How to Lose Weight with Hypothyroidism – Step by Step Guide
Did you know that losing weight with Hypothyroidism doesn't have to be impossible?
As a specialist in helping patients with Hypothyroidism and Hashimoto's I've been able to personally help hundreds of patients lose weight. And today I want to share with you how I do it.
I'm going to teach you How to Lose Weight with Hypothyroidism by giving you the recommendations that I give to my patients.
I will also go over case studies of real life patients that I've been able to help, and tell you what tests you need to order from your Doctor to get to the root cause of your weight loss resistance.
So let's jump in...
Don't Make These Mistakes when Trying to Lose Weight with Hypothyroidism
Does this scenario sound familiar:
You've been restricting your calories to try and lose weight but every time you do you get more fatigued than normal. You've been able to lose 5-10 pounds by doing this but once you start eating normally again your weight pops RIGHT back up to where it was.
I see this over and over again with my patients and it's something we have to stop right now.
Calorie restricted diets are harmful to patients with Hypothyroidism. Period.
Restricting calories actually makes your thyroid function WORSE.
By limiting your calories you're actually telling your body that you don't have enough calories to survive, so your body starts to lower your metabolism to protect itself.
It lowers your metabolism by reducing the active amount of Thyroid hormone or Free T3 Levels.
It also does this by increasing reverse T3 levels!
Both of these are things that your normal Doctor isn't even looking for.
So if losing weight isn't about restricting calories, then how do you do it?
- Bottom Line: Do NOT restrict your calories if you have Hypothyroidism for weight loss. It will only make your thyroid function worse in the long term.
Losing Weight is About Balancing your Hormones
Losing weight isn't about burning more calories than you consume.
If the weight loss equation were that simple then the rate of Obesity wouldn't look like this...
And I know you don't believe that model because you wouldn't be reading this post.
And you know from experience it isn't true. When was the last time that you went on a diet and kept off that weight?
It never happens.
There is about a 1% chance that a calorie restricted diet will result in long term weight loss.
And the problem isn't with YOU, it's with the model.
Losing weight isn't about cutting calories, it's about balancing your hormones.
Calories are important, but what your body does with those calories is WAY more important. And your hormones decide how your body is going to use those hormones.
Let me go over some examples of how this works to help you understand what I'm talking about here.
Case Studies from my Practice
These are all real life patients from my practice. Once you have the right understanding of why people can't lose weight, and you know what to test for, it becomes easy to treat patients with weight loss resistance.
Before we get into the most common hormonal imbalances we need to start with the basics.
If you want to lose weight you will have to optimize your thyroid function FIRST.
None of the other hormonal systems will come into balance if your thyroid function looks like this...
This is technically a "normal" tests, but this patient had ALL of the symptoms of hypothyroidism, and yes was told her labs were "normal".
Once she was given thyroid hormone (armour thyroid in this case), she lost weight and had almost complete resolution in her symptoms.
This concept holds true for patients that are being under treated or are being treated with the wrong type of medication too!
Before you check other hormones, start with your Thyroid function.
You can find 4 simple tests to see if your thyroid function is up to par here.
I've found that most patients do better on some form of T3 in their thyroid hormone.
That means Natural Dessicated Thyroid or some form of Liothyronine either by itself or with Levothyroxine.
Once you feel your thyroid function is optimized then you can jump into evaluating and testing for other hormonal imbalances.
1. Insulin Resistance with Hypothyroidism
I picked this case because SO many patients suffer from insulin resistance, and many don't even know it.
From a statistical standpoint you have about a 1 in 2 chance (or 50%) of having pre diabetes or diabetes as an adult in the US.
Insulin resistance is actually the condition that leads to diabetes and high blood sugar. What's even more interesting is that Insulin resistance comes BEFORE you get high levels of blood sugar.
And the only way to test for it is by looking at Insulin levels in the blood.
This patient has pre diabetes as evidence by her elevated Hgb A1c and elevated fasting insulin levels > 5.
If you have a fasting insulin level of > 5 then it will be IMPOSSIBLE for you to lose weight.
Insulin will block your body from burning fat as an energy source. When this happens you will feel sluggish, be reliant upon sugar for energy and will constantly have food cravings every 2 hours.
I commonly refer to this as getting "hangry". AKA - Hungry and Angry combined in one.
