Poor sleep is often linked to being overworked, loss of hair tends to be attributed to vitamin and mineral deficiencies, irregular menstruation is put down to polycystic ovary syndrome and weight gain and a slow metabolism are associated with poor eating habits. But often a malfunction of one of the main regulators of the body’s systems that causes such symptoms goes undiagnosed. The role of the thyroid, the butterfly-shaped gland that sits in the middle of the lower part of the neck and just above the windpipe, is the most crucial determiner of a person’s metabolic rate and energy.
“The main role of the thyroid is to produce and release the hormones that your body uses to determine how much energy to use,” says Dr Hussein Saadi, chief of the Medical Subspecialties Institute at Cleveland Clinic Abu Dhabi.
The hypothalamus section of the brain produces the thyroid-releasing hormone (TRH), which stimulates the pituitary gland to produce thyroid-stimulating hormone (TSH). That prompts the thyroid to produce and secrete thyroxine (T4) and triiodothyronine (T3) hormones into the bloodstream.
“Thyroid hormones help the body use energy, stay warm and keep vital organs like the brain, heart, muscles and others working properly and efficiently.”
Dr Samer El Kaissi, staff physician and endocrinologist at Cleveland Clinic, explains that there are several types of thyroid disorders, from an enlargement of the thyroid gland (goitre) to thyroid cancer. While UAE statistics on the condition are not available, the World Health Organization estimates about 750 million people around the world suffer from a thyroid malfunction. Women are up to eight times more likely to experience disorders than men.
“The thyroid becomes either overactive or underactive and this can affect metabolism as well as other bodily functions,” says El Kaissi.
“There are a number of reasons why these conditions develop, including deficiencies in diet, genetics and autoimmune disorders.”
Keith Littlewood, a rehab and performance coach at Dubai-based lifestyle consultancy Hapi, works with clients who have suppressed metabolic rates. “That’s because they don’t produce enough thyroid hormones. Thyroid hormones are one of the major factors why we produce what is termed the currency of energy, which is adenosine triphosphate [ATP].”.
ATP molecules transport chemical energy within cells for metabolism.
“If we do not produce enough of that in the cell, there is less energy, there is too much stress and the thyroid gland is unable to produce the thyroid hormones. So the metabolic rate and temperature is inextricably linked – about 37 degrees is what our temperatures should be.”
Some of the main causes of low thyroid function include pollution, stress, chronic inflammation caused by food intolerances and deficiencies of iodine, vitamins D, A and B, selenium and zinc.
Littlewood adds that excessive oestrogen directly affects the thyroid by suppressing its ability to produce thyroid hormones.
A simple basal temperature and pulse rate test at home in the morning, after breakfast, can provide an indicator of a malfunctioning thyroid. A temperature lower than 37 degrees and a low pulse rate are signs of hypothyroidism, while a higher temperature and pulse rate may indicate hyperthyroidism.
The main symptom of insufficient thyroid function or hypothyroidism, is low energy. “Hair thinning, constipation, poor sleep, irritability, weight gain, puffiness, infertility, cold hands and feet” are also symptoms, says Littlewood.
He adds that the clinical approach to hypothyroidism is to supplement with hormones, but lifestyle factors play an equally important role in regulating them.
He says the primary issue with people suffering from hypothyroidism is that they cut back on food and carbohydrates to lose weight, but that leads to a vicious cycle.
“The common concern of a hypothyroidism client is their inability to lose weight,” he explains. “Digestion, energy, emotional balance and good sleep should be the precedent before concentrating on weight loss.
“We have energy requirements and food gives us that. If the body cannot release glucose from the liver, then it has to liberate energy from stored fats, which can suppress long-term production of thyroid hormones.”
Low blood sugar also triggers the production of cortisol (stress and anti-inflammatory hormone). “The increase in cortisol for extended periods decreases the thyroid functionality further,” says Littlewood. “The more that we’re trying to produce cortisol because we don’t have enough energy available, it’s going to be a vicious cycle of low thyroid, low energy, and the body will want to create energy by liberating cortisol from stored fats. This in itself is a stress response.”
Chronic exposure to low blood sugar and cortisol can increase TRH and TSH and ultimately lead to low thyroid or hypothyroidism in the long term.
Littlewood advises against crash dieting to lose weight in a state of hypothyroidism. “Such individuals would have to keep a check on their blood sugar throughout the day. So eat small meals every three hours: you need adequate carbohydrates for the body to produce energy.”
Dr Charlotte Zoeller, a family physician at Top Medical Centre in Dubai who specialises in preventive medicine and acupuncture, uses an e-scan to develop an individualised nutrition and training plan based on a person’s metabolism. The patient breathes into the device for three minutes, and based on their oxygen and carbon dioxide uptake, a plan is suggested by a software program.
“The machine can tell me whether you are burning fat or sugar for metabolism. If the patient is only on sugar metabolism it’s not good because they have limited amount of capacity to store sugar in the liver and muscles. So high amounts of sugar will get converted into fat.”
Zoeller suggests patients cut out high-glycaemic and processed foods. “We also suggest a training plan according to the pulse rate that will cause aerobic energy production and aid in fat loss. Intensive training with a high pulse rate doesn’t always lead to burning fat,” she says.
While an underactive thyroid is more common, people can also suffer from an overactive thyroid or hyperthyroidism.
Causes include Graves’ disease, an autoimmune condition, inflammation of the thyroid, a thyroid nodule and excessive iodine or thyroid medication. Symptoms can mimic other ailments and include anxiety, irregular heart beat, shaky hands, sweating, loose bowel movements and weight loss. Depending on the causes, a doctor might recommendmedication or surgery.
“Surgery is only advised for patients with certain thyroid conditions, including cancerous and non-cancerous lumps, goitres and overactive thyroid glands,” says El Kaissi.
Experts add that mild cases of hyperthyroidism can be addressed by introducing berries, broccoli and protein-rich foods to strengthen the immune system and gut.