TS Episode 8: Why Your Thyroid Belly Won't Go Away And What Actually Works

practitioner and being put on T3 medication. Which is what maybe the integrative or functional medicine practitioner told you was missing is that you had enough T4 but your doctor didn't realize that you weren't converting T4 to T3. Your body was favoring the deactivation of T4 to reverse T3 and that reverse T3, is blocking your T3 from working. Which isn't true, but it's the justification for them to then provide T3 medication. And, it's despite many times being on a gluten-free,

dairy-free, fun-free diet. It's oftentimes despite doing excessive exercise, probably more than you should be doing under your current state. And it's oftentimes despite doing lots of different supplements to optimize your gut health, optimize your detoxification pathways, optimize your sex hormones, and optimize your mitochondrial function. Does this sound familiar? Does this sound like you? It may be They are on too many supplements. They are on too

restrictive of a diet for too long. And, it's also a the same person who shows up with a frustrated physician who often looks at the patient with skepticism; like are you taking the medication? Or are you really eating well? Or, are you really exercising? They almost look at you like they can't believe that you're doing what you should be doing because they've optimized the lab value they care about, and yet you're still struggling with chronic signs and symptoms.

But the reason we're doing this podcast is I want to explain to you why your efforts aren't paying off. Why their best intentions with medication are not paying off. sounding like you if you're listening to this podcast. This

So first, let's kind of paint the picture of modern thyroid care. Modern thyroid care in both traditional medicine and functional/integrative medicine is often just a management strategy. In allopathic medicine, you go to see your medical doctor, they run a TSH, and free T4. If TSH is high, free T4 is low, they'll say, "You have hypothyroidism, we're going to give you T4 medication to lower your TSH." "When that's in the lab range, we've restored your thyroid physiology."

And it's a good idea. It's what they've been taught. It is what they've been trained to do. But it's often not going to restore thyroid physiology. And when you don't feel well and function well, even though they brought TSH maybe into the 1-2 range, what typically happens is they just keep giving you more thyroid hormone and they keep driving TSH lower and lower, and this creates a couple issues. One, it suppresses TSH to a point where there's no way the thyroid gland can ever recover.

Two, it can up-regulate the sympathetic nervous system because of the state you're in. And three, it can actually make the peripheral conversion of T4 is oftentimes the type of person who's coming to me, the person to T3 worse and create more hypothyroid symptoms. At the same time, that excess thyroid hormone upregulating the sympathetic nervous system will often create hyperthyroid symptoms. And many patients are told that you can't have both at

the same time. You absolutely can. Many times, because somebody's over medicating you with thyroid medication.

In the integrative and functional space, we're not free of blame here either. We often are putting people on medication who should not be on it. I did a podcast probably last year. We talked about, I think it was with Joe El-Khoury, PhD, DABCC, FACB a clinical chemist, and we talked about thyroid prescriptions, and based on his research, he thinks that close to 70% of the people on thyroid medication were put on it inappropriately.

I don't think it's bad intent. I think what happens is people are struggling with hypothyroid signs and symptoms, and their TSH is above 2.0 they have symptoms of hypothyroidism, and who says, this is me. This is how I feel. This is how I'm somebody says, "Well, I'll just give you thyroid medication and we'll see if lowers your TSH and makes you feel better. And initially, that first hit, maybe does work. But, it doesn't last because of your state. And then you wind up getting on more

T4 medication and more T4 medication. And that medication in your current state, what we call an Allostatic state, also starts to suppress TSH too much, suppressing the gland, and now the gland can't produce T4 or compensate for the lack of T3 ,or the reduced T3 that's being made. You wind up on stronger and stronger doses of thyroid medication. Despite taking the T4 medication, you're not converting the T4 to T3 appropriately. In integrated and functional medicine, we often see the lower

T3 and we think we need to fix it. If somebody has appropriate T4 in the bloodstream, appropriate free T4 in the bloodstream, and they're not on medication, they likely don't need T3 medication to fix them. That reduce T4 to T3 conversion should be a sign that there's a cell stress, inflammatory process going on. functioning. Everybody's telling me I'm normal or I've been Your body didn't wake up one day and forget how to how to convert

T4 to T3. If you see elevated reverse T3, your body didn't wake up and say, alright, we're just not going to convert T4 to T3 anymore. We're only going to convert to reverse T3. The elevated reverse T3, the lower T3 is an indication of a cell stress, inflammatory state. And, if we rush in with T3 medication to potentially try and make the patient feel better, it can give them the hit or short term feeling good, but it doesn't restore cellular physiology. If it did, you'd feel and function good.