As you can see from the image above, in order to burn fat as an energy source insulin levels must be low.
In the patient above we were able to achieve weight loss by using Medically assisted fasting.
Every hour you go without eating carbohydrates or protein your fasting insulin level will continue to drop. Once it hits < 5, your body will be able to unlock the fat stores and burn fat as an energy source.
For the patient above, after her first 24 hour fast she lost 10 pounds total and 5 pounds of fat mass (as measured by impedance testing).
We also added in a high intensity interval training regimen at the office and after 2 months she has lost 40 pounds without losing any muscle mass.
- Lab Tests: Check fasting insulin levels (this should be < 5), Hgb A1c (should be less < 5.3), fasting glucose levels (should be < 85). If you are doing a fasting protocol make sure to check your fasting insulin level at the end of your fast to ensure that your level is < 5. Do NOT attempt fasting if you are on insulin as it may cause harm due to hypoglycemia.
- Treatment: Find a functional Medicine doctor who will work with you on the following: LCHF diet (if appropriate for your thyroid function and adrenal function), intermittent or prolonged fasting programs, and high intensity interval training. If you are looking for supplements I recommend the following: Berberine and Curcumin. Berberine has been shown in studies to be as effective as Metformin in lowering Hgb A1c and Curcumin has been shown to prevent the onset of diabetes from pre diabetes for 9 months.
2. Thyroid Resistance and Leptin Resistance in Hypothyroidism from chronic Yo-yo dieting
This is another all-too-common situation in my clinic.
I have seen patients who have chronically damaged their thyroid from years of recurrent yo-yo dieting, combined with diets like the HCG diet or very low calorie diets.
These diets will work to help you lower your weight... temporarily.
What invariably happens is that your body will ultimately lower your metabolism, decrease thyroid function and increase your appetite to make up for the lost weight.
Then you will not only gain all the weight back that you lost, but you will also have lost muscle mass in the process. So you basically take 1 step forward and 2 steps backwards.
Now rinse and repeat this process several times throughout your life and you have this set up:
Thyroid Resistance combined with Leptin Resistance.
And your labs look something like this:
The most frustrating part about this process is that your labs may look completely "normal".
It's not that you are actually normal, its that your doctor isn't looking for the right things.
With thyroid resistance your body converts Free T4 (thyroxine) to the inactive Reverse T3 while simultaneously increasing leptin.
This basically ramps DOWN your metabolism and sets your body into a mode where it thinks you are perpetually starving but in reality you are packing on the pounds with a ravenous appetite.
The patient above was suffering from all of these symptoms. She had a history of 3 rounds of using the HCG Diet to lose weight.
Each time she was able to lose some weight but each time she lost less weight until the last round was completely ineffective.
When she got to me her Reverse T3 levels were sky high and her Leptin was 19.
I treated her with pure T3 therapy (liothyronine) to wash out the reverse T3 in her blood along with a GLP-1 agonist to reverse Leptin resistance.
(Study showing effectiveness of GLP-1 Agonists in reversing Leptin resistance and helping with Weight Loss in Non diabetic women)
The first month of treatment she lost 20 pounds and is continuing to lose weight at about 15 pounds per month for the last 3 months without losing any muscle mass.
Think you have Leptin resistance or thyroid Resistance?
Here's what you need to do:
- Lab Tests: Check serum Leptin levels (< 12 is considered normal), anything > 12 is considered Leptin resistance. Check your Free T3/Reverse T3 ratio. This will tell you if you have too much thyroid blocking hormone relative to free and active Free T3. Your ratio should be > 0.2 (anything less is thyroid resistance).
- Treatment: Thyroid resistance responds best to NDT and/or Liothyronine or sustained release T3. You should monitor Reverse T3 levels regularly while on T3 to find out when you "wash" out the reverse T3 levels. Once they go down to < 5 you can back down on Free T3 levels. About 2/3 of patients respond to NDT and about 1/3 will need Pure T3.
3. Estrogen Dominance with Hypothyroidism
Estrogen dominance is very common in many women but specifically in women with Hypothyroidism.
Estrogen dominance means that you have too much Estrogen relative to your Progesterone levels.
This can happen in 3 different ways:
1. Too much estrogen with "normal" progesterone levels
2. Too little progesterone with "normal" estrogen levels
3. Too much xenoestrogens from the environment with "normal" estrogen and progesterone levels
Estrogen in Women causes weight gain in the hips, butt and thighs.
