If you’re getting your TSH levels checked to monitor your thyroid health, it’s best to get that done in the morning. Otherwise, your results may come back normal even though you have hypothyroidism.
All the body’s hormones follow a daily rhythm, including thyroid hormone. This means there are times of the day when it naturally higher or lower. Researchers tested the blood of hypothyroid subjects both before 8 a.m. and again between 2 and 4 p.m.
In hypothyroid patients both untreated and on thyroid medication, TSH dropped was substantially lower during the afternoon test. This means an estimated 50 percent of people with hypothyroidism are not being diagnosed.
In the untreated group, TSH was 5.83 in the morning and 3.79 in the afternoon. In the treated group, TSH was 3.27 in the morning and 2.18 in the afternoon.
A 2004 study also showed late morning, non-fasting TSH was 26 percent lower compared to the early morning, fasting TSH. This means even a late morning blood draw could result in a failure to diagnose. Do you really want to know what is going on with your thyroid? Schedule a FREE 15-Minute Consultation with Dr. Celaya.
TSH blood test timing and functional medicine ranges
The timing of your blood draw plays an important role in reading a thyroid panel. However, there is more to it.
Even with an early morning blood draw, many doctors will still fail to diagnose hypothyroidism because they use lab ranges that are too wide and that do not reflect genuine thyroid health.
Many doctors still use a hypothyroidism TSH range of 0.5 to 5.0 even though the American Association of Clinical Endocrinologists recommends 0.3 to 3.0.
In functional medicine, we use an even narrower range of .25 to 1.25. We also know that only looking at TSH can miss hypothyroidism.
For example, TSH may be normal but other thyroid markers are off. That’s why it’s important to order a thyroid panel that includes total and free T4 and T3, reverse T3, free thyroxine index (FTI), T3 uptake, and thyroid binding globulins. Many conditions can cause poor thyroid function, including inflammation, hormonal imbalances, and chronic stress. Ordering these other thyroid markers provides more insight into such imbalances.
Always include a test for autoimmune Hashimoto’s hypothyroidism
In addition to these markers, anyone with symptoms of hypothyroidism should also test for Hashimoto’s, an autoimmune disease that attacks and destroys the thyroid gland.
Why? About 90 percent of hypothyroidism cases in the US are caused by Hashimoto’s. To screen for Hashimoto’s, order TPO and TGB antibodies.
Thyroid medications may be necessary to support thyroid function, but they do not address the autoimmunity attacking the thyroid gland. Failing to manage Hashimoto’s increases the risk of developing other autoimmune diseases such as pernicious anemia, rheumatoid arthritis, vitiligo, and Type I diabetes. It will also make it more difficult to manage your symptoms.
Want to see if Dr. Celaya is the right fit for you? Schedule a FREE 15-Minute Consultation with Dr. Celaya to talk about your thyroid.
If you struggle with chronic exhaustion, insomnia, poor immunity, and persistent low blood sugar symptoms, you likely have poor function of the adrenal glands, which sit atop the kidneys and secrete stress hormones. However, your conventional doctor may have told you there is no such thing as adrenal fatigue based on guidance from The Hormone Foundation. What they may not understand is that there is a continuum of adrenal function and that the brain plays a role in adrenal fatigue.
The debate about adrenal fatigue versus primary adrenal insufficiency
The term “adrenal fatigue” has become a household word in the chronic illness world, and for good reason. The adrenal glands are our frontline against stressors large and small. In our constantly chaotic and nutritionally-depleted lives, these hard-working little glands can become worn down, sometimes to the point of barely working, right along with the areas of the brain that govern them.
What’s confusing is a recent statement by The Hormone Foundation which claimed adrenal fatigue does not exist and is not supported by any scientific facts, and that primary adrenal insufficiency is the only real version of adrenal dysfunction.
However, according to integrative physician Richard Shames, MD, both adrenal fatigue and primary adrenal insufficiency exist along the same continuum but are separated by the severity of symptoms and treatment methods. In a nutshell, adrenal fatigue can also be referred to as mild adrenal sufficiency.
If you really want to know about your adrenal health, schedule a FREE 15-Minute Consultation with Dr. Celaya.
Primary adrenal insufficiency is caused by damage to the adrenal glands, such as by an autoimmune condition like Addison’s disease that attacks and destroys adrenal tissue. Primary adrenal insufficiency is diagnosed through blood tests and can be treated with medications that replace adrenal hormones.
