How an underactive thyroid affects diabetes

[Winnie53]

Last night, I opened one of my bedside books and started surveying it. When I came upon the chapter, Thyroid and Thyroiditis, it occurred to me that I don't know much about the thyroid and it's relationship to diabetes. So today, my husband and I had a look around online and found all kinds of interesting information.

This article Unattended, Low Thyroid Function Doubles the Risk of Progressing to Type 2 Diabetes really surprised me.

Here's a few excerpts...

In this study (1), researchers from the Erasmus Medical Center in the Netherlands followed 8,492 adults, ages 54 to 74, for nearly eight years. At the start, 1,338 had prediabetes and 7,114 had normal blood sugar levels. After 7.9 years, 798 participants had developed type 2 diabetes (T2D). Overall, low thyroid function—even in the low-normal range—increased the risk for diabetes by 13%. But among those with prediabetes, the risk of progressing to type 2 diabetes ranged from 15% for those with normal thyroid function to 35% for those with signs of low function. Even “low normal” thyroid functioning increased risk.

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“Thyroid hormone is also directly involved in the control of insulin secretion and glucose homeostasis. Hypothyroidism is associated with decreased insulin sensitivity and glucose tolerance and treatment of hypothyroidism has shown to improve these effects. The exact mechanism or mechanisms that are involved in the association need to be investigated.”

Participants in the study are all part of the large, on-going Rotterdam Study tracking the development of age-related diseases in residents of Ommoord, a large neighborhood in the Dutch city of Rotterdam. Volunteers’ thyroid status had already been checked by measuring levels of thyroid stimulating hormone (TSH) and thyroxine (also called T4). Elevated TSH and reduced T4 indicate low thyroid function.
​

Read the full article here... https://www.endocrineweb.com/news/diabetes/55372-low-thyroid-hormone-raises-risk-type-2-diabetes

Adam Nally, DO is a board-certified family physician and obesity medicine specialist. He has 19 years clinical practice experience and 14 years experience using the keto diet to treat obesity. He wrote the book I was flipping though last night. Decided to go to his website, DocMuscles.com, to read what he had to say about thyroid. I was really surprised.

Some who have an underactive thyroid will struggle with insulin resistance and rising glucose levels. Additionally, he says high insulin levels can cause hypothryroidism.

According to the Mayo Clinic, hypothyroidism signs and symptoms may include: fatigue; increased sensitivity to cold; constipation; dry skin; weight gain; puffy face; hoarseness; muscle weakness; elevated blood cholesterol level; muscle aches, tenderness and stiffness; pain, stiffness or swelling in your joints; heavier than normal or irregular menstrual periods; thinning hair; slowed heart rate; depression, impaired memory, enlarged thyroid gland (goiter).
https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284

In this video, Dr. Nally shares his clinical experience with treating diabetic patients with an underactive thyroid, even some patients within the normal TSH range of 0.3 to 4.5 mg/dL.

https://www.facebook.com/video.php?v=1294868510641158

He's a fast talker, so I transcribed the two minutes of his talk that I wanted to share with you all beginning at minute 00:03:00...

Does the thyroid affect, or is the thyroid affected, by the ketogenic diet? And the answer is absolutely yes.

So this is probably the most common question I get from everybody I see, everybody online. They ask me this all the time: "Well, what about my thyroid? Is it going to be broken?" Um, no, it [the ketogenic diet] actually helps the thyroid.

So let me kind of back up and explain what happens. What I'm finding in the 17 years that I've been practicing medicine is that the thyroid is influenced by a number of things. Specifically though, the thyroid seems to be very greatly influenced by a high insulin response or a high insulin load. So the big challenge is if you are insulin resistant, if you're producing excess insulin response to starches or sugars then your going to actually suppress the thyroid function.

That thyroid function is suppressed at the thyroid releasing hormone level. Insulin actually makes thyroid antibodies worse, so if you have a predisposition to thyroiditis, or if you have a predisposition to thyroid disease, then what will happen is that insulin actually amplifies the effects.

A lot of people with Hashimotos actually have worsening symptoms when they eat a low fat high carb diet. And that's one of the things that really bothers a lot of people, and they haven't been able to identify that.

What shocked me 10, 12 years ago, when I started doing this, and started really lowering the carbs and improving insulin function, is that, now remember...let me back up...if we put you in a ketogenic state, it takes from anywhere from 3 to 6, and often up to 24 months, to see insulin correct itself.

And so what I do see as the insulin loads begin to improve...I begin to see that the thyroid function begins to get dramatically better. In fact, thyroid function will be improved by up to a full point in many people. It's actually really exciting, very fascinating to see this happen. And really thrilling for a lot of people.

