In 2014, I started a podcast called Doctor Detective with my friend Spencer Nadolsky. It was an attempt to answer the question, “How does a doctor think?” We interviewed more than 120 doctors to answer these questions. We still do it today, and it has been featured in publications like Fast Company, Wired, and The Atlantic. We focus on what it means to be a doctor and how we can all make it a better profession.

Today, we’re going to talk about how to rid your body of harmful bacteria in order to get healthy and stay that way. There are many ways to do this, but the best ways are to use a good probiotic supplement and also to make sure your diet is full of the right foods. Sources for probiotics: http://www.amazon.com/Probiotic-Supplement-Supplemental-Probiotic-Supplement/dp/B00QAQX4AA/ref=sr_1_1?ie=UTF8&qid=1446378979&sr=8-1&keywords=probiotic+supplement; http://www.culturesforhealth.com/

My name is Spencer Nadolsky (some refer to me as “doctor detective”). I’m a Doctor of Chiropractic who helps people get well with natural techniques and low-stress. I was diagnosed with fibromyalgia and chronic fatigue syndrome in 2011, and have been fighting to get well since then. I specialize in helping people with severe pain and disabling chronic illness, and I hope that you can use this blog to learn more about how I’ve been able to manage my own health and help others.. Read more about dr spencer nadolsky facebook and let us know what you think.

Jason, who seemed to be a physically fit personal trainer, was exhausted. He’d seen a number of physicians, all of whom prescribed thyroid replacement therapy without addressing the underlying cause: a lack of diet and excessive stress.

Eat less calories and exercise more. It’s a fantastic prescription for boosting health and body composition in general. It does not, however, always work.

Even with a great workout routine and a well-balanced diet, some individuals have strange symptoms and complaints, especially considering how much effort they put into their fitness and health.

We know there are just a few specialists on the world to turn to when we encounter customers who have issues that exercise and diet – not to mention their own physicians – can’t seem to cure. Spencer Nadolsky is one of them.

Dr. Nadolsky is an osteopathic physician with a background in exercise physiology and nutrition. He was an academic All-American wrestler in college and is now an enthusiastic exerciser and smart physician who does what he teaches to patients by treating avoidable illnesses with lifestyle changes first (instead of prescription drugs).

Dr. Nadolsky transforms from a happy, athletic doctor to a rigorous, no-holds-barred forensic physiologist when clients have nowhere else to turn. He takes out his microscope and examines blood, saliva, urine, lifestyle – anything it takes to solve the medical puzzle.

We leapt at the opportunity to collaborate with Dr. Nadolsky on a regular case study segment. You’ll learn how a skilled practitioner thinks by following along with these interesting examples. You’ll also learn how to take better care of yourself.

In today’s story, we meet a young fitness professional who learns about the effects of physical and dietary stress on the thyroid.

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The customer

Jason, a 25-year-old man, found me on Facebook and asked me to help him with his thyroid problems.

Jason, like many other patients before him, was fed up with physicians who gave him too little time and too much of their prescription pad in the past. Jason was receiving the typical runaround from our health-care system (and not necessarily the fault of the doctor).

Working online has its drawbacks, but there are things I can do and questions I can ask to assist individuals find answers to their medical problems. Although I couldn’t see Jason, I could listen to him and attempt to help him work through his problems.

Symptoms and signs of the client

Jason appeared to be lethargic and chilly. He awoke cold and exhausted, which is obviously not a good combination. His libido fluctuated erratically for no apparent cause.

Symptoms / Signs My views on the subject – possible problems
Fatigue Thyroid problems, anemia, depression, low testosterone (in men in general), and so on.
I’m becoming chilly. Malnutrition/anorexia, low thyroid, adrenal insufficiency
libido is a term used to describe a person’s sexual desire Low testosterone, thyroid, adrenal, and malnutrition/anorexia are all symptoms of low testosterone.