Symptoms of primary adrenal insufficiency include:
- Muscle aches
- Loss of appetite with weight loss
- Craving salty foods
- Dizziness, low blood pressure
- Feeling lightheaded when standing up
- Gastrointestinal symptoms such as nausea, vomiting, and abdominal discomfort
Adrenal fatigue describes when lab tests don’t support a diagnosis of primary adrenal insufficiency but a person still experiences adrenal-related symptoms such as:
- Excessive fatigue and exhaustion
- Non-refreshing sleep
- Feeling overwhelmed by or unable to cope with stress
- Craving salty foods
- Difficulty concentrating
- Brain fog
- Poor digestion
Functional medicine practitioners diagnose adrenal fatigue by considering symptoms as well as results from a 24-hour saliva cortisol test.
Current blood tests are good at diagnosing severe forms of adrenal insufficiency such as Addison’s disease but not mild adrenal insufficiency, or adrenal fatigue.
This debate between adrenal fatigue and primary adrenal insufficiency is reminiscent of the former debates about “mild” hypothyroidism. Twenty years ago, many endocrinologists denied mild hypothyroidism as a true diagnosis because they believed that as long as a patient was within conventional TSH reference ranges they could not possibly be sick.
However, doctors trained in functional medicine recognize that a functional reference range — a narrower TSH range that reflects optimum thyroid health — means that a serious thyroid problem can exist within the conventional TSH range.
As testing and recognition of adrenal fatigue, which affects many people, continues to gain medical acceptance, we will start to refer to it as mild adrenal insufficiency.
The role of the brain in adrenal fatigue
It’s important to understand the brain plays an important role in adrenal fatigue. This explains why nutrients to support your adrenal glands may not go the full mile when the real problem is happening between your ears.
Adrenal fatigue has at its roots poor function of the hypothalamus-pituitary-adrenal (HPA) axis. The HPA axis refers to the feedback loop between your body and areas of your brain that govern adrenal function. Unrelenting stress beats up this entire system, not just the adrenal glands, and it is more complicated and involved that simply low cortisol. The problem is compounded by the brain’s predilection for efficiency, in this case becoming so efficient at stress until the tiniest thing triggers a big stress response. Or, you are so advanced you are too tired to respond to anything.
How the adrenals become fatigued
When our bodies experience stress, no matter how small or large, our adrenals pump out hormones such as adrenaline and cortisol to help us fight or take flight. Our bodies are designed to return to baseline after a stressor so the nervous system can return to a “rest and digest” state necessary for daily function.
However, in our chronically stressed modern lifestyles, our bodies are constantly reacting to stressors, many we are not even aware of, such as dietary triggers, toxins, and even electromagnetic frequencies.
This constant state of high-stress hormones damages tissues in the body and brain and is linked to:
- Suppressed immunity
- Low energy
- Insulin resistance and diabetes
- High blood pressure
- Heart problems
- Increased belly fat
Removing all stressors in life is impossible, but there is much we can do to support adrenal function and buffer the damage of stress.
Adrenal adaptogens and phosphatidylserine are two natural routes that especially support the HPA axis and the brain’s ability to handle stress.
There are so many issues related to adrenal problems. To get to the root cause of your problems, schedule a FREE 15-Minute Consultation with Dr. Celaya.
Many of us start the day with a small breakfast as we run out the door, followed by a medium sized lunch and a large dinner. We also tend to snack throughout the day and even grab a bite before bed. However, while what we eat is important, a growing body of research suggests when we eat matters too.
The digestive system’s circadian rhythm
While you have likely heard of the circadian rhythm, the master “clock” in the brain that governs our sleep-wake cycle, we actually have a variety of circadian clocks that govern the daily cycle of activity for every organ.
These rhythms exist because every organ needs downtime for repair and regeneration.
The digestive system is no exception. During the day, the pancreas increases production of insulin, which controls blood sugar levels, and then ramps it down at night.
Circadian clocks optimize our health by aligning our biological functions with regular and predictable environmental patterns. Disrupting our circadian clocks — such as by skipping breakfast or eating at midnight — can result in health issues such as weight gain, metabolic syndrome, cancer, cardiovascular disease, and more, and if you want to know more about YOU and YOUR health, schedule a FREE 15-minute consultation with Dr. Celaya.
