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There are four prominent endocrine and metabolic disorders that not only contribute to obesity, but also make weight loss difficult. These conditions – “bad metabolism,” hypothyroidism, an underactive thyroid, and “adrenal fatigue” – are frequently misdiagnosed by doctors, or incorrectly self-diagnosed by patients. As a result, healthy people may think that they have them, while truly affected – may miss them. Both groups suffer needlessly. Let’s review some of the long-held misconceptions about this paradox.
The first misconception is about “bad metabolism,” and it is the most common, approaching a near 100% popularity. Medically and nutritionally speaking, it is a complete opposite. What you may think is “bad” is, actually, “good,” and here is why.
Bad Metabolism
The truly “bad” metabolic disorders concern water balance and fluid volume; the balance of electrolytes (sodium, potassium, calcium, magnesium, and phosphate); acid-base regulation; disorders of carbohydrate metabolism, such as hypoglycemia, type 1 and type 2 diabetes, diabetic and alcoholic ketoacidosis; and lipid disorders, such as dyslipidemia and hypolipidemia [1].
These conditions affect people of all ages, genders, and body weights. Some of them are outright deadly, while others – such as diabetes or dyslipidemia – are chronic. Within the same group of conditions, some are associated with obesity, such as prediabetes and type 2 diabetes. Others, such as type 1 diabetes or diabetic ketoacidosis, result in profound and life-threatening weight loss.
Consequently, any time you mention “bad metabolism” in relationship to your weight, your doctor will know exactly what you mean, but may still chuckle at your misinterpretation. And if you continue insisting that you may have it, he or she may also tell you that when it comes to body weight, a true “bad metabolism” is a sign of impending death, and that a precipitous weight loss, not gain, is one of its primary symptoms.
The emaciated gentleman on the left is Steve Jobs of Apple fame, shortly before his premature and unfortunate death. Take a hard look at this heartbreaking picture. That is what an actual “bad metabolism” – meaning the body’s inability to properly metabolize nutrients essential for life – really looks like.
Not so long ago, the dominant thinking and attitudes toward metabolism was a complete opposite. When my mother met my dad, a tall and handsome man with manners to match, she was short and moderately overweight, with big hips and large breasts, an ideal body shape for the 1950s. Single men would look at her thinking: “Gosh, this lady is so attractive! I want her to become my wife and the mother of my children.”
Today’s young men, conditioned by the Victoria Secrets’ standards, are more likely to pass over someone like my mother in favor of a waifish girl like Calista Flockhart (32A-23-30), who just three generations ago would have had a hard time finding a marriage partner because of prejudices typical for that era:
- Her appearance would reflect probable malnutrition or chronic illness throughout early development. In that rough era of near-zero upward mobility, malnourished children came predominantly from impoverished households, and no man or woman wanted to marry into a poor family.
- Before the near universal availability of on-demand C-section, her narrow hips would be considered life-threatening during natural childbirth.
- Her small breasts would be assumed inadequate for motherhood because she might have difficulties breastfeeding her numerous offspring. This isn’t, really, entirely correct, but that’s, unfortunately, how it was and still is in undeveloped societies.
- Back then, her small body would be deemed too weak to chop wood, milk cows, carry buckets of water, and cook, clean, and wash from dawn to dusk for the entire family.
- Personality-wise, a person of her shape would be considered a “cold fish” because underweight women have lower levels of estrogen and are believed to be not as libidinous as normal weight or, even better, overweight women. I don’t know if that is true, but that’s how it was.
All of that primitive, misogynistic, and mostly unconscious thinking – to find a partner who will last you and your children through thick and thin – was, essentially, a basic “animal” instinct in action, honed over hundreds of thousands of years of pragmatic and merciless natural selection.
Naturally, that’s exactly what my father did without giving it a second thought – he married a woman with a good metabolism. He knew instinctively what my mom’s doctor told her after every check-up: “Polina, you have a fantastic metabolism!” For her generation it was an asset, not a curse. (The photographs of my parents on the right are from 1958, four years after my birth. They are, respectively, 43 and 37 years old).
