This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.
According to the American Association of Clinical Endocrinologists, 27 million Americans suffer from thyroid dysfunction – half of whom go undiagnosed. Subclinical hypothyroidism, a condition in which TSH is elevated but free T4 is normal, may affect an additional 24 million Americans. Taken together, more than 50 million Americans are affected by some form of thyroid disorder.
Metabolic syndrome (MetS), also affects 50 million Americans, and insulin resistance, one of the components of metabolic syndrome, affects up to 105 million Americans. That’s 35% of the population.
With such a high prevalence of both thyroid dysfunction and metabolic syndrome, you might suspect there’s a connection between the two. And you’d be right.
Studies show an increased frequency of thyroid disorders in diabetics, and a higher prevalence of obesity and metabolic syndrome in people with thyroid disorders.
That’s because healthy thyroid function depends on keeping your blood sugar in a normal range, and keeping your blood sugar in a normal range depends on healthy thyroid function.
Thyroid, Blood Sugar, and Metabolic Syndrome
Metabolic syndrome is defined as a group of metabolic risk factors appearing together, including:
- abdominal obesity;
- high cholesterol and triglycerides;
- high blood pressure;
- insulin resistance;
- tendency to form blood clots; and,
- inflammation.
Metabolic syndrome is caused by chronic hyperglycemia (high blood sugar). Chronic hyperglycemia is caused by eating too many carbohydrates. Therefore, metabolic syndrome could more simply be called “excess carbohydrate disease”. In fact, some researchers have gone as far as defining metabolic syndrome as “those physiologic markers that respond to reduction in dietary carbohydrate.”
When you eat too many carbs, the pancreas secretes insulin to move excess glucose from the blood into the cells where glucose is used to produce energy. But over time, the cells lose the ability to respond to insulin. It’s as if insulin is knocking on the door, but the cells can’t hear it. The pancreas responds by pumping out even more insulin (knocking louder) in an effort to get glucose into the cells, and this eventually causes insulin resistance.
Studies have shown that the repeated insulin surges common in insulin resistance increase the destruction of the thyroid gland in people with autoimmune thyroid disease. As the thyroid gland is destroyed, thyroid hormone production falls.
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How Low Blood Sugar Affects the Thyroid
But just as high blood sugar can weaken thyroid function, chronically low blood sugar can also cause problems.
Your body is genetically programmed to recognize low blood sugar as a threat to survival. Severe or prolonged hypoglycemia can cause seizures, coma, and death. When your blood sugar levels drop below normal, your adrenal glands respond by secreting a hormone called cortisol. Cortisol then tells the liver to produce more glucose, bringing blood sugar levels back to normal.
The problem is that cortisol (along with epinephrine) is also a sympathetic nervous system hormone involved in the “flight or fight” response.
Unfortunately for hypoglycemics, repeated cortisol release caused by episodes of low blood sugar suppresses pituitary function. And as I showed in a previous article, without proper pituitary function, your thyroid can’t function properly.
Together, hyperglycemia and hypoglycemia are referred to as dysglycemia. Dysglycemia weakens and inflames the gut, lungs and brain, imbalances hormone levels, exhausts the adrenal glands, disrupts detoxification pathways, and impairs overall metabolism. Each of these effects significantly weakens thyroid function. As long as you have dysglycemia, whatever you do to fix your thyroid isn’t going to work.
How Low Thyroid Function Affects Blood Sugar
We’ve seen now how both high and low blood sugar cause thyroid dysfunction. On the other hand, low thyroid function can cause dysglycemia and metabolic syndrome through a variety of mechanisms:
- it slows the rate of glucose uptake by cells;
- it decreases rate of glucose absorption in the gut;
- it slows response of insulin to elevated blood sugar; and,
- it slows the clearance of insulin from the blood.
These mechanisms present clinically as hypoglycemia. When you’re hypothyroid, your cells aren’t very sensitive to glucose. So although you may have normal levels of glucose in your blood, you’ll have the symptoms of hypoglycemia (fatigue, headache, hunger, irritability, etc.). And since your cells aren’t getting the glucose they need, your adrenals will release cortisol to increase the amount of glucose available to them. This causes a chronic stress response, as I described above, that suppresses thyroid function.
