The following blog is a Case Study, written by Dr. Yousuf Siddiqui, NutriChem Naturopathic Doctor
A 43-year-old man, let's call him ‘John’, came into my practice concerned that he was no longer feeling like himself. He was experiencing deep fatigue that was not only impacting his work performance, but also his marriage and his confidence. His weight had increased by 25 pounds, his body felt stiff, and his endurance had significantly decreased. John was frustrated because nothing was helping.
About 4 years ago, John noticed that he was starting to slow down. He associated it with stress and ‘life getting in the way’. Motivated to get himself back on his feet, he started the Keto-diet and worked out again. In the past, John was an avid runner and played baseball 3 nights a week. In his 20s, while completing his master’s degree, John was on a competitive soccer team and working full time! He was used to pushing himself and had developed techniques to get himself back on his feet - but this time those strategies were no longer working like they used to.
Concerned, and with the support of his wife, he booked an appointment with his family doctor. He was getting desperate for answers as his go-to solutions were no longer working for him. His family doctor ran blood work and John was told that everything was ‘normal’ and he should focus on stress management and get a good night’s rest.
It was at this point that John’s wife booked him for an initial assessment with me. I could tell that John was worried about his health when I first met him. He wanted answers and he wanted to feel like himself again. After completing a full medical intake and physical exam, it was obvious that John had lots of gut inflammation. He thought it was healthy to have 3-5 loose bowel movements a day. His abdomen was slightly distended and tender. He rated his energy a 2/10 and mentioned that his libido was even lower. He was struggling to “pull his thoughts together” and described himself as feeling numb.
My approach may be different from other naturopaths. I like objective findings - lab tests. They help me to precisely, and quickly, evaluate what is going on in the body. We decided to requisition comprehensive blood work that would give me information on his hormones, thyroid, cholesterol, pancreatic enzymes, and so forth. In the interim, we opted to experiment with a low-FODMAP diet to see if decreasing the number of oligo-saccharides would decrease his bloating.
A few weeks later, John showed up for this appointment and we reviewed his blood work. His cholesterol, liver enzymes, testosterone (total and free), pancreatic enzymes were within range and normal. What became quickly obvious is that John’s body was inflamed and his thyroid was not functioning properly. His HS-CRP, ferritin, and platelets were in the high normal range. High normal means, according to conventional medicine, there is no disease process. As a functional naturopathic doctor - Alarm bells!
John’s thyroid was also not functioning properly. His family doctor had tested his TSH (Thyroid Stimulating Hormone) and suggested it was normal. After re-testing his TSH, free T4, and free 3, it was obvious that John was experiencing hypothyroidism. His TSH was slightly elevated and his T4 and T3 were within range. The diagnosis of this condition is called subclinical hypothyroidism and is often missed when only TSH is tested.
After starting the low FODMAP diet, John has noticed that he was less bloated and his energy had slightly increased to a 4/10. The low FODMAP diet limits the number of oligosaccharides - a fiber that feeds the good bacteria in your gut. However, if there is an imbalance in the bacterial flora, too much of these fibres will essentially feed the overgrowth and contribute to food intolerances, bloating, and poor digestion. This condition is known as “Small Intestinal Bacterial Overgrowth” or SIBO and a major cause of “leaky gut”.
I could tell that John was feeling more optimistic but he was still struggling. We discussed the link between gut inflammation/dysbiosis and thyroid health. In order for his system to be recalibrated, we would need to focus on his digestion and his thyroid.
Let's take a step back to understand how the thyroid works. TSH (Thyroid Stimulating Hormone) is released from the anterior pituitary gland in the brain. It is like a gas pedal to your thyroid gland. When your TSH is elevated, your brain is ‘pressing hard on the gas pedal’ as it pushes your thyroid to produce T4 (Hypothyroidism). When your TSH levels are low, your brain’s foot is off the gas pedal because your thyroid is producing too much T4 and T3 on its own (Hyperthyroidism). T4 and about 20% of your T3 (active thyroid hormone) are made by your thyroid gland. The remaining 80% of T3 is activated mostly in your kidneys and liver.
So how exactly are thyroid hormones linked to your gut health? T4 and T3 circulate in your body and strengthen the lining in your stomach and intestine; both of which protect the gut mucosal lining (think leaky gut) and prevent ulcers. Furthermore, T4 actually decreases inflammation in the gut by preventing too much intestinal intraepithelial lymphocytes (IEL) - which are immune cells that are found in the intestinal mucosal barrier - again think of leaky gut!
We also know that 20% of T4 is converted into the active thyroid hormone T3 though an enzyme called sulfatase. And where does sulfatase come from? You guessed it - healthy gut bacteria. A large research paper confirms that irregular bacterial patterns, called intestinal dysbiosis, significantly reduces the conversion of T3(S) and T3(AC) to active T3. This is one of the major reasons why individuals with poor digestive health may have thyroid symptoms and yet have normal lab results.
John was struggling to understand the link between his thyroid and his gut health however he did understand that he was bloated and tired. We did a trial of 30mg of desiccated thyroid to decrease his TSH and stabilize his T4 and T3 thyroid hormones which would help to increase his energy and feeling of well being. Considering that John’s digestion has improved when following the Low FODMAP diet, I requisition the SIBO Breath Test to confirm the diagnosis and determine if he was methane, hydrogen or methane-hydrogen dominant. This test will guide a more precise treatment protocol because it determines which group of bacteria have overtaken the small intestine resulting in chronic digestive complaints.
My approach is to create a treatment strategy that works for my patients. I wanted John to experience a ‘win’ - to take a large step forward and experience a noticeable increase in his energy, mood and possibly lose a few pounds. I prescribed 30mg of desiccated thyroid, we requisitioned the SIBO breath test, and scheduled a follow up in a month.
Dr. Yousuf, ND will be presenting his findings from this case during a Facebook Live on NutriChem's Facebook Page scheduled on June 18th at 3:00PM. Join us as he discusses John’s journey to rebalancing his body, regaining his confidence, and what his wife thinks about him now.
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