People often ask me about exercise. What’s the best kind of exercise for Hashimoto’s?
There are 2 types and both can be beneficial. But the real key is not to overdo it. If you do too much you defeat the purpose of exercise and you wind up doing more harm than good.
The first type is simple and slow.
Walking, slow jogging, slow cycling or other exercises like yoga, tai chi or qigong that involve endurance can support your adrenals. This type of exercise can decrease cortisol, help with blood flow and circulation and normalize blood pressure.
Something like this should be part of your routine a few times a week.
The second type involves high intensity for short duration. This should also be part of the mix.
According to research, the optimal exercise level to achieve all the health benefits described above is high intensity: when doing this you will:
* Break a sweat after 3-5 minutes
* Breathe deeply and rapidly
* Only talk in short phrases while you are doing this.
You want to go hard enough to achieve 70% or greater of your maximum heart rate. This can be calculated by this simple equation: 220 – your age in years = your maximum heart rate.
There is a fine line between the right amount of exercise which can really improve health and too much which can actually cause more health problems.
The key point is this: The more intense the exercise, the greater the potential for health benefits that include everything mentioned above, but also the greater risk of doing too much and this results in the loss of all those benefits.
This is especially true if you suffer from an autoimmune disease like Hashimoto’s because you may not be able to exercise like a normal person and you may reach the threshold of maximum benefit sooner than people who do not have this condition.
So the best thing to do is to start slow and gradually build. And the objective is not to “feel the burn” or “pain is gain”. You are in enough pain. The object is to feel better, feel energized and feel the beneficial effects of exercise. If you are wiped out after your workout, you’ve gone too far.
Start small and only increase when you feel like what you are doing is physically not demanding enough. A high intensity workout can be beneficial if you doing as little as 5 minutes per day. Err on the side of too little, if you’re not sure.
Here’s a longer blog post that really goes into detail and provides a great 7 minute high intensity work out. Check it out and try it!
With Hashimoto’s, its easy to lose sight of the forest for the trees. And some of the trees can feel like redwoods that take a lot of time and effort to deal with.
You work on your thyroid, then you have to deal with digestive problems. You clean up the diet, then you have to fix the adrenals. You work on the adrenals and then you have work on your liver and gall bladder, then you have to deal with stress and all the emotional issues.
Jeez Louise! When will it ever be over?
I think we all know the answer. If you focus on this process as being a destination, you will be continually frustrated because you will never arrive. There is no destination.
A better way to look at this is that this is a journey. And that journey involves a committed approach to developing a lifestyle that leads you towards healing. We are in this for the long haul.
It gets better, at first it’s all bad days. Then, when we accept that this is more than a thyroid issue and we start seeing and working on healing the whole forest, we start to have some good days.
Once we deal with a few problem trees, we start to realize they aren’t as huge as we had feared and then we start having more good days than bad ones. But the reality is, we’re going of have to revisit some of those things again as things progress.
So don’t be discouraged that you haven’t arrived at the destination yet. Enjoy the journey! There’s a lot to appreciate about simplifying your life and discarding old things that weren’t good for you in the first place.
It’s a beautiful forest, full of beautiful trees. I know some days it doesn’t seem that way, but it really is.
Hey people! Today’s post in about how the immune system and the thyroid interact.
In researching this week’s content I stumbled on something fascinating that I just have to share with you.
Did you know that the immune system actively modulates thyroid hormone levels and TSH?And I do not mean indirectly, I mean directly.
Check this out! TSH is not only produced in the pituitary. 20 years ago, it was discovered by researchers that immune cells actually produce TSH.
Where? In the bone marrow where immune cells are born, by white blood cells and also in the intestines, when exposed to a virus, or when exposed to bacterial toxins like lipopolysaccharide (LPS), which can end up in the blood stream when you have leaky gut or intestinal permeability issues.
LPS exposure also increases conversion of T4 to T3 causing a local surge of T3. This in can result in a lower output of thyroid hormone.
And 2 immune proteins, IL-18 and IL-12, both of which have been implicated as proteins that may make flare ups and inflammation worse with Hashimoto’s also produce TSH.
I was working with someone the other day, who is a perfect example of this.
Her lab tests say her TSH is too high, yet she is having all these hyper symptoms (she should be hypo). Anxiety, palpitations, mood swings, she’s going nuts.
