Hypothyroid Face

The before and after pictures shared by Korg Kcuf in the last post on low-carb hypothyroidism reminded me of the stunning before and after hypothyroid treatment pictures I once came across.  Fortunately, I have found these photos online, and they do show some remarkable changes in facial appearance. 

You often hear this swollen facial appearance referred to as "carbo face," which is one of the more retarded things I've ever heard.  If anything, this should be called "Eskimo face," as the native Eskimo had perhaps the puffiest and roundest faces on earth. You can even see telltale signs of facial myxedema in this young Eskimo mother, with quite a bit of fluid gathering below and above the eyes.  And this is someone who is incredibly well-adapted and epigenetically-programmed to a diet high in meat and fat and low in carbohydrate. 

Anyway, Korg's development of increased abdominal fat, a posture more rounded in the shoulder area, facial puffiness, and a drooping chin among other changes are prominent signs of hypothyroidism, as well as hypercortisolism/Cushing's.  These two conditions tend to go together, overlap, and cause one another - so it's hard to separate one from the other.  There is no question though that these facial and physical changes can be used diagnostically to tell what, in general, is taking place in someone's body.  And sorry to pick on low-carb.  There are countless paths to hypothyroidism and/or hypercortisolism, such as calorie restriction, endurance exercise, stress, chronic inflammation, infection, winter, or allergy.    

I remember when I had just finished doing 5 months of intense physical exercise on a low-carb diet for the first time my body and face became very puffy.  My eyes started looking very swollen, especially first thing in the morning (interestingly, laying down for long periods allows gravity to bring the fluid back from the body and into the face - it's very common to have a puffy face in the morning that ends up in the "cankles" if you have spent a lot of time standing during the day).  This is not just from the low-carb diet alone though.  My face (and belly) got very swollen again during re-feeding after my most recent bout of overly-strenuous endurance exercise in 2009, and has since cleared out even though my weight has increased by 15 pounds (mostly lean tissue increase).  But enough about me.  Here are some before and after thyroid treatment photos featured at http://www.jcrows.com/hypothyroidism.html. 

Pay attention to the hypothyroid/hypercortisol affects, including swelling of the neck, swelling below the eyes and in the upper cheeks, swelling between the eyes and eyebrows (the fluid presses the brow upward), disappearance of the outer third of the eyebrow and hair in general, and subtle retraction of the nose.  Very fascinating.  If you're a nerd I guess.  Following a hypothyroid diet many notice steady improvement in these exact facial patterns, even if they gain body fat.  

Ray Peat - Broda Barnes

“One of my recurring objects of thought has been the slowness with which raw knowledge is assimilated. For example, I have been thinking about Broda Barnes’s work on the prevention of heart disease with thyroid extract. He did solve much of ‘the riddle of heart attacks,’ but recent statements by the Heart Association show that the dominant forces in the health business haven’t learned anything at all from his work, which he began 50 years ago. His work is clearly presented, not hard to understand, and it is scientifically so sound that no one challenges it, at least not on the scientific level. It is ignored, rejected by people who choose not to be bothered to read it. How many people have died from heart disease, since his work first became available? (And how many more from cancer, tuberculosis, and other diseases he showed occur mainly among hypothyroid people?)”
~Ray Peat

Like myself, Ray Peat was highly impressed with the work of Broda Barnes when he came across it. Ever since, with a deeper understanding of the hormonal and biochemical systems and their relationship with the cellular metabolic rate, Peat has been a firm believer that the preservation of a high level of metabolic intensity is the key to health and resistance to disease – both infectious and degenerative alike. I too have seen very little to sway me away from what is far more compelling than some dumb theory out of left field about villainous saturated fat or carbohydrates or gluten being the root cause of rising rates of many diseases.

Peat often mentions Broda Barnes and the Barnes method of assessing thyroid functionality – the morning temperature test. While I have recommended this simple home monitor for ages, and it is a decent overall indicator – especially when you see it rising in response to diet and lifestyle manipulation, Peat offers much more insight about how to get a better overall assessment of the level of thyroid-generated metabolic activity.