I've been able to lower people's medication on thyroid dosages. A couple of people I've been able to take off. Will you get off your thyroid medication if following a ketogenic diet? There's a slim possibility you might, but not always though. But it is one of thos things that's very, very effective, and very, very powerful. - Adam Nally, DO, November 2, 2017.
​

Something that I've been wondering about is why is it a person who is severely insulin resistant, who is on the keto diet to get their insulin and glucose levels down and to lose weight, is producing ketones, then plateaus and is not make any progress? About 20 minutes into this talk he offers a strategy he uses that he has found helpful for to get things moving again with weight loss...

[Question from viewer]: "What is the real range for a normal thyroid?" So the labs will give you a range of somewhere between 0.4 mg/dl and 4.5 mg/dL as the range for TSH, thyroid stimulating hormone, that's produced by the pituitary gland telling the thyroid what to do.

I find that most people have trouble maintainnig or losing weight if that TSH level is not lower than 2.5 mg/dL, even though the normal range is all the way up to 4.5 mg/dL.

From a perspective of weight loss, I find that a lot of people need to be at 2.5 mg/dL or less. And often, when you go on a ketogenic diet, it corrects itself and drops itself to 1.5 mg/dL, which is really cool.
​

The above video is definately worth a listen. The next day, he livestreams again. It's titled "Thyroid & Nutritional Ketosis - Part II. It contains a few more interesting tidbits. His website is docmuscles.com I believe I found the videos by using the search term "thyroid".

Hope you all find this information as interesting as I did.

 

[DCUKMod]

That's all very well, until one develops thyroid issues when A1c is down to around 30, low BMI, HOMA-IR of around 1, and having been eating LC for a number of years.

Many Endos do not favour low carb, let along keto for those with hypothyroidism, as the claim is reduces T3 performance. My Endo swims against the tide on that bit.

Sadly, thyroid dysfunction is just like metabolic dysfunction; it has little hard and fast about it, and only digging deep, on a personal level will begin to give the clues to the puzzle.

As for symptoms from the list above, I was:

fatigue; a little
increased sensitivity to cold; a lot - this was my main issue
constipation; plenty, but longer standing than any other thyroid symptoms
dry skin; i could be persuaded, but then skin tends to dry as we age
weight gain; none - 1-1.5kg at the absolute maximum
puffy face; No
hoarseness; No
muscle weakness; No
elevated blood cholesterol level; yes, but longer standing that any hypothyroid signs
muscle aches, No
tenderness and stiffness; No
pain, Only related to gluten intolerance
stiffness or swelling in your joints; Marginal - long standing osteoarthritis in my hands
heavier than normal or irregular menstrual periods; no idea - post-hysterectomy
thinning hair; yes, but only latterly as my condition deteriorated
slowed heart rate; No
depression, low mood, but related to the frustration of the temperature regulation issues
impaired memory, In periods
enlarged thyroid gland (goiter). - No

As you can see, I am atypical in a million ways, but then I was always atypical T2.

To be fair, I haven't watched the video, but if he relies on TSH as any form of marker, after 1 or 2 tests, he is doing his patients a massive disservice. TSH signals the pituitary to release thyroxine (T4), it gives no indication whatsoever whether the pituitary actually produces the passive T4, or whether the individual can convert any T4 they produce into the active T3.

It's a bit like relying on random blood glucose tests to manage diabetes.

 

[Winnie53]

DCUKMod, sorry to hear you have a thyroid condition too. Not fun.

I think if you listen to the video, you'll feel more comfortable with what he's doing. I was diagnosed with subclinical hyperthyroid almost 20 years ago. It's made my life difficult.

I hope you have the time available to listen to the entire video. It's only 30 minutes. I've followed his work off and on for four years. He's very good at what he does. He has a website. He also authored a book with Jimmy Moore and Maria Emmerich in 2018. I'm reading it right now.

 

[Winnie53]

I should add, there are two endocrinologists who use low carb or keto with diabetic patients. Two come immediately to mind: Jake Kushner, MD and Robert Lustig, MD. It's a start. I'm sure there are others.

This recent interview with Dr. Kushner was quite good...

 

[DCUKMod]

of course, there are Endos who support and even promote LC for people living with diabetes. The chap I see is perfectly happy with my choice to live a LC lifestyle, and indeed, his strong recommendation was then to add gluten free into the mix.

I'm sorry, but the video presenter did nothing for me. He seems to be just undertaking a Q&A for random questions for people on Facebook.

He wouldn't be my go-to for knowledge and information.