One possible explanation? She isn’t gluten or dairy free. She has some gluten and dairy, it causes a massive immune response in her intestines, maybe she’s exposed to a bovine virus or viral fragments, these immune cells produce TSH. It looks high because of this, but she’s functionally hyperthyroid because the immune system has overcompensated.
And this works both ways, a hypothyroid state creates impaired immune function. There is still a lot that is not known about this, but one of the theories is that immune cells produce this local surge of T3 and this causes a systemic decline in TRH and TSH production.
One theory on this is that in times of infection and immune induced inflammation (which autoimmune disease is a chronic state of) the immune system shuts down thyroid function and then at some point kicks it back in again.
Well, with Hashimoto’s, this endocrine-immune communication is out of whack. The immune system may not be able to kick things in again. Or may not know when the “infection” is over due to chronic inflammation and tissue attack. The antigen is the tissue of the body. The fight never stops, you understand what I’m saying?
So the immune system is actively throwing the body’s thyroid hormone levels out of whack trying to keep the body in a lower metabolic state so that it can recover from this infection. But there may be a chronic state of infection, or ongoing chronic infections in the body.
Food for thought. Heal your gut. Address chronic infections. This is not just a thyroid problem!
There will be times,
When even though you are doing all the right things: eating right, exercising, meditating, dealing with stress, etc.
That you will still have set backs.
And some of these set backs may seem like they bring you right back to zero.
But, I can tell you from experience with working with many people that often:
The biggest implosions happen before the biggest insights.
The biggest defeats come before the biggest victories.
As one of my teachers, Jesse Koren, says, the biggest breakdowns happen before the biggest breakthroughs.
The worst doubts come before the miracle.
So, it comes down to believing.
Have faith, it will be rewarded.
In this post we’re going to break down the stomach, stomach acid, and, of course, it’s relationship to the thyroid and Hashimoto’s.
What does the stomach do?
It’s role is really to take food that has been chewed (hopefully well) and mixed with saliva and to break it down.
Break it down! Like James Brown!
Break it down, stomach! Do the mashed potato. Ok, what breaks all this food down?
Hydrochloric acid. This is vitally important for breaking down vitamins, minerals (like iron) and vital nutrients so that they can be absorbed by your small intestine.
A lot of people, misled by advertising, think that stomach acid is bad. 2 of the top 10 most prescribed drugs in the US are Nexium and Prevacid.
These are designed to block the production of stomach acid and are called proton pump inhibitors.
These proton pump inhibitors work by completely blocking the production of stomach acid. They do this by inhibiting (shutting down) a system in the stomach known as the proton pump.
Because we don’t need that.
No, actually, it’s hugely important.
Having enough stomach acid prevents food poisoning, parasites and other critters from taking over your digestive tract.
Enough hydrochloric acid also stimulates gall bladder and pancreas function to complete digestion and keep everybody in the digestive tract happy, happy, happy.
Proton pump inhibitors also affect thyroid hormone absorption and a study from Endocrinology Practice, the official journal of the Endocrine Society of America found their impact is so significant that patients taking these drugs and thyroid hormone may need to adjust their dosage.
What I’m saying is you actually do need hydrochloric acid or HCL and it’s production depends on the hormone gastrin.
And guess what else has an impact on gastrin? Thyroid hormone.
So hypothyroidism causes less gastrin to be produced, which leads to lower amounts of hydrochloric acid which, in turn leads to heartburn, bloating, gas and..wait for it…….!
Why, yes I did.
But didn’t you also say too little hydrochloric acid?
Why, yes I did.
Let me explain…mechanisms, people. It’s how things work.
It turns out, having enough stomach acid actually prevents heartburn by helping to thoroughly digest your food.
The burning sensation that people feel from heartburn is actually from the poorly digested food rotting in your gut and shooting up into your esophagus, where there is no protection from the acid.
Even a small amount of acid will cause problems there.
In an editorial published in the journal Gastroenterology first published online in 2009, the author remarked:
Treating gastroesophageal reflux disease with profound acid inhibition (which the popular drugs are) will never be ideal because acid secretion is not the primary underlying defect.
You see, there is the truth rearing it’s ugly little head. Another study referenced below suggests the actual cause of GERD is pressure on the abdomen (often made worse by weight gain and obesity) not too much acid.
