The human body is a wonderfully complex playground where hormones, immune cells, neurotransmitters, red and white blood cells, bacteria, and more all frolic.
With Hashimoto’s that playground gets invaded by a hurricane of inflammation and this disrupts many of the systems that produce these things.
In today’s post, we focus on how blood sugar problems can impact the thyroid and how Hashimoto’s and hypothyroidism can also make blood sugar problems worse.
It’s a two way street, people.
The endocrine gland that is responsible for helping maintain blood sugar balance is the pancreas. The poor, dear, much beleaguered pancreas.
What does the pancreas do? Quite a lot actually, we really should be nicer to it. It does endocrine stuff and non-endocrine or exocrine stuff.
On the endocrine side it produces insulin, glucagon and somatostatin. Insulin and glucagon are involved in blood sugar metabolism and somatostatin is involved in intestinal absorption.
The exocrine functions include secreting digestive enzymes into the small intestines. These breakdown proteins, fats and carbs in the diet.
Studies have found pancreatic function was significantly reduced in patients with hypothyroidism.
And, in many people today, the pancreas is under siege.
Americans are addicted to sugar. In some measure, it’s their own doing. In other ways, it is the food industry and public health officials who decided that fat was evil when it was discovered that cholesterol was linked to heart disease in the 1980s. The National Academy of Science made sweeping recommendations at that time to get rid of dietary fat.
So fat was taken out of many processed, fast foods and in an effort to make it taste less like an old ping pong table, it was replaced with sugar.
Carb Roller Coaster
What has since developed is a nation of carb and sugar addicts riding the roller coaster of sugar highs and crashes.
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.
It is estimated that almost half the population born after 2000 will become diabetic.
This is almost entirely due to diet. As Thomas Edison said, “We’re digging our graves with our teeth.”
Health is really all about balance. And nowhere is this idea more evident than when you look at blood sugar balance.
There are really 2 different kinds of blood sugar problems and many people have a mixture of both. These are hypoglycemia (or too little sugar in the blood) and insulin resistance (or too much sugar in the blood).
With Hashimoto’s either one or both of these blood sugar problems can make things worse. And just to remind you that this goes in both directions; its important to understand that hypothyroidism can also cause blood sugar problems all by itself.
(We have the makings of a vicious cycle.)
Your body is programmed to recognize low blood sugar as a threat because severe or long term hypoglycemia can cause seizures, coma, and death.
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.
Hypoglycemia is a condition in which there is not enough cortisol to raise blood sugar into the normal range.
The problem is that cortisol (along with epinephrine) is also a sympathetic nervous system stimulant involved in the “flight or fight” response. This can end up wearing out the adrenals.
In fact, we often see adrenal fatigue and hypoglycemia together.
Cortisol’s job is to increase the amount of glucose available to the brain, enhance tissue repair, and slow other functions – like digestion, growth and reproduction – that aren’t so important when you are running from hungry lions on the African Savannah (flight).
Unfortunately for these people, repeated cortisol release caused by low blood sugar can also suppress pituitary function.
And the pituitary is the master gland that instructs the thyroid. If this function isn’t working properly, then “Houston, we have a problem.”
And where do we have a problem? In the thyroid.
Cortisol directly inhibits the enzyme (5’-deiodinase) which converts inactive T4 into active T3. This can lead to low T3 levels.
In addition, elevated cortisol will cause thyroid hormone receptor insensitivity meaning that even if T3 levels are high enough, they may not be able to bind normally to receptor sites. And when this happens it doesn’t get into the cells.
Cortisol will also increase the production of reverse T3 (rT3) which is inactive. (It’s kind of like the anti-hormone.)
rT3 can cause an increase in the production of substances known as thyronamines that can cause hypothyroid symptoms (like, low basal body temperature,fatigue, depression, etc.) along with insulin resistance symptoms of increased blood sugar.
Cortisol can also lower the levels of protein that binds to thyroid hormone so it can circulate in a stable structure.
And finally, elevated cortisol will slow TSH production by messing with hypothalamic-pituitary feedback leading to lower TSH production.