 

[Winnie53]

DCUKMOD, you've very fortunate to have an exceptionally competent endocrinologist, who's utilizing best practices from within and outside his/her field. I have been equally fortunate with my gastrointerologist. He was like your endocrinologist, brilliant actually. He retired last year. I miss him. My new gastroenterologist has only been in practice for 10 years, also very good but a medication only man, doesn't get the life changing power of the right diet, yet...

Many do not have access to doctors like your endocrinologist. For them, having free, ongoing access to someone like Dr. Nally online has the potential to be lifechanging.

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[This section edited to add more detail]

Dr. Nally was 65 pounds overweight, triglycerides were almost 450, and he was already pre-diabetic despite eating a low fat diet of 1,200 to 1,800 calories a day and working out 5 to 6 days a week. His father weighed 400 pounds and had diabetes, hypertension, and heart disease. He'd had 3 stents, 5 vessels bypassed, and was on 150 units of insulin, took 32 pills a day. He died at the age of 58.

Dr. Nally, in his early 30's at the time of his dad's death, reviewed his father's medical history. Then he compared his current health status to his farther's earlier health status when his father was in his early 30's. They were almost the same.

Sometime after that Dr. Nally began the process of becoming board certified in obesity medicine. He looked at the research and results of the low fat diet and the low carb diet. The former had failed him, and many of his patients, so he decided to give keto a go. He lost all the weight in six months, then began using variations of the diet with his patients based on their health status, needs and goals. To date he says 50 of his patients have reversed their diabetes.

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The ketogenic diet changed the course of his life. Today he enjoys excellent health. And he's been out there teaching the low carb/keto diet ever since online, for free, generously making his knowledge accessible to anyone with online access, 24/7. We need more doctors like him.

 

[DCUKMod]

DCUKMOD, you've very fortunate to have an exceptionally competent endocrinologist, who's utilizing best practices from within and outside his/her field. I have been equally fortunate with my gastrointerologist. He was like your endocrinologist, brilliant actually. He retired last year. I miss him. My new gastroenterologist has only been in practice for 10 years, also very good but a medication only man, doesn't get the life changing power of the right diet, yet...

Many do not have access to doctors like your endocrinologist. For them, having free, ongoing access to someone like Dr. Nally online has the potential to be lifechanging.

Dr. Nally struggled with being overweight throughout medical school despite restricting calories and exercising. Sadly, his father died of diabetes and heart disease at age 57. He was devastated.

Dr Nally looked at his father's medical history, then compared his father's medical records at age 32 with his own and was shocked to see that they were very similar.

The ketogenic diet changed the course of his life. Today he enjoys excellent health. And he's been out there teaching the keto diet ever since online, for free, generously making his knowledge accessible to anyone with online access, 24/7. We need more doctors like him.

To be honest, I gave up watching the video about a third from the end because all he was doing was pontificating about what he does, not how he does it, how appropriate it might be for other people, or any course of action a patient could follow.

Of course,I understand why that would be. Why would anyone risk their livelihood or liberty by giving medical advice over Facebook, not knowing anything about the individual, aside from how they identify on social media.

Most Endocrinologists in UK are specialists in diabetes, with few having in-depth knowledge of more complex thyroid conditions. Lime most health conditions, we need to take an interest in our own health care and self-educate.

 

[Winnie53]

DCUKMod, I think what you're observing is the nature of live streaming and good old fashioned business marketing (which Dr. Nally could use some coaching on ). I only pay attention to the relevant content, and ignore the rest.

One of the challenges of working within the healthcare system is that doctors are forced to follow the standard of care. Health insurers greatly limit what doctors can and can't order: imaging, lab tests, medications, therapies, and other treatments approaches, etc. And on top of that, there's the daily threat of having to defend your medical license and/or facing litigation, rightly or wrongly. It's quite the tight rope performance.

So healthcare providers who are tired of watching their patients get sicker and sicker due to the current standard of care, are setting up private practices that operate on a cash basis, which is exactly what I'd do. I don't know if Dr. Nally has taken that step or not.

And apologies, to speak to your previous concern... He's looking at more than just TSH. He briefly presents other strategies he uses in response to other parts of the thyroid panel in one of the two videos. Can't remember which one.

My purpose in posting is not to promote Dr. Nally's work, rather to bring attention to the role of the thyroid in managing diabetes and losing weight. If the thyroid is underactive, overactive, or not functioning properly, you're going to struggle greatly with doing one or both. It's just something to look at if diabetes is not improving with the low carb/keto diet and exercise. Or if weight loss has stalled and other strategies such as fasting, etc. aren't working either.