How to Keep Your Blood Sugar in a Healthy Range
In either case, the solution is to make sure your blood sugar stays within a healthy range. There are two targets to consider. The first is fasting blood glucose, which is a measure of your blood sugar first thing in the morning before eating or drinking anything. I define the normal range for fasting blood glucose as 75 – 95 mg/dL. Although 100 is often considered the cutoff for normal, studies have shown that fasting blood sugar levels in the mid-90s were predictive of future diabetes a decade later. And although 80 mg/dL is often defined as the cutoff on the low end, plenty of healthy people have fasting blood sugar in the mid-to-high 70s (especially if they follow a low-carb diet).
The second, and much more important, target is post-prandial blood glucose. This is a measure of your blood sugar 1-2 hours after a meal. Several studies have shown that post-prandial blood glucose is the most accurate predictor of future diabetic complications and is the first marker (before fasting blood glucose and Hb1Ac) to indicate dysglycemia.
Normal post-prandial blood sugar one to two hours after a meal is 120 mg/dL. Most normal people are under 100 mg/dL two hours after a meal.
Now that we know the targets, let’s look at how to meet them. If you’re hypoglycemic, your challenge is to keep your blood sugar above 75 throughout the day. The best way to do this is to eat a low-to-moderate carbohydrate diet (to prevent the blood sugar fluctuations I described above), and to eat frequent, small meals every 2-3 hours (to ensure a continuous supply of energy to the body.
If you’re hyperglycemic, your challenge is to keep your blood sugar below 120 two hours after a meal. The only way you’re going to be able to do this is to restrict carbohydrates. But how low-carb do you need to go? The answer is different for everyone. You figure your own carbohydrate tolerance by buying a blood glucose meter and testing your blood sugar after various meals. If you’ve eaten too many carbs, your blood sugar will remain above 120 mg/dL two hours after your meal.
I highly recommend you pick up a blood glucose meter if you have a thyroid and/or blood sugar problem. It’s the simplest and most cost-effective way to figure out how much carbohydrate is safe for you to eat. There are tons of meters out there, but one that gets a lot of good recommendations is the ReliOn Ultima. It’s pretty cheap, and the test strips are also cheap, which is where the major expense lies.
Finally, if you have poor thyroid function it’s important that you take steps to normalize it. As I’ve described in this article, the cycle works in both directions. Dysglycemia can depress thyroid function, but thyroid disorders can cause dysglycemia and predispose you to insulin resistance and metabolic syndrome.
Maintaining healthy blood sugar is not only critical for thyroid health, it’s essential for overall health. Sadly, half of Americans has or is at risk of having diabetes, with one-third diabetics unaware that they have it.There are many causes of high blood sugar. One of the most significant but least-known is nutrient deficiency. Several vitamins and minerals are required for proper blood sugar regulation, and the majority of Americans don’t get enough of several of these micronutrients.
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When I was in my early 20s, I started having bad responses to cardio — even mild cardio such as a 45 minute walk or hike. I was used to being able to walk or bike endlessly without much issue other than sore muscles before that. Now, I would find my heart rate would not recover properly, my left gland would get sore and swollen, and I’d stay wound up well into the night and next morning and get pounding headaches just from an hour of walking. I would feel great right after for an hour or so, but not come down from it. It started to get to the point my body would go into panic mode and my body temperature would plummet 3-4 degrees and I’d get bad shakes.
I went to the ER 3 times in a row and I practically had to beg them to do a blood test, but all it showed was I was low on potassium. I thought for sure there would’ve been a blood sugar issue, but I don’t think they even checked it, much less worried about a thyroid issue — even though I stressed that both run heavily in the family. They diagnosed it as anxiety attacks. Alright, sure — the Ativan at least relieved them eventually so I could sleep in peace. But the attacks would still only appear after cardio, even years later to the point I completely had to change how I went about it. I’d have mild versions of this from eating certain types of starchy foods I noticed, in the months following. I of course changed my eating habits greatly, low carb and low sugar, and it helped, yet the problem persisted, hours after mild or moderate cardio. No amount of stressing these 2 direct connections seemed to concern my doctors, so for a long time, I gave up on them, and relied on my diet tweaks and short-burst (stop-start) forms of cardio instead of one big chunk at a time — which I discovered my body responded much better to this after so much trial and error.