This is actually an incredibly important concept, as body temperature and even metabolic rate are not the be-all end-all in assessing the health of your thyroid hormone system. For example, adrenaline is a powerful stimulator of the metabolic rate. Go into any “health food store” and you are likely to see walls filled with “thermogenic” weight loss formulas like Lipo-6, Slim Quick, Arson, Hydroxycut, and countless others (most of them made by the same company, Iovate). The term “thermogenic” refers to the ability of these stimulant-laced pills to increase heat production in your body.

And yes, even anorexics with very low thyroid output often wake up in the morning, with adrenaline peaking, with a high body temperature and high pulse rate (two of the most prominent indicators of metabolic rate). Eating, however, makes body temperature and pulse rate drop like a stone. In a sense, when adrenal hormone levels are lowered, the true output of the thyroid gland is revealed, and shown to be extremely low. In fact, testing your body temperature and pulse before and after meals is actually a pretty decent way to tell whether or not your adrenal glands are overactive. If pulse and body temperature drop, your adrenal glands were likely way too active prior to eating. All I have to do is eat low-carb for a couple of days and then have a big carbohydrate meal to trigger this – or even just skipping breakfast or a hard workout will do this.

If you don’t feel like monitoring, just assessing how you feel before and after the meal is very revealing. If you feel tired and sleepy and brainfogged (like when needing a cup of coffee to boost adrenaline) after eating, odds are your adrenals were overactive prior. Feelings you might feel prior to eating in a high adrenaline state are mental focus, nervousness or anxiety, jitteriness or irritability, and the big one – cold hands, feet, and tip of your nose (blood rushes away from the extremities when adrenaline surges).

According to Peat, this may be a better indicator of true thyroid function than an actual body temperature reading because of the interference you can get with the adrenal hormones on a body temperature reading. My real world experience thus far suggests that this might be the case. JT and I both for example, had healthy body temperatures on diets that destroyed our health via signs and symptoms of adrenal fatigue (and in JT’s case, actual diagnosed severe adrenal fatigue). My body temperature actually fell when I initially started doing RRARF, while the health problems I incurred on a low-carbohydrate diet vanished. Eat to keep fingers and toes warm and you might just find your health improving.

Peat also points out that Colorado, where Barnes was a medical practitioner, made the body temperature reading that Barnes relied upon more accurate – as the weather there is cool enough most of the year that low thyroid function would indeed surface with low body temperatures. In warmer weather, body temperatures could still be held at 98.6 F even in a hypothyroid state, due to the ease of maintaining a higher body temperature in warmer weather.

This comment is both true and false. For starters, Denver ain’t that cool. One year I lived there saw 60 days over 90 degrees F. You also can maintain body heat just as well wrapped in warm clothes in cold weather as you can in shorts and a t-shirt in warm weather. And in today’s day and age, no matter where you live, odds are everywhere you go is relatively climate controlled with air conditioning and heat. Climate is something that humans have managed to distance themselves from pretty well at this point. And Barnes’s subjects were taking their body temperature first thing in the morning, covered with blankets and toasty as can be.

But, I have noticed myself, as I do not use air conditioning in the Matt Cave, that my body temperature gets extremely warm late in the afternoon as I sit in my shorts and sweat in 85-degree heat. My body temperature, while just under 99 degrees F in the morning (rectal, huh huh), climbs up close to 100 degrees F when I am physically feeling hot and sweaty. After a MAXercise session the other day when I was feeling even hotter my temperature sprang up to 100.7 F! So yes, if you feel hot, body temperature will be artificially elevated. But most people do not feel excessively hot when taking a morning basal body temperature reading, so I find this to be somewhat of an irrelevant point that Peat is all too fond of making in interviews.

