Where to start?(Morbidly Obese, Hashimoto, Insomnia, liver problems)

[Kairo]

I don't know where to start.

A very difficult case
My brain is not working properly due to insomnia and stress
My problem is:

- Thyroid gland (hashimoto) - I start taking 3 mcg T3 x4 times every 4 hours and T4 in the morning
- Liver problems, pain under the right ribs, low glycogen levels (insomnia with nightmares/anxiety)
- Obesity, I think, because of this 2 problems
- Poor digestion of fats/sibo(i think because of liver)

I mean this is classic problems, but I do not know how to deal with it.
I take thyroid hormones, but they don't work because of fatty acids in the blood (I think) and constant stress due to poor liver condition
I can't lose weight because it makes me even more stressed, I feel like I'm trapped
Is it even possible to normalize the metabolism of a person suffering from obesity?
I'm just tired as hell.
No energy, cold hands, insomnia, bad mood - all kinds of problems that you can only imagine

I tried to lose weight with a low-carb diet, but insomnia is getting worse so i cant even sleep

 

[youngsinatra]

Ray said that thyroid can quickly fix a sluggish gallbladder.

The T4 you are taking (how much by the way?) might not be properly converted into T3 (which happens in the liver and is dependent on good liver functioning) and might even convert to rT3, which blocks the effects of T3, depending on how much T4 is used.

I‘d consider T3 monotherapy for a while. But then you‘d need a bigger dose of T3. (Total roughly around 50 mcg a day) I think Ray considered 50 mcg T3 sufficient to alleviate all hypothyroid symptoms.

 

[Peater]

It might be worth introducing coconut oil to your diet. as a quick, easy and mild first step.

Coconut Oil

Ray Peat

raypeat.com

 

[Herbie]

My opinion is that I would put a pause on the thyroid because it is difficult to dose correctly. I would use aspirin and progest e to help with insomnia and health. Maybe cyproheptadine for insomnia as well.

You need to do the opposite which is eat lower fat diet, only getting fats from highly saturated sources like dairy and coconut, moderate protein eat high carbohydrate but not low calorie. It's not about extremes and being malnourished and unhealthy. It's about being healthy and the body balancing the weight on its own. Forget about exercise, it's too stressful especially for insomnia.

Many people have trouble with sugar at first and do better with starch until their liver is healed.

All the information is here on this forum to normalise your metabolism and health. It will take years and is hardest at first but only gets easier and more and more improvements

 

[Momma]

These will help to know:
Age?
Are you male?
How did you get into this state?
What happened when you went low carb?
How long did you low carb?
**What is your current diet?
**What are your temps?
Are you taking other supplements orally?
Have you been obese most of your adult life?
Any recent lab work reveal anything worth noting? Ex. Low vitamin D. High cholesterol.

 

[Kairo]

These will help to know:
Age?
Are you male?
How did you get into this state?
What happened when you went low carb?
How long did you low carb?
**What is your current diet?
**What are your temps?
Are you taking other supplements orally?
Have you been obese most of your adult life?
Any recent lab work reveal anything worth noting? Ex. Low vitamin D. High cholesterol.

Age? - 25
Are you male? - Male
How did you get into this state? Hashimoto t4 monotherapy from age 15
What happened when you went low carb? Severe insomnia, muscle cramps, no energy
How long did you low carb? 1+ year
**What is your current diet? Rice/1-2 eggs/1-2L of Milk/Low fat meat(chicken/beef) coffee with milk and sugar,collagen powder/cacao/cola
**What are your temps? t35.9 p84 at wake and t36.6 p96 after breakfast
Are you taking other supplements orally? no
Have you been obese most of your adult life? yes and losing good amount of weight on lowcarb
Any recent lab work reveal anything worth noting? my TSH is 1.5 on 162mcg T4, no recent labs for cholesterol, but as i remember it was high, Testosterone is low, prolactin is high.

 

[AspiringSage]

Male hormone panel, sleep study.