Instead, what it often does is you get a hit of T3. You feel a little bit better. And so we think that's the right strategy but then it doesn't last because of the cellular state. And so, you wind up on more T3 and you get a benefit. And then it doesn't last. And then you get on more T3. Now as T3 is going optimized, and we just can't find the magic dose of thyroid up in this cell stress state, it starts to saturate the pituitary and suppress TSH. And now the thyroid gland starts to get shut

down. Now the glands not making hormone. Now you need more T4 or you need more T3 depending on whatever the medicine the practitioner is providing.

But how do we know that it doesn't? We know because you Allostatic regulation. So that's what I want to talk about next. still have thyroid belly, you still have weight that won't budge despite restrictive diet and over training and over exercising. You still have chronic fatigue when you wake up medication that works. in the morning. You still have the 3pm crash. You still fall asleep within minutes of sitting on the couch to watch TV; many

times, even before the first commercials hit. You still have brain fog. You still have depression and anxiety and irritability. You still have sluggish gut function and and poor hormone regulation. If somebody manipulated your T4, T3, TSH, rT3 or whatever lab they care about, into an optimal range, and it restored thyroid homeostasis, if it restored optimal Cellular physiology, you wouldn't have thyroid belly. You wouldn't have chronic weight

gain. You wouldn't have chronic thyroid signs and symptoms. They would go away. The reason we know that despite optimizing the blood level, they haven't optimized cellular level is because of your persistent signs and symptoms.

So here's the truth that practitioners completely miss, and that is that we operate in one of two states. One state is called homeostasis. This is a state where I make enough energy from the food I take in and from what my body can make to run all

of the systems of the body under my current stress load. And if the only issue was that your gland got destroyed by drugs, radiation, or surgery, whatever it is, and the gland was completely shut down and destroyed, and you're in homeostasis, and we give you 100 micrograms of T4, and 5-10 micrograms of T3, you should feel and function great. You wouldn't have thyroid belly. You wouldn't have chronic hypothyroid signs and symptoms.

But if you, if you take that level of medication, and you still don't feel and function well, then it's less about what's happening in the blood. Because you restored what a thyroid gland would have made, there should be sufficient levels in the blood. And if you say, well, there's enough T4 but I don't have enough T3 that's not broken physiology. That's an adaptive decreased conversion of T4 to T3. You're in Allostatic

regulation. And, that's what everybody needs to start to understand, is that when somebody has chronic hypothyroid signs and symptoms, even though we've manipulated their lab values into range, we have to be aware that there's this cell stress mechanism going on. That there's reduced peripheral conversion in the cells and tissues, and more thyroid hormone won't fix it. Matter of fact, many times more thyroid hormone actually makes the whole situation worse.

Another thing that's really important, and many clinicians don't get this part either, is that the thyroid gland was never typically the problem in the first place. Sure if you had your thyroid gland removed or irradiated, the thyroid gland is a problem. But technically, it still wasn't the initial problem. Whatever caused the thyroid dysfunction that required those types of treatments was the initial

problem. Oftentimes, the reduced conversion of T4 to T3 and the thyroiditis, are the effects of the cell stress response. They're not the primary cause. So if we assume that the primary reason you have low thyroid hormone is because the gland just can't make it, then, yeah, I understand their strategy. If you assume that your body woke up one day and forgot how to convert T4 to T3, then yes, I

could understand the idea that we have to give T3. But that's not really the case, and this has been written up in the scientific literature. When cells perceive stress, danger, low energy, they adaptively down regulate their metabolism. On purpose. They stiffen their cell membranes to potentially trap an organism or threat inside the cell, or prevent an organism or threat from getting into the cell. That's an adaptive response, unfortunately or fortunately.

The cell stress mechanism of stiffening the cell membrane reduces glucose transport, reduces nutrients into the cell. It also results in reduced production of peptides and hormones or and proteins inside the cell that makes us not feel good. But again, that's not part that's not broken physiology. That's part of the adaptive response. What the scientific literature shows is that when cells perceive danger, they're not bringing those nutrients in on

purpose so that the organisms or threat can't use them. They don't convert amino acids into peptides, peptides into proteins, so that the organism or threat can't use it. There's inflammatory mechanisms that are initiated within the cell to protect it, and then signaling mechanisms released from those cells in danger, to warn other cells, tissues, the immune system, for protection. And so what we'relooking and call dysfunction, is really the adaptive response, at least early on.

