In this weeks article I wanted to revisit a few key areas of the Functional Medicine work I do, and highlight some common ‘conventional’ errors I see in practice, and how they relate to & negativity effect other body systems. I’ll follow up this article with another that I’ve almost finished writing on a sub-topic intimately related to hypothyroidism that one of my mentors has been researching & studying for the last few years which is termed “Hypo-metabolic state” so keep an eye out for that one up next.

Every biochemical process that goes on inside our bodies requires energy; specifically, “metabolic energy.” From chewing food, digesting, breathing, moving, detoxifying, & the biochemical conversion of food into a useable cellular substrate – all require a power supply to run.

When there is inadequate energy being generated for body-systems (which includes glands & organs) to be able to carry out their function properly, many biochemical & biological events aren’t able to occur as they should. Couple that with missing nutrient co-factors and many other crucial metabolic reactions aren’t able to go through to completion. This results in the production of other chemical compounds via alternative metabolic pathways; some harmful; that have a knock-on effect in the overall derangement of metabolism, and reinforce metabolic disorders. Over time this can lead to dysfunction & chronic disease.

One simple example of the is if the brain has too little energy substrate (glucose); thought processes such as memory and focus become impaired. This then effects things further downstream.

The body also needs energy to maintain body temperature, and keep itself warm. A low body temperature therefore, usually accompanies low metabolic energy. Individuals who suffer with cold hands & feet, or low body temperature generally have a lower metabolic rate.

The words “metabolism” & “‘metabolic rate” are respective terms used to describe all chemical reactions involved in maintaining the living state of the cells and the organism, and the rate or amount of energy used by the organism per unit of time during this process.

You’ve probably heard the terms BMR or RMR which are abbreviations for Basal Metabolic Rate, and Resting Metabolic Rate; describing the amount of calories the body burns at rest. This is the amount of energy that the body would require in a coma, just to carry out its functions such as breathing, beating the heart, etc.

This demonstrates the importance of energy which comes comes in the form of ATP, as most healthy adults require anywhere between 1500-2000 calories just to exist, thats excluding any additional activity output on top which also requires extra metabolic energy. If energy production or metabolism is impaired, the body is forced to negatively compensate which usually results in a break down of body tissue (usually body proteins such as muscle tissue, the gut lining etc) to use a readily available emergency fuel source.

A substantial number of individuals who initially come to work with me are consuming way below the amount of calories that their body requires to not be in a hypo-caloric state. This means the body doesn’t have enough of what it needs to adequately maintain steady blood sugar levels when the system is weakened or compromised. Over time, this ends up becoming a chronic stress signal that often goes under the radar, which forces the body to adapt by slowing down the rate of metabolism as an adaptive move to survive. This forces the body to have to produce energy in a more metabolically/hormonally stressful way. For those who have endocrine or hormone disorders – this ends up further weakening or worsening the problem as they don’t have the adrenal/metabolic reserve to healthily self regulate this process without it becoming damaging. This is an area that I frequently have to restore when helping patients get back on the road to functional wellness.

The 2 states of metabolism can be conveniently divided into two categories:

  • Catabolism or being referred to as being in a “catabolic state.” This is the breakdown of molecules by way of various body tissues to obtain energy.
  • Anabolism or being in an “anabolic state” meaning the synthesis of all compounds needed by the cells. This is when the body is in a state of repair & regeneration.

An analogy i sometimes use to help patients distinguish between the two is by referring to bodybuilding. The term ‘anabolic steroids’ refers to synthetic androgenic hormones (Testosterone) often used by competitive bodybuilders that create a more anabolic effect in the body as testosterone helps the cells (which includes muscle tissue) repair & regenerate at a faster rate. This results in increase lean tissue growth under the right stimulus. Testosterone & DHEA are the main two anabolic hormones that counter the catabolic effects of cortisol.