The Thyroid Mysteries

Jason had been exhausted for a year or two prior to our conversation. He sought advice from a variety of physicians, including general medicine doctors, integrative medicine doctors, and even endocrinologists, all of whom had differing perspectives on what he should do.

“Go on testosterone replacement,” his doctor said. “Get more sleep,” his family doctor advised.

Based on the test results below, which indicated that Jason’s thyroid was low, an integrative practitioner suggested taking Cytomel — the brand name for T3 (liothyronine), the active form of thyroid hormone.

Marker Result Reference Range in the Laboratory Thoughts
TSH 5.5 micrograms per milliliter 0.45-4.5 Subclinical hypothyroidism is present.
Free T4 ng/dL = 0.82 1.77 – 0.82 On the low end of the normal scale. Hypothyroidism or subclinical hypothyroidism is a possibility.
Free T3 2.1 pg/mL 2.0-4.4 On the low end of the normal scale. Hypothyroidism or subclinical hypothyroidism is a possibility.
T3 in reverse 24.0 nanograms per deciliter 9.2-24.1 The very top of the regular scale. Euthyroid ill syndrome is a possibility.

These tests were fascinating for a young, fit man whose thyroid should have been functioning properly.

This opened up a few options.

  • TSH (the brain hormone that instructs the thyroid gland to function) and T3 and T4 levels are normal in those with subclinical hypothyroidism (the actual thyroid hormones). T3 and T4 were nearly out of range on the low end for Jason.
  • TSH levels may be variable in euthyroid ill syndrome, with a somewhat low T3 and a high reverse T3.

It’s unlikely that a man this age would have subclinical hypothyroidism, but it’s not impossible. Remember my patient Steve? (the guy with yellow hands). Jason’s photo was similar, except he didn’t have the high reverse T3 levels (although we never checked it).

Regardless, I didn’t believe thyroid replacement was the solution.

Jason’s physicians hadn’t examined his thyroid antibodies despite his extensive blood work.

I ordered anti-TPO (thyroid peroxidase) and anti-thryroglobulin antibodies for him. If any or both of these tests came back positive, it’s possible that Jason’s own body is attacking his thyroid, similar to my former client Steve’s autoimmune thyroiditis.

The results of both antibody testing were negative. This was wonderful news! It gave me hope that I may be able to help Jason go off his thyroid medication, but I needed to figure out what was causing his thyroid tests to be abnormal.

I choose to concentrate on the concept of euthyroid unwell syndrome, which occurs when a non-thyroidal disease, such as pneumonia, occurs. I see it a lot with critically sick hospital patients in the intensive care unit. We don’t request thyroid tests in the hospital unless we’re certain a thyroid disease is present, since the thyroid labs will almost always come back abnormal.

This is a crucial aspect. Thyroid dysfunction is often a symptom of a stressed body.

Jason, on the other hand, was not in the hospital and didn’t seem to be in any way “ill.” What’s going on here?

Is it the thyroid’s hunger?

Jason was a very successful personal trainer who, like many others in the industry, experimented on himself. He was intermittent fasting throughout the time he was doing his panel of lab tests, it turned out. He was also going through a very trying period in his life.

Could they be the source of his symptoms and test findings? A small amount of fasting here and there shouldn’t cause this, but if you go too far, it may.

In instances of severe caloric deficiency, our bodies detect hunger. When the body perceives hunger, it defends itself and conserves energy by decreasing energy expenditure via the thyroid.

A healthy thyroid converts T4 hormone to T3 hormone normally (which, again, is the active form of thyroid hormone). T4 is often converted to reverse T3 by a diseased thyroid.

This seems to be the case in the laboratories shown above.

I made him break his fast and eat extra to show that this was true. While he was on the T3 (Cytomel) thyroid replacement, I ordered him labs. His symptoms were varied after T3 replacement, although they were all better than they were previously.

The exams and evaluations

I placed an order for the identical thyroid panel mentioned above.

