There are numerous occasions when eating healthy is a challenge. There are birthday parties, weddings, Thanksgiving day, Valentine’s day, and other reasons why people choose to indulge in junk food. And then there’s the challenge of eating well when going out of town on an extended vacation. For someone with Graves’ Disease or Hashimoto’s Thyroiditis who is following a strict diet, having a single cheat day can have a negative effect on their recovery. But when someone goes on a vacation for a few days or longer, and chooses to eat poorly most of the time, it can completely ruin what they’re trying to accomplish. And so the goal of this blog post is to discuss how you can eat well while on vacation, and still have a good time.

Keep in mind that I’m not trying to be a “party pooper”, as I’d be lying if I told you that I don’t eat some bad foods when I’m on vacation. However, while it’s usually not a problem indulging every now and then after someone has restored their health back to normal, if you are in the process of trying to restore your health then you really do want to try to be as strict as possible. An ideal situation would be to either plan your vacation before following a natural treatment protocol, or after you have restored your health back to normal. With that being said, I realize that some people won’t follow this advice and will go on a vacation a few months after starting a strict diet, and I’ll list some tips to help keep you on track while you’re out of town.

Is Eating Unhealthy Necessary To Enjoy Your Vacation?

Different people will perceive this question differently. Many people eat unhealthy all of the time, but eat even worse when they are on vacation. Other people eat healthy while at home, but eat a lot of junk food while out of town. Other people will try to have some healthy meals while on vacation, although they will eat more junk food while away from home. And some super healthy people will eat the same regardless of whether they are at home or on vacation.

Most people can have an enjoyable vacation even when eating healthy. After all, I think it’s safe to say that the main reason people go on vacation isn’t so they can eat unhealthy foods. They usually go on vacation to relax, spend time with friends and family, do some type of activity, etc. And in most cases, poor planning and the inconvenience of the situation is a big reason why most people eat poorly while on vacation. Keep in mind that I’m not trying to be critical of those who indulge on vacation, as remember I admitted earlier that I don’t eat a perfect diet when I’m on vacation. But I eat better than most people while traveling, and the reason has nothing to do with greater willpower, but instead has to do with proper planning. When I eat junk food of some type, usually I know ahead of time that I’m going to indulge, although I admit that this isn’t always the case. So what are some of the things you can do in order to improve the chances of eating well while on vacation?

1. Stay somewhere with a refrigerator and kitchenette. If you plan on eating healthy most of the time while on vacation it usually is best to prepare most of your meals. But wait, doesn’t this defeat the purpose of going on vacation? If you consider cooking to be hard work then I understand that you might not want to cook while on vacation. And I’m not suggesting that you have to spend hours preparing meals. At the very least you can buy healthier pre-made options at a local health food store for some of the major meals, and if you bring some of your own pots and pans and/or a blender (or stay somewhere that already has these) you can start the day with a healthy smoothie or some eggs, both which aren’t too time consuming.
2. If you plan on eating out, do some research to find restaurants with healthier options. This is best done beforehand, as you can visit some websites to find some restaurants which have healthier options. Some examples include www.urbanspoon.com and www.findmeglutenfree.com.

Another thing you can do is to simply visit Google and do some searching for specific keywords involving healthy foods. So for example, if you’re taking a vacation to Orlando Florida you can type in “grass fed beef restaurant Orlando”, or “gluten free restaurant Orlando”. Something else you can do is look up a few of the local health food stores and contact them, as the people who work there hopefully will have some ideas about healthy places to eat.