For decades the medical establishment has been directing its attention at how to reduce stomach acid secretion in people suffering from heartburn and GERD, even though it’s well-known that these conditions are not caused by excess stomach acid.
Advertising, people. Great for making money, not so good for healing.
Another thing that HCL is important for is the absorption of vital nutrients like B12, iron, and calcium and for breaking down and absorbing protein.
Too little HCL can also lead to inflammation, lesions and infections in the intestines.
All of that leads to poor absorption of thyroid hormone, leading to…this one is a gimmee….(yup, you guessed it) normal lab tests but hypothyroid symptoms.
With too little stomach acid, also called hypochlorhydria, 2 important factors lead to GERD and acid reflux.
The first is bacterial overgrowth. Stomach acid acts like the police of the digestive tract. It keeps the riff raff out. When you don’t have enough you can get overgrowth of bacterial species that cause problems like copious amounts of gas. (Whew!)
The second problem that too little stomach acid causes is that it can lead to poor digestion, especially of carbohydrates. And these 2 problems feed each other because these problem bacteria really like to feed on carbohydrates.
So you wind with yet another vicious cycle.
This is also why people with acid reflux often feel better after going off of gluten (and other carbs). You stop feeding the problem.
I am very fortunate to have a robust community of Hashimoto’s folks at our Facebook support group.
I asked them how many of them experienced symptoms of acid reflux or GERD. And of the 75 respondents, virtually all of them had symptoms related to issues involving stomach acid.
Here’s a chart that illustrates their symptoms.
3 Symptoms of Acid Reflux – SURVEY TABULATION – January 13 2
And a second chart that looks at what helped.
3 Symptoms of Acid Reflux – SURVEY TABULATION – January 13 4
While this is hardly a scientific study, it is emblematic of how common these problems are among this population. Notice how many people improved by going off of gluten and wheat and/or going Paleo. All approaches that limited the number of carbs. Also notice how many are on proton pump inhibitors.
Too little stomach acid also leads to anemia because you can’t absorb B12, and you can’t properly absorb iron.
Couple this with heavy bleeding during your cycle which can also be caused by too little thyroid hormone (more on that in an upcoming post) and you have a recipe for iron deficiency anemia.
The stomach is important for breaking down and digesting foods and for allowing the body to absorb important vitamins, minerals and protein.
Too little stomach acid can lead to a host of problems: like heartburn (counter-intuitive but true), anemia, iron and protein deficiency.
All of this creates a vicious cycle of less conversion and utilization of thyroid hormone and lower stomach acid. Not good.
So glad you asked.
Let’s use logic, even though it can be counter intuitive. If you have too little stomach acid and this is the cause of the problem then….yup, that’s right, do something to increase the stomach acid when you eat.
Some simple natural solutions include:
* Going gluten free or Paleo (to cut out the carbs)
* Apple cider vinegar (to increase stomach acid)
*Lemon or Lime juice in some water (to increase stomach acid)
*Fresh Ginger or ginger tea (to increase stomach acid secretion)
*HCL supplements (to boost HCL levels)
How much really depends on how bad you’ve got it and on whether or not there are other things going on. And all the things that increase stomach acid should be done with your meal, not on an empty stomach.
There are some other things that can make resolving this more difficult. One of the most common is the bacteria Heliobactor Pylori also known as H. Pylori.
This little critter can take over when there is not enough stomach acid in your stomach. So be sure to test for it to rule it out if you have these symptoms.
This stuff is often marketed as the answer. “Cancer can’t grow in an alkaline environment.”
Here’s the thing. Different parts of your body have different acid and alkaline requirements. Your stomach needs to be acidic.
When you drink lots of alkaline water, especially if it’s with your meal, you may wind up causing everything I have just described.
Don’t believe the hype, acid ain’t all bad.
Once again we see how there is an explanation for what’s gong on and the conventional medical approach or the multi-marketed hype, while profitable, is actually counterproductive to healing.
I envision a day, sometime in the future when medicine actually becomes about healing and resolving people’s issues.
Wait! It’s here… at Hashimoto’s Healing where we provide hope, help and healing for Hashimoto’s and the varied ways that it wreaks havoc on our bodies. For example check out my program The 5 Elements of Thyroid Health.
Please, please, please! Give your body a chance to heal by learning the truth. Question the drug companies and the marketers who are talkin’ loud and sayin’ nothin’.