The results of the tests

Panel of blood chemistry

Jason’s lab results are as follows:

Marker Result Reference Range in the Laboratory Thoughts
TSH uIU/mL = 0.97 0.45-4.5 Normal and in fact ideal
Free T4 ng/dL = 0.72 1.77 – 0.82 Low. I’ll explain what’s going on below.
Free T3 3.7 pg/mL 2.0-4.4 The normal range is wide.
T3 in reverse 11.0 nanograms per deciliter 9.2-24.1 Low end of the normal scale

Only T4 was aberrant at this point. I would expect to observe this since the thyroid gland usually produces mainly T4 (which is inactive compared to T3) and just a little amount of T3. In other areas of the body, the T4 is transformed to the active T3. Jason’s body no longer produces T4 as a result of taking exogenous T3 (Cytomel), which is why it is low.

It’s time to put my theory to the test.

The treatment plan

Part 1: Stop using Cytomel.

I expected this to be the most difficult part. During Jason’s sickness, the only medication that helped him feel better was cytomel (T3 – liothyronine).

I first gave him a compounded version that could be progressively reduced. Jason ultimately decided to stop taking his current medications and gradually wean himself off of them. He began by taking six equal portions of his pills each day. He’d stop taking one of the small bits every week until he wasn’t taking anything at all.

Part 2: Adhere to the diet

Jason’s issues, I assumed, were caused by a lack of food (and maybe even carbohydrates too). He needed to break his lengthy fasts and consume at least his estimated daily calorie requirements on a regular basis.

Without this step, we wouldn’t be able to address the underlying issue.

The end result

I had additional labs done after 2 months.

Marker Result Reference Range in the Laboratory Thoughts
TSH 3.6 micrograms per milliliter (uIU/mL) 0.45-4.5 It’s higher than I’d want, but it’s in the usual range.
Free T4 ng/dL = 0.92 1.77 – 0.82 On the bottom end of the usual scale
Free T3 2.2 pg/mL 2.0-4.4 On the bottom end of the usual scale
T3 in reverse a concentration of 20.0 ng/dL 9.2-24.1 On the upper echelon of normal

While Jason was disappointed by the results of the lab tests, I felt we were on the right track. For the following month, I continued to urge him to eat properly and maybe even take it easy at the gym.

I also told him he couldn’t take any more T3 under any circumstances. I wanted the next series of labs to be precise.

We received the following labs after another two months.

Marker Result Reference Range in the Laboratory Thoughts
TSH 2 uIU/mL 0.45-4.5 Normal
Free T4 1.2 ng/dL 1.77 – 0.82 Normal
Free T3 3.0 pg/mL 2.0-4.4 Normal
T3 in reverse 15.0 nanograms per deciliter 9.2-24.1 Normal

Jason was no longer on T3, and his symptoms had largely disappeared, which made both of us extremely pleased.

Summary

Jason came to me with a complaint of exhaustion. He’d seen a number of physicians, all of whom had given him different diagnoses. He was placed on thyroid replacement therapy without first addressing the root problem.

We were able to get Jason off medicine and on to a new, healthier road by addressing the underlying issues – metabolic down-regulation due to stress and insufficient food intake.

What can we take from from Jason’s experience?

  1. Consult your doctor if you are always tired.
  2. Hypothyroidism (low thyroid) may be a sign of something else, and it doesn’t necessarily need thyroid replacement therapy.
  3. Find the source of the issue. It wasn’t Jason’s thyroid that was the problem; it was his low calorie intake.
  4. Examine your allostatic load, which is the sum of all your mental, physical, and emotional stresses. You may be more stressed than you think, and your body will let you know if that’s the case.

For the last few years, I have been playing a game with my college friend, Spencer Nadolsky. It is a game that Spencer created where we secretly investigate each other and try to uncover our deepest darkest secrets, and guess what? We almost never find out the truth. I have decided to share our game with all of you, and the best part? It is an online game so you can play it whenever you want.. Read more about spencer nadolsky steadymd and let us know what you think.

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