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Hypothyroidism – Managing depression and weight

9th September 2008

Hypothyroidism – Managing depression and weight

The final installment in the series on hypothyroidism discusses how to manage both the lingering depression and weight gain characteristic of hypothyroidism. Please keep in mind, I do not have all the answers – if I did, I wouldn’t have been inspired to create the series. I still struggle with depression even though I take both thyroid hormone replacement and an antidepressant. I still struggle with unexplained weight gain, even though my TSH levels are in the normal range and I enjoy a healthy diet and active lifestyle. I may not have all the answers, but the information provided here may at least help you better formulate the questions.

Depression and weight gain are amongst the chief symptoms of hypothyroidism, but unfortunately, are also among the most misdiagnosed, too. Some researchers estimate that as many as 52 percent of patients who suffer from major depression and do not respond to antidepressants have undiagnosed hypothyroidism. And many, especially women for whom hypothyroidism is five to seven times more likely than men, who go to their doctors and complain of unexplained weight gain are often dismissed with a prescription not for lab work, but for Weight Watchers. So, what are some ways in which people with hypothyroidism can better manage both depression and accompanying weight gain? More information follows after the jump.

Depression

In a survey of thyroid patients, 63 percent described depression as a continuing problem, despite being treated by their doctors for their thyroid condition. A malfunctioning thyroid may not only be a marker for depression, having a thyroid problem may make it easier to develop depression, or may worsen symptoms of depression. If you are being treated for your thyroid and your thyroid-related symptoms are all alleviated except for depression, you may want to talk to your doctor about treatment for depression. If you still suffer from depression as well as other thyroid symptoms, you may want to first ensure that you are receiving optimal treatment for your thyroid before accepting a depression diagnosis. As covered in the installment on medication and treatment, you may need a dosage change, a change in brand, or the addition of T3 drugs.

Weight gain is a side effect of many antidepressants, so those with hypothyroidism who already experience unexplained weight gain may be reluctant to go on one. Some people are able to manage their depression through therapy, but for others, clinical depression is caused by brain chemical imbalances and can only be remedied with medication that corrects these imbalances. Ultimately, only you can decide if living depression-free is worth the extra pounds you may or may not gain as a side effect. For the down and dirty on antidepressant medication and side effects, I recommend the site Crazy Meds. And keep in mind, exercise is not only key for overall health, it also works as an antidepressant in itself.

Weight Management

I want to begin this section first by clarifying a few important points and definitions.

Diet – The foods habitually eaten by someone in order to live.

Dieting – The active restriction or limitation of food in order to lose weight.

Unexplained weight gain – Weight gain despite a reasonable diet and physical activity.

I do not promote dieting and I don’t believe a thin size fits all. I do, however, believe that some people weigh more than what is healthy for them. Many body-size acceptance sites do not promote weight-loss of any kind. This is not one of those sites. I promote healthy diets and active lifestyles for healthy relationships with food and weight. It is my belief that for most people, a balanced diet and an active lifestyle will help them reach and sustain a weight that is healthy for them. That said, even those people with hypothyroidism who do enjoy healthy diets and active lifestyles may find it difficult to manage their weight. This section applies to them and them only.

When you’re hypothyroid, you can eat less than others and exercise more, and yet still gain weight. The equation of calories in/calories burned does not apply to people with thyroid irregularities, because our internal calculators that perform these calculations are broken. Even people with treated hypothyroidism experience unexplained weight gain and find it difficult to lose the extra weight. You are not lazy and you do not lack willpower. You’re probably not melded to your couch shoving a box of Twinkies down your throat. In fact, your eating habits are probably not much different or are even better than those of your thin friends and family. Your body may refuse to lose weight even on a restricted diet of rabbit food. It isn’t fair and it’s demoralizing, but there are things you can do to better manage a healthy weight for you.

Why do I gain weight?

Metabolism and You – With hypothyroidism, the metabolism is impaired in three key ways:

Metabolic Dysfunction – The thyroid gland is the master gland regulating metabolism, which determines how the body converts food to energy. Food not used as energy is usually stored as fat. With hypothyroidism, the body becomes highly efficient at storing every calorie consumed and in extracting more calories than usual out of the food we eat. Hypothyroidism affects the metabolism in three key ways:

Basal metabolism – Some 60 – 65 percent of the calories you eat each day are spent just keeping you alive. Even if you were to lie in bed all day, you would require a certain number of calories to sustain bodily functions. In hypothyroid patients, the basal metabolism is reduced and may be lower than normal. Metabolism also slows down with age, and since hypothyroidism is also more common as we get older, the combination can be a double whammy for some people.

