As we age and our resting metabolic rate naturally slows, it can become increasingly difficult to maintain a healthy weight. This unfortunate aspect of aging is compounded for those struggling with an underactive thyroid as this slows the metabolism further and causes fatigue, lowering energy expenditure – bugger right?
However, for optimal weight management, the following key strategies can be implemented and reviewed on a regular basis and those with an underactive thyroid may benefit further from one-one nutritional and physical activity planning.
Firstly – a quick overview of hypothyroidism for those not in ‘the know’
The thyroid is a small gland on the front of your throat which in response to thyroid-stimulating-hormone (TSH) will release Triiodothyronine (T3) and Thyroxine (T4) – hormones which help to regulate metabolism. It is estimated that approximately 8-10% of western populations have some issue with this thyroid gland (most involving hypothyroidism or underactive thyroid function) and that women are 10 times more likely than men to be affected with risk increasing with age. The reasons for hypothyroidism can vary, but it is commonly associated with an autoimmune condition – whereby, the immune system mistakenly attacks your own thyroid gland…not so clever…
Hypothyroidism is associated with weight gain, fatigue, depression, memory issues, hair loss, decreased libido and poor cold tolerance – though not all of these symptoms have to be present and one person’s symptoms and severity of symptoms can differ greatly from another’s. In severe cases, if left untreated, the thyroid gland can become enlarged and form a goiter, risk for other autoimmune conditions including rheumatoid arthritis can increase and rarely, but potentially, it can result in severe life-threatening depression, heart failure, or coma.
Strategy 1: Make sure your medication is right for you, both with respect to type and dosage
This will have the greatest effect on your weight management as, without question – it will have the most significant impact at the root of your problem by essentially correcting your hormone levels. Many don’t like the idea of having to take medication daily and indefinitely, but at this stage – such treatment is the only and best solution for hypothyroidism. So the first priority is certainly to make regular (initially monthly and then progressing to annual) appointments with your GP to get your thyroid-stimulating hormone (TSH) and perhaps also your thyroxine (T4) levels checked to determine what medication and dosage is suitable for you. Then of course it is essential that you take it correctly (this is definitely a ‘do as I say, not as I do’ as I’m the worst at this with mine!) – it needs to be taken daily, on an empty stomach and at least 30mins prior to food or as otherwise detailed by your GP or as detailed in your medication leaflet.
Some advocate taking thyroid support medications or supplements, funnily enough – especially those companies trying to make money out of you or ‘nutritional consultants’ who so happen to have such fabulous potions behind their counters! Though some people report that at least initially, this can improve energy levels – there is no significant clinical data published that show that any of these are of any long-term benefit when correct thyroid medication is taken with an adequately nutritious diet. So, bypass those selling ‘dreams in a pill’ (spend that extra money on a nice pair of shoes or something) and focus instead on optimising your diet and modifying your food intake.
Strategy 2: Aim to increase the nutrient density of all of your meals and snacks.
Hypothyroidism is often associated with other autoimmune conditions and these commonly and negatively affect nutrient absorption with increased likelihood of micronutrient deficiency. Prioritise a wide range of vegetables and fruits (especially those with high fibre) and good quality proteins and wholegrains while minimising refined carbohydrates and sugars. Generally, for those with hypothyroidism, your plate should be about 50% salad/veg (excluding potato), 25% protein (or a ‘palm sized’ serve) and 25% or even slightly less high quality carbohydrate – depending on how active you are.
Protein is a really satiating macronutrient which often helps with weight loss, controlling appetite and also with maintaining muscle mass during weight loss. You will also note further down, that meats, legumes, nuts, seafood and dairy also contain the key micronutrients required for optimal thyroid function. Also, please note, that I am not advocating to go ‘low-carb’ – there is absolutely nothing wrong with high quality carbohydrates and these can provide excellent fuel and can have great nutritious value, but refined (white) flours and sugars provide nothing but short-term bursts of energy, blood-sugar spikes and are often quite devoid of any nutritional value (despite being so extremely yummy when in the form of cakes or cookies!) – so it’s best to learn to only eat these foods occasionally.
Generally, my primary recommendation is to first significantly reduce the soft drinks, ice teas, high-calorie sports drinks and juices in your diet as these provide a load of empty calories which you will not then compensate for, leading directly to weight gain. To stop me ranting further about that here, if you’re interested in more on this – see my article The Great Sugar-Tax Debate for more detail and information about why these really have no place in any healthy diet, but particularly for those who are trying to lose weight.