3. Bring healthy snacks. While driving or flying to your destination, make sure you bring your own healthier snacks. And if it’s going to be a long drive or flight which involves you eating meals, I once again would try to do some planning to see which restaurants along the way or at the airport have healthier choices, gluten free options, etc. Obviously I would try to avoid fast food, but if the only options are common restaurant chains such as Chili’s, Applebees, etc., then I would eat something such as a grilled chicken salad without the croutons, perhaps a turkey burger without the bun with a side of steamed broccoli, etc.
4. Try to go on vacation with immediate family members. If you are trying to stick to a strict diet it can be challenging going on vacation with friends, unless if they have a more natural mindset. Truth to be told, it sometimes can be challenging going on vacation with immediate family members as well, as they might be fine eating well while at home, but plan on indulging when on vacation. If this is the case then at least try to convince them to eat a few healthy meals, and I would still try to plan ahead when it comes to eating out at restaurants. Once again, if you end up at a restaurant which doesn’t have healthier food choices I would at least try to stick to eating whole foods. And if you haven’t already done so I would visit the website for the Environmental Working Group and download the “dirty dozen” and “clean fifteen” lists, as the “dirty dozen” lists the fruits and vegetables with the greatest amount of pesticides, while the “clean fifteen” lists the top fifteen foods with the least amount of pesticides.
5. If necessary, postpone your vacation. I realize this isn’t always possible, and even when it is possible it is not desirable. After all, life is short, and you have a right to get some rest and relaxation. With that being said, if postponing one’s vacation will improve your chances of restoring your health, and therefore will result in you being better able to enjoy future vacations, then it probably is worth it. But once again, if you plan ahead and are flexible with regards to where you go and where you can stay, then it is possible to eat healthy.

In fact, when deciding to go on vacation perhaps you can use this as an opportunity to visit a city where there are plenty of health food stores and healthier restaurants. In other words, instead of just randomly choosing a location due to the proximity, or based on an attraction you want to visit, do some searching for cities which have numerous health food stores and healthier restaurant options. This combined with a hotel/motel which has a refrigerator and small kitchenette will make eating healthier. And rather than calling it a vacation, refer to it as a “healthy retreat”, or something similar.

Keep in mind that the above tips are mainly for when you are following a strict natural protocol to restore your health. Of course this doesn’t mean that you shouldn’t try to eat somewhat healthy while on future vacations as well, but as I’ve mentioned in past articles and blog posts, there is more room to indulge after someone has restored their health back to normal. On the other hand, if you are currently dealing with weak adrenals, a leaky gut, and/or other compromised areas of your body, it really is a good idea to be as strict as possible while trying to get healthy again.

In summary, eating healthy is a challenge for many people, but is even more challenging when going on vacation. However, most people can enjoy their vacation even when eating healthy foods. The key to eating healthy while away from home is to do some proper planning, which might include choosing a place to visit which has plenty of health food stores and restaurants with healthier food choices. Just remember that I’m not saying that you should never indulge when on vacation, but for those people who are following a natural treatment protocol, being strict with your diet is important to receive optimal benefits, and as a result you don’t want to wreck your diet while on vacation.

Many people with hypothyroidism experience a significant improvement in their symptoms upon taking thyroid hormone medication.  However, some people actually feel worse when taking thyroid hormone medication.  Some people feel worse when taking synthetic thyroid hormone and feel better when taking natural thyroid hormone, although there are some people whose symptoms worsen when taking natural thyroid hormone.  There are numerous reasons why someone can experience a worsening of their symptoms when taking thyroid hormone, and in this blog post I’ll discuss some of the more common reasons.

Fillers and other ingredients.  One of the main reasons why someone might feel worse upon taking synthetic or natural thyroid hormone is because they are reacting to one of the fillers or other ingredients.  For example, many brands of synthetic thyroid hormone include ingredients people can react to.  Synthroid is probably the most well known brand of synthetic thyroid hormone, and it includes corn starch, lactose monohydrate, as well as artificial coloring.  And so if someone has an allergy to corn or dairy, or if they have a reaction to the artificial colors, then they probably will feel lousy when taking Synthroid.  There are also fillers in some brands of natural thyroid hormone, such as Armour.  I discussed the ingredients in greater detail in an article I wrote entitled “Synthetic vs. Natural Thyroid Hormone: Breaking Down The Ingredients“.

But what can someone do if they are reacting to one or more of these ingredients?  Well, there are a few different options.  One option is to ask your medical doctor to switch you to a different brand of synthetic or natural thyroid hormone medication.  For example, Tirosint is a brand of synthetic thyroid hormone that doesn’t have all of the fillers and artificial colorings that Synthroid has.  As a result, someone might do poorly when taking Synthroid, but do well when taking Tirosint.  With regards to natural thyroid hormone, some people don’t do well when taking Armour, but do fine when taking Nature-Throid.  Another option is to visit a compound pharmacist, as they should be able to put together a hypoallergenic form of synthetic or natural thyroid hormone medication.