(I will give a free 30 minute consultation to anyone who can identify the numerous allusions to James Brown songs and/or dances that I have in this post.)
http://www.natap.org/2009/HIV/070409_02.htm :Article on how proton pump inhibitors actually cause the problem they are supposed to fix
http://www.gastrojournal.org/article/S0016-5085(07)01843-4/preview : The real cause of GERD
http://www.ncbi.nlm.nih.gov/pubmed/9079271 : Study showing how antibiotics can improve gastric reflux
http://www.ncbi.nlm.nih.gov/pubmed/16871438 : An interesting study showing that a low carb diet improves acid reflux
http://www.ncbi.nlm.nih.gov/pubmed/17669709 : Study showing how proton pump inhibitors affect thyroid hormone absorption
The Thyroid, A Fundamental and Clinical Text, Ninth Edition. Lewis E. Braverman and Robert D. Utiger 2005
This week’s tip involves blood sugar issues and Hashimoto’s. This is one of those vicious cycles where one thing leads to another and together they make a downward spiral.
Did you know that both high blood sugar and low blood sugar levels can make your Hashimoto’s worse?
On average, Americans hammer about 200 pounds of sugar a year, and diabetes is a serious threat to bankrupt our healthcare system in the next 20 years.
Well, diabetes doesn’t happen overnight, it’s progressive. And often that progression passes through something called metabolic syndrome and insulin resistance on its way to diabetes.
According to Chris Kresser, L.Ac., Metabolic Syndrome is defined as a group of bad things appearing together, including:
▪ abdominal fat; “the muffin top”
▪ high cholesterol and triglycerides (caused by sugar being stored as fat in the liver)
▪ high blood pressure (caused by plaque build up in the arteries that comes from excess sugar and cholesterol)
▪ insulin resistance
▪ tendency to have blood clots (because sugar makes the blood more prone to clotting)
▪ our good friend, inflammation (the root of all evil – well, at least the root of autoimmune diseases like Hashimoto’s)
Metabolic syndrome is caused by a chronic state of too much sugar in the blood.This is caused by eating too many carbohydrates.
So really, metabolic syndrome could be called “hammering too many carbs disease”.
Because that’s what it is.
When you eat too many carbs, the pancreas secretes insulin to move extra glucose from the blood into the cells where glucose is used to produce energy.
But over time, the cells lose the ability to respond to insulin. It’s like insulin is knocking on the door, but the cells won’t let it in.
“I hear you knocking but you can’t come in.”
The pancreas responds by pumping out even more insulin (knocking louder, “Please, let me in!”) in an effort to get glucose into the cells, and this eventually insulin receptors get tired of it all and this leads to insulin resistance.
Studies have shown that the repeated insulin spikes that come with insulin resistance increase the destruction of the thyroid gland in people with autoimmune thyroid disease. Read all about them in this detailed post on blood sugar.
Let me repeat that, insulin resistance increases the destruction of the thyroid gland in autoimmune thyroid disease (Hashimoto’s).
As the thyroid gland is destroyed, what happens? Less thyroid hormones are made by the thyroid and you get all the hypothyroid symptoms like fatigue, weight gain, brain fog, depression, joint pain, hair loss and on and on.
Low blood sugar or hypoglycemia can also cause problems with the thyroid.
Your body sees low blood sugar as a threat because severe or long term hypoglycemia can cause seizures, coma, and death. Not good things.
When your blood sugar levels drop below normal, your adrenal glands respond by secreting cortisol. Cortisol then tells the liver to make more glucose, bringing blood sugar levels back to normal.
The problem is that cortisol is involved in the “flight or fight” response. This response includes speeding up your heart rate and lung action, increasing blood flow to the muscles to get us ready to fight or to scream and run for the hills.
Cortisol’s job is to increase the amount of glucose available to the brain, help with healing, and to slow down certain things – like digestion, growth and reproduction – that aren’t so important when we were running from hungry lions on the African Savannah (flight).
Unfortunately for hypoglycemics, repeated cortisol release caused by episodes of low blood sugar makes the pituitary gland not work as well.
The pituitary is in charge of the thyroid and when it isn’t working properly, this can cause problems with the thyroid.
So either too much or too little sugar can mess with thyroid function and cause problems.
