Exploring the link between healthy weight, thyroid function and fertility

If you have been to the grocery store lately and waited in the check out line you will most likely have been bombarded by the annual obsession with weight loss and fad diets. On either side of the line the magazine rack will be taunting you with questions like Are You An Emotional Eater? (Marie Claire) , or suggesting you Shed Two Sizes (Women’s Health) or luring you with 15 ways to lose 15 pounds (Glamour).

*Also read: Weight loss: a holistic perspective

If you have been to the grocery store lately and waited in the check out line you will most likely have been bombarded by the annual obsession with weight loss and fad diets. On either side of the line the magazine rack will be taunting you with questions like Are You An Emotional Eater? (Marie Claire) , or suggesting you Shed Two Sizes (Women’s Health) or luring you with 15 ways to lose 15 pounds (Glamour). The timing of these magazine articles couldn’t be better, they prey on our insecurities and any guilt that may exist from the over indulgences during the holidays. The darkest time of the year has just passed and the winter weather can sometimes prevent our outdoor exercise.

The holiday season has come to an end, we are back to work, a new year has started and we are looking to make our weight loss resolutions come to fruition. Sadly very few people are able to achieve this goal. A major stumbling block to this success is not knowing how to achieve lasting weight loss. Many people also lose their motivation because they are unsure of why they should lose weight, the motivation of vanity tends to be short sighted and easily negated. In some cases the goal of weight loss is made even more difficult by an undiagnosed thyroid condition or other medical condition that disturbs metabolic balance.

What exactly is a “healthy weight”?
The link between a healthy weight and overall health is something that is commonly referred to but very rarely explained. Most of us will have heard that there is a connection between cardiovascular health and weight but there are many other systems of the body that are affected when an individual’s weight is either excessive or too little. The commonly accepted way of determining a healthy weight is by calculating your body mass index (BMI) and waist circumference. The BMI is a measure of your weight relative to your height. It is beneficial to measure the total waist circumference to determine its size relative to the circumference of the hips. These values give the individual an indication of the relative amount of fat contained in the body and in some cases, where it is being stored. Excess fat storage poses a risk to the cardiovascular system, the gall bladder, insulin regulation and glucose metabolism, and can disrupt hormonal regulation. Insufficient fat and a very low BMI could indicate malnutrition and osteoporosis.

Healthy weight and fertility
For those trying to conceive and concerned with reproductive hormonal regulation, it is essential that a balanced level of fat be maintained. Excess fat cells increase estrogen production and lead to a state of estrogen dominance in the body. Whereas, those with insufficient fat will be unable to produce reproductive hormones in the quantity they may be required. Fat in the form of cholesterol is required for the synthesis of all reproductive hormones. The apple shaped body (more weight carried in the midsection and a larger waist circumference than hips) is typically considered to be a greater health risk than the pear shaped body (excess weight that is carried in the hips and thighs). However in the case of hormonal regulation, both body types are a concern and an approach to reduce excess fat must be implemented.

What does my thyroid have to do with my weight gain?
Imagine after numerous years of the same New Year’s resolution without success. Going to the gym at its most crowded time of the year, starving yourself on the newest fad diet or buying the latest exercise equipment for home use only to find that the scale has not reduced or has even increased can be extremely frustrating. For one in eight women in the United States this inability to lose weight could be due to a thyroid disorder. A very typical symptom of hypothyroidism is weight gain and the inability to lose the weight. In addition to this, it is common to have cold hands and feet, dry and/or thinning hair, a puffy face, fatigue, and constipation. These symptoms may often be incorrectly credited to the excess weight alone and will not get any medical testing done or even mention it to their doctor. An under functioning thyroid can also disrupt reproductive function causing heavy and/or irregular menstrual cycles, inability to conceive or a propensity for early miscarriage and an increased risk for high blood pressure during pregnancy (pre-eclampsia). Although not all women who exhibit the above symptoms will necessarily have thyroid function disorders, it is an important possibility to rule out. Women with polycystic ovary syndrome (PCOS) may also exhibit similar symptoms, however they will have hormonal imbalances such as elevated androgens that appear on lab results.