True to form, my mother had an accidental pregnancy at the age of 45, while the usual rate of conception after age 40 is less than 5%. And that is after surviving the horrors of starvation and backbreaking labor during the four years of World War II as well as the devastation of postwar Russia.
Calista Flockhart, on the other hand, finally married actor Harrison Ford at the age of 46. In all probability, natural selection wasn’t on the mind of Mr. Ford, who at the time of their marriage in 2010 was already 68 years old. The couple is raising her adopted son Liam, who was born in 2001. Any way you look at it, the laws of evolution remain as tough today as they have ever been, even to someone as beautiful, talented, and famous as Ms. Flockhart.
So, if you too are endowed with a good metabolism just like my mother was, the problem isn’t with you, your genes, or your body, but with the times we are living – the sum of abundant food, minimal physical exertion, and all conceivable creature comforts is behind obesity epidemics on one hand, while the incorrect believe into “bad metabolism” causes many people to drop their weight loss diets too soon, or discourages them from considering one in the first place.
THE TAKEAWAY: Since it’s too late to get another set of genes, or become a lumberjack, or give up comforts, concentrate on the two factors that are still under your total control – what you eat and how your “burn” it! In fact, your “good metabolism” will work in your favor – the better it is, the faster you are going to lose weight.
Hypothyroidism and underactive thyroid
The situation with thyroid-related disorders is a lot more complicated than with bad metabolism. A true “underactive thyroid” – a vernacular for subclinical hypothyroidism – affects up to 10% of women and 6% of men, many of them over 65 years of age. The rate of clinical hypothyroidism is under 1.2% of women and 0.4% of men [2] predominantly among older adults, 33.3% of adult Americans are overweight and 35.9% are clinically obese, or 69.2% .
As you can see, the number of overweight people is significantly greater than the number of people affected by subclinical or clinical hypothyroidism [3], even though many people who are affected by adiposity – a shorthand for “overweight or obese” – believe they may have this condition because of weight loss resistance or weight gain on a moderate diet.
On the opposite side of the spectrum, there are people who are misdiagnosed and untreated because both conditions are challenging to manage even to specialists. According to The Merck Manual of Diagnosis and Therapy, the early stages of this condition are associated with the following symptoms:
“…cold intolerance, constipation, forgetfulness, and personality changes. Modest weight gain is largely the result of fluid retention and decreased metabolism. Paresthesias [tingling – KM] of the hands and feet are common, often due to carpal-tarsal tunnel syndrome…[4]”
Please also note one significant detail in the above quote: “Modest weight gain is largely the result of fluid retention…” This explains why some people who are affected by this condition can’t lose weight even on a very low calorie diet – most of that extra weight comes at the expense of water, not body fat.
Women with hypothyroidism may also be affected by menorrhagia – an abnormally heavy bleeding during menstruation, or amenorrhea – an abnormal absence of menstruation. If you are experiencing any of these symptoms, get evaluated by a board certified endocrinologist.
Because clinical hypothyroidism isn’t as common as some other disease, non-specialists may not be able to properly diagnose and treat you, especially during the earlier stages while the symptoms are still subtle, and the tests aren’t as definitive. If your diagnosis or treatment outcomes are not satisfactory, you may also consider working with alternative providers.
Things get even more complicated with Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis. It is an autoimmune inflammatory condition of the thyroid. In addition to the transient symptoms of hypothyroidism during early stages, it is distinguished by painless enlargement of the thyroid gland, and, in some cases, a feeling of fullness in the throat. It may or may not be associated with adiposity.
The prevalence of Hashimoto’s thyroiditis ranges from 0.1 to 0.15% of the population (1 to 1.5 cases per 1,000 people), and it affects women 10 to 20 times more often than men. It is most common between the ages of 45 to 65, and it often runs in families (i.e. it has a genetic component).