Peat prefers to look at all of the indicators as a whole, which is a fantastic idea. Barnes was a medical practitioner. He had a lot of hands on experience with diagnosing and treating patients for hypothyroidism. But he certainly did not possess the vast knowledge of human physiology and hormonal interactions that Peat seems to possess. According to Peat, one of the best tests is simply seeing how much oxygen and carbon dioxide you inhale and exhale. The more oxygen you take in, the higher your metabolism. But if carbon dioxide is low, you are in a high adrenaline state (burning fat for fuel instead of glucose lowers carbon dioxide levels, and adrenaline favors fat burning while thyroid-generated metabolism favors more glucose oxidation, yielding greater carbon dioxide levels).

Calorie consumption that is abnormally high or low for your body weight is yet another indicator that Peat believes should be taken into consideration when trying to get the best overall assessment.

Anyway, the point of this post is simply that Peat acknowledges the work of Broda Barnes as being highly significant. Few could argue that it is not. But Peat has looked deeper into the big picture and has a much broader understanding of the many factors, thyroid hormones as well as thyroid-stimulating hormone (TSH), adrenal hormone interaction, and other factors involved.

Body temperature is just one tool in the bag. It is not the only tool. Assessments of the warmth of your feet and hands, sleep quality, the number of hours you can comfortably go without eating, pulse rate, sex drive, energy levels, fatigue after eating, bowel frequency, water consumption (should be high), calorie consumption, reflex quickness, blood glucose levels – both fasting and postmeal, menstrual regularity – anything and everything should be used in making an overall assessment of your health and self-diagnosing what may be needed to rebalance your “body chemistry” as Melvin Page called it. With those in mind, you can use nutrition and lifestyle change to the fullest.

Taking all that into consideration, you can use something like this program on how to raise your metabolism wisely, paying close attention and tweaking meal frequency, carbohydrate, fat, and protein levels – as well as even levels of salt or experimenting with starch vs. sugar and vice versa in restoring and/or maintaining your health. Most find this approach to be much more effective than they thought it would be. Simple changes often make a big difference. Drastic changes often lead to excessive blogging, ruin your health, and make your parents and remaining friends (the ones that weren’t so weirded out by your fanaticism they stopped calling you) worry about you.

More from Ray Peat on the subject....

Janie Bowthorpe Fail

Recently I contacted the site host of Stop the Thyroid Madness (and author of a book by the same title) Janie Bowthorpe.  I've been trying to explain to Janie what's been taking place at http://www.180degreehealth.com/ for quite some time, as I've seen the diet and lifestyle manipulation outlined in THIS FREE EBOOK repeatedly outperform thyroid medication for raising low body temperatures.

Since the low body temperature was the primary diagnosis tool used by Broda Barnes and his modern-day followers Mark Starr and Stephen Langer - the world's leading advocates of the type of thyroid therapy championed by Janie's site, I've been nothing short of relentlessly eager to share what is truly a groundbreaking and pivotal nutrition/lifestyle discovery (although it's not recognized as such by an any "authority").

Of course, Janie just brushed it off, not realizing that the vast majority of hypothyroidism as defined by Broda Barnes, Mark Starr, and others has a cause that is not genetic, and can be overcome without medication.  I think it's pretty cool, but Janie insisted that this article was not appropriate for her site because it promoted my site which is not acceptable to her guidelines and because she deals with people that have "organic thyroid disease" and not problems with leptin, omega 6, or dieting.

So be it.  I will continue to deal with the other 95% plus cases of "hypothyroidism" as defined by Barnes and Starr that is NOT a glandular disease, and do so with great success.  Perhaps half of the global affluent population has a leptin problem, pretty much ALL have an omega 6 problem as that's been a century in the making, and at any given time over half of Americans for example report being on one type of diet or another.  Those are all problems than can lead to, for all practical purposes, "hypothyroidism."        

Eat Your Way Out of Hypothyroidism

Decades ago endocrinologist Broda Barnes took the first steps in popularizing the use of the basal body temperature test for diagnosing hypothyroidism. If the body temperature was low, and classic symptoms of hypothyroidism were present – which varied from constipation to acne to menstrual problems to hypoglycemia to you name it… that warranted the “hypothyroidism” stamp, regardless of what blood tests showed.