And, check this out. Hypo-function of the thyroid can cause everything we just talked about because:
▪ it slows the rate of glucose uptake by cells;
▪ it decreases rate of glucose absorption in the gut;
▪ it slows response of insulin to elevated blood sugar; and,
▪ it slows the clearance of insulin from the blood.
These mechanisms present clinically as hypoglycemia. When you’re hypothyroid, your cells aren’t very sensitive to glucose.
So although you may have normal levels of glucose in your blood, you’ll have the symptoms of hypoglycemia (fatigue, headache, hunger, irritability, etc.).
And since your cells aren’t getting the glucose they need, your adrenals will release cortisol to increase the amount of glucose available to them.
This causes a chronic stress response, as described above, that suppresses thyroid function.
A vicious cycle. If you want to heal your Hashimoto’s, you need to deal with blood sugar issues. And that means dealing with your sugar habit.
Sometimes living with Hashimoto’s is like being on a ride at a dark amusement park.
You get better, you get worse, you get flare ups: aches & pains, mood swings, you forget and just want to lay down.
It all seems random.
Start keeping a journal and you will start to see the things that take you for a ride.
What should you look for?
One of the most important things for you to learn to identify are your “triggers”. Triggers are the things that cause an immune reaction.
This immune reaction ends up triggering a more aggressive autoimmune response which means inflammation and tissue destruction.
These “triggers” cause “flare ups” or a worsening of your symptoms. One of the best ways to find your triggers is by observation.
Note the foods you eat, note the experiences you have especially those that are very stressful or emotionally draining.
Note what chemical toxins you are exposed to: cleaning products like bleach, cigarette smoke, formaldehyde, exhaust, etc.
Another thing that is really important to understand about Hashimoto’s is that how you feel is diagnostically relevant and clinically significant.
Somehow, inexplicably, many doctors have forgotten that one of best tools of diagnosis and treatment is clinical observation.
For some reason with Hashimoto’s and hypothyroidism this has been erased from their brains and the only relevant finding has become TSH and, if you’re lucky T4 blood test results.
There are about a dozen reasons why TSH and T4 testing is unreliable at best and clinically useless at worst. Check out this post to learn more about this sorry state of affairs.
Really, being a good doctor is a lot like being a good detective.
And in today’s conventional medical model you’re pretty much on your own when it comes to figuring out your Hashimoto’s.
So, don’t rely on anyone else.
Keep a journal, be your own detective. Identify your triggers and eliminate them.
Then your life will stop being such a dark amusement park ride.
Today’s health tip concerns the relationship between your adrenals and thyroid health.
Remember the body is an ecosystem with many systems interacting all the time. One example of this is the adrenal glands and how they impact thyroid hormone absorption.
Chronic immune stimulation, like Hashimoto’s, sets the stage for high cortisol for a prolonged period of time.
This chronic adrenal stress can:
* Increase thyroid binding proteins, so that thyroid hormones can’t get into cells to do their job.
With more thyroid binding proteins, you have less free and available thyroid hormone. It’s like going to a dance, if all the available boys or girls are with dates, your chances of getting some are a lot lower.
* Mess up detoxification pathways, which can lead to thyroid hormone resistance.
If your liver isn’t detoxing properly, thyroid hormone can’t get converted from T4 into it’s active form T3. It’s like driving on the freeway, if there’s lots of traffic, you ain’t goin’ nowhere.
* Slow the conversion of T4 to active forms of T3 that the body can use.
This happens in the liver, it also happens in the digestive tract where the whole process is helped along by good bacteria and in the peripheral tissue. High cortisol leads to problems in the first 2 areas. Eventually, you empty your cortisol tank and then you get problems in the third.
* Weaken the barrier system defenses of the digestive system, the lungs and the brain.
High cortisol leads to imbalances in the gut and intestinal permeability. It’s like your alarm system breaks down and all manner of riff raff just come on in.
This can trigger Hashimoto’s or cause flare ups or both.
Heal your adrenals by:
Balancing your blood sugar: Read all about it in this previous post.
Healing your adrenals: Read all about this in this other previous post.
And relax, people! It’s all going to be fine. Really, it is! 🙂
I have a confession to make. I tend to be rather obsessive. Lately, I’ve been obsessing about how to make affirmations work if you suffer from low self esteem.