Eat breakfast daily
About 20 to 30 percent of American adults skip breakfast. Some do it to save time, many do it in an effort to lose weight. However, studies show that people who eat breakfast daily are less likely to be obese, malnourished, suffer from impaired blood sugar metabolism, or be diagnosed with diabetes.
They are also less likely to have the heart disease risk factors of high blood pressure and high cholesterol. Even the American Heart Association recently endorsed biologically appropriate meal timing to reduce the risk of heart disease.
Just eating breakfast isn’t the only important thing, however. It’s critical to start the day with a breakfast that provides plenty of protein and healthy fats, and a minimum of sugars. This helps support blood sugar balance and proper brain function throughout the day.
Make breakfast the largest meal for weight control and fat loss
The timing in relation to the size of our meals is also important.
Research shows having the largest meal in the morning appears to help with weight control compared to having a large meal in the evening.
In fact, a person eating the identical meal at different times of day might deposit more fat after an evening meal than a morning meal.
This is partially because insulin, a hormone that helps with blood sugar control, appears to be most efficient in the morning. In addition, we burn more calories and digest food more efficiently in the morning than later in the day when most of us eat our largest meal.
In one study, a group of overweight women with metabolic problems were put on a 1400 calorie-per-day diet. Half consumed 700 calories at breakfast, 500 calories at lunch, and 200 calories at supper and the other half reversed that pattern.
Women in both groups lost weight and experienced reduction in fasting glucose, insulin, and ghrelin (a hunger hormone), but in the same time frame the large-breakfast group experienced added benefits:
- They lost 2.5 times the weight compared to those who ate the largest meal at dinner.
- They had a significantly greater decrease in fasting glucose, insulin, and triglyceride levels.
- Their satiety (sense of fullness) scores were significantly higher.
- They also lost more body fat, especially in the belly.
According to the researchers, a high-calorie breakfast and a reduced calorie dinner is beneficial and might be a useful alternative for managing obesity and metabolic syndrome.
The body needs fasting periods for optimum health
Fasting signals to the body to start burning stores of fat for fuel. Most of us eat meals and snack from the time we wake up until shortly before bed — or even in the middle of the night. In fact, studies show the average person eats over a 15-hour period during the day. This short fasting time period may interfere with optimal metabolism and increase weight gain.
Researchers put a group of prediabetic men through two eating cycles. In one phase, they ate meals within a 12-hour window for five weeks.
Then in another phase, they ate the same meals in a time-restricted six-hour window starting in the morning.
They ate enough to maintain their weight, so they could assess whether the time-restricted regimen had benefits unrelated to weight loss.
The six-hour meal schedule improved insulin sensitivity, insulin beta cell responsiveness, reduced oxidative stress, increased appetite, and significantly lowered blood pressure.
In addition, the men who ate only one or two meals per day fared better than those who ate three meals.
A recent review of the dietary patterns of 50,000 adults over seven years provides added evidence that we should ingest most of our calories early in the day, including a plentiful breakfast, a smaller lunch, and a light supper.
The researchers said that eating breakfast and lunch five to six hours apart and making the overnight fast last 18 to 19 hours may be an effective method for preventing long-term weight gain.
Another recent study found that subjects who added snacks to their daily meals tended to gain weight over time, while those who had no snacks tended to lose weight.
Light exposure is key for proper metabolism
Sufficient exposure to natural light and darkness also play an important role in how we metabolize food for either energy production or fat gain.
At night, the lack of sunlight signals our brain to release melatonin, the hormone that prepares us for sleep. In the morning, the light stops melatonin production and we wake up.
When we change that signaling — whether from a late-night meal, artificial lighting at night (especially blue screen light), shift work, flying and travel, or changing our eating patterns — it confuses our bodies’ circadian clocks. Eating at the wrong time of day strains the digestive organs, forcing them to work when they are supposed to rest.
Shift workers, who account for about 20 percent of the country’s workforce, have a particular problem with disturbed circadian clocks. Many frequently work overnight shifts, forcing them to eat and sleep at odd times. Nighttime shift work has been linked to increased risk of obesity, diabetes, heart disease, and breast cancer.
Studies have linked poor melatonin activity and disrupted sleep-wake cycles with an increased risk of dementia and Alzheimer’s, cancer, autoimmune flare-ups, obesity, and more.
Low blood sugar may require a before-bed snack
One important exception to the “don’t eat right before bed” rule is for those who have chronic low blood sugar. For these people, keeping blood sugar stable throughout the day — and night — is critical for brain health, energy level, and more.