Next areas to tackle are usually alcohol and pre-packaged or baked goods (think cookies, sugary cereals and museli bars, cakes, muffins, refined-flour breads etc). One by one, I recommend to go through any of these tempting morsels which you commonly eat and consciously reduce your intake and/or replace them with alternatives – though noting that many of the ‘healthy’ options will contain just as much sugar and energy. Please watch out for an article that I’m working on that will detail more actionable and practical strategies on how to change your food behaviours and reduce your reliance and ‘cravings’ for such foods – in the meantime, start experimenting with what works for you as everybody’s vices and solutions in dealing with them can differ markedly!
So, there are specific nutrients that support the thyroid to keep in mind and of course, the healthier your thyroid, the better it will function and the easier your weight management will be:
- Iodine – Over the last few decades, iodine deficiency used to be very rare in Australia – but deficiency rates are rising in certain sectors of the population and in particular, women over 50 years, who are also one of the most likely groups to suffer from thyroid issues. Post-menopausal women are consuming on average slightly lower than the Recommended Daily Intake (RDI) which is not a problem for most without thyroid issues, but could be for those with an underactive thyroid as it is required for thyroid hormone production. Rich dietary sources include: using iodised salt instead of regular salt, dried seaweed (nori), cod, baked potato (skin on) and milk. However, just to throw a spanner in the works, consuming too much iodine can also exacerbate hypothyroidism and cause a range of other health issues, so stay away from supplements (unless you’re pregnant) and as for most of my dietary advice, never go overboard on any one particular food or food-group.
- Zinc – In Australia, most adult women consume their RDI, so for most – your diet should already be adequate. This is really good news as it is essential in the regulation of TSH. However, if you are concerned about your Zinc levels, increase your intake of seafood (especially oysters and shellfish), legumes/nuts/seeds, beef and I just have to add in here – cocoa powder and dark baking chocolate is also very high in Zinc – huzzah!
- Selenium – On average, consumption of selenium in Australian adults is above RDI which again, is excellent news as it is a mineral which helps recycle iodine. Still, it’s best to ensure that adequate selenium levels are maintained by eating foods such as Brazil nuts, seafood, wholewheat bread, sunflower seeds, pork and other meats.
Strategy 3 – Increase your physical activity – both cardio and weightbearing
Unless you’re doing some really impressive sweat sessions, exercise does not contribute as much as you may think to weight management, which is why dietary control is key, especially for those with compromised metabolisms such as is the case with hypothyroidism. However, it does still certainly contribute to energy expenditure, especially if you have the time and motivation to really push yourself and by increasing your muscle mass, you will increase your resting metabolic rate – which means when you’re watching your fourth hour of Game of Thrones, you’ll be burning more calories merely sitting there on the couch than you would have without sporting your new buns and guns.
However, the benefit of exercise goes well beyond weight management and is instrumental in maintaining bone and cardiovascular health, blood glucose control, strength, balance and mobility and exercise is incredible for depression and memory – mental health issues commonly associated with hypothyroidism.
So wherever your currently fitness level is now, aim to improve it gradually through both cardio and weight-bearing activity and set goals to strive for – eventually it’d be great to be doing at least an hour of activity on at least 5 days of the week. You may benefit from working with a personal trainer or getting a health check and clearance from a GP, especially if you haven’t undertaken exercise for a while, and it can definitely be easier to set new habits if you have a good support team around you. The most important thing is that you find something that you enjoy to do and often enjoyment and motivation for your activity is raised considerably when you have good company to do it – and a promise of coffee at the end – so rope in some of your friends! I believe most people would agree that physical activity needs to fit into your lifestyle and that you look forward to it as special time that you’re investing in you – as otherwise it’ll just be a drag and be unsustainable – and we can’t have that!
Strategy 4: Maximise sleep and minimize stress
The relationship between poor sleep and weight gain is well established and so ensuring that you prioritize sleep is paramount.
Things to try if you’re not a great sleeper:
- Regulate the time you go to bed/wake up and implement a consistent sleep preparation routine (may include a shower, listening to music, reading)
- Turn off all electrical equipment including phones, ipads, TV’s at least 1 hour prior to bed – experts say up to 2 hours, but let’s be realistic!
- Restrict nicotine, caffeine and alcohol – especially in the afternoon and evening as this wrecks havoc with your sleep. Likewise do not go to be either hungry or overly full.