It just frustrates me, because I still suspect my thyroid had something to do with my anxiety and heart rate issues, rarely able to feel relaxed because of it. Since the anxiety attack diagnosis, I’m mostly stonewalled on trying to get these other issues taken seriously, since that’s the easier answer to feed me since the symptoms are similar (ignoring the trigger). I just worry about the damage done to my body having something undetected hammer away at my system.
Do you think any of this could be related to this thyroid blood sugar connection? If so, do you have any advice on how to approach my doctor in the future when I talk them into testing my thyroid once and for all? Thanks for your article.
ps –
I forgot to mention, I have had a basic diabetes screening that turned up negative.
Hi Chris, I have been on Synthroid for a year now due to hypothyroidism. I started with 50mg and I’m now up to 125mg. Recently my hair has been falling out in handfuls and I’m ready to get off it altogether. I started out on Armour Thyroid but doctor switched me because he couldn’t get it balanced. I just started research to see if there is anyway to cure hypothyroidism myself. I thought it very interesting that about a month after I first started on medication I happened to try a 30 day no sugar. When I went back to have my levels checked just after I finished the diet, I had gone from hypo to hyper. I told the doc that I had cut out sugar for 30 days (thinking that must be the reason I went from one extreme to the other in such a short time) but he didn’t seem to think much of it. Since then, I have always wondered if I would cut out sugar I could regulate my thyroid without medication. I’d love to hear your thoughts on this. My blood tests never show high blood sugar although I feel like I have the symptoms of one that does and eat a lot of sugary foods.
My boyfriend has hyperglycemia, blood glucose of 200-500+ sometimes after a fasting. He is still in the middle of neurological and endocrinology appointments. He’s having his b12 lvl and his thyroid tested. He’s now on two forms of injectable insulin and two pill forms. Beyond carbs are there any other suggestions for diet and in case he comes back with a over active thyroid leaving him practically sluggish all day, things he can do to help himself?! He also has severe full body nuropythy so excersise is hard. Also he’s thin and not obese. ( covering all our descriptive bases here 🙂
Jo
If I raise my thyroid too fast I get reactive hypoglycaemia. I found this out a NUMBER OF TIMES in my eagerness to get my thyroid right and my life back. Raising too fast messes with one’s blood sugar as it is harsh on the adrenals and they are involved in blood sugar regulation.
One of the criticisms of Wilson’s is that it works via very fast raises and can thus lead to symptoms such as you describe. It also taxes the adrenals. If you have high RT3, I’d suggest you check out Nick Foot’s website and increase T3 in a slower way. If you have just plain ol’ hypothyroidism, I’d suggest you check out stopthethyroidmadness.com.
Hi Chris:
Great information. I have both insulin resistance and low thryoid right now. I am currently on time-release T3 therapy (Wislon’s protocal) which has worked well for me two other times in the past ten years, but this time, (the first that I knew I had blood sugar issues too) I have not responded so well to the T3. I did buy a glucometer and have been keeping very careful records, cutting carbs, measuring and recording every bite, and exercising — but my fasting blood sugars seem to increase everytime that I change my T3 dosage — up or down….is this as I am starting to suspect, because of the changing T3 amounts — or could there be something else going on here that I need to consider?
The other thing I am wondering about — I have all but cut fruit out of my diet — having it only in a morning protein shake, after which my blood sugar is usually in the 80s (lower then when I wake up!) But I do miss it sooooo much. So I succumbed twice in the past week to an apple late in the afternoon and was shocked to see my blood glucose spike after words — BUT it seemed to spike much more the day following my liberal use of coconut and cashews — more fat than I typically have….when I get my t3 dosage figured out and stabilized I plan to do a controlled experiment — fruit following a day of very low fat eating and fruit following a day of higher fat eating and see if there is a difference — what do you think I will find here?
Thanks,
Jo
Hi Jo,
I’m wondering if you ever got clarity on your situation at all? I am following in your footsteps and am curious. (Currently on T3 therapy via Wilson’s plan…)
Many thanks.