Conversion problem.  If someone has a problem converting T4 into T3 then they might not do well when taking certain forms of thyroid hormone medication.  Remember that most people are told to take thyroxine, which is T4.  And so if someone is taking levothyroxine, which is synthetic T4, and they are unable to efficiently convert this into T3 then they will most likely continue to experience hypothyroid symptoms.  Switching to a natural form of thyroid hormone very well might improve the symptoms since this form includes both T4 and T3.  However, taking natural thyroid hormone won’t do anything to address the cause of the conversion problem, which can be due to high cortisol levels, a selenium deficiency, gut dysbiosis, or other problems.  I discussed this in greater detail in a blog post I wrote entitled “6 Factors Which Can Affect The Conversion of T4 to T3“.

Autoimmune Response To Thyroid Hormone.  If someone takes natural thyroid hormone (i.e. Armour, Nature-Throid) and feels significantly worse, this might be due to an autoimmune response to thyroid hormone.  In other words, your immune system can produce antibodies towards T3 and T4.  This is one reason why some doctors won’t prescribe natural thyroid hormone to any of their patients.  I find this to be rare, although over the years I have had a few patients feel horrible when taking natural thyroid hormone and I suspected their immune system might have been reacting to it.  While in most cases I still prefer natural thyroid hormone over synthetic thyroid hormone, this is something to be aware of.

Adrenal Problems.  Although an elevated TSH usually is related to a hypothyroid condition, in some cases it can be due to problems with the adrenals.  One study examining three case reports linked adrenal insufficiency with subclinical hypothyroidism (1), while another study showed a relationship between the TSH and cortisol (2).   As it result, if someone has subclinical hypothyroidism (high TSH and normal thyroid hormone levels) and the thyroid antibodies are normal, then it probably would be a good idea to address any adrenal problems before the person takes thyroid hormone medication.

Thyroid Hormone Resistance.  Thyroid hormone resistance is when the thyroid receptors are not responsive to the actions of thyroid hormone.  If someone has this condition then taking thyroid hormone medication probably won’t cause their symptoms to worsen, although they most likely won’t notice an improvement in their symptoms when taking thyroid hormone.  I discussed this condition in greater detail in a blog post entitled “Thyroid Resistance and Natural Treatment Methods“:

In summary, when someone with hypothyroidism has a worsening of symptoms after taking thyroid hormone medication there can be numerous reasons for this.  Some of the most common reasons include the person reacting to fillers and other ingredients, having a conversion issue, an adrenal problem, or perhaps thyroid resistance.  In addition, for those taking natural thyroid hormone it is possible to experience an autoimmune response to the thyroid hormones.  Sometimes it can be challenging to determine why someone is having a negative reaction to thyroid hormone medication, and while there can be causes other than the ones I listed in this post, initially it’s a good idea to look into these factors I discussed.

In the last post I spoke about some of the main causes of insulin resistance.  In this post I am going to focus more on hypoglycemia.  I will then discuss seven factors which can help to balance blood sugar levels.  These will be important regardless of whether you have insulin resistance or hypoglycemia.

Hypoglycemia refers to low blood sugar levels, typically less than 70 mg/dL.  What happens is that either the body’s glucose is used up too quickly, is released into the bloodstream too slowly, or too much insulin is released into the bloodstream (1).  Some of the causes of hypoglycemia include alcohol consumption, an infection, hypothyroidism or hypoadrenalism, and severe heart, kidney, or liver failure (1).  I’ll talk more about these causes shortly.  Some of the common symptoms associated with low blood sugar levels include weakness, fatigue, sweating, disorientation, and shakiness (2).

Reactive hypoglycemia is an exaggerated fall in the blood glucose levels, and is due to excessive insulin secretion in response to a meal.  Dr. Alan Gaby has dedicated a chapter to reactive hypoglycemia in his excellent book “Nutritional Medicine”, and he discusses how if the blood glucose levels fall too rapidly then the body compensates by releasing adrenaline, as well as other compounds which raise the blood glucose levels.  This in turn results in “fight or flight” symptoms such as anxiety, panic attacks, hunger, palpitations, tachycardia, tremors, sweating, and even abdominal pain.  Dr. Gaby also talks about the symptoms presented when the blood glucose levels fall slowly over a period of hours, as this can lead to symptoms such as headaches, fatigue, blurred vision, mental confusion, impaired memory, and even seizures.  These symptoms usually are worse before meals, and frequently are relieved by eating.