Over the past decade I’ve personally explored this strange phenomenon to the deepest depths that I can, and my general conclusion is that Barnes was simply genius to pinpoint a low metabolism as a causative factor in an endless array of health conditions. By targeting and treating a low metabolism specifically, his performance as a physician was, and still is, unprecedented.

In the last several years I’ve had some major breakthroughs in my own personal research of this matter. For starters, to call a low metabolism “hypothyroidism” when thyroid hormone panels are at least close to normal is misleading. It really should be distinguished from true thyroid glandular malfunction, and I think Mark Starr, in coining the name “type 2 hypothyroidism” is definitely on the right track.

We now know that the thyroid gland is not the head honcho when it comes to metabolism, just as the dealer is not the head of Caesar’s Palace in Vegas even though it is the dealer that is controlling the cards themselves.

The thyroid takes its orders, rather, from the hypothalamus in the brain, which sends out signals to the entire body as to whether to run at full tilt, or in what could best be described as “conservation mode.” It’s this mysterious conservation mode – this chronic low metabolism that so many people in the modern world suffer from, that I’ve spent so much time wrapping my head around.

When the thyroid gland is healthy and functional, but the metabolism is still low, it’s obvious that something peculiar is going on. In the rest of this post I’ll try to briefly describe what I think that peculiar something is and precisely what can be done about it in lieu of taking medication –desiccated thyroid, synthetic T3, or otherwise – as I’ve found that to be unnecessary to raise body temperature back to the ideal level in most cases – and the typical person on thyroid meds following my program has to stop taking the meds to avoid hyperthyroid symptoms.

In 1994, Jeffrey Friedman of Rockefeller University in New York discovered a brand new hormone – one that scientists had been chasing for decades. This hormone was leptin.

Leptin resides in the fat tissue where it communicates to the hypothalamus as to the overall state of things. When leptin is high, it signifies abundance – and the thyroid kicks into high gear, growth hormone increase, the body is highly sensitive to insulin, and a whole chain of positive metabolic effects take place. Adequate or high leptin levels = Good times baby!

When leptin levels are low, this signifies famine or shortage. In this state, the hypothalamus activates all the “programs” that help us store fat and keep our metabolism reduced. The thyroid goes on vacation while fat storage enzymes are ramped up, we become less sensitive to insulin to prohibit muscle growth and energy for muscular activity, and our appetite skyrockets.

These are the master programs that determine not just our weight which everyone is so concerned about these days, but our metabolism – which I believe Broda Barnes and his modern-day followers have shown to be the kingpin in many modern disease phenomena – from heart disease to autoimmune disease to infertility.

But of course, it’s not just a simple matter of getting more leptin. The much more common cause of a chronic low metabolism is not a shortage of leptin at all in a strict sense – and certainly not a shortage of thyroid hormones (although overriding a low metabolism by taking thyroid medication can certainly help), but a leptin communication problem. Leptin, like most hormones, depends on receptor sites – and the body of your typical modern human is resistant to the hormone leptin.

Leptin resistance = The body thinking that it’s in a famine scenario

Wonder why you are tired, don’t feel like exercising, have trouble losing weight, gain weight easily, are hungry all the time, have a low body temperature, and have really strong cravings for fattening foods like doughnuts, ice cream, and French fries? Your body is acting like it’s starving that’s why, and that’s what it feels like to be starving if my own personal experience with it and my thorough word-for-word exploration of the 1,300-page The Biology of Human Starvation is any indication.

What is this villainous foe causing the bodies of modern humans to be unresponsive to leptin and suffer from a lifelong urge to store fat with an ever-declining metabolism?

