When you skip a meal or eat inconsistently in other ways your body has to compensate. Several hormones are involved including insulin, cortisol and thyroid.  Cortisol has an important anti-inflammatory function. Insulin is involved and works hard to stabilize the metabolism. Thyroid hormone is affected because the conversion of T4 to T3 depends on a constant source of carbohydrate. Receptors for thyroid are found in most tissues highlighting how crucial it is for many physiological functions.  You can see why clinically, one of the first layers I look at is stabilizing blood sugar especially if there is thyroid or other endocrine involvement.

Pain and Hunger

Cortisol is anti-inflammatory. If it is overused cellular resistance can happen which can lead to systemic inflammation or increased pain in the body.  If there is an underlying autoimmune condition it is likely to worsen as the tissues that are under attack have less protection.  Cortisol spikes at night and may be the cause of recurrent night hunger. A high protein snack before bed can be helpful for both this and insomnia. Adaptogens like ashwaghandha normalize cortisol. However this particular one is a nightshade which is contraindicated where autoimmunity is present.

Testing cortisol and hormone metabolites can be very helpful but blood sugar and gut health have to be addressed.  Creating a stable baseline is the starting place. Hormones will sometimes regulate themselves once there’s new baseline. If this doesn’t happen then we have other places to look.  I find this process to be empowering process for patients because they are engaged in treatment on a day to day basis that creates change.

Carb Tolerance: Learn to moniter your glucose 

Glucose levels can stay high or drop too low. In reactive hypoglycemia there is an excess release of insulin resulting in an intense blood sugar crash. A higher protein diet can help stabilize blood sugar. For those with metabolic issues, a Paleo-type diet is recommended. Some will do better on a lower-carb version of this diet, although that’s not always necessary depending on the individual.  As I mentioned earlier thyroid requires a more constant source of carbohydrate.

Studies show an increased frequency of thyroid disorders in diabetics. This is a bidirectional problem, meaning thyroid disorders increase the frequency of metabolic problems, and metabolic problems increase the frequency of thyroid disorders. Metabolic syndrome is associated with inflammation, insulin resistance and hormonal imbalances.

Chronically high blood sugar leads to insulin resistance and inflammation; repeated insulin surges increase the destruction of thyroid gland in autoimmune thyroid disease.

There are a couple botanical supplements that support blood sugar regulation. Eating an autoimmune diet low in goitragens and nitrils is a good starting place.  Looking at iodine levels is also relevant.

An autoimmune diet

Improving gut health is key for all autoimmune and gastrointestinal disorders including leaky gut. Thyroid hormones affect the tight junctions and of the small intestine and stomach. Lipopolysaccharide is an endotoxin that comes from pathogenic bacteria. In leaky gut it can escape and trigger autoimmune reactions and inflammation.

Adequate intake of sea vegetables along with fish or brazil nuts offers the iodine and selenium needed to support thyroid function. Sweet potatoes are goitrogenic when raw but cooking them makes them a safe choice along with yams, plantains, taro, yuca, and squash. Fermented veggies are encouraged on a daily basis in small amounts. They can be goitrogenic in high amounts.

The autoimmune diet requires removing a few foods like nightshades, nuts/seeds and eggs in order to seed if the body is reacting to these as they are common allergens.

The cycle: Blood Sugar, HPA Axis and Cortisol

Chronically low blood sugar levels lead to increased cortisol as I mentioned at the beginning of this article. Cortisol is a glucocorticoid meaning its job is to increase the glucose so the brain and muscles have what they need.  It also slows digestion, growth, and reproduction meaning prolonged or repeated surges undermine these functions. Interestingly thyroid hormone is required to help clear cortisol metabolites.

Diet, exercise, supplements, and hormone replacement cannot overcome stress-induced hormonal imbalance although each of these do play a role. Stress management is the central player. Stress can impair estrogen clearance, weaken immune barriers in the gut, brain and lungs and create cellular resistance as we talked about.

Stress management is going to be the focus of many articles to come.  Using an evolutionary framework is incredibly powerful in terms of reconnecting with our genetic legacy of adapting to new environments.  Today’s world requires that we remember how to live as our ancestors did. Being able to regulate stress is part of our birthright.