How is thyroid function measured?
Thyroid function is analyzed using a blood test. In most cases doctors will only order the the thyroid stimulating hormone (TSH) levels to be tested. This is a measure of how the thyroid organ is responding relative to the signals it is given from the brain. The usual normal range for TSH is between 0.3 and 5.5 milliunits/L. (This may vary slightly between laboratories used). However the optimal range is slightly tighter. If the levels are elevated, meaning that more signal is required for adequate output, then hypothyroid is suspected; if the levels are low, less signal is required and hyperfunction of the thyroid is taking place. Often, the TSH value alone is sufficient for doctors to prescribe medication to regulate the thyroid function. In some cases, further testing may be required to determine more precisely what the cause of the imbalance is and if there further complications that may be taking place. A more complete thyroid panel can be ordered which includes the testing for the hormones produced by the thyroid organ T4 and T3. Total values are measured as well as their usable or “free” form. To determine if there is an autoimmune component, Thyroid Peroxidase antibody (TPO Ab), Thyroglobulin antibody (TG Ab) and Thyroid Stimulating immunoglobulin (TSI) may be requested.

The most common cause of hypothyroidism is an autoimmune condition called Hashimoto’s disease. This is a condition in which the body’s immune system malfunctions and has been informed that the thyroid should be attacked. This causes inflammation and the under function of the thyroid organ. The hypothyroidism produced by this inflammation then results in the above symptoms. A brief period of hyperfunction and weight loss may occur at first but this is often undetected or unreported, it is not until the hypothyroid symptoms develop that it is usually diagnosed.

Treatment of hypothyroidism and monitoring
Getting the correct diagnosis is critical in determining treatment. Usually it will mean the prescription of the synthetic thyroid hormone levothyroxine (Synthroid) to bring the thyroid levels back into optimal range. In many cases, most of the symptoms then return to normal. Ongoing monitoring of thyroid levels are required at regular intervals with a greater frequency during pregnancy as the demand on the thyroid organ increases dramatically, especially during the first 12 weeks of gestation. At around 12 weeks of gestation the fetal thyroid begins to function and reduces the strain on the mother. Therefore, it is very important to continue monitoring to ensure that the thyroid is only supported when needed and in the correct amount.

A Chinese Medicine approach to weight loss and hypothyroidism
Treating hypothyroidism and weight gain with a Chinese medicine approach is possible and can be quite effective. Since the symptoms of hypothyroid are more associated with cold and a lack of metabolism, the treating principle usually involves warming the circulation and restoring metabolism. If there is an autoimmune component to the presentation then it will be necessary to clear inflammation and balance immune function as well.

A course of acupuncture treatment generally consists of weekly sessions for 10-12 weeks. Since menstrual irregularity is often associated with hypothyroidism, the goal of treatment includes regulating the menstrual cycle to achieve 3 cycles of 28-30 days, in which ovulation is confirmed and menstruation is of a moderate amount, with minimal or no cramping and contains blood that is fresh red in colour without clots.

Chinese herbal medicine is tailored to address each individual symptom as well as the underlying mechanism. As with the acupuncture, time is required for the benefit to be realized. Treatment is addressing the mechanism of the imbalance and assisting in the body’s ability to heal itself. It can be safely administered in conjunction with levothyroxine (Synthroid) and other thyroid medications.

Losing weight when the thyroid is under functioning can be very difficult. The equation for losing weight is to burn more calories than are being ingested. The problem with this when someone is hypothyroid, they lack the metabolic ability to break down the fat stores that could serve as energy and make up the deficit. The body continues to be fatigued and the energy to continue exercising decreases, sugar cravings increase because the cells of the body are not getting enough nourishment so they call out for a quick source of energy and the mouth most often obliges further frustrating the pursuit of weight loss. The best way to address this problem is to have the thyroid levels re-balanced either through medication or Chinese herbal medicine and then adopt a way of eating and exercising that can sustain a healthy weight.

Save your money and your self confidence, don’t buy the checkout aisle hype
So next time you are in the checkout aisle waiting to pay for your groceries don’t be duped by the Look Great By Tonight (Harper’s Bazaar) promises or the wondering if you should peruse the Readers Digest Body Issue and see How They Lost 300 lbs, don’t! Instead, take charge of your health and get support that is tailored for you. If there are underlying medical conditions you suspect then have a thorough work up from your doctor. Whether you are working with your doctor or you would like an alternative to conventional treatment of hypothyroid and weight loss, team up with your doctor of Chinese medicine to customize a treatment plan that will address all of your health concerns and help you to achieve your goals.

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