Not only can too much estrogen cause weight gain in women (as in Estrogen Dominance), but too little estrogen can also cause weight gain! (as in Menopause).
I don't jump into testing Estrogen for women right away unless they have a significant history of: PMS, PMDD, Uterine fibroids, Fibrocystic breast disease, and/or Endometriosis.
This women above had elevated levels of Estradiol, Estriol and Estrone in her blood. In addition to that she wasn't metabolizing and eliminating Estrogens very well through her liver - leading to a build up of metabolites and excess Estrogen.
She had symptoms of Weight gain and weight loss resistance - especially in her butt and thighs.
Once we optimized her liver function, put her on herbs to help eliminate estrogen down the protective 2 hydroxy pathway and opened up her ability to methylate with activate B vitamins - she was able to lose weight and eliminate her Estrogen Dominance symptoms.
If you think Estrogen Dominance is making it impossible for you to lose weight I recommend the following:
- Lab Tests: Check Urinary Estrone, Estradiol and Estriol plus metabolites (16-hydroxy Estrone, 4-hydroxy Estrone and 2-hydroxy Estrone) on day 19-22 of mid-luteal phase of your menstrual cycle. I use DUTCH urine testing.
- Treatment: Clean up and improve liver function, increase consumption of cruciferous vegetables, consider FAR infra red sauna use, and consider supplementing with DIM or Indole-3-Carbinol to help metabolize excess estrogen through the liver. Depending on progesterone levels you may also benefit from using Bio-identical Progesterone cream.
4. Low Testosterone with Insulin Resistance AND Hypothyroidism
Testosterone is not only important for men, but it is also very valuable in Women too!
Testosterone helps to build lean muscle mass, help burn fat and improves overall mood.
Women with low testosterone may feel "flabby", find it difficult to gain muscle mass, find it difficult to lose weight and may experience mood problems like irritability or depression.
Low testosterone can even contribute to a low sex drive or decrease libido!
These lab tests were found in a patient of mine who complained of decreased sex drive and felt like she couldn't gain any muscle mass despite doing cross fit several times per week.
In addition to low "normal" testosterone I also found this:
This particular patient was suffering from both Low testosterone and Insulin resistance.
Insulin resistance and low testosterone often come in a pair. And it's very important to treat BOTH for weight loss.
In this patient once we gave her some bioidentical low dose testosterone she was able to lose weight, build muscle and improve her mood.
In addition it was easier to reverse her insulin resistance with dietary changes alone.
If you think low testosterone and/or insulin resistance is contributing to your weight loss resistance try this:
- Lab Tests: Check Free and Total Testosterone. Optimal levels depend on the patient and their symptoms, however in general I like to see testosterone in the mid range for women unless they have a history of autoimmune disease or Hashimoto's - in which case DHEA and Testosterone can reduce autoimmunity.
- Treatment: If Testosterone levels are low I would consider using bio-identical testosterone cream. Start low dose and check testosterone levels after 4-8 weeks. Also check for insulin resistance and treat aggressively if present, treating insulin resistance may cause a natural increase in Testosterone levels.
5. Adrenal Fatigue with Elevated Cortisol Levels and Hypothyroidism
Adrenal fatigue is another extremely common hormonal imbalance in patients with hypothyroidism.
When thyroid hormone is low your body will turn to cortisol for energy production which can lead to "adrenal fatigue" over time.
Adrenal fatigue starts first with elevated levels of cortisol and that can lead directly to weight gain.
Cortisol is our stress hormone and it's meant to reduce inflammation and help our body cope with the stressful situation. It increases the effectiveness of insulin - which can be good in the short term.
However in the long term, chronically elevated levels of cortisol lead to weight gain, especially in the belly area.
Patients with adrenal fatigue and elevated cortisol have the following symptoms:
- Extreme fatigue
- Weight loss resistance
- Weight gain especially in the belly
- Food cravings for sugar and salt
- Feeling "wired but tired"
- Anxious or jittery feeling
This particular patient was dealing with a high stress job, was sleeping 5 hours per night and was unable to get any rest due to some serious stress that happened in her life over a year ago.
As a result she persistently gained weight and was dealing with all of these symptoms.