Physical activity – Some 25 percent of the calories you eat are burned by movement and physical activity. Fatigue, muscle and joint aches and pains and carpal tunnel syndrome are common symptoms of hypothyroidism and can all result in reduced activity. Less exercise and activity also means there is less muscle (muscle burns more calories than fat and raises metabolism). Outside of the myriad of benefits exercise brings, this is one of the reasons why exercise should be an especially key part of hypothyroid treatment.

Thermic effect of food – Many chronic dieters or people with eating disorders are familiar with the concept of “negative calorie” foods – that is, foods that require more calories to digest than they contain. The thermic effect of food concept is kind of similar. About 10 percent of calories are spent processing and digesting the foods you eat, so, if you eat 2,000 calories a day, then 200 of those calories are spent eating and digesting your food. For people with hypothyroidism, the thermic effect of food is limited and fewer calories are expended in digestion. People with hypothyroidism who overeat compound the problem further by taking in even more calories that aren’t expended by the body.

Changed Metabolic Set Point – We often hear about “set point” weight theories on fat acceptance blogs, but rarely is the term defined nor is it acknowledged that one’s set point may possibly change over time. The basic premise of the theory is that the body has a built in weight regulating mechanism, largely genetically determined, that works to keep your weight within a physiologically established range healthy for you. Think of it like your body temperature: A normal body temperature is 98.6 degrees and the body works to maintain this particular temperature at all times. Temperatures above and below 98.6 degrees may indicate sickness, disease or trauma. In people with hypothyroidism, it is thought that the body puts up only a modest metabolic resistance to weight gain. If you take in more calories than you burn – and because of slowed metabolism, this doesn’t necessarily mean you overeat — the metabolic resistance loses strength and your body establishes a new, higher weight set point.

Let’s say you are a 5-foot-3-inch woman who weighs 140 pounds. You need 2,130 calories-a-day to maintain this weight. Fast forward several years later. You have been diagnosed with hypothyroidism and have steadily gained weight, so that you now weight 200 pounds, a weight that requires about 2,500 calories-a-day to maintain. If you dropped your caloric intake back down to 2,130, would you lose the extra 60 pounds? No. As you reduce your calories and lose weight, your metabolic rate slows down. You may lose some of the weight, but it would probably only be about 10 – 15 pounds even though you are consuming the same number of calories as another woman of the same height who’s stayed steady at 140. Because metabolic resistance is impaired in people with hypothyroidism, the body establishes higher set points, making it harder to lose weight.

Changes in Brain Chemistry – Hunger is regulated by the hypothalamus, which sends messages the body interprets as “hunger.” Once the hypothalamus senses that you’ve eaten enough, it releases serotonin to tell the body “enough.” Chronic hypothyroidism can interfere with brain chemistry to reduce the release of serotonin. Thyroid irregularities also slow down the metabolism, but the brain doesn’t get the message and isn’t able to adjust its appetite level accordingly. What your brain perceives as appropriate food intake levels then exceeds your impaired metabolism’s ability to process it, thus resulting in weight gain.

Insulin Resistance / Metabolic Syndrome
– When you eat foods that contain carbohydrates, your body converts the carbohydrates to simple sugars. These sugars enter the bloodstream, becoming blood sugar. Your pancreas then releases insulin to stimulate the cells to take in the blood sugar and store it as an energy reserve, returning blood sugar levels to normal. Insulin resistance means that cells have become less responsive to the effects of insulin. Your body, in turn, has to produce more and more insulin in order to maintain blood sugar levels. Some doctors estimate that, for as much as 25 percent of the population, eating a “normal amount” of carbohydrates may in fact raise blood sugar to excessive levels. For this group, consistently eating too many carbohydrates – and what is too many for this group is not necessarily too many for the average person – creates insulin resistance.