Let’s face it, Hashimoto’s can definitely impact your self-esteem because it can affect the way you look and feel and it can deplete you of the energy to do something about it.
I think the issue here may be one of believing what you say to yourself. Sometimes, we say an affirmation and we believe it and it resonates. Other times we say something and a louder inner voice shouts it down and tells you its not true or its a bunch of baloney (not my first choice of words).
So, I pondered obsessively, how can we use some internal tai chi move to quiet that inner voice and get ourselves to believe the affirmation long enough to make it work?
EFT. EFT or Emotional Freedom Technique can be a powerful tool to get the negative emotions out of your body even if that inner voice is drowning out the good stuff. EFT uses acupuncture points to help you access emotions held in your body.
Dr. Candace Pert is a researcher and really smart person who wrote a great book called Molecules of Emotion that explores that mind-body connection. For me the book was basically saying that the body is the subconscious mind. Your emotions get buried in your cells.
You can use EFT to unbury them. There is a place you can tap right below your pinky finger on either hand.If you trace the outside of your pinky down to the bottom, there is a bone there. Continue down to the bottom of that and there is a tender spot. It’s where you might do a karate chop.
In this photo, I permanently disfigured myself with a Sharpie to show you the exact spot.
You can say an affirmation like “I deeply and completely love and accept myself” or “I completely forgive myself” while you are tapping this point.
As you do it check in with your inner voice, if you here the screams from the inner peanut gallery, don’t fight them.
Acknowledge them, and say “Even though I think this is total crap ( or whatever word comes to mind), I deeply and completely love and accept myself.” or words that resonate for you.
And observe how you feel. Often with repetition and determination, you can take the sting out of that negative self talk and start to replace those neural pathways with more positive self talk that you start to believe.
Social psychologist, Amy Cuddy, explains in this TED Talk how to use physical postures to change the way you feel about yourself, as well as how others feel about you.
By spending just two minutes “power posing” with their arms or elbows out, their chin lifted and their posture expansive. (Think Superman or Wonder Woman).
Cuddy’s research, done in collaboration with Dana Carney, has shown that adopting the body language associated with dominance for just 120 seconds is enough to create a 20 percent increase in testosterone and a 25 percent decrease in the stress hormone cortisol.
In other words, adopting these postures makes a person feel more powerful.
It also makes you feel more positive and happy. Do it with a smile and see what I mean!
Another positive pose is the “victory pose” that most athletes do naturally. Arms raised above your head in a “V”, legs spread wide.
I’m doing them all day long! What makes you feel more powerless than Hashimoto’s?
No longer, people!
To learn more, check out this article:http://www.huffingtonpost.com/amy-cuddy/body-language_b_2451277.html
Please share your obsessive insights about making positive changes in your life.
Today’s health tip concerns blood tests.
As I’m sure many of you have experienced, most doctors and even some alternative care practitioners rely heavily on test results.
The most commonly ordered are TSH and T4. Some doctors won’t order anything other than TSH. And many labs now do what is called a TSH cascade, which means they only test more than TSH if TSH is out of range.
Which it isn’t, a lot of the time. Regardless of how lousy you feel.
Lately, several people have posted questions regarding their lab values.
In most cases, I can’t give a good answer.
I’m not trying to be a jerk, it’s because lab tests are flawed. They are not the be all and end all.
They do not provide answers by themselves.
With Hashimoto’s, what you feel, the symptoms you have, are clinically significant and diagnostically important.
And here’s why this is especially true of TSH.
TSH is thyroid stimulating hormone. It is released by the pituitary gland to signal the thyroid to release thyroid hormone.
And research has found that the pituitary does not absorb thyroid hormone in the same way that the rest of the cells in the body do.
A recent study published by the European Thyroid Association looked into the question of whether or not TSH and the amount of thyroid hormone in the cells of the body were directly correlated and why T4 was sometimes poorly absorbed.
Another study from the British Medical Journal showed that TSH levels had no correlation with tissue thyroid levels and could not be used to determine a proper or optimal thyroid replacement dose.
The authors concluded that “TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure. … We found no correlations between the different parameters of target tissues and serum TSH.”
Do want to know what your test results mean? Look at them in the context of how you feel. A thorough assessment of your signs and symptoms is, by far, the best way to understand how you feel.
Trust your body. It will tell you whether or not what you are doing is working.