopath and had her run these tests in addition to many others. My serum B12 and B6 are three times the top of the reference range (no supplements for a few days prior) and my WBC's continue to be low (roughly 3 years). I honestly don't know where to start with the leptin and ADH. I know you can't offer medical advice, but have you found anything particularly helpful with this breed of dysfunction? It seems I've really destroyed my hypothalamus/pituitary (low testosterone last time I checked as well).

    Thanks in advance for anything you can offer!

    Josh

  59. Hello Dr. Childs,

    I have been diagnosed with both insulin and leptin resistance.
    Currently on Naturathyroid and 16 other supplements. Problem is, no one can seem to help me get the insulin and leptin under control. My weight just keeps going up and up and it seems like everything I eat gets stored as fat. Where are you located or can you recommend a DR in or near Tampa, Fl?
    Thank you for your help.

  60. I was on levothyroxine 25 mcg before these labs and my functional med doc increased it to 50mcg after them. She added a saliva cortisol and fasting leptin after them too.

    She wants some me to try low dose naltrexone but I am very nervous to do that. Have you prescribed that?

    I’ve gained 50lbs despite working out and being on a plant-based diet…I have very low energy and achy joints

    I’m so sick of these side effects. Is there anything other labs I should ask my functional medicine doc for other than leptin and cortisol?

    TSH 4.06 (ref 0.45-5.33)
    Free t4 0.8 (ref 0.61-1.44)
    Free t3 3.1 (ref 2.5-3.9)
    Reverse t3 16 (ref 9-27)
    Thyroglobulin Ab, quantitative 26 (ref <4)
    Thyroid peroxidase Ab 490 (ref <9)
    Insulin 9 (ref 20)

  61. I am a bit confused. Everything else I have read says to eat more protein. I have also been reading Jack Krause and all of his stuff. Can you help me understand why there would be a difference between the interpretation of the data?

    • Hi Kimberly,

      You’ll find that there are a number of ways to interpret the same data. You’ll also find a big difference between scientific data and the real world. I provide information based on my personal experience and success with various patients.

  62. I have been on Victoza for 3 months and my levels have increased. I feel discouraged. I have not gained weight but I have not lost any either. I’m taking Armour thyroid and I’m talking to my doctor about trying just T3. My leptin was 22 and it increased to 44. My reverse T3 is 29.5 it increased as well. Still waiting on my insulin results but I’m guessing it is high too. Thoughts????
    Thank you for your time…

  63. Hi Dr.
    Thank you so much for all the great info on Thyroid and leptin resistance. My daughter is 17 yrs old and has several thyroid symptoms-cold clammy hand and feet, fatigue, anxiety, weight gain no matter what she does, very difficult to lose weight even with exercise and diet. Muscle aches in legs frequently.
    The family dr diagnosed her with Hashimoto’s so she has been on mostly paleo diet for several months but no weight loss and still has symptoms hypothyroid symptoms. We improved B12 from 450 to 757 and Vit D from 30 to 50 with supplementation. Here are labs: TSH 0.853, T4 7.8, DHEA 138.4, Reverse T3 33.7 (high), T3 free 2.8, Thyroglobulin antibody 4.9, Thyroid Peroxidase 15. I started her on Selenium and zinc last week and will be doing an iodine loading test to see if she is iodine deficient. She also had blood drawn for leptin serum last week-have not gotten results yet. I’m trying to learn more about leptin resistance. Do you have anymore suggestions for me? I feel like I’m leading the Dr. instead of the Dr. leading me… would you suggest any natural thyroid hormone?

    • Hi Elisha,

      The single best thing you can do is find a knowledgeable doctor to help put it all together for you! I’m coming out with a program designed to help patients work with their doctor but it won’t be finished for a few weeks at least. In the meantime, this resource may be helpful: https://www.restartmed.com/thyroid-doctor/

  64. Thank you so much for all of this. I’ve been overweight all my life despite being an avid swimmer and healthy eater. A progressive doctor put me on levothyroxine at a young age because he suspected that though my hormone levels were within the “normal” range, they may need a boost. In my adulthood, less progressive doctors have refused to re-up my prescriptions when they view my lab results within the “normal” range. I always thought, “the doctor knows more than me,” and followed their advice. My last lab results are from 2 years ago and follow the trend you outlined. It makes sense for me. Normal isn’t optimal given the interconnected relation hormones have with one another. I am going to go back to the doctor, recheck the levels mentioned in this article, and demand that, no matter what they say, I get on a T3 synthetic. A doctor may know medicine better than me, but I know myself better than them. If it’s not going to kill me, I want to try it. It could solve a 15 year mystery I’ve been trying in vain to unravel. Again, thank you for your insight. I hope to be able to get in touch with you if I have questions or concerns.

    • Hi Jenn,

      Unfortunately, I don’t have anyone to recommend or I would be happy to do so. I am planning to open a small clinic this year to train new physicians to accept patients and I will notify my email list when that becomes available.