Well, interestingly enough — I have made some very helpful discoveries just recently. I am now menopausal by several years, and clearly the T3 only protocol is harmful to me now — although it did work amazingly well for me several times years ago. I now believe I was/am dealing with entirely different problems. Before — I was consuming gluten and I suspect it was stirring up an autoimmune reaction to my thyroid (don’t know for sure, because antibody levels were never measured back then) Several years gf and I no longer needed thyroid replacement. When menopause hit and I had hypo sytmpoms again I (and was still GF) I did get antibody levels measured and they were negative — and this time, T3 did NOT work — in fact, I had to take large amounts and only got partial symptom relief and much evidence that I was taking too much. Recently I read the FANTASTIC BOOK, The Functional Approach to Hypothryoidism by Kenneth Blanchad — it makes a lot of sense. I am now taking mostly T4 and a tiny tiny bit of T3 and seeing improvement. The big thing I came to appreciate — I don’t think I fundamentally have blood sugar issues — I think it was an artifact of the high high T3. Interestingly the abnormal response to carbs was a symptom — not a cause of what was going on — It really didn’t matter what I did diet wise — when I was taking that much T3– even the tiniest bit of carb –was problematic and now — I can eat a few peaches before bed and my fasting glucose is none the worse.
Hashimoto’s is far from rare. 9 out of 10 women with hypothyroidism in the U.S. have it.
You’re right: blood sugar is confusing. But your numbers are typical for a low-carb dieter. I’ve explained it here.
I’m very confused about my blood sugar. I had fbg done at my Md’s and it was 103″ and somehow he said that was normal and I looked at the lab ranges and the lab he uses defines normal unto fbg of 110! Weird.
Also, i have eaten lower carb for the past year plus, and 1 year ago at the doctors my fbg was LESS, 94, prior to trying lower carb. So I bought a meter and tested at home and found my fbg was 105 one day, and tested a few times and it is never below 95. But, 2 hours after eating a breakfast of eggs, bacon and white potatoes my bg was 85. What gives? I ate carbs and bg was normal a couple hours later, but my fbg is generally high.
My tsh is ok, 2.3, the doctor didn’t do a hasimotos test as he thinks it’s very “rare”.
Ann – What thyroid med are you on? Dosing shouldn’t be based on TSH, which is what your doc is doing. Instead, you need to look at the Free T4 and Free T3.
I’d advise you to check out http://www.stopthethyroidmadness.com
Ann: check out my series on diabesity, which is still in progress. If you subscribe to my blog for email updates, you’ll get all the new articles as they’re published. You can do that on the homepage.
I just read this and I am freaked out. I have had a thyroid condition for 13 years and i have had it monitored regularly. I started feeling weird and my hair was falling out. So I went back to doctor, and my thryoid was like 8 when it was supposed to be 1 or 2. She also said my fasting glucose was 102. I have never had glucose problems. I am a very health eater(ridiculously so) and am thin. I am normal weight and have always been normal. I am 45 and I had two kids and never had gestational diabetes. I was also taking a lot of fish oil for dry skin. I have heard that this can impare fasting blood glucose. I don’t want diabetes. I went back to the doctor once and my thyroid meds have to be bumped up again, and glucose was borderline. What can I do to avoid diabetes?
Read Lose the Wheat, Lose the Weight. Great book. Mine went from 111 to 103 in short order.
Hi Chris,
Thanks for all your posts.
Do you think that somebody with potential adrenal and thyroid problems should eat 3 meals a day instead of the usual 2 meals recommended for IF? If the glycogen stores are not re filled the same day the liver is going to make glucose from protein and that taxes the adrenals so a certain amount of carbs is recommended too. Do we need the 400 kcal that Paul Jaminet recommends?
See this comment I just wrote on Paul’s blog on this exact question. The short answer is that I’m wary of IF for people with hypoglycemia, adrenal and thyroid problems. Some argue that IF can have a blood sugar stabilizing effect, but I’m not convinced of that in this particular patient population. I’ll be curious to see how Paul responds. Yes, I think 400 kcal of glucose is a good target for those with blood sugar issues.
Chris, thx for great info.
Phoenix
Regarding eating high fat diet and haveing a high blood glucose and just want to say that high fat levels in the blood stream (TGL) can reduce insulin sensitivity and therefore eating low carb high fat can still make your blood glucose hight.
