For any of you reading this article that are familiar with my work, content, or recent writings will have heard me talk about metabolism, and the metabolic rate many times before. Although both words are very similar sounding, they both have different definitions or meanings.
Metabolism is a term that describes the chemical processes that occur in a living organism in order to maintain life. Just think about that for one second…. ‘in order to maintain life’. This is why it’s a big area of my Functional Medicine (FM) work because restoration of life sustaining metabolic processes is mission critical in achieving functional wellness. The metabolic rate on the other hand is amount of energy used or burned by an organism per unit of time. In other words, the rate of which you burn calories.
In this article I mainly want to focus on the latter of the two, and it’s connection to thyroid function as thyroid gland regulates the rate of metabolism in each living human organism.
One way to describe cellular metabolism (within the cell of the mitochondria) is to the engine of a car, and thyroid hormone is the fuel. In individuals who have sub-optimal thyroid function, there is insufficient fuel (thyroid hormone TH) to supply the engine with the amount or fuel it needs to get maximum (energy) output. TH regulates both the basal metabolic rate (BMR) which is the amount of energy over time that person needs to keep the body functioning at rest, or in a coma; and adaptive thermogenesis (the regulates production of heat in response to environmental changes in dietary intake, activity levels, energy expenditure, etc) and which has a significant impact on body weight & the burning of stored body fat. Its this revving of the engine (metabolism) that increases body temperature which is a result of increased consumption/turnover of oxygen and ATP hydrolysis, which is the catabolic chemical reaction that occurs when stored energy is released by producing work in the form of mechanical energy.
Out of the several thousand patients I’ve helped over the years; the ones who have had a degree of hypothyroidism; most of which are women; I’d say at least 80% of them have had issues with managing their weight – ie – they seem to store & hang onto body fat a lot more readily than before their thyroid condition became a known issue to them – despite claiming to eating the same, or in most cases ‘less food’ than before. What a lot of them do is continue to reduce their food intake thinking they are eating too many calories, and if they do they’ll lose weight. To their surprise, the complete opposite happens… they gain even more weight! How can this be…?!
Whist the metabolic rate is dynamic, meaning the body adapts to the environment or situation its presented with in order to survive; it can also be influenced in a number of ways which result in ean increase in the rate of metabolism (the amount of energy required) meaning the person can eat more food, and is more likely to give up stored adipose tissue for fuel providing the metabolic conditions are right. The flip side of this which I eluded to, is that by reducing caloric intake below what the body requires to function under the conditions, force the body to adapt its rate of metabolism rate by reducing the amount or energy it requires per day, thus slowing ones BMR. This is part of our innate survival mechanism to conserve energy in a crisis situation but over time this leads to what’s known as metabolic damage. This is another huge stress signal that negatively effects other body systems indirectly as it will always start to catabolise lean functional tissue when there’s a shortfall of fuel. Theres been a number of women that I’ve had to help rebuild their metabolisms by slowly reverse dieting them up from eating 1000 or less calories per day, up to around 2000+ per day where they hold a steady weight. Some of the individuals I’ve worked with have had what I refer to as metabolic induced hypothyroidism, meaning what’s coming in (food), or being digested & absorbed, doesn’t meet the demands of the biological machine (our bodily functions) which results in a slowing of metabolism, and impaired or reduced thyroid output. If the thyroid is down-regulated, the adrenal hormones have to keep stepping in to take up the slack, thus exhausting the adrenal reserve. A very slippery slope indeed. This can lead to HPA dysregulation, and adrenal/hormone disorders. The body is a complex machine with many interconnected moving parts, and systems that integrate with one another. Fat loss is way more than just calories in vs calories out. The metabolic/hormonal environment needs to be right for healthy fat loss, and in building lean tissue (muscle) which increases the metabolic rate & BMR.
Moving slightly away from metabolism for a moment, and going back to the thyroid – Determining normal thyroid levels is often a far greater challenge than one would imagine. There are so many competing reasons to test thyroid hormones in the first place that each group of health care practitioners has staked out their own version of normal and we are left in a situation where it’s just crazy confusing to figure out what any of it means.
On one side there are allopathic medicine model & the lab range values that your conventional MD/GP/endocrinologist will use & swear by. Then there are functional medicine lab range values that I use in practice (which of course are different) that your Functional Medicine Practitioner (FMP) will swear by. FMP’s often use/consider a wider range of important biomarkers as well. Then there are sub-clinical thyroid conditions that don’t fall within functional medicine lab ranges or the conventional ranges, yet the patient is experiencing significant symptomatic thyroid imbalances. An experienced FMP can identify evidence to support sub-clinical cases during a comprehensive functional assessment, even when thyroid numbers appear to be ‘in range’.
FM hypothyroidism differs from conventional medicine hypothyroidism and I’ll explain how & why below.