And so this is why, despite your doctor's best attempts to optimize the thyroid lab value they care about, they're unfortunately failing you because they're not aware that you are in a state we call allostasis. And that, despite their best efforts, more thyroid hormone isn't going to do more than maybe optimize the labs. It may provide some temporary benefit. But it's not going to restore cellular health and cellular physiology, because the cells are not in an optimal

metabolic state. They're in this slowed metabolic state, this pro inflammatory state that we call the cell danger response. The other thing that's really important here is that when a cell perceives danger, the hormone that it uses to help shift from homeostasis to allostasis, to activate all this cascade of events that occur in the cell danger response is the down regulation of T4, to T3 that helps slow the metabolism. It helps reduce the mitochondrial function. Many

times people say, you've got mitochondrial dysfunction. Of course, you do. If you have chronic cell stress that's resulting in the cell danger response, that's resulting in a reduced conversion of T4 to T3, of course there's a down regulation of mitochondria. But a whole bunch of B vitamins and mitochondrial supplements aren't going to change that. Matter of fact, you may not get a lot of those nutrients into the cell. The body isn't trying to increase mitochondrial

function. It's trying to down regulate mitochondrial function on purpose, because if there's a cell stress response in the cell. Part of the cell trying to protect itself is creating more free radicals. If you had free radicals from the cell danger response and free radicals from full tilt mitochondrial function, you'd have an excessive amount of free radicals that your cell can't make enough antioxidants for, and that would cause more cell damage and cell destruction.

So if you're struggling with chronic hypothyroid signs and symptoms, if you're struggling with thyroid belly, if you're struggling with not feeling where you feel they should be, like you're stuck between where you were without medication and where you want to be, that's what I call thyroid purgatory. This is a not a great place to be, because doctors will start to tell you, Hey, we've optimized you. Or we've restored your thyroid physiology. But you're sitting on the other side

saying, I don't feel normal. I don't feel optimal. I still feel like I'm hypothyroid. And some of you, because of higher doses of medication, may actually feel hyperthyroid as well. So what do we do, like, what's the solution here? How do we get you to recover? How do we get you to feel and function better?

Well, we have to be aware that you're more likely in this Allostatic regulatory state. You're in this cell stress physiology. Once you understand that, then you'll understand why you can't find the optimal level of thyroid hormone. Because there is no optimal level of thyroid hormone replacement when you're in this state. Because in this state, the body wants to decrease the amount of T4 to T3. There's probably no amount of medication that's going to make you feel well, to feel make you

feel restored. If you're in allostasis, you'll be constantly trying to manipulate the system to try and catch the feeling, and it won't last, even if it gets there short term. And the other thing that's really important is, when you're in this cell stress physiology, it's not just thyroid hormone physiology that's in this Allostatic state, or Allostatic regulatory state. Many systems within the cells are down regulated;energy production, normal metabolism, normal

hormone production, protein production. Multiple systems become down regulated. Glucose transport, down-regulated. That's why you can't get as much glucose into the cell, which is why you're tired. More glucose gets stored as fat, which is why you gain fat. Liver gets down-regulated, so you can't detoxify things as well. More toxins are wind up staying in the body. They have to get stored. They go into fat cells.

Gut physiology gets down-regulated, because when you're in cell stress and running from the tiger, you're not going to stop to eat. So what happens? Stomach acid production goes down. Motility slows down. Pancreatic enzyme production goes down. Bile flow goes down. Now you can't break down and digest the foods very well. Now you can't kill the organisms coming in on your food, and they start taking up residence in the GI tract. Now you wind up with imbalances of

the bacteria in your gut. You wind up with inflammation in the gut. You wind up with food or food breakdown and food reactivity and food sensitivities and a cascade of continual problems. Sex hormone regulation gets down-regulated, so your cycles become abnormal. You have estrogen imbalances with progesterone, and you just feel awful. Unfortunately, you feel awful. Somebody could say, well, we're going to optimize your thyroid hormone. Then we're going to

optimize your adrenals with adrenal support. Then we're going to optimize your sex hormones with bioidentical hormone replacement. All of these things are management strategies. They're not getting to the root issue, which is what's causing this cell stress, cell danger response. If you don't address that, everything's a management strategy. You're going to be stuck in thyroid purgatory.

You're going to be stuck with thyroid belly, and you're going to be stuck with all these chronic hypothyroid symptoms. And for many of you, hyperthyroid symptoms as well, just based on what type of medication you're taking.

