Let's debunk this myth once and for all.
No doubt you've heard people claim that their weight gain is due to having thyroid problems.
The reply is always something along the lines:
"Blaming your thyroid is an excuse for not having self-control or for being lazy".
But is this really true?
Not really, in fact, recent science supports the exact opposite.
This is a big deal for patients who are overweight or for those with thyroid problems because it validates what they are going through.
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Your Thyroid and Weight Gain
You're left to believe that weight gain is the direct cause of eating too much and exercising too little.
This message is crammed down your throat on a near-daily basis.
While eating excess calories certainly won't help your weight loss it's rarely the sole CAUSE of excess weight.
Instead, you need to think about weight gain and obesity as a metabolic disorder.
A disorder that stems from underlying hormone imbalances that may be caused by the type and quantity of food that you eat, your activity level, your environment, and your mental status.
This is a jump from the conventional way of thinking about weight gain but it is a much more accurate representation of what is actually happening.
Let's apply this thinking to weight gain and your thyroid:
We know that your weight is intricately connected to thyroid function, this isn't up for discussion - studies show this to be the case.
Thyroid hormone (specifically T3) is responsible for activating mitochondrial energy production, for increasing heat production and for regulating the metabolism of your entire body.
To suggest that hypothyroidism does not cause weight gain would be to go against the standard physiology of thyroid function as we understand it.
So why do people still believe that there is no connection between weight gain and thyroid function?
Much of this controversy stems from the current treatment paradigm as it relates to thyroid hormone replacement.
Let's consider this:
If you are hypothyroid (meaning you have low thyroid function in your body) and it is causing you to gain weight, doesn't it make sense that replacing that thyroid hormone with medication like Levothyroxine would cause you to lose weight?
It makes perfect logical sense but that isn't what we see in clinical practice.
You know this if you've taken levothyroxine or other thyroid medication.
In most cases replacing the lost thyroid in your body doesn't cause any net change to your weight and in some cases, it may actually cause you to gain weight.
We can basically take two approaches to this problem as we see it in clinical practice:
First (this is the position that most people take) - You can double down on your position that the thyroid has no impact on weight and that any weight gain must be caused by the patient.
Second (the better option) - You can rethink the treatment and current understanding of thyroid function to see if science is missing something.
The truth is that most physicians have failed patients when it comes to weight loss.
Doctors are stuck in a 20-year-old understanding of weight loss and they are all too eager to blame the patient instead of looking inward.
Thyroid hormone management has become "streamlined" into a simple algorithm that basically flows like this:
Is the TSH Normal?
If TSH is > 5.0 then slightly increase the dose of levothyroxine/Synthroid (or start medication if the patient isn't already on it)
If TSH is < 1.0 then lower dose of levothyroxine/Synthroid.
But what if the patient is fatigued, is having hair loss, is gaining weight or has all of the symptoms of hypothyroidism?
It doesn't matter because the TSH is normal, therefore these symptoms MUST be caused by something else.
Does this even sound logical?
How can something as complex as a hormone which interacts at a nuclear level in basically every cell in the body be controlled by 1 single measure?
What if instead of focusing on the TSH we evaluated your thyroid in the context of your symptoms? What if we took into consideration other hormones and how they interact with thyroid hormone in the body? What if we evaluated how well you are actually converting T4 to T3 in peripheral tissues? What if we considered the fact that some tissues may have a higher DEMAND for thyroid hormone than other tissues?
Does this sound like a better approach than basing treatment off of the TSH?
If this sounds crazy it's because it is, so let's debunk the thyroid obesity myth using some practical and logical studies:
#1. Obesity CAUSES Hypothyroidism
Let's break this down:
First, you need to realize that being overweight is NOT a normal condition and having excess fat cells in your body really does wreak havoc on normal hormone systems in your body.
Simply gaining 10-20 pounds is enough to trigger this cascade of hormone imbalances:
First -> Excess fat cells (adipocytes) secrete a hormone called leptin (1). Excess levels of leptin lead to leptin resistance and changes to TSH.
Second -> Leptin resistance directly leads to an increase in TSH (2) but also... (skip to #4)
Fourth -> Inflammation and Leptin resistance reduces peripheral T4 to T3 conversion causing tissue level hypothyroidism (5).
Fifth -> Overweight patients try various diets through calorie restriction which increases reverse T3 and leads to low T3 syndrome (6).
(See the links for relevant clinical studies supporting the claims)
This cascade of events is very well documented, but just not well known among physicians (or if it is it tends to be ignored).
The point is this:
Even if your thyroid didn't CAUSE your weight gain, to begin with, it is most certainly being worsened by having extra fat on your body.