Keep in mind that not everyone who has hypoglycemic symptoms will have low blood glucose levels or an abnormal glucose tolerance test.  And so this can be a challenging condition to diagnose.  I briefly mentioned some of the causes of hypoglycemia earlier, but there are other factors which might play a role in this condition, such as food allergies or sensitivities.

The following are some of the potential causes of hypoglycemia:

1) Eating refined foods and sugars.  Most people reading this know that eating a lot of refined foods and sugars will affect the blood sugar levels.  Eating a lot of refined sugars over a period of time will usually lead to hyperglycemia/insulin resistance, and eventually can set the stage for a condition such as type 2 diabetes.  However, in some people it can also lead to hypoglycemia.  Skipping meals frequently also can have a negative effect on the blood sugar levels and lead to hypoglycemic episodes.

2) Alcohol consumption.  Alcohol has a hypoglycemic effect, which is probably caused by the inhibition of gluconeogenesis in the liver (3) (4).  Gluconeogenesis involves the production of sugars (primarily glucose).  While having an occasional alcoholic beverage usually won’t lead to hypoglycemia, frequent consumption of alcoholic beverages can cause blood sugar imbalances.  And if anyone currently has blood sugar imbalances it probably would be a good idea to completely eliminate any alcohol consumption.

3) Thyroid hormone imbalance.  There is evidence that hypothyroidism can be a factor in hypoglycemia (5).  However, it is also possible that having hypoglycemia can inhibit the pituitary-thyroid axis (6).  And while hyperthyroidism isn’t usually associated with hypoglycemia, hyperthyroidism with congestive heart failure or liver dysfunction can induce hypoglycemia, although this is very rare (7).

4) Adrenal Insufficiency.  Hypoglycemia is one of the clinical manifestations of chronic primary adrenal insufficiency (8) (9).  Most cases of primary adrenal insufficiency are considered to be Addison’s disease, which is an autoimmune condition involving the adrenals.  However, secondary causes of adrenal insufficiency can also cause hypoglycemia (10) (11).  And so if someone has low cortisol levels, a low serum ACTH, and/or low DHEA levels, then this can be responsible for the hypoglycemic symptoms.

5) Acute infections.  Most cases of hypoglycemia aren’t caused by infections.  However, in some cases hypoglycemia can occur in bacterial sepsis (12) (13), or in bacteremic pneumococcal infections (14).

6) Food allergies or sensitivities.  Earlier I mentioned the book “Nutritional Medicine” by Dr. Alan Gaby.  In this book he mentions that “the ingestion of allergenic foods can trigger a hypoglycemic response in some people”.  Sometimes this can be challenging to determine, and in people with Hashimoto’s Thyroiditis and Graves’ Disease food sensitivities are common, although many times they are the result of a leaky gut, and don’t cause hypoglycemia.  However, if someone notices hypoglycemic symptoms upon eating a certain food, and if this pattern occurs every time after eating this food then one obviously should suspect that this food is responsible for the hypoglycemic effect.

How Can Blood Sugar Imbalances Be Corrected?

Diet.  Regardless of whether someone has hyperglycemia/insulin resistance, or hypoglycemia, eating well is very important.  Obviously you want to eat whole foods, and minimize the refined foods and sugars.  You also want to minimize your overall carbohydrate intake, and this is especially true if you’re suffering from insulin resistance, as when this is the case you will usually want to consume less than 150 grams of carbohydrates per day, and eating less than 100 grams of carbohydrates per day is sometimes necessary.  Keep in mind that I’m not suggesting that everyone should eat a low carbohydrate diet, but a big problem is that many people eat too many carbohydrates, which is one of the main reasons for the high incidence of insulin resistance and type 2 diabetes.

Although I love eating fruit, eating a lot of servings of fruit per day can cause problems in some people, and this is especially true in those with blood sugar issues.  If you are dealing with blood sugar imbalances it probably is a good idea to limit your consumption of fruit to one or two servings per day.  Even though fruit is high in phytonutrients and consists of natural sugars, you can still overdo it by eating too much fruit.

You also want to eat regularly throughout the day.  This is especially important for those who have hypoglycemia, although I think it’s important for most people to eat breakfast within one hour of waking up, and then every two to three hours after this.  Some people reading this might bring up the benefits of caloric restriction and intermittent fasting, which I wrote about in an article entitled “Intermittent Fasting and Thyroid Health“.  I agree that intermittent fasting can be beneficial, although it probably isn’t a good idea in someone who has hypoglycemia.