 

[zand]

Thanks for posting this @Winnie53

There are many people who are not classed as being hypothyroid by their GPs ( and GPs rarely test for full thyroid function)but who nevertheless have sub clinical low thyroid function. My naturopath got me to check my own temperature daily for a month because of this and this was when I found that my basal temperature was lower than normal.

 

[JohnEGreen]

And then there is (and I know it is not the same thing) hyperparathyroidism which can and often does adversely effect diabetes so much so that if you have it along with diabetes the parathyroid glands often are removed.

 

[Winnie53]

@JohnEGreen I know nothing about the hyperparathyroidism. What you shared is interesting. Could you talk a little bit more about how is can adversely effect diabetes?

@zand that's so good that you found someone willing to treat you. How did your life change after you began treatment?

Okay, I didn't want to post these until I listened to them last night. Here's a presentation he did specifically on thyroid…

I'm going to relisten to the last part of the lecture again tonight, hoping both listening and looking at his slides will help me understand what he's explaining about the thyroid.

And here’s an interview with him in which he talks about how he uses the keto diet with patients. Somewhere in the last half he makes some surprising statements about specific artificial sweeteners, black, green, and oolong tea spiking insulin levels.

 

[JohnEGreen]

What drew my attention to it was the fact that my daughter has the opposite problem her parathyroid glands are totally defunct and she has hypoparathyroidism so consequently very low calcium levels.

In the course of searching out info on her situation I came across articles on hyperparathyroidism.

As the parathyroid glands regulate calcium It seems with this condition you get very highly raised levels of calcium and PTH (parathyroid Hormone ) and It is known that both high PTH and hypercalcaemia can increase insulin resistance resulting in compensatory hyperinsulinaemia.

IR in this case caused by the higher intra cellular or interstitial calcium levels requiring higher production of insulin.


This is an abstract from PubMed.

"
Abstract
Hyperparathyroidism is associated with abnormalities in glucose tolerance and insulin secretion. To assess the effects of hyperparathyroidism on the control of diabetes mellitus, 56 patients with concomitant hyperparathyroidism and diabetes mellitus were studied before and after parathyroidectomy. Fifty patients (89.3%) had hypercalcemia, and six patients (10.7%) had normocalcemia associated with inappropriately elevated parathyroid hormone. After surgery, three of five patients with insulin-dependent diabetes mellitus showed more than a 50% reduction in insulin requirement. Thirty-nine of 49 patients with noninsulin-dependent diabetes mellitus were followed. Of these, three patients had restoration of normal blood glucose levels without any diabetic treatment including diet restriction. Diabetes control improved in eight parents, remained stable in 18, and deteriorated in 10 patients. In the remaining two patients, impaired glucose tolerance disappeared in one patient and progressed to frank diabetes in the other. Overall 60.7% of the patients improved or remained stable in their diabetes control after parathyroidectomy. We conclude that in patients with hyperparathyroidism, the coexistence of diabetes mellitus might be a further indication for parathyroidectomy. Physicians should be alerted to the possible change in diabetic regimen and the risk of hypoglycemia in patients with diabetes after parathyroidectomy."

https://www.ncbi.nlm.nih.gov/pubmed/3538462

And there is this article.

Parathyroidectomy Ameliorates Glucose and Blood Pressure Control in a Patient with Primary Hyperparathyroidism, Type 2 Diabetes, and Hypertension

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559184/

 

[Winnie53]

What drew my attention to it was the fact that my daughter has the opposite problem her parathyroid glands are totally defunct and she has hypoparathyroidism so consequently very low calcium levels.

In the course of searching out info on her situation I came across articles on hyperparathyroidism.

As the parathyroid glands regulate calcium It seems with this condition you get very highly raised levels of calcium and PTH (parathyroid Hormone ) and It is known that both high PTH and hypercalcaemia can increase insulin resistance resulting in compensatory hyperinsulinaemia.

IR in this case caused by the higher intra cellular or interstitial calcium levels requiring higher production of insulin.


This is an abstract from PubMed.

"
Abstract
Hyperparathyroidism is associated with abnormalities in glucose tolerance and insulin secretion. To assess the effects of hyperparathyroidism on the control of diabetes mellitus, 56 patients with concomitant hyperparathyroidism and diabetes mellitus were studied before and after parathyroidectomy. Fifty patients (89.3%) had hypercalcemia, and six patients (10.7%) had normocalcemia associated with inappropriately elevated parathyroid hormone. After surgery, three of five patients with insulin-dependent diabetes mellitus showed more than a 50% reduction in insulin requirement. Thirty-nine of 49 patients with noninsulin-dependent diabetes mellitus were followed. Of these, three patients had restoration of normal blood glucose levels without any diabetic treatment including diet restriction. Diabetes control improved in eight parents, remained stable in 18, and deteriorated in 10 patients. In the remaining two patients, impaired glucose tolerance disappeared in one patient and progressed to frank diabetes in the other. Overall 60.7% of the patients improved or remained stable in their diabetes control after parathyroidectomy. We conclude that in patients with hyperparathyroidism, the coexistence of diabetes mellitus might be a further indication for parathyroidectomy. Physicians should be alerted to the possible change in diabetic regimen and the risk of hypoglycemia in patients with diabetes after parathyroidectomy."

https://www.ncbi.nlm.nih.gov/pubmed/3538462

And there is this article.