This is important because it expands our understanding of hypothyroidism and weight gain and may actually help physicians understand how these hormone systems interact with one another.
#2. Calorie restriction CAUSES Low T3 Syndrome + Hypothyroidism
Again, this is another well-documented consequence of dieting.
Calorie restriction (as defined by 21 days of less than 1,000 calories per day) is enough to LOWER thyroid function.
This is felt to be a protective mechanism by the body.
So how does it work?
Remember when we said that your thyroid helps control your metabolism?
Well, when calorie consumption is low your body will act to try and match the number of calories you are consuming to the amount that you are burning.
That means trying to "trick" your body into burning 2,000 calories when you only eat 1,000 calories is a lost cause.
Your body catches on and then dupes you in the process by lowering your total T3, increasing reverse T3 and by putting the brakes on your metabolism (7).
So instead of burning 2,000 calories per day, your body lowers your metabolism down to 1,000 calories.
So as soon as you start eating more food guess what happens?
Your body starts packing on the pounds.
Again, this isn't up for debate, this is exactly what happened to the biggest loser contestants and it is reflected in their damaged metabolism which is STILL damaged some 7 years after they tried losing weight (8).
But the most important thing to understand in this section is that calorie restriction will NOT lead to long term weight loss!
This is especially true if you have existing hypothyroidism!
It will seriously only make your problem worse and lead to long term weight gain.
In this case, the conventional advice from physicians to eat less and exercise more may actually cause more harm to your metabolism and make weight loss more difficult.
#3. Patients taking T3 tend to LOSE WEIGHT
Here is where things get interesting:
So we know that taking Levothyroxine and Synthroid don't actually lead to weight loss, but what if other thyroid medications DID lead to weight loss?
Well, some studies support this hypothesis:
First study -> Studies support and confirm that using T3 thyroid only medication leads to weight loss (9) in certain patient populations likely through its effects on thermogenesis.
Patients who may benefit from T3 according to the study:
- Patients taking beta blockers for blood pressure or for other reasons
- Overweight patients on T4 replacement after treatment for hyperthyroidism (see this post to understand why hyperthyroid patients almost always gain weight)
- Overweight patients on T4 only medications (Read this article for more info)
- In patients showing 'dietary treatment-resistant' weight increase while stopping cigarette smoking
- In patients on VLCD or LCD with low T3, and slowed weight loss despite continued calorie restriction (I don't recommend you do this but the study confirms the need for T3 in these patients)
- In patients with abdominal obesity and metabolic syndrome resistant to dietary treatment or showing inadequate improvement in metabolic aberrations (Most of you fall into this category)
- In patients showing, before or during dietary treatment, signs and symptoms of subclinical hypothyroidism (read more about subclinical hypothyroidism and weight gain here)
Second study -> This study supports that switching patients from T4 only medications to natural desiccated thyroid (T4 + T3 combination medication) resulted in modest weight loss (10) and most patients preferred the switch in medication.
Despite these results, the authors concluded that the "quality of life" was not increased in these patients.
But let me ask you:
If you lost weight would your quality of life increase? I think so.
Third study -> Treatment with T4 only medications results in lower than normal T3:T4 concentrations (11) even when the TSH is "normal" or considered "euthyroid".
This study supports the idea that TSH may be an insufficient marker for assessing cellular thyroid levels.
We can assert that it's not that thyroid hormone doesn't cause weight loss but instead that T4 only medications like Levothyroxine and Synthroid don't.
This supports the idea that patients tend to do much better when using a combination of T4 + T3 in their treatment and hormone regimen.
If you aren't familiar with the differences in thyroid medication then I recommend that you read this post about Cytomel and weight loss and WP thyroid and weight loss.
As a quick primer:
#4. TSH Tracks Perfectly with Weight
Lastly, which shouldn't come as a surprise, is that changes to circulating TSH and thyroid hormones result in weight gain.
Specifically, weight tends to track quite well with TSH and serum Free T4 levels (12).
As TSH rises (meaning you become hypothyroid) you will find that BMI rises as well.
As Free T4 levels fall weight tends to rise.
I've only included this section in here to confirm that hypothyroidism does indeed cause weight gain.
So now we have a double whammy:
Weight gain leads to reduced thyroid function and low thyroid function leads to weight gain.
Your Next Steps (Easy)
Hopefully, this is all making sense to you and starting to get you excited.
Because if you know what is actually going on in your body then you can start to reverse the process and get the right treatment.
So the next topic is going to focus on what should you be doing NOW to make a difference.
I've split this section into 2 parts -> the easy section and the advanced section.
The truth is that understanding these concepts is really just the beginning, what matters more at this point is actually getting treatment so you can lose weight and feel better.