In my previous post on the adrenal glands we learned about the HPA (hypothalmus-pituitary-adrenal) axis.
Well, there is also an HPT (hypothalmus-pituitary-thyroid) axis.
And much like wires going through a transformer on an electric grid, the HPT and HPA axis are very closely related and problems in one area can affect the other.
“When things go wrong, wrong with you, it hurts me too.” sings the HPA to the HPT axis.
Common symptoms of hypoglycemia include (These come from a form called a Metabolic Assessment Form that I use in my practice that I got from studying with Dr. Datis Kharrazian):
(Many of these symptoms improve when you eat )
*Irritable if meals are missed
*Depend on coffee or other kinds of caffeine for energy
*Eating relives fatigue
*Feel shaky, or jittery
*Feel agitated or nervous
*Get upset easily
*Poor memory, forgetful
It’s important for hypoglycemics to eat often throughout the day and not skip meals. Each meal should be a combination of protein, carbohydrates and fats. And, for these people, too many carbs will often cause serious problems with their blood sugar levels.
When you eat too many carbs and too much sugar, 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 a little dog barking outside the cell, but the cell won’t let it in.
“I hear you barking, but you can’t come in.”
The pancreas responds by pumping out even more insulin (barking louder) in an effort to get glucose into the cells, and this eventually causes insulin resistance.
Studies have shown that the repeated insulin surges that come with insulin resistance increase the destruction of the thyroid gland in people with autoimmune thyroid disease.
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? Thyroid hormone production falls. And this causes hypothyroidism. Not good.
Insulin resistance can also cause a reduced conversion of T4 to T3 hormones.
When this is addressed, the cells can once again start using glucose for energy and T3 production picks up.
So for a person who is insulin resistant, a lower carbohydrate diet may help restore better T4 to T3 conversion and often these people lose weight in the process ( a nice side effect).
For other people, other things like long-term chronic stress may be affecting their response to low carb diets. As we have seen in my previous post, chronic stress can interfere with thyroid hormones in several ways.
(These are also from that form mentioned above):
(Eating generally doesn’t improve these symptoms )
* Fatigue after meals (this is the hallmark symptom)
* General fatigue
* Constant hunger
* Craving for sweets that isn’t relieved when you eat sweets
* Must have sweets after meals
* Waist girth equal to or larger than hip girth
* Frequent urination
* Increased appetite and thirst
* Difficulty losing weight
* Migrating aches and pains
Life is not a textbook. Many people are somewhere in the middle of this blood sugar odyssey and they have some symptoms of hypoglycemia and some symptoms of insulin resistance.
I put this question to my Facebook Support Group and of the 66 respondents with Hashimoto’s, 24 reported symptoms of hypoglycemia and 14 reported symptoms of insulin resistance.
16 reported some symptoms of both.
While this is hardly a scientific study, it does demonstrate how common this problem is in this population.
On thing that’s important to understand is that whether you have high or low blood sugar, you probably have some amount of insulin resistance.
I explained how high blood sugar causes insulin resistance above, but insulin resistance can also cause low blood sugar.
This condition, called reactive hypoglycemia, happens when the body secretes excess insulin in response to a high sugar and carbohydrate meal.
For example: A burger on a sesame seed bun, french fries and a soda – causing blood sugar levels to spike and then drop below normal. (I’m not lovin’ it!)
If you eat like this and you have Hashimoto’s (and hypothyroidism), you are setting yourself up for a world of hurt.
Hypo-function of the thyroid can cause everything we just talked about because:
These mechanisms present clinically as hypoglycemia. When you’re hypothyroid, your cells aren’t very sensitive to glucose (they are resistant).
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 I described in a previous post, that suppresses thyroid function.
Does this sound familiar?
In another post on Synthroid, TSH and T4, I wrote about how some people are functionally hypothyroid. In other words, they have enough thyroid hormone, but it’s not getting into the cells.
Many of these people also have enough sugar in their blood but its not getting into the cells. Its another vicious cycle.
And let me tell you this from clinical experience. It is really, really, really, really, really, really, really, hard to manage a Hashimoto’s patient or someone with functional hypothyroidism if he or she doesn’t stop this sugar happy carb fest.
