A Case Study: with surprising findings........
Almost 8 weeks ago, a lady was referred to me through a friend. I've been working with her for the last few weeks, trying to help her overcome what I'm realizing is a common problem.
(she agreed to share her story in an attempt to help others).
Here's her story:
Kate (not her real name!) is from the UK but has lived in the GCC for a number of years. She's in her early 40s, married and has 3 young children.
For the past 5-6 years, she's suffered from frequent weight gain, fatigue, insomnia, etc.
She's tried absolutely everything:
- She's seen multiple doctors and ran over 30 tests, including some back home in the UK
- She counted calories religiously for a long time, and even followed Weightwatchers for several months
- She's worked with 7 different personal trainers at 3 different gyms, as well as a yoga teacher
- She's reasonably knowledgeable about what to eat, and generally eats a clean diet devoid of processed foods (most of the time anyway)
Yet she was still struggling:
- She lost weight with Weightwatchers only to gain it back and then some
- The same thing happened with her personal training: she would get better, and then get worse again
- Her blood tests came back all ok: no low iron/anemia, now thyroid problem (at first glance), blood sugar and cholesterol "within the range"
But something was clearly "off".
After 2 long calls with her, I asked her to get another blood test: I had a suspicion of what might be going on, but the doctors usually don't run these tests (doctors are trained to treat diseases, and they couldn't find one with her...).
I asked to test for:
- Full Thyroid panel (not just TSH)
- Full adrenal hormones panel
- Inflammatory markers
Initially, the doctor was refusing to conduct these tests, saying there is no reason for her to do them: TSH was normal on her previous tests, white blood cell counts were normal, so inflammation unlikely... but she insisted and got it done (on her own dime). Here's what we found out:
- While her TSH was normal, her T3 was well below the "range"
- Her DHEA (produced by her adrenal glands) was also very low
- She "flagged red" on inflammation markers, including hsCRP
The Thyroid Problem
- the Thyroid produces primarily T4 (and a little bit of T3)
- T4 is "inactive". It gets converted to its "active" form (T3) mainly in the gut and liver
- T3 is the one that controls your metabolism
- Depending on the concentration of T4 in the blood, the Pituitary Gland in your brain secretes Thyroid Stimulating Hormone (TSH), which tells the Thyroid to produce more T4 because the level is too low. The Pituitary is basically the thermostat
In Kate's case: TSH was normal, so from the doctor's perspective, T4 was normal, so no "hypothyroidism" and thyroid hormones could not be the reason for her weight gain and other problems. So he never wanted to run a full thyroid panel.
When she did do the test which showed that T3 was low, the first thing that the doctor did was prescribe "thyroid replacement hormones". For him (and most doctors) it's simple: T3 too low? ok here's some artificial T3.
I'm not a medical doctor, so I obviously cannot give medical advice. But my recommendation to her was to hold off, and give us time to jointly find out what's causing T3 to be low in the first place... back to that in a minute.
DHEA is produced by your adrenals. This hormone is absolutely crucial for health: Low levels of DHEA have negative implications on strength, memory, female reproduction, cardiovascular health risks, etc.
One reason for low levels of DHEA that I've historically seen is "adrenal fatigue", which is typically the result of consistently high levels of stress (physical or mental). For example, Crossfit or ultra-endurance athletes are typically prone to adrenal fatigue.
Kate is "active" but not an endurance or Crossfit athlete, so I didn't think stress was the reason behind low DHEA.
I had another suspicion which I'll tell you about in a minute.
First, low T3 for me was a clear indication that hypothyroidism was at least partially responsible for her weight gain problems (and other symptoms).
Second, the inflammation evidenced by her inflammatory markers told me that inflammation could be the primary reason for low T3.
My theory: she wasn't showing any symptoms of inflammation, but the test said it was there. T4 gets converted to T3 in the gut, and that wasn't happening (low T3). ==> so my theory was that there was some form of gut inflammation happening.
In addition, a gut inflammation would lead to inability to absorb nutrients from food, so even if you're eating "clean", your body cannot get access to those nutrients. When this happens, the body goes into "survival" mode, bringing metabolism down even further, increasing fat storage.
Mission #1: find out if gut inflammation is to blame and work on fixing it.
Regarding low DHEA: of course inflammation could be a contributor, but given her total cholesterol level of 160mg/dL, I suspected that she didn't have enough cholesterol to even manufacture DHEA.
You see cholesterol is the "mother" of most steroid hormones in the body. You need cholesterol to make sex hormones, DHEA, cortisol, Vitamin D, etc. Low cholesterol means you don't have enough "raw materials" to produce any of these...
Mission #2: increase total cholesterol to provide enough building blocks for the body to make hormones.
...and What We Did About it
So here is what we did:
1. I looked at her diet and removed any inflammatory foods. She already ate clean diet, with minimal sugar or processed foods, and had even been gluten free for a year. I took out 1 item that was prominent in her diet: 3 boiled egg-whites daily. It was the only inflammatory food she ate regularly (other than occasional grains).
2. We increased healthy fat intake: grass-fed butter, coconut oil, organ meats, grass-fed lamb, etc...
And here's what happened
- Her sleep quality (as measured by Sleep Cycle on iphone) went from an average of <50% to 70-80%
- She only had 1 day of sugar-cravings, compared to daily cravings
- She did 3 personal training sessions and for the first time in years, felt "good"
- She had told 1.5Kg by the 10-day mark
- She was sleeping through the night, and felt stronger
- Sugar cravings had all but disappeared
I was confident we had "cracked" it: it was the EGGS! She was severely sensitive to eggs, and they were causing inflammation in her gut. Even though she wasn't having any major digestive symptoms, the gut inflammation meant she couldn't absorb nutrients, and even worse: couldn't convert T4 into T3.
- DHEA was in normal range
- T3 was in normal range
- She had dropped 7Kgs without counting calories or dieting
If you know someone who's suffering from similar issues and you think would benefit from a similar approach, please feel free to share my contact details with them.