The same immune mechanisms which cause Hashimoto’s thyroiditis may also cause Graves’ disease (thyroid enlargement, goiter), Addison’s disease, type 1 diabetes, celiac disease (an autoimmune inflammation in the small intestine), vitiligo (skin depigmentation), premature graying of hair (same mechanism as in vitiligo), pernicious anemia, and connective tissue disorders.
If you suspect that you may have Hashimoto’s thyroiditis, GET TESTED. The level of thyroid hormones T4 and TSH may remain normal during early stages, making its diagnosis difficult in non-specialized clinical settings. Seek out a specialist trained in diagnosing and treating this relatively rare condition. 1 case in 1,000 is, indeed, rare for an internist who treats on average 2,000-3,000 patients a year, and may not encounter a single patient with Hashimoto’s in years.
I do not recommend commencing any type of weight loss diet until you are properly diagnosed and treated for hypothyroidism. A reduced calorie diet may deny your body from getting essential nutrients, and may exacerbate the progression of the disease. Besides, it isn’t likely to be effective anyway because of fluid retention.
As clinical hypothyroidism progresses, the symptoms become more severe and obvious, including precipitous weight loss. You can learn more about other manifestations of clinical hypothyroidism in countless online resources.
THE TAKEAWAY: Do not rely on outdated misconceptions about clinical and subclinical hypothyroidism. If you are experiencing any symptoms related to either condition, seek out the best treatment money can buy. Continuous weight gain in healthy people isn’t always a symptom of hypothyroidism. As epidemiological statistic – however flawed it may be – demonstrates, the majority of people with adiposity are not affected by hypothyroidism. If you are in this fortunate majority, you earlier failures to lose weight weren’t related to bad health, but to bad diets.
Adrenal fatigue
What you may think is “adrenal fatigue” endocrinologists call primary or secondary adrenal insufficiency. Both conditions are ascertained by a blood test, and treated, when necessary, with appropriate medication.
Primary adrenal insufficiency – also known as Addison’s disease – is a hard to miss condition because it is accompanied by severe skin pigmentation. Its prevalence – a medical term for the number of affected people – is less than 1 person in 14,000 (<0.007%) in population [5]. Just like truly “bad metabolism,” it causes weight loss, not gain:
“The slowly progressive loss of cortisol and aldosterone secretion usually produces a chronic, steadily worsening fatigue, a loss of appetite, and some weight loss. Blood pressure is low and falls further when a person is standing, producing lightheadedness. Nausea, sometimes with vomiting, and diarrhea are common. The muscles are weak and often go into spasm. [6]”
If you have any of the above symptoms, get tested immediately. This debilitating condition can be well controlled with medication.
The prevalence of secondary adrenal insufficiency is less than 1 person in 3,600, or 0.027% of the population. The symptoms of this condition are similar to Addison’s disease, but without pigmentation. Again, a blood test is required to screen it out and receive an appropriate and effective treatment.
A popular opinion exists that this condition may be substantially underdiagnosed. It may very well be correct, so let’s assume that there are 100 times more people affected by secondary adrenal insufficiency than what epidemiologists are telling us. Alas, it still comes to only 2.7%, a drop in the bucket next to 69.2% of the population with adiposity.
THE TAKEAWAY: Just as with “bad metabolism” and hypothyroidism, don’t rely on outdated misconceptions about “adrenal fatigue” and its relations to weight loss or gain. Seek out expert help to screen out primary and secondary adrenal insufficiency, and, if necessary, obtain adequate treatment.
References
[1] Endocrine and Metabolic Disorders; The Merck Manual of Diagnosis and Therapy, online edition; Last accessed March 30, 2013; [link]
[2] Vanderpump, Mark P.J., “The epidemiology of thyroid disease.” (2011) : 39-51. [link]
[3] This calculation is based on the following numbers: percent of adults age 20 years and over who are obese: 35.9% (2009-2010); percent of adults age 20 years and over who are overweight (and not obese): 33.3% (2009-2010). Source: Department of Health and Human Services, Health, United States, 2011, by Kathleen Sebelius, et. al., 2011, [link to PDF]
[4] Hypothyroidism; Symptoms and Signs; The Merck Manual of Diagnosis and Therapy, online edition; Last accessed March 30, 2013; [link]
[5] Division of Medical Sciences, University of Birmingham, and Department of Medicine, Endocrine and Diabetes University of Wurzburg, “Adrenal Insufficiency,” Lancet, 361 (2003): 1881-93; [link to PDF]
[6] Margulies, Paul, MD; National Adrenal Diseases Foundation; Addison’s Disease – The Facts You Need To Know; “What are the symptoms of Addison’s Disease?” Last accessed March 30, 2013; [link]
Previous posts from the “Why Diets Fail?” series:
1. The Real Reason Diets Fail and What You Can Do About It
2. How Long Will It Take Me to Lose the Weight?
3. Why One Calorie For Her Is Half a Calorie For Him
For your health and safety, please read these important Weight Loss Common Sense Warnings and Disclaimers before commencing a reduced calorie diet.
I’ve decided that I am no longer going to follow your page. Being healthy is my goal, not propaganda or misinformation.
Seriously, no such thing as adrenal fatigue?!?! WHERE did you get this incredibly erroneous bunch of hog wash?? Talk to any certified naturopathic physician who has graduated from an accredited school of naturopathic medicine and get the whole story next time. As a person who has been treated for adrenal fatigue and has tests to PROVE that I had it, and also a person with hypothyroidism that was left untreated by stupid MD’s who offered me antidepressants (which have a terrible track record for working no better than a sugar pill placebo and having terrible side affects) because I was in the “low normal” range, I am deeply disappointed in this lopsided article that will only further serve to keep people with hypothyroidism untreated and keep people suffering needlessly. Such a shame! Three and a half lies written by Konstantin Monastyrsky! I’ll stop short at calling Konstantin a liar, and just call him ignorant.
I don’t believe you read my article. I never said anything like that (i.e. that “adrenal fatigue” doesn’t exist.) What I said is that many people with weight problem incorrectly believe that they may have this condition, and urged them to get tested.
I’m not overweight, nor do I suffer from any of the health problems discussed in the article, but I still found it to be disappointing and inaccurate from a functional medicine/holistic perspective. The tone of the author, especially in some of the comments is a huge turn off.
Katy,
What exactly did you find inaccurate in my article from holistic/functional medicine perspective? Please let me know.
This guy is a joke and I can’t understand why you are giving him a forum on your blog. If his post wasn’t bad enough, he is so condescending in his comments. Sarah, get back to what you do well and don’t let this clown drive your readership away!
James, I just checked, and there were 3665 Facebook shares, and 4125 other shares as of 12:18 am on Apr 7th. This is much better “social lift” than 95% of the articles on Slate, Huff Post, Lifehaker, and other national publications. Apparently, a lot of people don’t share your opinion, and they find this material engaging enough to share it with their trusted friends, some of whom will become new and welcome readers of this site.
“The true “underactive thyroid” is a “can’t miss condition” because it refers to the inadequate levels of thyroid hormones. It is properly and objectively diagnosed not by measuring your basal body temperature, or evaluating your complaints, but by performing a blood test that determines the level of thyroid hormones in the blood.” This is COMPLETE AND TOTAL MALARKEY, BOLOGNA, BS AND THE BIGGEST MISTAKE REGARDING HYPOTHYROID.” I can’t stress enough how totally ignorant and dangerously stupid that comment is. The doctors who use blood tests as the “gold standard” leave many hypothyroid patients undiagnosed, and suffering for no good reason other than they don’t know how to think past seeing some ink dots on paper. Broda Barnes, MD diagnosed and treated thyroid conditions long before blood tests were developed. After the tests came out, he found that his “normal range” patients still had all the symptoms of hypothyroid and he treated them despite the blood tests. And with proper treatment with natural, not synthetic, thyroid medication, they all did very well under his care with complete elimination of their symptoms. Thank GOD for the Broda Barnes Institute and shame on all doctors who don’t treat the patient but instead treat numbers on a page.