When insulin remains in your blood in higher concentrations, this is known as hyperinsulinemia. High insulin levels can stimulate your appetite, making you feel hungrier than normal for carbohydrate-rich food, while lowering the amount of sugar your body burns as energy and making your cells more effective at storing and less able to remove fat. Excess insulin also prevents your body from using its stored fat for energy. Thus, your insulin response to excess carbohydrates causes you to gain weight or makes it difficult to lose weight. Insulin resistance can also pose a host of other serious health problems, from diabetes and coronary heart disease to high blood pressure and high cholesterol.

So, how does this relate to hypothyroidism? Hypothyroidism slows down our body’s ability to process carbohydrates and our cells’ ability to absorb blood sugar. Excessive carbohydrates results in higher insulin levels, which causes excess weight. And any illness, like chronic hypothyroidism, creates physical stress. Stress raises cortisol levels, which, in turn, increases insulin levels. What this means is that insulin resistance is more of a risk for overweight people with hypothyroidism than it is for the general public.

So, how can I lose the weight?

The information I’ve provided on thyroid problems and weight is pretty depressing, but there are things you can do to help manage a healthy weight.

Optimize your thyroid treatment. It is crucial that you are receiving optimal treatment for your thyroid problem. You may gain weight even with the best diet and fitness program if your thyroid levels are too high or you are one of the many patients who needs T3 drugs. And be sure you are taking your medication properly for maximum absorption.

Check your blood sugar. Home kits will allow you to get a glucose level, but a fasting glucose test is recommended to see if your blood sugar is normal or elevated. It can also signify if you are at risk for developing type 2 diabetes. Medications to treat elevated blood sugar levels are available.

Reevaluate your diet. I weighed about 200 pounds when I graduated high school. Five years later, I weighed 300 pounds for an average weight gain of 20 pounds a year. My diet at the time consisted largely of too much fast food, processed foods, and high carbohydrates and little to no physical activity. I lost 175 pounds, in large part from anorexia, and gained back 50 of those pounds from a year’s bout with bulimia. My diet and eating disorder stabilized three years ago, and I now eat a relatively low-glycemic vegetarian diet of about 1,800 calories a day and am fairly active. No food is off-limits, although I eat some in more moderation than others. I’ve gained about 25 pounds in the past three years for an average weight gain of 8 – 9 pounds a year. While weight gain is still an issue for me, I credit my improved and healthy diet and activity levels as the reason why I am only gaining less than 9 pounds a year, opposed to the 20 a year I gained previously. Sometimes, hypothyroidism is a matter of looking at the glass half full.

Thyroid deficiencies can vary person by person, so my plan may not work for you. I share my experiences simply to illustrate the limitations and benefits that good fitness and a healthy diet can have for one struggling with hypothyroidism. Caloric intake is a fine balance for people with hypothyroidism: We often have to eat less calories than someone of the same height and weight, but if we don’t eat enough calories, our already sluggish metabolisms will switch into hoarding mode and slow down even further. Low-glycemic diets high in protein, fiber, good fat and complex carbohydrates are generally recommended for people with hypothyroidism. You may also want to see a nutritionist who is familiar with thyroid problems for personal nutritional counseling.

Check your resting metabolic rate. A couple of years ago, I shelled out $40 for a test offered by a local nutritionist’s office that promised to measure my resting metabolic rate. The test I took used the MedGem Indirect Calorimeter device, which works by measuring oxygen consumption to determine one’s resting metabolic rate and ergo, daily energy needs. Of the three independent reviews I read of it, all have suggested the device to be reliable and accurate. The test provides the exact number of calories a person needs at rest each day. From that, you can deduce the average daily caloric intake that is optimal for your own personal health and lifestyle needs.

Drink water. Hypothyroidism can cause water retention and bloating and can also slow down digestion and elimination. It’s recommended you drink at least 64 fluid ounces of water each day.

Exercise. If you experience fatigue or muscles aches and pains characteristic of hypothyroidism, it can be an exercise itself in summoning up the motivation to exercise. The key is to start slowly and gradually work exercise and activity into your life. It’s also important that you find an activity you like, so that exercise becomes something you want to do and not something you have to do.

Have realistic expectations. People with hypothyroidism will find it difficult to lose weight, even if you’re doing everything doctors recommend for healthy weight loss. Your weight loss will be slower and harder than that of other people with your height, weight and build, who do not have thyroid problems. Most doctors say that a loss of 2 pounds a week is healthy and sustainable, but hypothyroid patients should count it a success if they lose just one pound a week.

