I have terrible PMS and I feel like my Hashimoto’s symptoms get worse right before my period. I am exhausted and extremely emotional right before my period and my breasts are really tender, like they hurt to touch them. What is going on?

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My question is about flare ups and what tools you can use to combat them. I have Hashimoto’s and am on 30 mg of armour a day. In the last week, my grandmother died, I lost my job and had a late night. The next day I had debilitating symptoms of 100-101 fever, terrible body aches, chills, fatigue, was really weak and had no appetite. I went to the doctor and was tested for a bunch of stuff including covid- everything was negative. When this has happened before I usually recover within a few days and am starting to wonder if this is what is considered a flare up. - Kim

How to manage your blood sugar and why it is so important for managing Hashimoto’s.

If there is one thing I would suggest you do in order to get your autoimmune condition, any autoimmune condition in the direction of being under control rather than it controlling you, it is managing your blood sugar. It was the one thing that kept me from feeling better in the beginning because all I got from my naturopath was “watch your sugar intake”. Well, I needed to really watch my sugar intake. I didn’t manage my diet well in the beginning. I thought the paleo diet was going to be the life giving diet answer and it wasn’t. That’s not to say it isn’t a good diet if done properly but all I am learning now is that a balanced diet might be better for me. We are all biochemically different, remember? What works for me may not work for you. BUT when it comes to blood sugar and Hashimoto’s and other autoimmune diseases, keeping it balanced is a really big deal. Blood sugar levels that are out of balance will F up your adrenals as well because they play a role in blood sugar management when things get out of hand. It also will cause your antibodies to rise. 

Blood sugar in medical terms is called glucose. It is a part of sugar but it is also a part of fruits and other carbohydrates, especially refined or white foods. It is what our body uses for energy for the most part. As sugar or glucose goes in to your blood stream through your gut or small intestine where most nutrients are absorbed. When we take in too many sugars our blood sugar becomes out of balance and insulin is released from the pancreas to shuttle sugar to our cells and what is left over gets converted to triglycerides in the liver. The more sugar we eat, the more insulin is released. Carbs are not bad, I want to be clear. Even starches like beans and potatoes are not evil but they can be a problem when consumed in high amounts. The key here is balance. I eat beans and potatoes but I don’t eat them everyday and I don’t eat a lot of them though I have been eating beans and rice with a vegetable for lunch for the last few days. That combo is a great source of protein and I have been enjoying a break from meat two to three meals a day. I’m trying to mix things up because I tend to eat the same thing over and over and over. 

When your blood sugar is on that roller coaster, it can flare up or increase symptoms of Hashimoto’s. Diabetes and Hashimoto’s have a relationship. One more reason to manage your blood sugar. Blood sugar dysregulation is a stress on the body and as with any stress, it can cause flare ups or damage to your thyroid gland. 

What are some signs you may have a blood sugar imbalance?

If you wake up between 1am and 3am and have a hard time getting back to sleep that is a classic sign of low blood sugar. Your blood sugar will drop at night, especially around 1am, causing you to wake up due to a surge of adrenaline. When your blood sugar gets low while you’re sleeping, it is your adrenals that release cortisol to help raise your blood sugar and sometimes it releases too much and you get a big enough surge to wake you. This release of cortisol can also cause an immune response or flare. When this happens regularly it is a form of chronic stress on the body and can lead to chronic fatigue, mood swings and an increase in thyroid antibodies. 

Another indication is when you are constantly craving something sweet. Sugar cravings. The bane of my existence. I still battle with that though I have healed my gut enough to be able to occasionally enjoy a sweet treat. I still crave sugar though, like a drug. No joke. Sometimes those cravings are not something we can control with will power. There can be very physiological reasons for your cravings so just let go of the guilt right now. You can have a deficiency of B vitamins, a yeast overgrowth in the digestive tract, a deficiency in digestive enzymes or HCl, or even hidden food allergies. 

• You may have an excessive appetite- you can never get full or you always feel hungry.

• You may crave coffee or sugar in the afternoon as a pick me up

• You may feel sleepy in the afternoon

• You may have fatigue that is relieved by eating

• You may get a headache, become irritable or shaky if you skip or miss a meal

• You may have brain fog, forgetfulness, nervousness

• You may have cold hands and feet

• You may have trouble losing weight

You can test your own blood sugar swings at home by getting a glucose monitor. If you have big swings in blood sugar after eating, this will be a good idea to do. High carb meals can be the cause of this type of blood sugar swing, called Reactive Hypoglycemia, but not always. 

Here is how you test: 

First thing in the morning you test your blood sugar. Don’t eat first. Record the number on your monitor. The monitors usually come with a little book for this purpose. 