 

[Momma]

Age? - 25
Are you male? - Male
How did you get into this state? Hashimoto t4 monotherapy from age 15
What happened when you went low carb? Severe insomnia, muscle cramps, no energy
How long did you low carb? 1+ year
**What is your current diet? Rice/1-2 eggs/1-2L of Milk/Low fat meat(chicken/beef) coffee with milk and sugar,collagen powder/cacao/cola
**What are your temps? t35.9 p84 at wake and t36.6 p96 after breakfast
Are you taking other supplements orally? no
Have you been obese most of your adult life? yes and losing good amount of weight on lowcarb
Any recent lab work reveal anything worth noting? my TSH is 1.5 on 162mcg T4, no recent labs for cholesterol, but as i remember it was high, Testosterone is low, prolactin is high.

So although you feel awful; it’s far from hopeless. Hashimoto's is about stress and inflammation. Where is this source of stress? Ex: over training. Night shift. Unresolved trauma. Your line of work. Type A personality. Parents driving you.

The good is you are on no supplements and your tsh isnt sky high. You’re young. Big plus’s.

What is your height? Weight? All over weight? Or stomach / gut weight?

15 year old boys require much nutrition.
Must know if you were restricting or eating a lot during those teen years. From 15-18.

 

[AspiringSage]

High prolactin can cause weight gain, depression, low dopamine, low testosterone, crashed sex drive, etc

I’ve had great luck using vitamin B6 and low doses of idea lab metergoline to bring down my lab ferrets prolactin levels. I’ve also experimented with cabergoline and P5P in the past. Cabergoline is very effective but also expensive. Didn’t have too much luck with P5P; but, I’ll re-run that experiment eventually. Always best to start low and slow with such experiments wouldn’t want to make your lab ferret manic from sky high dopamine. Dopamine is suppressed by prolactin. So, you need a little prolactin, but too much or even “high normal” can cause issues.

IdeaLabs Online Store - Lab / R&D Chemicals

 

[Momma]

Stress ups cortisol/estrogen/prolactin, drops DHT, causes male infertility and prostate issues

If you try to discuss infertility with a fertility/reproductive specialist or an endocrinologist, and mention that chronic stress may be a factor in infertility, you will probably get laughed out of the room. This is not just speculation. This exact same thing happened to several friends and...

raypeatforum.com

Stress is a potent stimulator of prolactin and GH release

It is common knowledge among Peatarians that both prolactn and growth hormone (GH) are stress hormones that ar ebest kept as low as possible. This study shows that things hypoglycemia, surgery and exercise are all potent stimulators of these stress hormones. The last time I talked to my doctor...

raypeatforum.com

 

[AspiringSage]

I agree with others, I definitely think stress is a factor in this sort of a situation. There are questions around the best level to intervene in a stress cycle though.

Weight associated sleep apnea (episodes of interrupted breathing) can be a source of stress. It can be a viscous and ultimately deadly cycle. Being over weight or obese can trigger sleep apnea, which in turn drives stress hormones further impairing sleep. Someone in this condition often doesn’t have enough energy to exercise. Leading to even more weight gain. It’s a vicious cycle that ultimately leads to cardiac damage. High prolactin, low testosterone, etc.

So one level of intervention is diet/exercise and the resulting weight loss (evidence says this rarely succeeds alone). Another is to treat low testosterone and high prolactin with TRT and prolactin suppressants. Sleep studies and CPAP/BPAP are also another valid level of intervention. I think these approaches are more likely to work together than individually.

Wrist/finger blood O2 monitors are an inexpensive way to evaluate sleep quality and gives you data to approach your doctor. A blood hematocrit test (easily added to a hormone panel from a self service like Walk In Labs, My Quest, etc) is also a great test for sleep apnea. The test works because the body body often over produces hematocrit in response to intermittent hypoxia.

 

[Momma]

“(Melatonin and) prolactin are induced by stress, and darkness is a stress because it impairs mitochondrial energy production.”