After seeing her lab work I put her on neurofeedback therapy, took away caffeine and all stimulants from her diet and put her on supplements to help heal the adrenal glands.
She has continued to lose weight over the last 3 months, is now sleeping better and her energy level has improved from 3/10 to 7/10.
If adrenal fatigue and elevated cortisol levels are contributing to your weight loss resistance try these:
- Lab Tests: Check Urinary Cortisol and Cortisone x4 throughout the day. Avoid serum/blood testing of cortisol levels as they are not reliable. I use DUTCH urine testing to evaluate cortisol and cortisone.
- Treatment: If Cortisol levels are elevated consider a combination of the following: removing caffeine and stimulants, adding higher doses of salt into your diet, eating smaller more frequent meals, using stress reduction techniques, and supplementing with adrenal glandulars or adaptogens.
How to Test for these Hormonal Imbalances
I've built a table of hormone levels and how to test for each of this.
If after reading the above section you think you have a hormonal imbalance simply go down to the area and look at the tests.
It will show you which tests you need to order to evaluate your hormones and show you the reference levels your results should fall into.
Remember that there is a big difference between being "normal" and being "optimal".
Don't let someone tell you that your labs are "normal" if you feel like crap. It's not that your labs are normal, it's that the doctor isn't ordering the right tests or he/she isn't interpreting them correctly.
Want a PDF with a list of Hormones you need to test for? Get it by clicking BELOW
Testing For Hormonal Imbalances
|Test||Optimal Levels for Health|
|Thyroid Deficiency||Blood: · TSH, Free T3, Free T4, Reverse T3, Thryoglobulin Antibodies, Thyroperoxidase Antibodies, Sex Hormone Binding Globulin (SHBG), Ferritin, TIBC, Serum Iron||TSH: < 2 Free T3: 1/3 of reference range Free T4: 1/3 of reference range Reverse T3: < 15 Thyroglobulin: <15 Thyroperoxidase: < 15 SHBG: · Male: 20-30 · Female: 70-80 Ferritin: 70-80 Serum Iron: Mid range TIBC: 35-38%|
|Estrogen Dominance||Urine: · Estrone, Estradiol, Estriol, 16-hydroxy Estrone, 4-hydroxy Estrone and 2-hydroxy Estrone||Optimal levels highly variable, must be compared to Progesterone and in the setting of symptoms. Generally 2-OH Estrone should be preferred over other pathways.|
|Progesterone Deficiency||Blood: · Progesterone Urine: · Pregnanediol||Check on day 19-22 of Menstrual cycle if menstruating. Progesterone levels should be higher than Estrogen levels during days 19-22 (see image below).|
|Insulin Resistance||Blood: Insulin (Fasting and 2 hours after meals), Hemoglobin A1c (Hgb A1c), Fasting blood sugar (FBS), Uric Acid, Fasting Triglycerides, Fasting HDL||Insulin: · Fasting: < 5 · 2 hours after meal: < 30 Hgb A1c: < 5.3 FBS: < 85 Uric Acid: < 5 Fasting trig: < 100 Fasting HDL: > 60|
|Leptin Resistance||Blood: · Leptin levels · Thyroid studies (above) · Insulin tests (above)||Leptin: < 12|
|Cortisol and Adrenal Fatigue||Urine: · Cortisol and Cortisone x4 Salivary: · Cortisol x4 Blood: · AM Cortisol (Not very accurate)||Range is dependent upon the person and is relative. If Cortisol levels are low = Late stage adrenal fatigue. If cortisol levels are high = Early stage adrenal fatigue.|
Some of this information may be new to many of you, so I would recommend that you read through it a couple of times to let everything sink in.
It is helpful if you grab your lab work and compare some of your results to the examples that I've shown above.
Just remember that you are an individual and even if your tests results may look "similar" that doesn't mean you have the hormonal imbalance if you don't have the symptoms!
Make sure that you get proper evaluation if you think your hormones are out of balance. You shouldn't have to go through life feeling like you're crazy because your labs are all "normal".
My patients are often vindicated when they realize they actually do have abnormalities in their lab report, they just needed someone educated to read and interpret them!
Now it's your turn
What have you done to lose weight with Hypothyroidism? What worked and what didn't? Tell us in the comments below so you can help other people with hypothyroidism!