What if nothing works?

So, you’re eating healthy and working out and you’re being treated optimally for your thyroid, yet you still can’t shed the weight. Keep in mind, “healthy” doesn’t mean a size 6. Or even a size 14. A healthy weight for you may be 150 pounds or it can be 250 pounds. If an inability to shed pounds is your only symptom of hypothyroidism, perhaps you have reached a weight healthy for your body. Part of living well with hypothyroidism means feeling well, and this is something that cannot be measured on a scale.

And so, this concludes the series on hypothyroidism. I hope it has been useful and educational for you. For more information, see:

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This entry was posted on Tuesday, September 9th, 2008 at 12:00 am and is filed under Health, Nutrition & Fitness, New Research. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

There are currently 9 responses to “Hypothyroidism – Managing depression and weight”

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  1. 1 On September 9th, 2008, Piffle said:

    Unfortunately, a new twin study shows that exercise may be correlated with less depression, not the cause of it. Exercise increases should not be expected to help with depression, though exercise is certainly good for your health in other ways. I don’t mean this to be a reason not to exercise, but if someone is told that they’ll feel better if they do “x” and then they don’t, that can cause feelings of failure that aren’t warrented.

    http://www.sciencedaily.com/releases/2008/08/080804165318.htm

    This has been a very interesting series of posts, thank you for all the good information.

  2. 2 On September 9th, 2008, Rachel said:

    Piffle, I find this study surprising, given the wealth of other validate studies that show quite the opposite — here, here, here and here, for examples.

    Even if the study is correct, I wonder how many of the people in that study had hypothyroidism. Exercise has been shown to improve metabolism, which in turn, is linked to both mood and anxiety symptoms. For people with impaired metabolisms, improvements in metabolic function can help alleviate symptoms of depression and anxiety.

  3. 3 On September 9th, 2008, Marste said:

    Rachel, THANK YOU SO MUCH FOR THIS SERIES. At 31, I only recently had a doctor (in my case, a Doctor of Oriental Medicine, not an allopathic doctor) diagnose me with mild hypothyroidism, and put me on supplements. It’s incredible to me what a difference it made. At my first check-back appointment she laughed when I told her that I didn’t even realize that other people weren’t chronically exhausted. I always wondered how people went out after work and socialized – by the time 5:00 rolled around, I just wanted to go to BED.

    And thank you again for articulating the viewpoint that a healthy weight for one person may not be a healthy weight for another person. Although I’m still trying to sort out for myself where my social conditioning to be thin intersects with my actual health, I know that I’ve been at weights (both high and low) that were unhealthy for me. But I’ve definitely noticed the unwillingness to acknowledge the possibility that the heaviest weights were unhealthy (for me) in other body-acceptance sites (though there doesn’t seem to be an issue with acknowledging that my lowest weights were unhealthy for me). So thanks for that, too.

  4. 4 On September 9th, 2008, Lisa said:

    These posts have been highly informative and very well researched. Thanks for writing!

  5. 5 On September 9th, 2008, Piffle said:

    Yep, I understand it’s surprising, that’s why the “may” is in there. If it wasn’t a twin study, I wouldn’t have payed much attention to it. I’m not trying to say that the science is settled, just that it’s not as cut and dried as we’ve thought for a long time.

    I’d also say that it’s conclusion is counter-intuitive, most of us feel better after we exercise, so that makes me unsure of this study too.

  6. 6 On September 9th, 2008, Rachel said:

    Yeah, I usually feel better and less depressed the more active I am, so in this case, I’ll trust that its working for me, even if its just a placebo effect. It’s kind of odd seeing a study come out like this when every other researcher is trying to motivate people to move more.

  7. 7 On September 9th, 2008, Tiana said:

    Piffle, thank you so much for that link. I’m extremely glad that I came back to this post to have a look at the comments. The Fatosphere is full of people constantly pointing out how awesome exercise is and it was making me feel like a failure indeed.

  8. 8 On September 10th, 2008, Piffle said:

    Thank you, Tiana, I like to help people. :)

  9. 9 On March 11th, 2009, Hypothyroidism update and worthless doctor rant » The-F-Word.org said:

    [...] Managing Depression and Weight [...]

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