Address food sensitivities.  This seems to be more of a trigger with regards to hypoglycemic conditions, but of course even if someone doesn’t have any blood sugar imbalances they want to try to avoid any foods they are reacting to.  It can be very difficult to determine which foods you are sensitive to.  There is testing available such as IgE testing for food allergies, an IgG panel for delayed food sensitivities, and other types of testing such as the ALCAT.  These all can be valuable, but they also all have limitations.  And testing for food sensitivities can be very expensive, yet still provide false results.  I usually recommend an elimination diet for 3 to 4 weeks, followed by reintroducing the “suspicious” foods one at a time over a three day period.  This also has certain limitations, and of course takes more time than conducting a test for food sensitivities.

Improve insulin sensitivity.  It is also important to do things to improve insulin sensitivity.  This is especially important with insulin resistance, although it also can benefit those who have hypoglycemia as well.  Some of the best nutrients which can help to increase insulin sensitivity include chromium (15) (16) (17), magnesium (18) (19), and alpha lipoic acid (20) (21).  Vanadium (22) (23) and bitter melon (24) can also increase insulin sensitivity.  Berberine can benefit those with insulin resistance and type 2 diabetes by lowering blood glucose levels, and it might do this by modulating the microbiota (25).  The herb gymnema sylvestre can help to balance the blood sugar levels (26) (27).  You can also improve insulin sensitivity through exercise, which I’ll discuss next.

Exercise.  We all know that regular exercise is beneficial.  Although there are many nutrients which can increase insulin sensitivity, there is plenty of evidence which shows that exercise can also help to increase insulin sensitivity (28) (29) (30).  A big problem is that many people who exercise regularly also spend a good part of their day sitting.  So for example, someone might have a job that involves sitting behind a desk for most of the day, and then they expect three or four sessions of exercise each week to offset all of this inactivity.  Unfortunately this isn’t the way this works, as regular movement is very important.

Decrease inflammation.  Earlier I discussed how inflammation is a big factor in insulin resistance, and so one needs to do things to reduce the inflammatory process.  Obviously eating a healthy diet can help to reduce inflammation.  But it frequently is necessary to take nutrients to help break the inflammatory process.  I spoke about this in my blog post entitled “The Role of Cytokines In Autoimmune Thyroid Conditions“, as there is a transcription factor called Nuclear Factor Kappa B (NF-kB), and this needs to be downregulated.  Certain nutrients which can help with this include vitamin D, fish oils, turmeric, resveratrol, gamma-linolenic acid, ginger, and green tea.

Reduce oxidative stress. I also discussed how oxidative stress and mitochondrial dysfunction can play a role in insulin resistance.  And so doing things to reduce oxidative stress and improve the health of the mitochondria can be beneficial.  Some nutrients which can help with this include vitamin C, lipoic acid, acetyl-l-carnitine, CoQ10, resveratrol, and omega 3 fatty acids.

Correct dysbiosis.  Since intestinal dysbiosis can play a role in inflammation and insulin resistance, it is necessary to address this problem.  As I mentioned earlier, I have written a separate article on this topic, and so I would refer to this when you get the chance.

So hopefully you have a better understanding of the different factors which can cause insulin resistance and hypoglycemia, as well as some of the things you can do to address these health conditions.  Insulin resistance is when the body no longer is responsive to the effects of insulin, and some of the factors which play a role in the development of insulin resistance include inflammation, mitochondrial dysfunction, lipotoxicity, gut dysbiosis, circadian disruption, and genetics.  Hypoglycemia involves low blood sugar levels, and some of the potential causes of this condition include alcohol consumption, an infection, hypothyroidism, hypoadrenalism, as well as food allergies or intolerances.  Eating well and exercising regularly are both important factors when trying to regulate blood sugar imbalances, but some of these other factors I discussed in this post also need to be considered.

Many people with thyroid and autoimmune thyroid conditions have blood sugar imbalances.  However, there are different types of these imbalances.  Two of the most common health issues involving blood sugar imbalances are hypoglycemia and insulin resistance.  In the past I’ve spoken about these in separate articles, but since so many people suffer from blood sugar problems I figured it would be a good idea to talk about the similarities and differences between these two conditions.  In this post I will focus on insulin resistance, and then in the next post I will talk about hypoglycemia, and I will also discuss what you can do to correct blood sugar imbalances.