So what's the strategy for getting rid of thyroid belly, to lose weight and improve all of these hypothyroid signs and symptoms? I talk about this in my strategic thyroid solution and my thyroid recovery blueprint. There's a few key things that have to be done, and these are things I've been doing with my clients for working on 30 years now. Number one, we've got to determine if you're in a

homeostatic state or an allostatic state. I would argue that if you still don't feel well, and you've tried lots of different medication strategies, or you've been told that your labs have been optimized, and you still have hypothyroid signs and symptoms you're in allostasis. You can evaluate that on your own, but you're probably in an allostatic state. So that's number one. Once you understand that you're in an allostatic state, it

changes the game. Now, instead of wasting time trying to find the optimal thyroid dose that is going to make you feel well, you're going to realize that there isn't an optimal dose that's going to make you feel well. Because your body's adaptively decreasing the production of thyroid hormones. Adaptively decreasing the conversion of T4 to T3. You don't need to waste as much time trying to find the magic dose or the magic supplement that's going to fix you, because it doesn't exist.

The second thing you have to do is start to identify what's creating the excessive stress load. This is what I talk about in the Thyroid Debacle. That's my book on thyroid physiology that I wrote with my my friend and colleague, Dr Kelly Halderman. We talked about the fitness factors in the book. We put 10 in the book. that I address with clients. We now assess 18 areas of their health, or what we call fitness factors.

We can give somebody the fitness factor questionnaire and have them complete that, and once they complete that, we've got a pretty good idea of what's contributing to their excessive stress load from a habits and lifestyles perspective. Somebody could start right there. Once they know what aspects of their life they don't have a high level of health in; say, your sleep health is not very good, start working on it. My respiratory health not very good. Start working on it. My

mindset health is not very good, start working on it. My relationships are not very good. Start working on them. These are the things that are contributing to the excessive stress load. We get, oftentimes too caught up in the shiny objects; the bacteria, the parasites, the Lyme, the mold, the yeast, the Candida, the toxins. We want it to be something external that got into us that's creating the problem.

And those things do exist, but more often than not, it's the life and lifestyle factors that are creating a heavier load on the physiology, and then you got a virus, and then you got pushed into the cell danger response. The virus comes, it goes, it goes into dormancy. But because we had all of this stress in our life already, once that virus gets us into the cell danger response mode, the poor life,

lifestyle habits, behaviors, diet, keep us there. You're stuck in the allostatic state, and we waste way too much time and money looking for the organism or toxin that's the the guilty party, when many times those things have come and gone, and so the your best money spent is working. If you want a copy of the fitness factor questionnaire, you can DM me on Instagram and just DM me fitness and we'll send you a copy of the fitness factor questionnaire. And you

can do your own self assessment. Once you see what areas you're the weakest in, and be honest when you're scoring yourself, then you'll know where to start working. f you're a person who needs some structure and doesn't want to try and figure out. You want to know how do I improve my Mindset Fitness on my own? I have a program that's like a kind of a DIY program, where you we give you an assessment form for each

of the fitness factors. You do a self assessment, and then there's support strategies for every question in the self assessment. So if you you scored low in question one, you scored a three out of 10. Then there's asupport strategy for that question of the things that you can start to do to improve your

level of fitness in that category. What you need to do is start slowly and progressively working to improve these individual fitness factors, and you're going to start working to improve your health right away. So step one to thyroid recovery and getting out of thyroid purgatory, is to realize you're probably in the allostatic state. Step two is to assess what's contributing to your excessive stress load and start improving your level of fitness in whatever categories you scored poorly in.

Part three of the thyroid recovery process is to support the shift back to homeostasis. and we do this not by throwing a handful of supplements at you and hoping it works. Instead, we need to be more strategic with our supplemental strategy. So number one is getting you to work on the fitness factors as we work on the process strategy. Number two is strategic

supplementation. Not just throwing a whole bunch of supplements in there and having you on massive quantities of supplementation, but strategic use of supplements, a few used at a time for a specific purpose. Once we've achieved the goal with those supplements, we wean those out and layer a few more on. But this isn't necessarily something you should be doing on your own. You'll wind up taking way too much

supplementation trying to do this on your own. I would fully suggest that you work with the functional medicine practitioner to make sure you're doing limited, targeted, supplemental strategies to support the recovery and the shift from allostatic to homeostatic regulation.

