Transcription
We get a lot of questions about thyroid, about the thyroid hormone and its effect on fat, and on insulin resistance, and so on weight gain. So we're going to talk about thyroid hormone in our classroom this morning for a few minutes, and then we're going to go to your questions and spend the balance of our time answering questions. So unless anyone has anything else to add, I'm going to turn the time over to Dr. Bickman.
Yep, great. Thanks, Jack. Now, Rich and Carly, I can only imagine you guys have to see even more questions about thyroid hormone and weight than I even do. Now, I see comments on social media, but because I'm not directly interacting with clients that are wanting to lose weight and improve metabolic health, I suspect you guys see it ten times more than I do.
Right. That's a common. Yeah, a lot of women who have it are worried to eat this way. Yeah, I'm thinking that it's going to mess up their hormone even more. And a lot of women who are fearful of thyroid problems are worried to eat this way. Yeah. Um, and that, that is totally unjustified. So, uh, the, the evidence suggesting that a ketogenic diet, although this is outside the scope of the article I want to get to, but this is a relevant point, the evidence that a ketogenic or low-carb diet is in any way going to negatively impact thyroid hormone production or function is totally unsubstantiated. I know of no evidence that suggests there is a direct problem that is that that this dietary intervention is going to somehow aggravate or even or cause any thyroid problems. So I'm extremely confident in saying that.
Now, this article, it's, it's entitled, are you guys going to show a little title of it or a snap? It's entitled "The Influence of Thyroid Hormone Level on Insulin Action in Human Adipose Tissue." I wanted to highlight this manuscript, although it's very, it's very basic. What we would call in, in a laboratory setting, it's very basic. What they did was actually pull fat biopsies from people. In fact, what we do that in my lab here. And then they looked at the composition and the action of insulin on those fat cells, whether in two groups of people or three, actually: healthy people with normal thyroid, people with hyperthyroidism, and people with hypothyroidism. And I like this manuscript because it really represents this confluence of a lot of interesting ideas: thyroid hormone, fat cells, and insulin.
Let me interrupt for just one second. Yeah. So the, the actual article is behind a membership wall. However, yeah, however, I'll have the team put the link in there because you can read the abstract, and you could pull, excuse me, our followers could pull up the article. That's right. You can pull up the, and even read the abstract, which always highlights some of the key points. Okay. And those of you who are tempted to pay, don't. It's not worth paying for this manuscript. If you're tempted, if you've got a lot of extra money, well, and I guess, go ahead. It's not worth it.
So again, just to set the stage, there is without a doubt a tremendous connection between thyroid hormone and body fat control. If, and that's because thyroid hormone is known to kind of set the, the, the choke valve or the idle speed of the engine, the metabolic engine. The, the entirety of human metabolism is the sum of all the reactions in all the cells. Thyroid hormone basically accelerates those reactions. So when someone has hyperthyroidism and they're losing weight, they have a higher body temperature, they're hotter, they're sweaty all the time. It's because their metabolic rate is much, much higher. Thyroid hormone is is pushing the accelerator of virtually every chemical reaction. In contrast, if someone has hypothyroidism, then they're gaining weight more, and that is, at least on the surface, because their metabolism has slowed greatly, and it has. They're much colder, and and even body temperature is a function of metabolic rate. Metabolic rate has slowed, they are colder now, and they always need to be bundling up.
Now, there's something more than just metabolic rate, and that's what this study touches on: how thyroid is is having a direct effect on fat cells. And I'm, I'm taking too long. So I've described the connection between thyroid and obesity, as well as what thyroid hormone does. One interesting note from this study is that people with hyperthyroidism actually have about double the normal amount of insulin in their bodies. But can you see the problem? Right. That immediately sort of creates this paradox because I'm very much an advocate that insulin matters for obesity, and when insulin is high, it's promoting more energy storage, and fat cells are growing. And yet, people with hyperthyroidism are losing weight like gangbusters. How do we reconcile this? Um, and on one easy answer, it is, while there's other things going on and that we can't explain, but there is an explanation, and this study highlights this. Much of that, up to half of all of that insulin that is being detected as insulin is actually something called pro-insulin. And when some, so if, if someone is has hyperthyroidism and they would their doctor would say, "Your insulin is in 22 micro units," which is what the average was in this study, that is high. I would say that is high. Um, but half of that could be this pro-insulin, which is the kind of primordial version of insulin. It's, it's insulin in an immature state. It's not matured all the way, and in fact, it's not nearly as functional. It only has about 5% of the functionality that normal insulin has. So we say they have almost double the normal amount. In reality, it's that's not what is happening. They're about normal with regards to their actual insulin level. So that's one sort of discrepancy to reconcile. If anyone's noticed this, hyperthyroidism, they'll have higher insulin. It's not really insulin, it's this primordial or immature version of it.
