On July 19, 2007, I had the pleasure of being interviewed by Helen Foster, a writer for the British women's magazine Psychologies. Her article is on hypothyroidism, and I'm only one of the thyroid doctors and researchers she will quote in the article. I am especially pleased to participate, however, because she intends to include information on thyroid hormone resistance. And as many readers of drlowe.com know, few doctors understand anything about this important subject.

I told Helen that not long ago, doctors and researchers thought that thyroid hormone resistance was rare. However, the condition is common, and precious few patients with resistance are treated properly.

I emphasized an important point: one reason that few resistance patients get proper treatment is a dreadful mistake made by conventional endocrinologists—that is, they've defined hypothyroidism as a high TSH level. Patients with the peripheral form of thyroid hormone resistance have "normal" TSH levels. Most endocrinologists let their patients use thyroid hormone therapy only when they have high TSH levels. Because of this, most endocrinologists (and other conventional doctors who take their advice) deny resistance patients any thyroid hormone therapy at all.

When my book The Metabolic Treatment of Fibromyalgia[1] was published, I included a proposal by Dr. Richard Garrison.[1, pp.322-323] His proposal is that we rename peripheral thyroid hormone resistance "type II hypothyroidism." He was making an analogy to diabetes, in which type I diabetes is a deficiency of insulin, and type II diabetes is insulin resistance. This analogy, as all analogies, breaks down at certain points. However, viewing the need of patients with thyroid hormone resistance from this perspective has humane potential: it could lead doctors to rescue the patients  from the conceptual mistake of the endocrinology specialty that no one needs thyroid hormone therapy unless he or she has a high TSH.

Helen made one of her main goals clear to me: She was concerned about how readers of Psychologies can avoid or correct their thyroid hormone resistance. I explained—as I detailed at great length in The Metabolic Treatment of Fibromyalgia[1, pp.226-231]—that man-made chemical contaminants are a major—probably the major—cause of thyroid hormone resistance.

Eliminating these contaminants from our bodies (virtually all of us are contaminated with them) is probably the most productive course of action. We should all avoid the foods and other environmental sources of the contaminants. (Successfully avoiding them will, of course, be tough nowadays. The Bush Administration has engaged in a wholesale reversal of environmental protection legislation, and it has given industry free reign to pollute the world with no concern for the adverse impact on human health.) Also, we should occasionally reduce our body fat to liberate the chemicals, which tend to deposit in fatty tissues. Unfortunately, as I said, we're all polluted with these chemicals. Because of this, if environmental pollutants are the major cause of thyroid hormone resistance, it would at best take decades for committed environmentally conscience administrations to free the world of thyroid hormone resistance.

In the interview with Helen, I also mentioned patients with central hypothyroidism. In this condition, the patient has less than optimal thyroid hormone production from a problem with the pituitary gland or hypothalamus in the brain. For many years, I studied the percentage of patients with central as opposed to primary (thyroid gland failure) hypothyroidism among fibromyalgia patients. I found that some 44% of fibromyalgia patients met the criteria, and had "normal" TSH, free T3, and free T4 levels.[2][3] What's important to realize about this finding is that the usual TSH, free T3, and free T4 levels that doctors order cannot identify patients who have central hypothyroidism. So, like patients with peripheral thyroid hormone resistance, these hypothyroid patients are forsaken by the endocrinology specialty's poorly-conceived and incredibly limited definition of hypothyroidism. Tragically, most conventional doctors take the specialty’s advice as gospel. As a result, they fail to identify these patients and usually deny them the therapy that they so badly need.

Helen and I covered other points, but I'll stop with those I mentioned above. Magazine writers have pressures that dictate what they include in their final articles. Because of this, after one of these interviews, I never know what the writer will use or not use of what I've said. I never know until the final article is published whether I'm quoted at all. I will say, however, that I'm grateful to Helen for anything she includes from our interview. She'll be giving some voice to those of us fighting to liberate hypothyroid patients from the endocrinology specialty's false and harmful beliefs about hypothyroidism. In addition, it was a delight to spend time talking with Helen.