Glycemia refers to the presence of glucose in the blood.  As the name implies, hypoglycemia is a condition characterized by low blood sugar levels, whereas insulin resistance is more characteristic of hyperglycemia, which of course involves high blood sugar levels.  And the solution might seem simple, as if someone has high blood sugar levels  then they obviously want to reduce their sugar intake, and if someone has low blood sugar levels they will want to eat more regularly, right?  For the most part this is true, but while dietary factors are obviously important with both hypoglycemia and insulin resistance, these conditions are frequently complex and require more than simple dietary changes.

Before talking about insulin resistance I’d like to briefly talk about insulin.  Insulin is a hormone that is produced by the beta cells of the pancreas.  Insulin has numerous roles, but one of the primary roles is the regulation of blood glucose levels.  So when someone eats a meal, this will cause their blood sugar levels to rise, and the beta cells will secrete insulin to help the body utilize or store the glucose.

As for how insulin reduces blood glucose, it does so by inducing glucose uptake into insulin-sensitive tissues such as skeletal muscle, fat, and heart (1).  Insulin also inhibits glucose production in the liver, kidney, and small intestine in the control of blood glucose (1).  Insulin has other functions, as it stimulates the synthesis of fatty acids and glycogen (2), and it also plays a role in mitochondrial function.  What happens with insulin resistance is that the body is no longer responsive to the effects of insulin.  This in turn can lead to other conditions such as type 2 diabetes, accelerated atherosclerosis, hypertension or polycystic ovarian syndrome (3).

What Causes Insulin Resistance?                                                    

But in order to understand how to correct insulin resistance, it’s important to understand how insulin resistance develops.  Although eating a poor diet and a lack of exercise are definitely factors in many people, the development of insulin resistance is usually more complex.  Here are some of the factors which are thought to cause or contribute to insulin resistance:

1) Inflammation.  Inflammation is one of the biggest factors associated with insulin resistance, and this is one of the primary reasons why weight loss is so challenging in those with autoimmune thyroid conditions.  The following information is going to be somewhat advanced, but then I’m going to do my best to clarify it so that you better understand it.  Activation of immune cells is closely associated with insulin sensitivity, and research shows that classically activated (M1) macrophages sustain insulin sensitivity, whereas alternatively activated (M2) macrophages induce insulin resistance through the secretion of proinflammatory cytokines (4).  Apparently in a lean state Th2 cells, regulatory T cells, natural killer cells, or eosinophils contribute to the M2 activation of macrophages, whereas obesity causes alteration of the constituent immune cells, in which Th1 cells, B cells, neutrophils, or mast cells induce M1 activation of macrophages (4).

So what exactly does this mean?  Essentially the activation of certain immune system cells will cause insulin resistance, while the activation of others will decrease insulin resistance.  One of the main takeaways is that Th1 dominant conditions are more commonly associated with insulin resistance, whereas Th2 dominant conditions involve an increase in insulin sensitivity.  Since most people with Hashimoto’s Thyroiditis are Th1 dominant, this can be another mechanism which makes it difficult for people with this condition to lose weight.  If this is the case, the main factor which will help with losing weight is to suppress the autoimmune component and decrease the inflammation, which can be very challenging, and has been discussed in other blog posts and articles.  Graves’ Disease is in most cases a Th2 dominant condition, although this doesn’t mean that people with this condition can’t develop insulin resistance.

2) Mitochondrial dysfunction.  Mitochondria are located in the cytoplasm of our cells, and they are where cellular respiration occurs.  I’ve written a separate article on Mitochondria entitled “The Relationship Between Mitochondria and Thyroid Health“, and so if you’re not familiar with mitochondria I would read this article when you get the chance.  There is evidence that dysfunction of the mitochondria can play a role in insulin resistance (5) (6) (7).  But how can damage to the mitochondria cause insulin resistance?  Well, adipocytes (fat cells) play an important role in regulating energy metabolism and glucose homeostasis, and it appears that free radicals which are caused by mitochondrial dysfunction causes impairment of the function of adipocytes in maintaining glucose homeostasis (7).  So what this is essentially saying is that the mitochondria helps to regulate glucose homeostasis in fat cells, but when there is mitochondrial dysfunction, this causes free radicals, which in turn impairs the fat cells.