Now, some of the direct findings from the study, and this was highlighted in Figure 1, if you guys do have the manuscript and you want to follow along. What they found was that the number of insulin receptors on fat cells varied widely in these two groups of differing thyroid levels. Basically, the people with hypothyroidism, so the people with low thyroid level, they had about 70% more insulin receptors on their fat cells. And an insulin receptor is a place where insulin will come and knock on the door of the cell and tell the cell to do something. And when insulin comes to a fat cell, it tells it to take up energy, like glucose and fat, and to prevent the breakdown of that fat. So it inhibits a process called lipolysis. So it prevents a fat cell from shrinking. And again, in hypothyroidism, these people's fat cells have 70% more insulin receptors. So insulin is doing that much more of telling fat cells to grow. In contrast, the people with hyperthyroidism had 40% fewer insulin receptors than the normal people. So the difference between them ends up ends up being more than double, where the hyperthyroid, the hypothyroid individuals have more than double the amount of insulin receptors on their fat cells, specifically not other tissues, their fat cells, as the people with hyperthyroidism. So it's amplifying what insulin is going to be doing at the fat cells.
And even independent of fat cell number, in also in Figure 1, they found that insulin was binding to the insulin receptors much, much better in the people with hypothyroidism. So not only do they have more insulin receptors on the fat cells, allowing insulin to work better, but the insulin is actually binding much better. There's something about those insulin receptors on the fat cells in hypothyroidism that is allowing insulin to work even better than it was before.
Do we know what's causing that? Um, they actually do elaborate some. What's called, uh, post-receptor mechanisms. So when insulin comes and binds to a receptor, there's a series of biochemical events called a signaling cascade, and thyroid is directly altering how those kind of secondary players are working. Oh, wow.
Now, one last comment as I, and I'll finish this up. Um, it is, look, they looked at what insulin does to lipolysis. And that is the term to refer to the breakdown of stored fat. Fat is stored as triglycerides, and it's this big pool of triglycerides in a fat cell, and then you start pulling off the individual fatty acids from those triglycerides. That's lipolysis. In hypothyroidism, low thyroid, even though there's a lot more, well, not even though, because of there a lot more insulin coming and working better, lipolysis is dropped significantly. Just insulin, even like molecule per molecule, insulin is inhibiting lipolysis better in the hypothyroid fat cells. In other words, insulin is making the fat cell more inclined to store its energy. In contrast, in the hyperthyroid fat cells, insulin is not inhibiting lipolysis as much. So even though the insulin is coming to the hyperthyroid fat cell, the fat cell is still breaking down fat much more readily. So in that sense, the fat cells kind of become a little insulin resistant, you know what I mean? Because normally, insulin should be telling a fat cell to inhibit lipolysis. So the fat cells are actually more responsive, they're more insulin sensitive in this regard. Insulin is working even better to inhibit lipolysis and force the fat cell to store more. In contrast, in the hyperthyroid fat cell, it's become a little insulin resistant, only in this aspect where insulin, even though it's coming, it's not as powerfully inhibiting the breakdown of fat. So the fat cell is breaking it down more.
Now, there's a lot to unpack there. Hopefully, yeah, hopefully you guys could follow along. One other finding that they note in this study is a note of warning. People who are going to be tempted to abuse thyroid hormone, don't. Because that will directly start altering insulin production. So these are drugs to be used with thyroid medications to be used very carefully. If you've been prescribed them, don't abuse them. Think you're gonna accelerate fat loss and do yourself a metabolic favor. No. When you start messing with thyroid hormone, you are messing with a powerful signal that affects the entire body from brain to toes and everything in between. So don't be tempted. But here, hopefully now you understand a little more the axis, the interaction between insulin, fat cells, thyroid, and basically, independent of what thyroid does to metabolic rate, increasing it or decreasing it when thyroid is high or low, we also have this direct effect of thyroid on the fat cells. When thyroid hormone is up, the fat cell is is, uh, has changed its insulin signaling, and now it's releasing fat more readily. There you go. There you go. Yeah, hopefully that wasn't too much. Don't worry if it was too much. We won't, I won't do this much of basic research in the future. I'll try to, I'll try to stick it the whole human level. Yeah, I just can't help myself.