References

1. Lowe, J.C.: The Metabolic Treatment of Fibromyalgia. Boulder, McDowell Publishing Co, 2000.

2. Lowe, J.C.: Thyroid status of 38 fibromyalgia patients: implications for the etiology of fibromyalgia. Clin. Bull. Myofascial Ther., 2 (1):47-64, 1997.

3. Lowe, J.C., Reichman, A., Honeyman, G.S., Yellin, J.: Thyroid status of fibromyalgia patients (abstract). Clin. Bull. Myofascial Ther., 3(1):69-70, 1998.

Low Blood Sugar
Despite a Complex Carb Diet:
Finding It and Fixing It

Over the last two years, I've been helping patients to objectively identify blood sugar problems through home glucose tolerance tests. Many years ago, I used to order those horrible glucose tolerance tests done at laboratories. I stopped ordering those partly because so many patients were sickened by the large amount of pure glucose the lab personnel required them to swallow. I also stopped ordering them because I don't believe the test results reflect the reality of what happens to a  patient's blood sugar after his or her typical meal.

I've had a specific motivation in having patients do home glucose tolerance tests; that is, I wanted to help them identify blood sugar problems that might be interfering with their recovery. I'm happy to say that because of these tests, I've succeeded at helping some patients whom I otherwise would have failed.

I named the clinical approach that I developed in the 1990s metabolic rehabilitation. Most patients who undergo "metabolic rehab" are hypothyroid or partially resistant to thyroid hormone. As probably most of my readers know, the patients'  hypothyroidism or resistance has usually been misnamed "fibromyalgia," "chronic fatigue syndrome," or other such mysterious new disease.

To succeed at metabolic rehab, most patients must begin using effective thyroid hormone therapy. For example, when I first see many patients, they are using T4-replacement (in the U.S. and Canada it's usually with Synthroid). Many of these patients soon smoothly recover by switching to more effective therapeutic approaches that include their use of products such as Armour Thyroid or Cytomel. For some patients, though, the path to recovery isn't smooth; obstacles block their way. For them to finally get well, we have to learn what the obstacles are, and then either remove them or get the patients past them in some way.

I began to study the issue of low blood sugar during the time I taught clinical nutrition back in 1979 in the Clinical Sciences Division of the Texas Chiropractic College. Since the early 1990s, I've done my best to persuade patients to go on a diet that corrects low blood sugar.

About two years ago, I decided to start objectively verifying the nature of patients' blood sugar problems. As a clinical researcher, objective evidence is, of course, treasure to me. So, I went about collecting evidence in the form of patients' blood sugar measurements. I now have enough evidence to start writing about what I've learned. And I hope that what I've learned will help patients and their doctors improve their treatment results during metabolic rehab.

I've learned a lot in the last two years that has surprised me. For example, I had long held a presumption: that the major blood sugar problem blocking patients’ recovery is low blood sugar. However, after many patients sent me the results of their home glucose tolerance tests, I saw that my presumption was wrong. Rather than low blood sugar, most patients’ test results showed the exact opposite—high blood sugar. The patients' blood sugar levels weren’t high enough to diagnose diabetes. But their levels were high enough to account for symptoms such as fatigue and poor memory and concentration.

Later, I'll write extensively about these patients with high blood sugar. It's important to do so because we now have research-based natural medicine treatments that can help many patients recover from high blood sugar levels. And,  these treatments can presumably prevent patients from progressing to frank diabetes.

Here, though, I want to describe a subset of patients I've found who have a blood sugar problem I didn't anticipate. They are patients who generally eat  wholesome foods. As part of their various diets, they eat almost exclusively carbs that are complex. They eat foods such as brown rice, whole-grain cereals, hummas, spinach, whole-wheat spaghetti, tomatoes, yams, potatoes, and similar carbohydrate foods. They also eat wholesome protein foods such as lean white meat and healthy-fat foods, such as avocados.

On principle, we usually associate reactive low blood sugar with refined carbs. In contrast, we usually expect people who eat complex carbs to have comparatively normal blood sugar levels. This expectation, however, is wrong for the subset of health-conscious patients to whom I refer!