  65. HI.
    I was diagnosed with Hashimoto’s in 2013. I have been to hormone doctors, endocrinologists, functional medicine doctors… all trying to get back to normal. For a while, I felt much better and with the help of HCG injections, I was able to lose some of the weight.
    However, now I am going through menopause and all hell has broken loose again. I can’t lose weight. I feel like you described: eating a strict diet only to stay the same. I am currently using the anti-inflammatory diet that the functional medicine dr had me use 5 years ago. Not losing anything. I also showed your article about LDN to my doctor, so he prescribed me some. I am just now up to 2.0, so I have a few more weeks before I hit 4.5.
    I have asked so many times for ALL of these lab tests you list. I don’t ever get them, though… they aren’t ordered. I am at a loss right now. I have no idea how to get my body back to where it will work again. I”m worried I have screwed up my metabolism to the point that it’s dead. I have one of those scales that tells your resting metabolism, body fat, etc. And my metabolism is 1285 calories a day. It’s impossible. I am so frustrated. My regular doctor prescribed me Victoza, but insurance wouldn’t cover it and it was expensive, so I didn’t get it.
    I do want to get these supplements you mention, but I’m wondering if without exact testing, how do I know which ones to take?
    It seems like in a year I have put on about 12 pounds. Pretty quickly and they have stayed put for the past year. Even doing HCG this summer, I only lost about 8 pounds in 3 weeks. Another reason I think I have damaged my metabolism even more.
    I pray there is hope for me. My clothes are tight and I am constantly thinking about when I can get home and just go to bed. Or I’m wishing I could eat comfort foods every now and then without the scale going up 5 pounds the next day.
    For my friend’s birthday, I ate 2 chicken street tacos, rice, a few beans, very few chips, guac, 2 margaritas and a slice of cake. It’s less than most of the other guests. However, I gained 5 pounds from it which took me a week to get rid of. I am so frustrated.

  66. My Dr gave me a prescription for T3 when I was first diagnosed and it made me extremely nauseous, I finally convinced him to do my reverse t3 lab test. If it comes out high, do you know of a medication that is less likely to cause nausea. He prescribed the generic liothyronine. Thank you.

  67. Dr Westin
    I am a provider that is trying to now treat Leptin Resistance. I have been following your guide. I have a patient to which we have treated low ratio of RT3 for a long time and finally tested Leptin with initial level of 38. Tested food allergies IgE, IgG4, IgG and CD3 and removed all inflammatory foods. Is a avid weight lifter and use to do competitions until weight gain became crazy. We put her on a cytomel, thyroid support with selenium, zinc, iodine and then added Trulicity for 3 months. Pt had an immediate weight loss of 10 lbs within 2 weeks then it stopped. Retested Leptin at 3 months and now it is at 39.1 – Treating adrenals, and sex hormones too through nutrients and bioidentical hormones. Sleep is good. No caffeine – diet is pretty clean is also doing intermittent daily fasting.
    Being trying to find more indepth protocols but nothing is much different. Taking Magnesium vitamin C, Cortisol support/ashwaganda and vitamin D3 in optimal range. She does have MTHFR and is on a methl-folate.
    Any thoughts? Frustrated in Boise Idaho.

    • Hi Tamara,

      I’m glad you are using the treatments in your practice! That’s awesome. In regards to GLP-1 agonists, it’s important to realize that each person will do better on one over another. It may take some time to play around with the various medications to figure out which one is ideal. Simply switching up which GLP-1 agonist she is on may be enough. Although there are also numerous other factors to consider as well but I would start there.

  68. Hi, I just got my leptin tested and it came back at 11 ng/ml. is this high? and if so what should it be? Thank you for any help. Sammie.

  69. Hi Doc! My mom and I have both been fighting with hypothyroidism for years. Currently my mom is experiencing hair loss and has been for five years. We have traveled to doctors in Ohio, Arkansas, Chicago, etc. We have been to endocrinologist, natural path doctors, functional medicine doctors etc. You get the idea. No one is knowledgeable enough in hypothyroidism. We have spent thousands of dollars . We are currently consulting with a life coach/author of a thyroid/Paleo book. She has been a great help and has been very positive. However, she is not a doctor and can only help us so much. With every increase in Cytomel, my mother experiences more hair loss, depression, weight gain, etc. Along with the Cytomel increase, her Armour Thyroid has been decreased to practically nothing. I will do anything to help my mother. I truly believe we have tried everything and I don’t know where to go from here. I fear for my mother’s health. I’m sure she has an address adrenal issues along with hypothyroidism. We have cases of supplements that have been handed out to us over the years which did nothing. I’m at a loss. Can you give any guidance?

  70. Dr. W Childs – I just found out my fasting leptin is 92. I’m dealing with significant health issues – cfs best describes it. I asked my Dr to test Leptin as I was curious – have gained significant weight and currently trialing t3 for a high-ish RT3 (other thyroid labs are normal). I’m in another country and there are not too many Drs treating this stuff – my Dr would be open to trialing the medication you mention – but the side effects worry me greatly. For example – delayed gastric emptying? This is a big cause of SIBO, which in turn increases inflammation – so it feels counterproductive to use it for leptin resistance?

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