Often when one is in a catabolic state, the body tends to breakdown lean muscle tissue to release amino acids into the bloodstream to be used as a fuel source over its real “emergency fuel” it’s fat stores. This is because muscle tissue is what I call “metabolically expensive” to maintain, over storing body fat. It’s denser, heavier, and requires more nutrients to preserve.

Metabolism is very intimately linked to nutrition and the availability of nutrients. If any one of the body systems are dysfunctional, the entire energy production chain is impaired, and so is the degree of health potential.

Bioenergetics is a term which describes the biochemical or metabolic pathways by which the cell ultimately obtains its energy. Energy formation is one of the vital components of metabolism. I’ve written about this in some of my other articles, but the full body systems approach that I practice all contributes & effects one thing… METABOLIC ENERGY.

A large amount of disease & dysfunction I see today is down to insufficient cellular energy production.

Take cancer for example… Cancer is a metabolic disorder where the cellular energy respiration morning process is deranged.

The main metabolic differences between a normal cell, and a cancer cell are as follows:

Normal cells primarily metabolise glucose to pyruvate for growth and survival, followed by complete oxidation or pyruvate to CO2 through the TCA & the OXPHOS process in the generation of 36 ATP’s per glucose. O2 (oxygen) is essential as it’s required as the final acceptor of electrons. This process is referred to as anaerobic glycolysis. When O2 is limited, pyruvate is metabolised to lactate. The net result in a healthy cell in terms of ATP production is 36 x ATP per glucose from OXPHOS, and 2 x ATP per glucose from anaerobic glycolysis.

Cancer cells on the other hand tend to convert most glucose to lactate, regardless of the availability of O2, diverting glucose metabolites away from energy production and shifting it to anabolic processes that accelerate cancer cell proliferation at the expense of only generating 2 ATP.

Derangements in the process of how glucose is metabolised in the cell of the mitochondria is a mechanism of how cancer cells grow &  proliferate.

Glycolysis can be assessed through a comprehensive metabolic assessment that I run on all my patients.

Within the Mitochondria of our cells; the body converts the nutrients from the food we consume into ATP, which is the energy currency of the body.

However, it doesn’t just end there…

There are many other factors involved that can affect how well our body can make this conversion of the nutrients that enter the cell into molecules of ATP.

This brings me nicely on to one of the body’s metabolic regulator… The thyroid.

The thyroid gland is located just below the Adam’s apple, and is responsible for making the hormone T4 (thyroxine). T4 converts to T3 (triiodothyronine) and RT3 (reverse T3). The T3 turns on the ATP making machinery inside each living cell while the RT3 slows it down. Production of these thyroid hormones is controlled by TSH (Thyroid Stimulating Hormone), which is released by the pituitary gland in the brain. The pituitary takes its orders from the hypothalamus, which is also part of the brain.

Then there’s the other one of body’s two energy producing endocrine glands… the adrenal glands.

The adrenal glands are located on top of each kidney and assist the body deal with stress. The name “Adrenal” is formed from 2 words…

“Ad” meaning “above” In Latin; and “Renal” meaning “Kidney”……

Ad-renal = “Above Kidney”

If the metabolic activity is excessive, the adrenals perceive this as a stress. In response to this stress, the hypothalamus will signal the pituitary to produce less TSH, thus producing decreased T4 and thyroid activity.

Here are a few situations that can cause or contribute towards metabolic energy production problems

  • The thyroid gland can not make enough T4 (hypothyroidism).
  • Chronic stress has signalled the HPA axis to limited the output of the adrenal glands & their ability to handle the stress. By default, this forced a down-regulation of metabolism effects energy production.
  • The enzymes or cellular machinery which make ATP may be held back due to chemical interference such as toxins, lack of needed nutrient or co-factor, or breakdown due to auto-immune disease or pathogenic, bacterial or viral damage.
  • Hormonal imbalances with growth hormone, testosterone, estrogen, progesterone, and DHEA.
  • Severe caloric restriction, or malnutrition through malabsorption, or inadequate diet.