Jodie,
My post addresses three thyroid-related conditions that are codified in medical literature. The first one is called “hypothyroidism,” the second “sublclinical hypothyroidism (i.e. underactive thyroid),” and the third — “Hashimoto’s thyroiditis.” These three conditions have a well defined set of diagnostic criteria. The epidemiology of thyroid disorders is based on these criteria, and so is their treatment.
There may very well be other thyroid disorders that some people (or many, many, many other peoples) may have, and since I am not one of them, I can’t describe what I don’t know and what I can’t study from mainstream academic literature. Just like any other field, medicine is an evolving one, and new discoveries are quite possible thanks to the pioneers like Dr. Barnes.
None of the symptoms of hypothyroidism are exclusive to this condition. Other conditions may have similar symptoms. It very well may be that by administering natural and extremely potent thyroid medications, the patient body is stimulated in the same way many people stimulate themselves with caffeine.
Using successfully alternative approaches doesn’t mean that everyone else is involved into “COMPLETE AND TOTAL MALARKEY, BOLOGNA, BS AND THE BIGGEST MISTAKE REGARDING HYPOTHYROID,” but simply means that a disorder that you may have hasn’t been yet described in mainstream clinical literature.
If Broda Barnes Institute can accomplish these excellent outcomes, I am sure their methods will find its way into mainstream medicine. Until then, I can only write about what I know.
I think you are opening up a huge can of worms by comparing natural thyroid meds (Armour, etc) to steroid use in athletes. If you read previous comments, you will see natural dedicated thyroid has been used for over 100 years to successfully treat hypothyroidism. Synthroid and the TSH test are the newcomers and are obviously not working very well for some people. And, yes, people taking natural thyroid meds have been diagnosed through thorough bloodwork (not just TSH) and obtain these meds via prescription. Synthroid has the backing of big-pharma, which has not served many of us well as far as finding open-minded physicians not clouded by pharma perks.
Ella,
I am not comparing anything to anything. I am simply stating that any therapeutic substance, natural or synthetic, may have an effect just like […name your favorite substance…] here.
Natural dessicated thyroid is used to treat all of the thyroid conditions you mention. It is not used to treat some newly imagined thyroid condition that has somehow just appeared on the scene. It is used in the same way as Synthroid to treat the same thyroid conditions and is prescribed by doctors who run bloodwork to check for the same conditions. The difference is that it contains both T3 and T4, not just the T4 that Synthroid contains and hopes we will convert into t3. So people taking natural thyroid meds are not just confusing our symptoms with other diseases–we have been diagnosed and have chosen Armour (etc) over Synthroid. I just wanted to clarify this.
Ella,
My article doesn’t discuss or recommend any drugs or treatments. It is strictly between you and your medical provider. Take whatever is best for you.
Let’s stop running a medical clinic here, and concentrate on the essence of my post: if you have misdiagnosed endocrine disorders — get the best treatment money can buy; if your are healthy — stop blaming imaginary conditions, and concentrate on modifying your diet and lifestyle.
I liked the article. The author says more articles on being healthy are coming – this isn’t the final word. And it’s true – a lot of current dissatisfaction with body size is purely cultural and recent.
Thank you, Linda!
This article was a bit of a let down. I was enjoying it, until he ended with saying basically that if you’re overweight you should just be happy that your metabolism is so good and be happy that you’re a vision of the picture of health during his mother’s generation. I get that this society worships stick figures as a picture of health and beauty, which is definitely wrong, but there was no “answer” for those struggling to lose weight, who really do need to…not just the pleasantly plump and healthy.
Are you TRYING to drive devoted readers away? I’ve been tested for Hashimotos, and I am NOT less than 1% of the population! This article is insulting and condescending .
Thankyou for updating your post in regards to Hashimoto’s.
From experience, it is very hard to hear from doctors and experts that your inability to lose weight is all an exuse, when you know for a fact you are following all the mainstream conventional advice to the letter.
I originally lost about 20kg – the first ten by just cutting out junk and adding exercise, the next ten by attending weight watchers and a LOT of running.
