I feel worse after changing my diet.

Welcome to episode 67. I missed last week. Sorry about that. I was writing a paper on sarcopenia for my sports nutrition class. I’m now in week 8 of 11 and cannot wait for this class to be over. The class is a little demoralizing so 3 more weeks to go after this week and that cannot come soon enough. Makes you want to run right out and get enrolled in this nutrition program doesn’t it!? Anyway, I’m grateful you are listening. Let’s get to this weeks topic/listener question. 

Hello! I am a new listener and I really appreciate the podcast, thank you for doing the work to put it out.

I was diagnosed with Hashimoto's after my first son was born - he turned 5 in August and I have been very fortunate with how it has very minimally affected me. I am an athlete and have an overall very healthy lifestyle and recently, after a conversation with an NP at a kid's birthday party about autoimmune disease, I thought that perhaps I should be doing more with my diet to try to minimize or, if possible, stop the degeneration of my thyroid.

In that effort, I have gone gluten and dairy free and have done pretty well with it for about 4 weeks now, it terms of preparing food and keeping those things out of my diet but I'm writing to you because I have to say, I really feel worse now than I did before I started changing things.

My two primary complaints are significantly increased migraines. I've been having a few a week for the last few weeks when previously it was mainly just the last week of my cycle. I mentioned that I am an athlete earlier because I suspect part of the problem is that I might not be eating quite enough with the elimination of gluten and dairy, do you have other thoughts on this?

I also feel like my heart is just a little bit racy and out of breath which makes me feel....blah. I wouldn't say I feel fatigued, I still have energy for the things I want to do, I just feel like I've lost my power...if that makes sense? 

My inclination is to stop taking my levothyroxine which I have never had a problem with before now. I wake up in the morning feeling good and then 10-15 minutes after taking it, I start to feel stressed. I would like to make an appointment to have my meds adjusted but before I do that I wanted to get input from you in case you wanted to suggest other questions to ask or points to bring up with my Dr. 

I really appreciate your help, thank you so much! 

Hi Beth, 

Thanks for writing in. This is a really good question and timely since I am in a Sports Nutrition class right now. Going gluten and dairy free were the right thing to do though replacing those carbs in your diet may be what you need to do. Depending on what you do for exercise and from your picture on the Gmail it looks like you are a runner. You want to be sure you are fueled properly for your workouts but here is the thing. The running- it is creating a stress response, like a fight or flight response for you which will eventually create problems with your adrenals. Athletes need some source of carbohydrate for fuel. Carbs turn in to glucose in the body which are an immediate source of fuel for you as you are exercising. You probably have no problem storing glucose in the muscles- that is called glycogen. We all store glycogen in our muscles but those of you who have more muscle are able to store more glycogen for fuel when you need it, such as in exercise and in Beth’s case, running. Physiologically, as the duration and intensity of your exercise increases- so how long and hard you workout, your body will quit using fat for fuel and will burn only glucose or sugars. This is not what my ketogenic diet people will want to hear, but it is what the science says. 

The current recommendation for an athlete’s carb intake is 2-12g/kg of body weight daily- take in to consideration that this study that determined this amount probably only tested men so I would play around with the lower end- 2-6g/kg of body weight. Though if you are doing a long run, you may want to go a little higher than that. It is something you have to play around with. Generally, hashimoto’s patients do better on a higher carb diet- lots and lots of veggies and you need a fair amount of starches in your diet on your workout days- again, something you have to play around with. Use rice or sweet potato and make sure you are getting in at least 100g of protein per day, especially on workout days. Shoot for 1.2 or so g/kg of body weight in protein and supplement with a powder if you have to- for a 10km run, my book recommends 6-8g/kg of carbohydrate as well. Designs For Health Pea Protein is what I use because I struggle to get enough protein in- most of us do. Now because you are an athlete, you will be able to tolerate some sugar too, especially on running days so you may want to do some kind of sports drink. Be  mindful of digestive upset due to too much sugar though you can do a mouth rinse which works well for some. If you are exercising less than an hour, you may not need to replenish your carbs with a bunch of sugar but because you are dealing with hashimoto’s you might need to do a banana, rice or sweet potato or something like that. 

You gave up gluten- wheat products typically have B vitamins in them, and B vitamins are helpful for migraines. This is one possible clue. It sounds like they are hormonal if they are happening around your cycle. Our endocrine system not only includes our thyroid but it also includes our reproductive glands and when one is out of whack, the others will be also. My thoughts on this are 1. it is possible your thyroid is getting better with the elimination of gluten and dairy which is balancing your sex hormones too and things might just be wonky for awhile. 2. when the adrenals are exhausted, that can trigger migraines as well. There is not a lot of research on migraines and exercise except to say that it is thought that regular exercise can help reduce them- though I know a few people that is not true for. Menstrual migraines are either cycle related or something called pure menstrual migraines- a migraine associated with the onset of menses. Cycle related migraines are ones that happen throughout your cycle. The menstrual migraine is thought to be because of the quick drop in estrogen that occurs with your period starting each month. These usually don’t have an aura that comes with them, they are more severe and debilitating and treatments with conventional drugs like NSAIDs don’t work as well. Of course I cannot find any research that gets to the WHY of this issue. Why are you getting migraines? I can’t say for sure. My first inclination is that you need some liver support to help clean things up in house so the body can do its job well. 

I would see if you can go back in and have your labs done again because it sounds like your medication dose might be too high based on how you describe the way you feel. I don’t recommend stopping it altogether as that can be dangerous- I did that and completey f-d up my body for a good year, so don’t do that. If you feel like crap after taking your meds, your adrenals (also part of the endocrine system) are being impacted and you can try to do half doses but really you need to be taking it easy and working on getting your adrenals back, as well as keeping hormones balanced. So you want to make sure that you are managing your blood sugar. If you are not eating enough, that will be a problem. Insulin is there to bring sugars to your cells, when you have too much sugar in the blood at once, you get a surge of insulin which leads to that crash an hour later- the rollercoaster. Cortisol on the other hand will raise your blood sugar along with epinephrine (adrenaline) and the hormone glucagon. We have several mechanisms to raise blood sugar but only one, insulin, to lower blood sugar. If you are not eating enough, going too long between meals, cortisol will take sugar from your muscles and your liver to raise your blood sugar. Cortisol is also involved in the stress response which will raise your blood sugar too. I wouldn’t bet you are dealing with insulin resistance as an athlete but for those of us who are not athletes, if that sugar has no where to go it will be stored as triglycerides- aka fat. 

Without knowing more about how much you workout and how hard in addition to what exactly you eat and what your labs say, this is about as much as I can say. I hope it helps. 

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