To illustrate the nature of these patients' blood sugar problem, I'll give the actual test results of a patient whom I'll call Sally. After switching from Synthroid to Armour, Sally improved overall. But she had persisting fatigue and "mental fog." (For clinicians interested in my deductive approach to identifying the causes of persisting symptoms despite otherwise effective metabolic therapy, please see Section IV and Chapter 5.2 of Section V in my book The Metabolic Treatment of Fibromyalgia.[1])

Below, I've provided two of Sally's line graphs. Line Graph 1 shows eight of her blood sugar levels over a six-hour time. I had her measure the blood sugar levels at home before and after a meal of complex carbohydrates. Line Graph 2 shows Sally's cortisol levels at four times over that six-hour time.

Measuring cortisol levels during the glucose tolerance test can help clarify that a patient's blood sugar level drops too low. Assuming that a patient's adrenal cortices (the "cortices" are the outer layers of the two adrenal glands that release cortisol) are working properly, a dip in blood sugar will cause the cortices to secrete more cortisol. As a result, the patient's cortisol level spikes. We can measure this by having the patient take saliva samples at set intervals. (Some doctors with out-dated beliefs say they "don't believe in salivary testing." This attitude is unfortunate; it short-changes patients who could benefit from salivary testing. Hundreds of scientific studies show that the salivary free cortisol is a valid and highly reliable test.)

What Sally's Line Graph 1 shows—as have the graphs of other patients like her—is low blood sugar levels despite a complex carb meal. Her Line Graph 2 shows that her adrenal glands reacted to the low blood sugar by secreting a large amount of cortisol. (I graph the typical patient's blood sugar levels and email the graph to him or her in pdf format. If the patient has also taken salivary samples during the glucose test, I graph those results, too, and email them as a pdf file. That way, when we talk by phone about the results, we can both clearly see his or her sugar levels compared to what lab pathologists consider normal (indicated by the yellow lines in Line Graph 1).

Not all patients’ graphs are as clear and telling as Sally's. When they’re not, the patient and I must do more diagnostic detective work. Even when a patient's graphs are clear and telling, I often ask the patient to repeat the tests to confirm the sugar and cortisol levels. Sally did a second set of tests, and the results were almost identical to the first.

To understand the graphs, keep in mind that the yellow lines in Line Graph 1 mark the upper and lower ends of "normal" blood sugar levels. The yellow lines in Line Graph 2 show the upper and lower ends of "normal" cortisol levels. The red lines in the graphs show what the patient's measured blood sugar and cortisol levels were.

Our challenge was to figure out why Sally's blood sugar levels were low. She had eaten about 200 grams of complex carbs. This is enough to raise most people's blood sugar. But her blood sugar levels showed that too little of the sugar from the carbs had entered her blood.

Sally's pattern of low blood sugar and high cortisol, in view of her healthy diet of complex carbs, suggested two possible causes of her low sugar levels. First, as I document in Chapter 3.14 of The Metabolic Treatment of Fibromyalgia,[1,pp.681-687] people with too little thyroid hormone regulation typically have impaired digestion and decreased absorption from the small intestine. Sally's  hypothyroidism, however, was being treated effectively. Three grains of Armour Thyroid had relieved most of her hypothyroid symptoms and raised her basal temperature and heart rate to normal.

The second possibility was that for some other reason, Sally wasn't digesting and absorbing the complex carbs she ate. I ordered a comprehensive set of intestinal lab tests for her. The results ruled out conditions such as inflammation of her small intestine. However, the test results did indicate that she wasn't secreting normal amounts of pancreatic digestive enzymes, including amylase. (Amylase is a set of enzymes that digest carbohydrates.) This appears to have been the source of Sally’s low blood sugar levels.

Sally began to take a digestive enzyme product that worked for her. It relieved intestinal gas that had been a minor problem. And when she did the home glucose tolerance test twice again, her glucose levels were well within the "normal" range. Most importantly, she was soon free from her mental fog and fatigue.

Sally is representative of several other patients I have worked with over the last couple of years. For them, low blood sugar levels are apparently caused by poor digestion of complex carbohydrates. I'm especially interested in their cases because in the past, I expected only refined carbs to be a source of low blood sugar. Complex carbs are far healthier than refined ones—as long as the patient can digest and absorb them. If not, the proper course isn't to switch to refined carbs. Instead, it is to continue the complex carbs and identify and correct the problem in digesting and absorbing them.

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