The thyroid hormone interacts on a cellular level in the body, controlling the rate of metabolism – or how quickly we can break down substance into energy. Understanding this, you can imagine that if metabolism is slowed down – in the case of an under active thyroid gland, or an autoimmune process such as Hashimoto’s thyroiditis – there will naturally be some difficulty losing that extra weight. Especially if the weight loss program you’re on is not also correcting for suboptimal thyroid functioning.
‘I know I should be going to the gym. See, I know all these things already, but actually doing them is another thing. I want to lose the weight, I really do, but I just can’t seem to bring myself to actually do it.’ – recent patient
My go-to response when I hear this answer – it’s important to not be so hard on yourself, as there very likely is a hormonal imbalance at play, inhibiting you from achieving (and maintaining!) weight loss.
Let’s have your hormones work with you, rather than against you. But first, we need to run lab work, to see where you’re at.
Oftentimes, this includes also looking at the stress hormone cortisol, insulin (just because your blood glucose is ‘fine’, doesn’t mean insulin is!), and of course, the thyroid hormones. The thing with hormones when they are suboptimal, is that they can be the road block you never realized you had. You might be eating the right foods, doing the appropriate body movements, yet weight loss likely won’t be happening if your thyroid is telling the rest of your body – slow metabolism down! How does your thyroid shift from optimal to suboptimal? Poor sleep habits, a family or personal history of an existing autoimmune concern, chronic stressors over time including both physical and emotional, and less than ideal food habits or diets that are not supportive of hormonal health in general.
How do you know if you have a thyroid concern? How do you test?
We’re requisitioning for blood work on the first visit, if thyroid levels are suspected to be suboptimal. We do this to determine if – and to what extend – they are suboptimal, potentially altering our treatment approach for weight loss. I often requisition for a full thyroid panel, including TSH, free T3, free T4, reverse T3, and thyroid antibodies anti-TPO, anti-TG. The reason being that TSH does not tell us enough; it does not tell us what our actual thyroid hormone status is, nor if there is an autoimmune component needing to be addressed, such as Hashimoto’s thyroiditis. Usually TSH is a good predictor for T3 and T4 hormone status, but not always. For this reason, I feel more comfortable as a practitioner testing rather than guessing.
Understanding the thyroid tests further;
• TSH is typically on the higher side, in those when weight loss is difficult. With a TSH ‘range’ of 0.23 – 4.00, I like seeing closer to that 2 mark as the sweet spot, especially in my weight loss patients.
• When we talk about having an under functioning thyroid, free T3 and T4 are the actual active and inactive hormones, respectively, that we are referring to. When TSH is on the higher side, we typically see free T3 and free T4 in the lower end range, again not always. Ranges on blood work will say 2.6 – 5.8, and 9 – 19, however this is a very large range. Reverse T3 is the communication between the active (T3), and the inactive (T4) hormone, and can tell us more about the conversion rate; any nutritional deficiencies that may be affecting thyroid status.
• Thyroid antibodies tell us if there is an autoimmune component going on with your thyroid. TSH alone cannot tell us this. We ideally want to see these come back as negative. In the case they are elevated, we incorporate an autoimmune protocol into our weight loss approach.
Trying to lose weight can be extremely draining and confusing – but it doesn’t need to be.
Aside from thyroid health, there are many other hormonal factors at play that need to be functioning optimally. Other notable hormones for weight are possible insulin resistance and leptin resistance, or a flattened-out cortisol peak. Ideally for cortisol, we want a good morning cortisol peak upon waking, followed by a steady decent as the day progresses. These are all factors that we can objectively test for, and address.
As a Naturopathic Doctor, I hold with great regard the importance of discovering the root cause of whats really going on with our health, including addressing obstacles to maintained weight loss.
Are there underlying hormonal imbalances contributing to weight gain? Disturbances with the digestive process? Is what we’re putting into our bodies – from the food we eat, to the thoughts we hold – contributing to a healthy weight, or hindering it?
My job is to get to the root cause for why you’re struggling with weight loss, so you’re able to lose the weight naturally and safely.
Yours in health,
Dr. Alison Gottschalk, ND