As mentioned earlier, when one or a combination of these factors comes into play, the symptoms of low metabolic energy such as fatigue, weight issues, memory loss, cold hands, dry skin, hair loss to name a few; may start to manifest.

When adrenal output is weakened, even normal thyroid activity places an excessive burden on the glands. This is why trying to jumpstart the thyroid with stimulating pharmaceuticals, or thyroid substances ends up making the adrenal hormone weakness even weaker.

One may begin to feel ‘hypo-adrenal’ which often manifests as coldness, weight loss, dryness, fatigue, insomnia, and/or anxiety. The body then innately turns down its own thyroid energy production by increasing production of RT3.

Conversely, if the adrenals are strong and the thyroid is weak or unable to keep up with the adrenals, one begins to feel ‘hypothyroid’ which often shows up as heat intolerance, weight gain, fluid retention, tiredness, excessive need to sleep and/or depression.

A very common error made by medical practitioners is to focus entirely on the thyroid whilst ignore the adrenal hormone cascade.

In a weakened adrenal state, prescribing thyroid medication that contains T4 and/or T3 may produce limited or transient improvement but will almost always require increases in dosage as the underlying issues that are driving the problem are still very much there, unaddressed.

Subsequent increases in the doses that were originally given over time tend to offer little or no benefit as the medication pushes the energy machinery into overdrive. I see this all the time when assessing the functional lab work of patients I work with from all over the world in FM practice.

A personal observation I’ve seen on the lab work of individuals I work with who are on thyroid medication for hypothyroidism is taking synthetic T4 puts further stress on the adrenal hormone cascade.

Although thyroid medication may give a patient experiencing low metabolic output an initial boost; unfortunately, this temporary higher energy level is short lived, and unsustainable due to the stress on the adrenal hormone cascade. Eventually adrenal output becomes less & less, and the system goes into an exhaustive state where symptoms of low energy return.

If, however, the adrenal reserve is good, the HPA axis is communicating the way it should, and the glands are functioning well, the thyroid hormones can do their job and the result is good metabolic energy.

Another way of looking at this thyroid/adrenal relationship is to think of the thyroid as ‘generating’ the energy while the adrenals need to be able to ‘handle’ the energy. If the thyroid generated energy is excessive for the adrenals’ ability to handle it, the body will down-regulate the thyroid energy as much as it is capable of doing to accommodate what the adrenals can safely handle.

Sometimes, in an effort to help the patient feel better, the GP or M.D. will keep increasing the thyroid dose or even give a T4/T3 combination like Armour Thyroid or just a T3 support like Cytomel. The problem with this is that it forces the system to function at a higher energy than the adrenals can handle. It’s like putting a high powered turbocharger on a shitty little car that’s had no other modifications to buffer the extra torque. Eventually the machine is going to burn out as it just can’t handle the extra power. It wasn’t built to do that job. The adrenals are no different.

In the early stages the adrenals have enough reserve to handle the higher levels of thyroid output so the individual feels better. When the adrenal reserves are exhausted; which can happen as quickly as weeks or months; can develop fatigue, anxiety, bursts of rapid heart beat, palpitations or other symptoms of either high thyroid function or of low adrenal function.

This is the ‘crash and burn’ phase of the thyroid treatment which ignores the adrenals’ capacity to handle the thyroid support. It is often followed by a recommendation for an anti-anxiety, anti-depressants, or beta blockers.

Hopefully by now I’ve given you a greater understanding of the chaotic metabolic cascade that happens and how quickly it gets out of hand.

Most of the people I work with already have broken metabolisms, damaged endocrinology, deranged biochemistry, hormonal issues, and gut problems. This is why a full body systems approach is key in uncovering the layers of dysfunction to be able to intelligently engineer a bespoke functional wellness restoration programme, and have a fighting chance of a better quality of life.

Thank you for your attention.

*Steve Hawes

If you are sick & tired of feeling sick & tired; and want to work with an experienced professional in FM to help you change that – feel free to head on over to my website and book your free 30 minute consultation to see if we are the right fit to work together.