With about, 3kg to go of vanity weight, I got engaged, and decided to ramp up the diet and exercise to get them off for the wedding. I continued to measure, weigh and count every calorie that passed my lips, and ran for 50mins per day 5 days a week, one day per week I did a 2 hour run, and also weights twice per week. Minimum. I ran two half marathons in this time.
In spite of this, I gained 5kg by my wedding, and was diagnosed with Hashimotos somewhere in there too.
After my wedding, I went on honeymoon, and in spite of being quite restrained – very little alcohol, dessert maybe twice in over two weeks, salads, exercised every day etc – I gained another 5kg.
My GP told me that I would always struggle with my weight, and that all I could do was eat even less + exercise more. I tried this for another few months and the weight DID NOT budge.
Eventually I started researching on the internet, and tracked down a GP in another city who didn’t just look at the mainstream facts – i.e. t4 levothyroxine does NOT work for everyone, and that you can be hypothyroid even when you blood tests are ‘within’ range.
She did a variety of tests, including testing my reflexes and detrmining that my metabolism was severely supressed, and I also had a high reverse t3 level – meaning that my body was taking all the t4, turning it to reverset3, which is both inactive and BLOCKS the active t3.
I trialled a number of different drugs after that – combinations of t3 and t3 and slow release t3. Still had trouble losing weight – i.e. I did not lose any.
I think did a 24hour salivary test for cortisol, and determined that I was very low in cortisol in the morning, and slightly too high at night – helped explain the tiredness and inability to sleep.
Now that I am on a combo of low dose cortisol + t3 only, I FINALLY have started to lose weight (still counting my calories to 1300 net + exercise, no where near as much exercise as before, no running at all). It is slow – 1kg per month, but at least it is moving.
My point is that there is a large movement of GPs etc who no longer buy into the mainstream thyroid advice, and understand that patients needed to be treated based on symptoms not arbitrary ranges in blood tests .
Lucy,
Thank you for sharing this important information. Please let others know the name of your doctor, so they can consult a specialist who is well versed in this particular condition.
Could you do an article for the 20% who do not have weight issues, but do have a family history of the diseases of affluence? As far back as I can go on both sides of my family, the women are very petite, even into old age. However we are no more healthy than our overweight neighbors.
I wonder at your broad strokes regarding natural selection. One of my grandmothers was raised doing manual labor on a farm, being a similar size to Mrs. flockhart, but six inches shorter, did not keep her from doing her share of the work. My other grandmother was raised in poverty but despite her petite frame (4’11”) caught the eye of a man from a well to do family, in the early fifties. Didn’t Audrey Hepburn become popular in the 1950’s as well? All my grandparents came from large families, having six or more brothers and sisters, it seems unlikely that being petite was preventing the continuation of the family line. There has as yet been no c-sections in our family either. I fit in my grandmothers wedding dress and have given birth four times without medical intervention.
Perhaps the belief in ‘good birthing hips’ is just an old wive’s tale?
MKC,
In general, people who do not have a genetic ability to gain weight are more likely to succumb to liver disease, diabetes, heart disease, and stroke because their bodies can’t absorb excess energy as efficiency as of people who can accumulate fat easily. Also, genetically skinny people are less likely to survive a serious trauma, surgery, or infection because they don’t have enough internal resource (proteins, fats) to assure survival while their digestive organs are “shut.”
In terms of safe pregnancy, it isn’t the shape of the mother that is so critical, but the size of the fetus. When there are plenty of foods (especially carbohydrates), fetuses tend to get larger, and this may lead to a great deal of mortality during natural childbirth not only due to the obstruction of the fetus, but also from a blood loss related to vaginal tears. Of course, these concerns aren’t as acute in countries with modern perinatal care as they were just a few generations ago, and are still today in underdeveloped countries.
Also, if all family members are petite, fetuses follow the proportions of their parents. That’s just genetics. On the other hand, a very skinny woman among other petite women in her tribe with normal build will still carry a greater risk of stillbirth (due to trauma in a narrow vaginal canal) or maternal death during pregnancy (due to bleeding or obstruction) than her better developed peers.