As a result, if someone has insulin resistance then it probably would be a good idea to do some things to help improve the health of the mitochondria.  But how can one tell if they have mitochondrial dysfunction?  Well, this can be challenging, and one of the methods of determining problems with the mitochondria is through an organic acids test, although other testing methods which can be useful include an amino acid analysis and a carnitine analysis (8).

3) Lipotoxicity.  Lipotoxicity refers to an excess of free fatty acids in certain tissues, which can include skeletal and cardiac muscle cells, hepatocytes (liver cells), and pancreatic beta cells (9) (10).  This can be a factor in insulin resistance and metabolic syndrome, and it will typically show up as elevated triglycerides on a lipid panel.  A good example of a condition associated with lipotoxicity is nonalcoholic fatty liver disease (NAFLD), which not surprisingly is usually associated with insulin resistance.  I’ve written a separate article on NAFLD entitled “Nonalcoholic Fatty Liver Disease and Thyroid Health“.  But just as a reminder, these fatty acids can accumulate in other cells as well, and not just the liver cells.

4) Gut dysbiosis.  Accumulating evidence indicates that the gut microbiota play a significant role in the development of obesity, obesity-associated inflammation, and insulin resistance (11).  Many people with thyroid and autoimmune thyroid conditions have gut dysbiosis, which I discussed in an article I wrote entitled “Intestinal Dysbiosis and Thyroid Health“.  I’ve also spoken about PCOS in the past, which is characterized by insulin resistance.  And there is evidence that gut dysbiosis can cause activation of the immune system, thus interfering with insulin receptor function, driving up serum insulin levels (12).

5) Circadian disruption.  I’ve spoken about the circadian rhythm in the past when discussing the adrenals and cortisol.  Circadian rhythms follow a 24-hour cycle.  So for example, cortisol is normally at the highest levels when a person first wakes up, and should be at the lowest levels right before going to bed.  The opposite is true with melatonin, as this hormone should be at the lowest levels upon waking up, and at the highest levels upon going to bed.  Many hormones that modulate insulin secretion and glucose homeostasis are regulated by the circadian system, and in addition to cortisol and melatonin, this includes hormones such as leptin, glucagon, growth hormone, and the catecholamines (13).  Disruptions in the circadian rhythm can lead to an increase in body weight, elevated leptin levels, and increased insulin secretion (14) (15).  As a result, if you are having problems with sleep, you most likely have problems with the circadian rhythm, which can be a cause of insulin resistance.

6) Genetics.  Yes, genetics is also a factor in insulin resistance.  However, just as is the case with most other chronic health conditions, lifestyle and environmental factors usually trigger the genetics.  Although some people are more susceptible to developing insulin resistance due to genetic factors, the good news is that it is possible to change the expression of our genes by modifying our lifestyle and environment.

So hopefully you have a better understanding with regards to the different factors that can cause insulin resistance.  In the next post I’m going to talk about hypoglycemia.  And then at the end of the post I will discuss seven factors which can help to balance the blood sugar levels.

For those people who have normal T4 levels, but low or depressed T3 levels, a thyroid hormone conversion problem needs to be suspected.  The thyroid gland mostly produces thyroxine, which is also known as T4.  The thyroid gland also produces a small amount of triiodothyronine, which is T3.  Most of the T3 is produced by the conversion of T4 to T3.  But there are numerous factors which can affect the conversion of T4 to T3, which I’ll be discussing in this post.

Before I discuss some of the factors which can affect the conversion of T4 to T3, I’d like to briefly talk about this process.  The enzyme 5′ -deiodinase is responsible for this conversion process.  There are three forms of this enzyme, which include deodinase type I, deodinase type II, and deodinase type III.  The type 1 and type II deiodinases are primarily responsible for the conversion of T4 to T3, whereas the type III deiodinase is mainly involved in the inactivation of T4 and T3 (1) (2).  Most of this conversion takes place in the liver, although some of the conversion also takes place in the gastrointestinal tract.  As a result, if someone has liver problems and/or gut dysbiosis then this can potentially affect the conversion of T4 to T3.  A certain percentage of T4 is also converted into reverse T3, which I have spoken about in a different post entitled “Reverse T3: What You Need To Know About It“.