Some of these easy therapies you can get started with right away while the more advanced options may require a physician for further help.
#1. Support Thyroid Function in your body
The first thing you want to consider is using supplements.
Because supplements can help improve thyroid conversion, reduce inflammation and help promote normal hormone balance in your body.
There are a lot of supplements that you can potentially get started with so let me simplify this a little bit:
I recommend that you start with an adrenal supplement and a strong probiotic first.
Adrenal supplementation will help stabilize your energy levels which will help you in more than 1 way.
It will help balance cortisol levels while allowing you to feel more like yourself to get up make healthier choices (diet, exercise, etc.).
Probiotics act to naturally restore intestinal microflora, reduce systemic inflammation, improve your mood and may help increase nutrient absorption.
I recommend this supplement because it helps promote healthy adrenal function through adaptogens, helps reduce inflammation with bioflavonoids and will help increase energy through adrenal glandulars.
Make sure you purchase high-quality supplements that have been proven in scientific studies to help.
If you are ready to step it up a notch you can read this post about further supplementation to support your thyroid.
#2. Clean up your Diet
Your next step should be to clean up your diet.
Changing your diet isn't likely to result in significant weight loss for all the reasons we mentioned above, but changing your diet is still very helpful.
What you put in your mouth will directly influence hormone levels for better or worse.
Certain foods will either promote inflammation or reduce it, certain foods will either promote fat loss or promote fat gain, while other foods may limit weight loss through other actions.
Your goal with diet should be to provide your body with all the nutrients it needs to promote healthy thyroid function and to promote hormone balance.
This means finding the right type of diet for YOUR body.
You can read more about altering your diet to fit your needs in this post.
#3. Talk to your Doctor about Adding T3 medication to your regimen
Lastly, you might find tremendous benefit with a small addition of T3 to your existing dose of thyroid medication.
Sometimes as little as 5mcg to 20mcg of Cytomel or liothyronine may help with weight loss and reduce the symptoms you are experiencing.
Most physicians will be reasonable and may consider adding T3 to your current regimen if you let them know how you are feeling.
In addition, you might find some benefit by showing them this article and the clinical studies referenced here.
Your physician wants to help you, they may just not have the time available to them right now to put hours and hours into research.
Make it easier on them by providing them with information that they understand (studies) and work with them.
Try to avoid having arguments or heated discussion as this won't help your situation at all (if you don't trust me just read some of the comments on my blog posts).
More Advanced Steps
The "easy" steps listed above are just meant to get you started but are by no means everything you will need.
I've found that patients tend to get overwhelmed with information that may cause them to enter a paralytic state.
They ingest so much information that instead of taking action they simply don't make any changes, and that's not what I want you to feel like at all.
So if you are just a beginner start with the steps above, if you've already tried them then it's probably time to move on to these next steps.
#1. Check other Hormones in your body
Hypothyroidism is notorious for causing or potentiating other hormone imbalances in the body.
The problem is that these other hormone imbalances may mimic the signs and symptoms of hypothyroidism but they won't be reversed simply by taking thyroid hormone.
If you having trouble with weight loss despite changing your thyroid medication or your symptoms persist then I recommend evaluating the following hormones (and treating, if necessary):
These hormones require advanced knowledge so take your time to read through the articles referenced above before you jump into treatment.
#2. Optimize T4 to T3 Conversion
Some patients have difficulty with the peripheral conversion of T4 to T3 due to a variety of reasons.
For patients with reduced peripheral conversion taking T4 only medication may make your symptoms worse as your body uses T4 to create the inactive thyroid hormone metabolite reverse T3.
If you have documented high reverse T3 levels then make sure to assess and treat the following areas (all of which are known to increase reverse T3 levels):
You can find more information about how to increase free T3 levels here.
#3. Consider Advanced Medications
Lastly, you may need to consider the use of high powered and targeted medications to help reverse hormone imbalances and help you with weight loss.
I've discussed the specific uses of these medications at length in other places on my blog but I will mention them here for reference:
These medications aren't for everyone and must be used in special ways (at reduced doses, higher than normal doses or pulsed for brief periods of time).
If you use these medications incorrectly they may make your metabolic problems worse.
You can find more information on how to use them correctly here.
Back to you
The bottom line is that your thyroid does indeed influence your weight and other hormonal systems in your body.
If you are struggling to lose weight then don't let your provider put the blame on YOU.
Understanding some of these topics may be complex, but retaking your life back is worth the effort!
Now I want to hear from you:
Are you struggling to lose weight with hypothyroidism?
Do you feel that your other hormones are out of balance or that more than just your thyroid is contributing to your weight?
Leave your comments below!
References (Click to Expand)