In short, it’s the adrenal hormone cortisol (and upregulated activity of an enzyme in fat cells themselves that helps manufacture more cortisol called 11-HSD-1). Cortisol is considered a “stress” hormone, but it’s much more than that. It’s also a counter-inflammatory hormone, and cortisol, along with another hormone that counters inflammation called SOCS-3, are the leading suspects in blocking the action of leptin and leaving us all hungry, tired, fat, and sick due to the resultant low metabolism/low body temperature.

Unfortunately, the question of what causes cortisol to be so high is quite complex and individual. Anything that is chronic, whether it be chronic infection, tooth decay or gum disease, sleep apnea, dehydration, or nutrient deficiency, can all cause the activation of the “famine programs.” Anxiety, worry, fear, loss of a loved one through death or divorce, self-esteem issues, past emotional trauma, or other kinds of mental/emotional stress that is of a chronic nature can trigger it too.

But there are two causes of a leptin resistance-induced low metabolism that shine brightly above all others…

1) High omega 6 fatty acid concentration in cells and tissues

2) Dieting

Target #1 is particularly intriguing. Prior to 1900, vegetable oils, rich in omega 6 fatty acids, had scarcely been invented and were seldom used. But solvent extraction made it possible to produce oil out of corn, soybeans, and other cheap commodities for the first time. In 1909 in the United States there was no epidemic of type 2 diabetes, no obesity epidemic, no early puberty epidemic, no infertility epidemic, no autoimmune disease epidemic – and heart disease had yet to be documented. Not a single case had been seen!

Top household fats at that time were beef tallow, butter, lard, olive oil, and coconut oil.

But soon vegetable oil-based margarines would outcompete with more expensive butter. Vegetable oil-based shortenings would beat out lard. And oils for cooking in the home and in restaurants became vegetable oil, vegetable oil, and more vegetable oil. From 1909 to 2009 vegetable oil consumption in the U.S. increased 1,450%. Consumption of margarine by 800%. The other richest sources of omega 6 are nuts and poultry, which saw increased consumption of 37.5% on behalf of nuts (mostly peanuts with a handsome omega 6 to omega 3 ratio of 177 to 1), and 278% on behalf of poultry.

During this time we witnessed the world’s first documented case of heart attack followed by a wave of heart disease out of left field that became the leading killer of both males and females alike in affluent nations. Of all the dietary changes that took place during this time, there is none more drastic or biologically significant than the huge rise in omega 6 polyunsaturated fat consumption.

Why is this so important? Because what we are witnessing is a multi-generational, cumulative increase in inflammatory disorders as well as an increase in low body temperature as reported by Barnes and his followers Stephen Langer, Mark Starr, and others. And what does omega 6 have to do with inflammatory disorders and “low thyroid?”

Well, for starters omega 6 forms the raw substrate used by your body to manufacture its primary inflammatory molecules such as Interleukin-6 and TNF-Alpha. The higher ratio of omega 6 to omega 3 (a competing fat) in the cells and tissues of the body, the more of these inflammatory molecules the body manufactures. It really is as simple a formula as that, which is rare in human biology.

This leads to a mass epidemic of inflammation – and inflammatory responses to all kinds of benign substances (the core cause of most allergies, including food allergies, and autoimmunity), which causes a release of counter-inflammatory hormones that are anti-thyroid, immune-suppressive, and otherwise problematic. One is, of course, our buddy cortisol. Another, which is released in direct proportion to the amount of omega 6-derived molecules is SOCS-3, suspect #1 in biochemistry today for being the predominant cause of leptin resistance.

Fun huh? Watch out for those heart disease-causing saturated fats! Fats like metabolically-stimulating, immune system-enhancing, insulin-sensitizing butyric acid found in butter (gasp), or the medium-chain triglycerides with similar properties found in the world’s richest source of saturated fat – coconut oil (the subject of one of Janie’s recent blog posts).

What’s ironic is that Broda Barnes was innately skeptical of the recommendation to eat polyunsaturated vegetable oils over saturated fats throughout his career – as he openly mentions in Solved: The Riddle of Heart Attacks. Wow, if he could have only seen the Pandora’s box that was opened with the discovery of Eicosanoids – the hormones derived from polyunsaturated fats with incredibly far-reaching biological and hormonal significance, particularly as it pertains to his baby – the metabolism.