Conventional medical thyroid ranges have a unique and clear purpose; to determine if you have a sufficiently severe thyroid issue that will require you to take prescription thyroid medications to maintain normal thyroid levels. The kicker here is that these synthetic hormone medications, will over time shut down your own body’s production of thyroid hormones even more meaning you’ll be on them the rest of your life. It’s an important decision and one not to be taken lightly. To make matters worse some people test positive on the conventional medicine lab ranges, take the thyroid prescription and still don’t improve. I see this a lot in FM practice. The ranges that conventional medicine use such a range that is from one extreme to another – meaning your either sick or well (according to them), and completely miss the in-between where early onset dysfunction can be identified & corrected before it develops into something more serious. It also happens to be where most patients experience all the symptoms that go along with hypothyroidism, yet if you fall in this range you are told you are fine, and sent on your way.
FM thyroid lab ranges are much narrower and meant to detect thyroid issues prior to the onset of more advanced thyroid disease. FM thyroid lab tests also typically include additional markers beyond the typical TSH and include T3, T4, reverse T3 as well as autoimmune antibody markers. FMP’s also assess other body systems, and lifestyle that are integrated with, and directly/indirectly effect thyroid function. This too makes sense because a well-trained FMP has many ways to treat thyroid disease other than the typical thyroid medications. A basic premise of FM is that the thyroid responds to inflammatory issues elsewhere in the body and many thyroid conditions have an underlying cause to be found outside the thyroid itself. Once this underlying causes are addressed the thyroid tends to recovers.
There are some fancy specifics here in that the conversion of thyroid hormones from the inactive to more active forms can be blocked by inflammation coming from various other non-thyroid places like the gut, the diet, toxins in the environment, even severe emotionally stress can create a thyroid imbalance, so once these underlying issues are addressed, oftentimes thyroid problems tend to improve on their own.
And to make it even more complex there are some people who have outright thyroid disease where the underlying cause IS the thyroid gland itself. In these instances, these individuals are often best treated with medications. And just in case you thought we were winding down here, there is a very interesting sub category of thyroid issues that are connected to problems with mitochondrial function.
To step back a second and clarify this last zinger a little bit, I’ll name a hormone and you name its action. Easy, right? If I say insulin you would say blood sugar regulation. If I say estrogen you’d say female reproductive organs and so on. Cortisol? Stress. You get it.
Well if I say “thyroid hormone” to any doctor trained in any field from any country the immediate response is “basal metabolic rate”. In other words, we all know WHAT the thyroid does, it regulates basal metabolic rate. But then, and I’ve asked this question many times to incredibly intelligent physicians and never gotten the right answer, then the next question is “How does the thyroid do that? What tissue, what cells, what structure in the body does it regulate metabolism through?” It’s such an overly simply question, yet no one ever seems to get it right. This lack of ability for any trained physician to provide an answer this question reveals a massive bias or blind spot in the current conventional education system. We don’t in any significant way associate the thyroid gland with the mitochondria.
It seems crazy but it appears fact. We all know it’s insulin-blood sugar and cortisol-stress but no one is thinking thyroid-mitochondria; when in reality the way the thyroid works, it’s very mechanism for regulating metabolism is the mighty mitochondria – which I’ve written about in a previously titled article “The Mighty Mitochondria”. There is a point here and I’m about to get to it. If you make this (appropriate) connection then the next thought is, patients who are put on natural thyroid substance, plain old prescription thyroid, or every thyroid nutrient and herb on the planet but only get a partial response – it’s highly possible they have a concomitant mitochondrial issue.
A Doctor mentor of mine has been writing a book for the last few years about the “hypometabolic state” wherein the sheer numbers of mitochondria are reduced leaving the thyroid unable to act. In this instance you can have the right amount of thyroid hormone circulating to be classed as ‘functional’ amounts, but there’s just not enough mitochondria present for it to work. It would be like getting enough fuel in a car and it’s just the exact right kind of gas but the engine isn’t running. There is nothing for the fuel to do but sit there.
This low mitochondrial state can be assessed & defected using functional metabolic screening lab tests.
So in summary:
You can have (1) a thyroid problem that is diagnosed based on abnormal thyroid levels and end up with either a conventional treatment (typically consisting of thyroid prescription medication) or (2) a functional medicine thyroid treatment, often times “natural” thyroid prescriptions or a combination of herbs, vitamins, diet interventions, etc. combined with an investigation about the underlying cause of the problem. Or (3) you may have normal thyroid levels from the conventional perspective meaning the regular MD’s will say you are fine but you may fall into the functional medicine thyroid lab ranges that are seen as potentially problematic and end up with a functional medicine approach. Or (4) you may have completely normal thyroid lab ranges from both a tradition and functional medicine viewpoint BUT STILL HAVE A THYROID PROBLEM, if your mitochondria are not present in sufficient numbers.
If you feel you fall into this category, fear not. If you are already being treated by a conventional medical approach, or another practitioner and not feeling better, or seeing improvements in your overall condition, then why not consider a functional medicine approach but someone experienced in screening mitochondrial function and a “hypometabolic state” among other functional issues. It can be corrected with an intelligently designed intensive nutrient-based program and it complements other thyroid treatments well.
Thanks for your attention.