Can I ask 20 questions now? Anything. Please. Let me set that. Let me let me set up these questions with two quick comments. First of all, we always remind our viewers, never, we are not your doctors. Yeah. Okay. Dr. Beckman is not your physician. Yep. Can consider and get together with your doctor. Always consult with your doctor before making any changes in lifestyle or medications. Okay. We okay with that? Yeah. Yeah. Number two, we know our audience pretty well. We have lots of really, um, we have lots of metabolic scientists in our audience that understood every single word said. Good. Good. On the other end of the spectrum, we have a lot of people that are quite new to this space and certainly are more, need that broken down just a little bit. So if some of the questions that we're gonna have, Carly and Rich, maybe pose, if you could from our clients, from our students' perspective, kind of frame up a couple of quick questions on this topic before we leave the topic, that'd be great. I love that. Be partly because I'm a student as well. I'm trying to figure out my own, um, body and how it works. And also all the clients who come to me and want answers and don't necessarily, I can't necessarily give them all the answers. So my first question is, you kind of indirectly exposed this idea that although you can control your insulin through what you eat, not everyone is going to see the same effect to lipolysis or weight loss. Yep. Um, based on what they do. And I think this has always been kind of a debate. You know, when we have clients come in who say they're doing the program perfectly, and I believe that they are, and they see a lot of improvements to their A1C, their their blood glucose, even their insulin, they see an improvement to insulin, but they're a little, I don't really like this term, but they're a little weight loss resistant. And, um, that kind of, I mean, this is one example of how you could be absolutely lost. We know without a doubt that there are direct differences on fat cells that can predispose someone to losing weight more easily than someone else. Not only the expression of insulin receptors, as this touches on directly, and we this highlights directly the effect of thyroid on insulin receptor number. And there are people with very natural fluctuations in thyroid that can even they can fall within the normal range and thus not be flagged, but because they're significantly different from someone else, we know the study proves that can affect the degree, the the number of insulin receptors. And if you have more insulin receptors on your fat cells genetically than someone else, you are going to have fat cells that are just going to want to be bigger than someone else's. There's just no way around that. So the question is, when you have a client that comes in and weight loss is their goal, which we try, the first answer to this, this client who that's all they care about is the number, yeah, the first thing I try and help them do is change your perspective. My dad always said, "You get rich quick or how do you get rich quick overnight by changing your perspective?" And I think that that's often the case with health. We focus on the wrong things, and we need to care more about our long-term health and less about what magazines show us or, you know, Instagram or social media shows us is what we consider healthy, apparently. Yeah. Yeah. And I think that's really important to understand that. But also, um, a thyroid condition isn't something someone can necessarily fix or it depends on the problem. Yeah. You have some are more easily addressed than others. But it is, it is hard. This is a, this is a hormone that is so fundamental to life, and its production is different. Thyroid hormone is almost in its own kind of class. It's not a cholesterol-based hormone like the sex steroid hormones. It's not a, like peptide-based hormone. It's its own kind of thing, uniquely produced, uniquely metabolized or or removed from the body. That it's, it's a difficult one to just go in and try to fix with a simple solution. In fact, you can't. Yeah. So are there other conditions off the top of your head that have the same, um, effect on those insulin receptors and kind of a resistance to lipolysis? Um, yes, yes, but they are extreme. There are some conditions known as monogenic obesity where there are actual gene mutations in some of the genes that control expression or hormones that also influence this expression. But they are very uncommon. Short, in, in the average individual where you guys see this kind of heterogeneity, some people respond well, some people don't. I do believe people will be quick to to invoke, "Oh, my metabolic rate or my metabolism just doesn't work." That is just not accurate. Metabolic rate is not the key. That's why I wanted to shift the conversation to this because we know that the bigger the person, the higher the metabolic rate. And everyone as they start to lose weight and there's just less of their body, the metabolic rate comes down. That should be a study actually, another time. There was a very cool study that looked at this phenomenon and just kind of blew it apart. But the expression of insulin receptors on fat cells, that is going to much more explicitly dictate whether someone's going to be shrinking their fat cells more easily than someone else. But it is a note of caution and an encouragement to be patient, right? That if the person is getting frustrated and and they're, they're 45 years old and it took him 20 years to gain that weight, expect it to take 20 years to lose it, and you'll be pleasantly surprised when it only takes six or seven, you know, or something like that.
So what they could have, what might be an interesting follow-up study to this would be to then look at people because this was looking at people regardless of their diet. Yeah. No dietary intervention. So that my my follow-up question would be, if you were to eat in a way that controls your insulin, would that change the effects of lipolysis or how your body's responding to that insulin? Yeah. Yeah. Well, I'm sure it would, just because you would be avoiding foods that are spiking insulin. And that would then, even though those fat cells have more insulin receptors, if there's just less insulin, then there's just fewer people knocking at the door. Yeah. Yeah, that makes sense. So it goes back to the same principles, really, that we teach. Even if this thyroid condition is a, is another problem or another roadblock or a stumbling block, in many ways, it goes back to exactly the same, same answer. Yeah. I don't think it changes the conversation. Yeah. It just maybe helps us have a little more, um, patience and compassion. Yeah. Good.
Carly, have you ever had clients with menopause that struggle on the on the program? Yeah. What I typically see is that this, for lack of scientific wording, seems to have kind of an anti-aging effect. So I've seen people, women who thought they were through menopause, start to kind of slide backwards and see menopausal problems. Or people who haven't had a period for a while and they think they're getting through menopause, go back to a, a very regular period. So it's almost like an infertility age. Yeah. It makes you younger. Yeah. Which is interesting. Yeah. Well, that that would be, there are studies that look at some of the metabolic changes that accompany menopause, including the loss of estrogens, which does have direct effects on fat cells and changes in insulin resistance status and insulin levels. Those also change with menopause. Yeah. We might want to do a metabolic class. Oh, I got the articles. I got the articles for it. I got, if you guys, I got articles for everything. That's like, I'm trying to sell. I got like my trench coat on PCOS articles, like metapods, dementia articles. And we love your suggestions. If you have a topic you'd like to suggest for one of the metabolic classroom episodes, please do so. So yeah. Right. Anything else about thyroid? We'll move on.