Then eat your normal breakfast writing down what you eat then check your blood sugar with the monitor every 30 minutes for the next four hours. This will give you a good picture of what a meal does to your blood sugar. You can continue to test the whole days worth of meals so you know what foods cause such spikes and dips in your blood sugar. It will help you really start to hear your body when it is telling you something isn’t right. Not all foods will cause a blood sugar spike and you might be surprised which foods do cause a spike for you. 

Other things that can cause a blood sugar imbalance are 

• Low HDL cholesterol levels

• Being overweight with a bigger midsection

• Insulin resistance

• High blood pressure

• High triglycerides

• Type 2 diabetes (an obvious one)

• PCOS for females

  • menstrual irregularities including not ovulating

  • insulin resistance

  • hair growth on the face or other odd places

  • acne

You can control your blood sugar levels through diet and lifestyle changes. You can try a Whole 30 or join a RESTART class or work with someone qualified to help you figure out just what you should be eating. You don’t have to do a ketogenic diet, paleo diet, vegan diet, carnivore diet or anything else. If you are in a flare you should be doing some kind of diet change anyway. Learn which carbs cause blood sugar spikes by checking your blood sugar levels with a glucose monitor. Proteins and fats will slow keep your blood sugar more stable than carbohydrates for the most part though that doesn’t mean stop eating them. Have one serving of protein to two servings of carbohydrates which could look like a 4 ounce pork chop with 8 ounces of rice or potato. Vegetables are carbs but are typically not an issue with blood sugar regulation. Many practitioners may tell you to follow the glycemic index to know which foods may cause a spike in your blood sugar but glycemic load may be more important.  It takes in to consideration the quality and quantity of a carbohydrate.https://lpi.oregonstate.edu/mic/food-beverages/glycemic-index-glycemic-load#glycemic-load

the glycemic index of a serving of watermelon and a donut is 76. The watermelon has 11g of carbs and the donut has 23g of carbs. The glycemic load of watermelon is 8 but a donut is 17 so in this case, the watermelon is going to be the better choice. Glycemic index compares the potential of foods with the same amount of carbohydrates to raise blood sugar. Glycemic load again, takes in to consideration the quality and quantity of the food. 

Until you get things working better you may need to eat 4 or even 5 smaller meals to help your body out. Opt for protein type snacks like hard boiled eggs, nuts or seeds. Avoid any sugars before bed time- so nothing after 7pm. Limit caffeine and try to eliminate coffee altogether for some time to allow your body to heal. Obviously we want to avoid gluten and potentially dairy but you don’t have to avoid beans and legumes. Grains may be an issue for some but not all. Eat breakfast and be sure to eat protein with each meal. 

Cinnamon can help lower blood sugar because it slows the rate at which carbohydrates are broken down in your gut and will keep your blood sugar from spiking. Add it to anything and everything you can. 

Exercise. It helps your cells become more responsive to insulin, meaning they will use it and not be resistant to it. This will help reduce thyroid symptoms. Our muscles typically use glucose for fuel so even walking everyday- for an hour if you can will help pull sugar from your blood and let your muscles use it. After awhile it will help keep your blood sugar stable. Swimming and yoga are good options too. No need to over do it. Your body doesn’t need any extra stress while it is trying to heal. 

Drink water. This will help your kidneys flush out excess blood sugar through your pee. Adding electrolytes will help that water get to your cells. I like Designs For Health Electrolyte Synergy which you can get at https://us.fullscript.com/welcome/hfh. To me it tastes like gatorade without sugar but I haven’t had gatorade in 15 years so I could be way off. 

Make sleep a priority. Big time. The quality of sleep you get is very important to healing. I probably hadn’t sleep well for 20 years and was one of the reasons why I was not getting better. My sleep suffered due to blood sugar problems and the wrong sleeping environment for years. Plus having kids- those early years, I didn’t sleep much like any mother. Not sleeping well was the bane of my existence. Honestly, when I started school last year, I had to move out of my bedroom because my husband snores so loud and he chokes in the night and then punches the air. One time he almost hit me and that was it for me. It makes me sad, I guess, that we can’t sleep in the same bed but I’ve been told it is more normal than I realize and I just wasn’t willing to sacrifice my sleep or my sanity or my health any more. I now sleep soooo good in cold, dark and peace and quiet. But my relationship has suffered and that is another stressor to deal with. For right now, I’ll take good sleep because physically I feel so much better. 

Supplements. Magnesium (most of us are deficient and we need it to process sugar at the cellular level). Chromium (helps break down carbs and fats as well as control blood sugar- found in eggs, nuts, green beans, broccoli, meat or supplements). B vitamins, particularly thiamine or B1 (converts carbs to energy, aids digestion of proteins and fats which help us use those nutrients and not crave or feel hungry). A good B complex may be needed. Florastor probiotic and prebiotic fibers like fructooligosaccharides and inulin. Glutamine (for gut healing and curbs carb cravings by suppressing insulin levels and stabilizing blood sugar).