I notived myself, if i eat lost of nuts (over 100 g of fat) in the evening or other fats liek coconut oil my fasting glucose levels goes up 5 or even high, whilst normaly is around 4.7 – 4.7.
I would like to know what kind of meal is best eaten before checking post prandial blood sugar ? Im sure what you eat affects your readings,and eating what you normally eat may not cut it. Should one include sugar ? Or how many grams of carbs should that meal include ?
The whole point is to eat what you normally eat and see how it affects your blood sugar. If it goes too high, you know you’ve eaten too many carbs. If it doesn’t go too high, that suggests you’re able to tolerate the amount of carbohydrate the meal contained. This doesn’t mean you are free to eat anything as long as it doesn’t raise your blood sugar. It’s only one criterion.
Thanks, Chris. I guess I need to do some reading on treating hypothyroidism as high TSH, and see about getting that cortisol test. (I know you’ve written more stuff on thyroid than I’ve read so far, so I won’t ask you to repeat it here. 🙂 ) I’ve already decided to cut out gluten, since my wife had to, and it seems like a good idea for anyone. I’m going to test my BG more often to figure out how much non-refined carb (probably mostly potatoes) I can eat without going over 120 BG. Stuff I’ve read over the years on healing adrenals, like the book Adrenal Fatigue, always said not to go too low carb, but they never really said why, so I just ignored them since I also wanted to lose weight. Maybe I need to focus on the hormones first and worry about weight later.
Incidentally, what do you think of the raw milk diet for adrenal fatigue and/or hypothyroid? We just did that for about 10 days and my BG stayed surprisingly good, never exceeding 110. We basically stopped out of boredom, but I’d do it again for longer if I thought it’d help.
Thanks again.
Hi Chris,
There’s a lot of good stuff to think about here. A couple questions: Do you think going too low-carb can be a problem for people with thyroid/adrenal issues? Also, do you really think overconsumption of carbs causes insulin resistance by itself? I used to think that, but reading about the Kitavans and other societies that eat a high-carb (unrefined) diet without any metabolic disease is making me think there must be some other factor (inflammation, nutritive wasting by refined carbs, stress) that kicks off the insulin resistance, maybe in combination with carb load.
My background: After a bad bout of mono and a stretch of trying to combat fatigue and long work hours with caffeine and ephedrine, a chiropractor/kinesiologist diagnosed me with adrenal fatigue about 15 years ago, and told me to lay off the stimulants and ‘white’ foods: white sugar, white flour, potatoes. I did for a while, and felt better and lost some weight. Of course, I drifted back to a SAD diet, and ever since I’ve had problems with fatigue and stress. (I’m naturally introverted anyway, but now any sort of social stress leaves me needing a day to recover.) I also gradually gained weight, and discovered low-carb to combat that. It seemed to help with the fatigue and mood too, but after a few years that effect (and the weight loss) lessened. But I stuck with it because a ‘normal’ diet would drive my BG over 120 (and junk food like potato chips would drive it to 180+).
But now I’ve been reading about how going too low-carb long-term might be a problem for people with adrenal issues, because the adrenals have to produce more cortisol or other hormones to break down protein for sugar. So instead of over-working your pancreas, you end up over-working your adrenals. Does that make sense? Does it mean I should go just low enough to keep my post-prandials under 120, and no lower? Should I eat more carbs spread out in small snacks, to keep BG supplied without the help of the adrenals? Would it be helpful to get an adrenal test done to see whether my cortisol is high or low, and that sort of thing? Also, my TSH is high (4.280), but my T3 and T4 are in the middle of their normal ranges. That, together with your articles, also has me thinking about gut inflammation, and all the omega-6 I got over the past few years from snacking on nuts and peanut butter to stay low-carb.
Sorry for all the questions, but this seems like the one place where all my issues are being discussed. Most places focus on one thing, like adrenal health, to the exclusion of everything else.
Aaron,
I am aware of the Kitavans and yes, I think the problem is more related to refined carbs than starch. Unfortunately, that’s predominantly what Americans eat. Also, once dysglycemia sets in, even natural starches can push blood sugar to unhealthy levels. I’ve seen this over and over by asking patients to measure their blood sugar after various meals.