Ray Peat

 

[qminati]

**What are your temps? t35.9 p84 at wake and t36.6 p96 after breakfast
that spike in pulse means your adrenaline is going up after breakfast which means you are lacking in energy before you eat and there isn't enough energy in your meal. You have to up your carb ratio until you see an increase in thyroid activity. Soon as you wake up you need pure carbs to get that adrenaline down, start with a glass of OJ and see if you can get some of that adrenaline down before you eat your breakfast. I remember when my coach kept telling me I needed more carbs, I thought he was crazy, but everybody is different and I was in such an energy deficiency that I had to go as high as 70% carbs in my meals just to activate my thyroid. Protein lowers blood sugar, so when you eat eggs you Also, not all carbs are created equal, for me personally, nothing works better than fresh squeezed sweet OJ. In your situation, I strongly suggest getting a continuous glucose monitor, you need to know how these meals are affecting your blood sugar and bypass the guessing game. Don't stop checking your temps at breakfast, when you are in a bad state of health, you need to know everything, even when you go for a walk you need to make sure that the walk isn't triggering adrenaline by checking temps before and after. Every single thing you do you need to monitor how it is affecting your temps, no more guessing, get all the info you can about your body all throughout the day so you can see what's hurting you and what's helping you and stop doing anything that hurts and keep doing everything that helps.

 

[Momma]

**What are your temps? t35.9 p84 at wake and t36.6 p96 after breakfast
that spike in pulse means your adrenaline is going up after breakfast which means you are lacking in energy before you eat and there isn't enough energy in your meal. You have to up your carb ratio until you see an increase in thyroid activity. Soon as you wake up you need pure carbs to get that adrenaline down, start with a glass of OJ and see if you can get some of that adrenaline down before you eat your breakfast. I remember when my coach kept telling me I needed more carbs, I thought he was crazy, but everybody is different and I was in such an energy deficiency that I had to go as high as 70% carbs in my meals just to activate my thyroid. Protein lowers blood sugar, so when you eat eggs you Also, not all carbs are created equal, for me personally, nothing works better than fresh squeezed sweet OJ. In your situation, I strongly suggest getting a continuous glucose monitor, you need to know how these meals are affecting your blood sugar and bypass the guessing game. Don't stop checking your temps at breakfast, when you are in a bad state of health, you need to know everything, even when you go for a walk you need to make sure that the walk isn't triggering adrenaline by checking temps before and after. Every single thing you do you need to monitor how it is affecting your temps, no more guessing, get all the info you can about your body all throughout the day so you can see what's hurting you and what's helping you and stop doing anything that hurts and keep doing everything that helps.

I agree with this. Stress will respond well with more BALANCED carbs. Meaning eat them with a fat and protein so you are not adding more stress with erratic blood sugar.

Edit: no CGM needed IME. Temperature will guide you.

 

[Elderflower j58]

This all be it very young thyroid pharmacist has some very interesting points.


View: https://youtu.be/gryScORY9Qw

 

[qminati]

I agree with this. Stress will respond well with more BALANCED carbs. Meaning eat them with a fat and protein so you are not adding more stress with erratic blood sugar.

Edit: no CGM needed IME. Temperature will guide you.

CGM is added information and blood sugar will show changes before your temperature does, balancing blood sugar is EVERYTHING, and understanding it will give you a better read on what your temps mean. I have done this and my improvement speeded up big time by not having to wait for my temps to give me bad news, why not go to the source? It makes absolutely no sense for somebody in bad shape to ignore blood sugar levels. More information is always better. Relying on less information instead of more is just wasted time.

 

[Kairo]

Thank you for all your posts.

Yes, stress is very destructive, but I think it all started with my childhood obesity (pufa/junk food) and Graves' disease (then hashimoto's), I had hyperthyroidism, and then I fell into a hypo-state.

Such a low level of thyroid hormones is already stressful, as I know that it constantly goes into a state of stress/adrenaline to compensate for low thyroid function, as Peat said
But since I was young, I felt pretty good on T4 monotherapy because liver health was fine.

I tried to add and take T3 in different doses and at different times. But I don't feel any benefit from it, I even experience symptoms of hypo after that
My plan now to fix this is

-Calorie deficit - slowly get rid of fat (including in the liver) (yes, it's stress and yes, it promotes lipolysis, but this is the only way)
-I only take T4 - because I can't stand T3, and this only causes me hypo and low energy levels even more
-Repair the liver (here I need to do some research to make sure that its function is fully restored)(like best vitamins/supplements)

If you have any tips on how to optimize this, I'll be glad to see them.

 

[Nfinkelstein]

This isn't a peaty answer but since you are significantly obese, and suffering as you have described, it might be worthwhile to consider a drug (semaglutide) ---doctors would readily prescribe it (not sure what country you are in) and it might get you over the hump initially. Sometimes in the beginning of a difficult health journey like you are on, a drug can be of help.