Note, this omega 6 fat accumulates in our cells and tissues and continues to pile on generation after generation. This is a 100 year omega 6 pileup, your average American citizen has well over ten times the amount of omega 6 in cells and tissues that can be considered normal, and it will continue to negatively impact us individually and collectively until radical changes are made to tilt the balance back in the opposite direction – which takes several years to achieve with diligence.

Target #2 is dieting. First we had a problem with all this omega 6 making our bodies think we were starving, and then we addressed it by ACTUALLY STARVING ourselves. I believe restricted dieting is the greatest immediate threat to the human metabolism and human health – particularly extremes of calorie cutting, carbohydrate restriction, or low-fat vegan diets (despite apparent short-term results or what the priests of various dietary religions are preaching).

Talk about throwing gasoline on a fire. By far the worst health predicaments and lowest body temperatures I’ve encountered (96 degrees F and below, sometimes WAY below), were the result of severe calorie or macronutrient restriction – vegan and very low-carb being the worst.

But don’t just take my word for it that dieting is a dead-end strategy that lowers metabolism. See if you see anything that rings a bell in our discussion here and at www.stopthethyroidmadness.com from the greatest-selling diet author of all-time, Dr. Robert Atkins, issuing a warning about all diets including his own as referenced by the phrase “this one”:

“…remember that prolonged dieting (this one, low-fat, low-calorie, or a combination) tends to shut down thyroid function. This is usually not a problem with the thyroid gland (therefore blood tests are likely to be normal) but with the liver, which fails to convert T4 into the more active thyroid principle, T3. The diagnosis is made on clinical ground with the presence of fatigue, sluggishness, dry skin, coarse or falling hair, an elevation in cholesterol, or a low body temperature. I ask my patients to take four temperature readings daily before the three meals and near bedtime. If the average of all these temperatures, taken for at least three days, is below 97.8 degrees F (36.5 C), that is usually low enough to point to this form of thyroid problem; lower readings than that are even more convincing. It may be appropriate for those of you who fit these criteria to be prescribed thyroid by your doctor, and if so, a natural form of the hormone, which contains T3, is far superior to the most popular form of prescription thyroid, synthetic T4.

The good news is that I have had very little difficulty whatsoever with helping people to bring up low body temperatures to Broda Barnes’s magic 97.8 degrees F or above (axillary/armpit temperature). In fact, I would gladly put my protocol up against thyroid medication any day, as temperature gains from 95.0 F to the upper 97’s is something that my followers regularly achieve in as little as 30 days.

The main points of the program, which you can read about in exhaustive, intriguing, and entertaining detail in my free 64-page non-promotional eBook on the subject at www.180degreehealth.com, is to…

1) Anti diet – this means eating ample calories, carbs, fat, animal protein, and whatever the latest diet guru calls to restrict in abundance until the point of complete satisfaction or even beyond in the initial stages to jumpstart your metabolism

2) Favor saturated fats like coconut oil, butter, and beef fat over polyunsaturated fats like vegetable oils, poultry, nuts, and seeds (but this takes a LONG time to make a really substantial difference) – start by throwing ALL liquid oils out of your house and eating mostly your own, homecooked food

3) Eat whole, unrefined carbohydrates and avoid white flour, white sugar, high-fructose corn syrup, etc.

4) Favor starches like potatoes, yams, brown rice, and corn over sugars like white sugar, soda, fruit juice, honey, agave nectar, maple syrup, and fruit

5) Sleep like it is your job – as many hours as you can get per night

6) Keep exercise minimal until body temperature rises

Matt Stone is an independent health researcher, author of 6 books, and voice of http://www.180degreehealth.com/ and its associated blogs: http://www.180degreehealth.blogspot.com/ and http://www.180kitchen.wordpress.com/