I have heard anecdotal reports that a very low-carb diet can cause hypothyroid symptoms and adrenal issues, but I haven’t seen that firsthand. There are some physiological mechanisms that make it plausible, which is why I don’t recommend a VLC diet over the long term for most people. Steps must be taken to restore insulin sensitivity along the way, with the idea of being able to reintegrate some healthy carbs later. There’s no hard, fast rule though.
It’s super important to keep your BG below 120 post-prandial, and I personally would prioritize that and then focus on supporting the thyroid and adrenals. Testing your cortisol (using the salivary profile offered by Diagnos-Techs) would be worthwhile to see where you stand there. High TSH on its own is hypothyroidism, even according to the mainstream definition, regardless of your T4 and T3 levels. That needs to be addressed, and my guess is your blood sugar and adrenal issues will improve when you do that (and vice versa).
Chris,
I am a 46-yr-old female, recently diagnosed with multi-nodular goiter but have “normal” blood results (including autoimmune); needle biopsy of a large nodule which I was told revealed “nothing abnormal” (although my mom, who is a physician, said didn’t look like a very good sample as it was “mostly blood with a few follicular cells”). I have what I feel are hyperthyroid symptoms upon waking (racing thoughts, OCD, fast heartbeat, palpitations) and hypothyroid-related symptoms throughout the day (lethargy, constipation, depression, low Vitamin D, unexplained high cholesterol, long periods, hot flashes). The tightness in my neck from the goiter is very uncomfortable. My question is this — After reading your articles I’m going to try to address leaky gut, gluten intolerance etc. — Is there a chance that will help me with the NODULES, or are are those only going to go away with thyroid hormone and/or surgery?
I’m SO glad to have found your site.
Thank you! Denise
So it should be under 5 mmol/l ? Mine is always 5.2 or higher (as high as 5.6) first thing in the morning, it can go up a couple of points with moderate exercise, ie an hour of jogging, and it goes down into the 4’s if I kill a workout (go with hard intensity) and feel tipsy afterward.
I have been eating lettuce as my only carb and lots of fat and a little protein over the past couple of days and I still get my blood sugar at 6 mmol/l 2 hours post.
Although yesterday it never went about 5.4 all day.
Testing is very thought provoking I can say that. Like the first week I got it, I had a coffee that had sugar in it, and it went up to 8.5 or something ridiculous…no more drinking calories for me. The bio feedback is good for me.
It should be under 85 ng/mL when fasting. If it’s not, it indicates blood sugar dysregulation. That doesn’t mean diabetes, but keep in mind diabetes develops slowly over time. It’s not like catching a cold. So identifying imbalances like this early is an important step in preventing them from developing into full-blown diabetes later in life.
As I’ve written in this series, it’s not just about diet. The adrenals and the immune system must be addressed.
Phoenix, yes, balancing the adrenals is trickier when autoimmunity is involved. As you pointed out, certain botanicals have a stimulatory effect on the Th1 system, which is often overactive in Hashimoto’s patients. This is why it’s important to find someone to work with on this stuff. I wish it was simple enough to just write a couple articles on and give people enough information to treat themselves. Unfortunately, thyroid disorders are far too complex and multi-factorial for that. And I wish it was easier to find practitioners who are well-versed in functional medicine. I’m doing the best I can to get the word out, but there is a definite lack in this area.
I’m going to keep taking them and recording it so I can show my dr. ugh…I think I need diabetes like I need a hole in the head…
so 102.6 mg/dL first this this morning (fasting). Then 92, 3 hours post prandial a 14 g carb lunch.
A normal fasting blood sugar is 85 mg/dL or less. Doctors say anything under 100 mg/dL is normal, but plenty of research shows that fasting blood sugar in the mid 90 mg/dl (5 mmol/L) range often predicts diabetes that is diagnosed a decade later. In your case there is definitely a blood sugar imbalance going on based on the readings you have shared.
Phoenix – Your adrenals do sound very fatigued, HOWEVER it could also be the ERFA. I found it to be an inneffective med for my body and I had to switch back to the Thai Thiroyd. It basically made me very hypo again. This could be an issue for you too. If you are looking for support or advice, the forums at http://www.realthyroidhelp.com are excellent.