Parathyroidectomy Ameliorates Glucose and Blood Pressure Control in a Patient with Primary Hyperparathyroidism, Type 2 Diabetes, and Hypertension

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559184/

Thank you. I"ve been studying diabetes for 5 years and I've never until now heard or perhaps paid attention to the parathyroid being discussed. This is good to know. After I get off work, I want to try to better understand this.

What happened before and after diagnosis to your daughter? And do you have one of these conditions? If yes, what happens to you pre and post diagnosis and treatment?

 

[zand]

Since treatment my basal temperature has risen about 1 C (still about 2 C lower than normal though) and I managed to lose a little weight. However other issues were present and I lost my focus a bit, plus the naturopath left work to have the baby that NHS specialists said she would never have (physician heal thyself - she did!)

 

[Winnie53]

Zand, I have the greatest respect for naturopaths. Sad for you, but happy for her. Good to hear you did experience some improvements under her care.

 

[JohnEGreen]

@Winnie53 no I do not as far as I know have this I take calcium supplements because of the actions of prednisolone but my daughter's parathyroid glands do not function at all so she has very low levels of calcium and has to have very potent calcium supplementation
It can also lead to higher than normal levels of phosphorus in your blood.
But the doctors have not really addressed that as yet I think diet exercise and keeping well hydrated is the way to go on raised phosphorus but am not sure.

Though come to think of it I do have raised levels due to CKD

And some times raised phosphorus levels can be caused by DKA

These are some of the symptoms of hypoparathyroidism

Tingling or burning (paresthesia) in your fingertips, toes and lips
Muscle aches or cramps in your legs, feet, abdomen or face
Twitching or spasms of your muscles, particularly around your mouth, but also in your hands, arms and throat
Fatigue or weakness
Painful menstruation
Patchy hair loss
Dry, coarse skin
Brittle nails
Depression or anxiety

Melody at some point has exhibited most of the symptoms but not all.

 

[Winnie53]

Sorry to hear you have chronic kidney disease JohnEGreen. My friend is going back and forth between stage 4 and 5. We've learned about it together over the last three years. I believe they monitor her sodium, potassium and phosphorus. There's two protein supplements designed specifically for CKD patients, but they're really expensive. My friend cannot afford them.

Lee Hull is a kidney patient himself and has published two books to date, and has one or two more in the pike. You can learn more about his books on Amazon. He really digs into the research and summarizes each study. It's an excellent resource that her nephrologist and naturopath reviewed for her so they were all on the same page.

I have struggled with leg cramps off and on most of my life, but they're responded well to supplementing with magnesium since starting the keto diet five years ago. I'd heard that muscle cramps can be due to calcium issues too. Not fun.

Thank you so much for listing the symptoms. I know someone with burning lips but I don't know if she has the other symptoms. I'll have to ask her next time I see her.

Are there any online organizations who support those with these two conditions related to the parathyroid?

 

[MrsA2]

Interesting thread
I have only half a thyroid following a goitre decades ago.
Ever since I have been told I don't need any medication as the remaining half works well, I.e within normal ranges.
I will now be requesting regular thyroid function tests and monitoring the results as my bg changes as I will trying to manage my diabetes through diet.
Never crossed my mind they could be related

 

[JohnEGreen]

My daughter's doctor suspected that she has a goitre so ordered thyroid blood tests done when she phoned the surgery for the results was told results normal no further action required by the receptionist

When she contacted the doctors to ask what was going on one of the other doctors said well there is definitely a growth in your neck so I will refer you to the head and neck department at the hospital with a prospect of a scan to find what is going on.

She attended the appointment at the hospital today the specialist looked up her blood test results to find no thyroid tests had been done instead the surgery had done Liver function tests.

So the specialist has ordered the proper tests done and is setting up a scan for about three weeks time can you believe it what a mistake to make.

On the bright side at least she knows her liver seems OK.

 

[MrsA2]

Please tell her to not wait if it grows uncomfortable. Mine grew so quickly it was impeding swallowing. 3 weeks sounds a long time to me