So why is it a concern if someone has problems converting T4 into T3?  Well, T3 is the active form of thyroid hormone.  Unfortunately not all endocrinologists test for T3, but when they do they will either test for total T3, where most of T3 is bound to a protein, or free T3, which isn’t bound to a protein.  Free T3 is what actually binds to the thyroid receptor.  If someone has normal T4 levels but low T3 levels then this is considered to be a hypothyroid condition.  Many medical doctors will only test the TSH and T4 levels, and the reason for this is because if the T3 is low then the TSH will typically be elevated, although this isn’t always the case.  I always recommend testing both the free T3 and free T4, along with the TSH.  If doing an initial thyroid panel it’s also a good idea to test the reverse T3, along with the thyroid antibodies.

Why Do Most Medical Doctors Give Synthetic T4?

When someone presents with hypothyroidism, most medical doctors will recommend a form of levothyroxine, which is synthetic T4.  A common brand is Synthroid, although there are other forms as well.  But if T3 is what actually binds to the receptor, wouldn’t it make sense to give the person T3 instead?  Well, some medical doctors will recommend synthetic T3 in the form of Cytomel.  However, many doctors are understandably cautious about doing this, as too high of a dosage can put the person into a hyperthyroid state.  Synthetic T4 will convert into T3, but of course if someone has a conversion problem then this won’t be the case.  Plus, even if someone doesn’t have a conversion problem they might do better taking a natural form of thyroid hormone such as Armour or Nature-Throid, which consists of both T4 and T3, along with T1, T2, and calcitonin.

Now that you have a better understanding of the importance of T3, I’d like to discuss the five factors which can have a negative effect on the conversion of T4 to T3.

Factor #1: Problems with the liver.  Since most of the conversion of T4 to T3 takes place in the liver, it would make sense that some health conditions affecting the liver can decrease the conversion of T4 to T3.  However, this isn’t always the case, as one study which investigated the relationships between thyroid function in obese adolescents with non-alcoholic fatty liver showed that they had a  higher conversion of T4 to T3 due to increased deiodinase activity as a compensatory mechanism for fat accumulation (3).  With that being said, if someone has problems converting T4 to T3 it usually is a good idea to give some liver support, such as milk thistle and N-acetylcysteine.

Factor # 2: Gut dysbiosis. As I mentioned earlier, the good bacteria in the gut helps to convert T4 into T3 through the help of an enzyme called intestinal sulfatase.  There isn’t much evidence in the literature showing that gut dysbiosis negatively affects the conversion of T4 to T3, but obviously if someone has dysbiosis then this should be addressed even if they aren’t having a conversion issue.  I did come across one study which showed that Crohn’s disease can affect the conversion of T4 to T3 (4).

Factor # 3: Selenium deficiency.  The iodothyronine deiodinases all contain selenium in the form of selenocysteine, and they play crucial roles in determining the circulating and intracellular levels of T3 (5).  Numerous studies show that a selenium deficiency can affect the conversion of T4 to T3 (6) (7) (8).  However, this might only be the case with a severe selenium deficiency, as one study showed that only when selenium levels were decreased by more than 80% was deiodinase activity markedly decreased (5).

Factor # 4: Stress.  Elevated cortisol levels can affect the conversion of T4 to T3.  Studies show that stress can inhibit both type I iodothyronine 5′-deiodinase activity (9), as well as type II 5′-deiodinase activity (10) (11).  This is yet another reason why it’s important to improve your stress handling skills.

Factor # 5: Certain medications.  Amiodarone is an anti-arrhythmic compound, and due to the structural similarity between this and thyroid hormone it apparently inhibits the activity of 5′-deiodinase (12).  Beta blockers are commonly taken in hyperthyroid conditions, and certain ones such as propranolol, alprenolol, atenolol, and metroprolol can affect the conversion of T4 to T3 (13).

Factor # 6: Pro-inflammatory cytokines.  There is also evidence that certain pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) can inhibit type 2 5′-deiodinase (5’D-I) enzyme activity (14) (15) (16).  These cytokines are commonly present in autoimmune conditions, including Hashimoto’s Thyroiditis and Graves’ Disease.

In summary, normal T4 levels along with low T3 levels frequently indicate a conversion problem.  This involves the enzyme 5′-deiodinase, and is one reason why when obtaining a thyroid panel you want to not only look at the TSH and free T4 levels, but also the free T3.  And it usually is a good idea to look at the reverse T3 as well.  Six common factors which affect the conversion of T4 to T3 include problems with the liver, gut dysbiosis, a selenium deficiency, high cortisol levels, certain medications, and pro-inflammatory cytokines.