If you suffer from the following chronic low blood sugar symptoms, it may be best to take a small, high-protein low sugar snack just before bed:
- Constant sugar cravings
- Nausea or lack of appetite in the morning
- Irritability, light-headedness, dizziness, or brain fog if meals are missed
- Craving caffeine for energy
- Eating to relieve fatigue
- Afternoon energy crashes
- Waking around 3 a.m.
Daily habits to maximize your dietary rhythm
To help maximize your meal timing and metabolism, incorporate the following habits into your day:
Make breakfast your largest meal and make dinner your smallest. While this may prove difficult for those with a busy social life or family that sits down to a big dinner every evening, make the evening meal smaller whenever possible.
Prioritize protein and healthy fats with breakfast, and minimize sugar and caffeine intake especially before lunch, to stabilize blood sugar and regulate metabolism.
Avoid between-meal snacks and bedtime goodies. The exception is for those who have chronic low blood sugar as mentioned above.
Try a time-restricted eating pattern, or intermittent fasting, to maximize weight management.
Manage exposure to blue light at night:
- Avoid screen light in the evening
- Install the f.lux app on your phone and computer
- Read a book
- Wear blue-blocker glasses at night
- Install amber or red light bulbs for evening use
If you have chronic low blood sugar, a small before-bed snack with plenty of protein may be a good idea to keep your blood sugar stable all night and prevent that 3 a.m. wake-up.
While studies suggest that prioritizing larger meals early in the day helps support metabolic health, it does not necessarily mean that you should skip dinner. Instead, have your dinners earlier and make them relatively light.
The take-home message here is like the old proverb, “Eat breakfast like a king, lunch like a prince and dinner like a pauper.” Schedule a FREE 15-Minute Consultation with Dr. Celaya.
If you have symptoms of hypothyroidism, how do you know if it’s caused by Hashimoto’s, an autoimmune thyroid disease? Although about 90 percent of hypothyroidism cases in the United States are caused by Hashimoto’s, most doctors do not test for it. Why? Because it does not change their treatment. However, it’s vitally important for you to know whether you have Hashimoto’s to stop the damage to your thyroid and prevent other autoimmune diseases.
Hashimoto’s is an autoimmune condition in which the immune system attacks and destroys the thyroid gland over time. Even if medications normalize TSH (thyroid stimulating hormone) on a blood test, an unmanaged autoimmune Hashimoto’s condition continues to damage and destroy the thyroid gland and cause symptoms.
One of the most common scenarios with undiagnosed Hashimoto’s is that your hypothyroidism and symptoms continue to worsen even through you take your thyroid hormone medications. Your doctor may also continually increase your dosage.
Another common scenario is when symptoms and TSH levels fluctuate between being under active and over active. The person can feel like they are hypothyroid one week and hyperthyroid the next. In fact, some doctors may even mistakenly diagnose them with hyperthyroidism when in fact it’s the result of autoimmune Hashimoto’s waxing and waning attacks on the thyroid gland.
This means the patient could suffer from fatigue, headaches, constipation, and depression one week and then when the thyroid becomes over active they suffer from heart palpitations, anxiety, tremors, and insomnia. Blood tests will also show the TSH level going up and down during these swings, which may result in an inaccurate diagnosis.
Sometimes TSH can even be normal as it’s going through a swing resulting in a misdiagnosis all together. Instead, the patient is diagnosed with an anxiety disorder or even bipolar disorder.
What causes these swings with Hashimoto’s hypothyroidism? Autoimmune diseases are not steady. Instead they flare up or go into remission depending on triggers, which can be dietary, chemical, stress related, hormonal, and so on.
When an autoimmune flare damages the thyroid, it releases hormones that are stored in the gland. These thyroid hormones flood the bloodstream in excess causing symptoms that look like hyperthyroidism.
To confirm whether you have Hashimoto’s, you need to run thyroid peroxidase antibodies (TPO Ab) and thyroglobulin antibodies (TGB Ab) test. It’s also helpful to rule out hyperthyroidism, or Graves’ disease.
But keep in mind that because the immune system fluctuates with autoimmune disease, it’s possible to produce a negative antibodies test result. If symptoms strongly suggest Hashimoto’s it’s important to test again.
Ask my office for more advice on identifying Hashimoto’s hypothyroidism.