What I see especially in functional medicine, is that they're using the same strategy that they use for medication, which is, we're trying to manipulate a T4 into range, a TSH, a T3, into range with more T4, more T3, or more armour, whatever the medication is. And then when they look at a test and say, Oh, B6 is low, B12 is low, let's just give more B6 more B12. And that's not the appropriate strategy to get

somebody better. We want to use supplementation strategically to help restore function and physiology. The last part of the support process is making sure that we are providing the least amount of thyroid hormone support as possible, so that it's supporting the gland's ability to recover, and supporting an appropriate conversion of T4 to

T3. What many people don't realize is that if you take too much T4 medication, and it suppresses TSH below 2.0 or below 1.0, that excessive amount of T4 medication suppresses TSH and inhibits the thyroid gland from actually recovering, from actually doing more work, from actually making more thyroid hormone.

If we provide more T4 medication than the body needs, and there's more T4 in the bloodstream than the body needs, not only does it suppress TSH and potentially suppress the gland from ever recovering, it actually reduces the peripheral conversion of T4 to T3, especially if you have the cell stress inflammatory mechanism going on.

So we want to make sure there's enough T4 in the system to to support the circulation, not necessarily suppress TSH into a specific range, but that there's enough T4/ free T4 in circulation to be available to convert to T3 if and when the cells are want to do that. And they'll do it. It just won't be at the same level in allostasis as it would be in homeostasis.

From a T3 perspective, and I know a lot of my colleagues would argue with me, I don't think adding to T3 is a great option if you don't have a completely destroyed gland. If there's no thyroid gland because it's been removed or irradiated, the goal is to provide some T3 medication. We probably shouldn't be providing more than five to 10 micrograms to replace what a healthy thyroid gland would have made.

Yes, more thyroid hormone may change some signs and symptoms temporarily and make somebody feel better, but taking more T3 medication than a healthy thyroid gland would make actually suppresses TSH, suppresses thyroid gland production. So it too, can inhibit the thyroid gland from ever recovering. Plus, T3 can actually create more inflammation. It can up regulate the sympathetic nervous system, it can create more oxidative stress, especially as those

doses go higher and higher. So I don't think part of the recovery process should be to optimize T3 in the bloodstream. I think we look at a max 5 to 10 micrograms to replace a destroyed thyroid gland, if that's the case, but if you have a thyroid gland you want to recover, I don't think T3 is

should be part of that recovery process. In most cases, this is going to really come down to the physician you're seeing and how they're treating you, but this is where a lot of times people get stuck because their doctors are busy trying to optimize their labs as if they're in homeostasis when they're not. If you're struggling with chronic hypothyroid signs and symptoms and sometimes hyperthyroid symptoms, you're in

allostasis. And I think the time spent trying to optimize blood levels and to manipulate them into an optimal range is costly. From a cost perspective, and from a time perspective. You'd be much better off working on these fitness factors and making sure you just have enough T4 in the blood to be able to convert when the body's cell danger response goes away. You'll convert more of that T4 to T3. Your body be able to do it. You were able to do it before you were diagnosed with

hypothyroidism. You'll be able to do it, if you address the cell stress mechanisms.

So here's what I want you to walk away with, this thyroid belly and this excess weight that you're struggling with is not a life sentence. You can recover from this. The reason you're storing body fat and not releasing body fat is because your body's still in this cell stress, cell danger physiology. You won't fix this by just adding more thyroid hormone to the picture. You fix this by addressing the excessive stress load, which is what I've talked about through this podcast.

If this resonates with resonates with you and you're looking for a different strategy, you can go to Instagram and DM me "fitness", and we'll send you the fitness factor questionnaire. You can do your own self assessment, and then once you do that self assessment, you can start working on the weakest areas on your own. Go to Google. Go to your functional medicine practitioner that you're already working with and say, hey, these are the areas I think I need to work on. What are the strategies?

If you want some guided help, you can go to my website and you request my Thyroid Recovery Blueprint, and in that blueprint, we give you assessments for all 18 of the fitness factors and strategies to improve each of those fitness

factors. And if you're really struggling and you really feel like you need some personalized help, you can go to my profile in Instagram, or you can go to my website, DrEricbalcavage.com, and you can schedule a complimentary discovery call where we can talk about what's going on with you and what's the next logical steps for you. Maybe that might be to work with me. Maybe it's just, hey, start working on these fitness factors. But at least we can have a discussion and get you on

the right track. So I hope this Thyroid Shorts episode has been helpful. If you have any questions, you can reach out to me on social media, and you can, as I said, you can go to my website, DrEricbalcavage.com, and schedule complimentary discovery call. Take care.