- Ensure that you get adequate natural light during the day and minimize light sources at night – this will keep your circadian rhythm regular and ensure that your melatonin levels are increased at nighttime, making you sleepy.
- Ensure that your bed and pillows are suitable for you and that your room is a comfortable, cool temperature.
- Exercise is great for sleep!
Stress will also interfere with good sleep, so avoid confrontation or doing or thinking about your work or other problems at night. Stress also has the effect of releasing cortisol which encourages the consumption and storage of energy (to replace that which you theoretically expended when running away in an adrenaline-fueled panic from some frightening predator). Additionally, the brain seeks to reduce tension by releasing pleasure-inducing chemicals and what better way to do this than through seeking pleasurable, dopamine-inducing foods such as cake, chocolate or hot chips? This is problematic in today’s modern world as our stress is unfortunately not associated with any great energy expenditure and such foods are readily available 24/7 so over time, if this adrenaline/cortisol cycle becomes chronic – stress will inevitably result in weight gain.
But, how to control stress is of course the million dollar question and ultimately many of us feel we have limited control over the source of our stress (work, family, finances, dogs chewing the irrigation – again!) – but this is certainly the first port of call as the rest is just treating the symptoms. Where possible, tackle, eliminate or outsource stressful tasks – or better still, where applicable – ‘reassign’ them to the people who should be doing them anyway (Question: How did that issue suddenly become yours in the first place?!) Where possible, learn not to stress about things you can’t change or control and create distance between you and people who are causing you undue stress and pressure, even if you are only able to temporarily remove yourself from the situation. It’s an ongoing process to learn to live fully in the moment and not spend time in regretting or resenting the past or dreading what may come the future – but working towards this is a key for many in reducing stress and living better today.
Aside from eliminating stress at its source – do your best to find your zen and what works for you in helping to deal with it (and no, eating icecream straight out of the tub until you’re in a food coma is not a suitable solution…sorry). This will ideally require a multi-level strategy – starting with good sleep, good food and taking time out of your busy life to prioritize exercise and also some other quality time just for you. Yup, your family will survive for an hour (they are capable of making their own lunch!) and your mountain of work will still be there if you were to catch up with a friend for a yarn or simply relax somewhere with a book for an hour.
Some like to practice meditation – unfortunately, I have no patience for that, I figured I mastered breathing a while back and I’m too skittish to sit still for that long – perhaps I’ve just identified one of my key problems! However, I do try to practice mindfulness, both to ensure that I’m fully enjoying the stress-free moments, and this includes when eating so that I don’t blankly guzzle down food and not even taste or enjoy it. Main point again is that it has to be something that works for you.
A quick parting note on hypothyroidism, gluten and goitrogens
Though not directly related to the main topic of weight management – I’m anticipating that there maybe a few questions on the relationship between hypothyroidism and gluten or goitrogens – so here are the quick answers:
Gluten: There are suggestions that as many cases of hypothyroidism arise due to Hashimoto’s (autoimmune condition), and given that other autoimmune conditions commonly also present can be exacerbated by gluten ingestion, that there maybe a link between hypothyroidism and gluten intake. However, the research on this to date is not conclusive and there are still many grey areas that are unclear or not fully understood. My recommendation at this point is that it is not necessary for all those suffering from hypothyroidism to go ‘gluten free’, such a link is far from clear – but if there is a family history of gluten intolerance, coeliac disease or if your symptoms have not improved despite implementing all the above strategies, then it would be harmless and perhaps beneficial to try going gluten-free for a while and seeing how this many affect how you feel.
Goitrogens: are substances that are found in cruciferous vegetables such as kale, broccoli, cabbage and cauliflower and if consumed in sufficiently super-large doses, can negatively affect the thyroid’s function. As goitrogen levels are greatly reduced during the cooking process – unless you are juicing ridiculous quantities of these vegetables raw (as in basically living on the conconction and little else!) – the presence of these goitrogens should not be of concern as the sheer quantity required to negatively affect your thyroid is next to impossible to consume. The benefits of these nutrient-dense vegetables far outweigh the very low goitrogen risk. So feel free to enjoy your green blend – your thyroid will not shrivel up and die in horror!
Thanks for reading! I hope you’ve enjoyed reading this article on weight management for those with hypothyroidism and please share it with anybody you know who is or who may be suffering with an underactive thyroid and stay tuned for that article I promised above for practical tips and strategies for changing ‘food behaviours’ and restructuring your eating habits.