In fact, I’m going to say it. It’s a deal breaker.
If this high sugar diet isn’t stopped, you might as well throw in the towel, pack it in, wave the white flag, say “Uncle”, hear the fat lady sing, and give up, because you’re done.
All the money you’re spending on supplements and therapies won’t work. Instead, the first thing you need to do is to balance your blood sugar.
When balancing blood sugar, there are two things to consider. The first is fasting blood glucose, which can be measured first thing in the morning before eating or drinking anything.
In functional medicine we define normal range for fasting blood glucose as 75 – 95 mg/dL. Although 100 is often considered the top of the range for normal, studies have shown that fasting blood sugar levels in the mid-90s may set the table for future diabetes a decade later.
And although 80 mg/dL is often defined as low end of the range, plenty of healthy people have fasting blood sugar in the mid-to-high 70s (especially if they follow a low-carb diet – all you Paleo fans- time to do the wave).
The second, and more important thing to measure is post-prandial blood glucose. This is measured 1-2 hours after a meal.
Several studies have shown that post-prandial blood glucose is the most accurate predictor of future diabetes and is the first marker (before fasting blood glucose and Hb1Ac) to indicate blood sugar imbalances.
Normal post-prandial blood sugar one to two hours after a meal is 120 mg/dL, but most normal people are under 100 mg/dL two hours after a meal.
How does this apply to you? If you’re hypoglycemic, your challenge is to keep your blood sugar above 75 throughout the day.
The best way to do this is to eat a low-to-moderate carbohydrate diet (to prevent the blood sugar fluctuations I described above), and to eat frequent, small meals every 2-3 hours (to ensure a continuous supply of energy to the body.
If you’re insulin resistant, your challenge is to keep your blood sugar below 120 two hours after a meal.
The only way you’re going to be able to do this is to restrict carbohydrates.
Everyone should buy a blood glucose meter. The technology has gotten to the point where they are very precise and quite inexpensive.
How low-carb do you need to go?
Its different for everyone. (But, for most people with Hashimoto’s it is recommended to reduce carbs significantly.)
First, figure out your carbohydrate tolerance by buying a blood glucose meter and testing your blood sugar after various meals.
If you’ve eaten too many carbs, your blood sugar will remain above 120 mg/dL two hours after your meal.
Finally, if you have Hashimoto’s, it’s also important that you take steps to make sure your thyroid is properly balanced as well.
As you have seen, this thing works in both directions.
Sugar problems can mess with thyroid function, and thyroid disorders like Hashimoto’s can cause sugar problems and put you at greater risk for hypoglycemia, insulin resistance and if nothing is corrected, diabetes.
As you can also see, there are layers and layers here that may need to be addressed and worked on.
Hashimoto’s is so much more than a thyroid problem. Its a multi-system problem and it requires a multi-system approach.
That’s why I created my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health.
In it you will discover how all these systems interact and cause vicious cycles and you will also learn how to correct these imbalances and heal.
In the meantime, put down the happy meal and step from away from the counter! 🙂
http://www.ncbi.nlm.nih.gov/pubmed/16530289: Study on insulin resistance and inflammation
http://www.eje-online.org/content/134/1/21.extract : Cytokines and autoimmune disease
http://www.ncbi.nlm.nih.gov/pubmed/3500324: Impact of immune cells on TSH
http://care.diabetesjournals.org/content/24/8/1448.full: Study on Glucose Tolerance and Neuropathy
http://www.ncbi.nlm.nih.gov/pubmed/939192 : Study on impact of thyroid hormone on insulin secretion.
http://www.ncbi.nlm.nih.gov/pubmed/2013384 : Influence of the thyroid on pancreatic function
http://diabetes.diabetesjournals.org/content/16/9/643.full.pdf+html: Effects of thyroid function on insulin secretion
http://www.ncbi.nlm.nih.gov/pubmed/19364696 : Excess thyroid hormone and carbohydrate metabolism
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Why Do I Still Have Thyroid Symptoms? (When My Lab Tests Are Normal), Dr. Datis Kharrazian, Elephant Printing 2010