by Sanford Siegal, D.O., M.D.

Chapter 1

But Doctor, I'm Telling the Truth

My patient looks troubled.

"I don't care what that doctor says, there has to be something wrong with my metabolism."

She's one of today's new patients. Her name is Marie. We've just met. She doesn't hesitate to tell me of her dissatisfaction with the last doctor she saw. I gather that her former doctor thinks she just eats too much.

"He said the tests showed that my thyroid was just fine. I followed his diet but it was just like all the others. It didn't work. I just want to be thin. What's wrong with me?"

Her words and her manner don't startle me. I've heard such words spoken too many times in the past. I truly sympathize, but at the same time I'm impatient. There's work to be done. I've a lot of questions to ask. I will do an examination. Then there will be much explaining.

Clearly Marie wants to vent her feelings, and it may be doing her good. From experience with many others, I know those feelings. At this point, I can see that she will repeat her complaint for emphasis, but I don't want to be impolite, so I let her go on. And she does.

There's no complaint I've heard more frequently during that most important first patient visit than what Marie has just expressed. Her monologue is so typical that after the first few words I could have completed her remarks. In the last thirty-eight years, I've had literally thousands of patients voice that same complaint. Of course, they aren't all as bold as this patient. They don't all blame their former doctors. They do express this same discontent, but they phrase it in many different ways:

"I don't understand why I'm so fat; I eat very little."

"I've had my thyroid tested. There's nothing wrong. Why can't I lose weight?"

"Will you give me something to burn up this fat? Nothing seems to work."

"Maybe I have a thyroid problem or something."

"No matter what I do, it won't come off."

Let's make it clear why they're telling this to me in the first place. It is because I specialize in treating overweight problems. In my medical practice, those are the only kinds of patients I see. I don't accept those whose complaint is a sore throat, a broken arm, a nasty rash, or a nose that needs to be reshaped. For forty years, I've limited myself to helping people whose ailment is an excess of fat. My experience has been acquired from hundreds of thousands of overweight patients. (I've truly lost count.)

True, a formidable number of my new patients do admit to major indiscretions. "I eat like a pig" isn't that infrequent. Marie is clearly not in that camp.

She has come to me because she has an acquaintance who seems to have undergone some sort of metamorphosis. Her friend, a once pudgy, dull, couch potato, has a new svelte figure and radiates an astounding personality change. She's given up her menial employment and is going to school to learn court reporting.

Marie knows that her friend has been my patient for a while and that I must have had something to do with that transformation. She believes that the effect of the diet I prescribed for the lady was to reduce her weight and that all the other benefits were derived from some newfound confidence. Her remade friend is now proud of her body and has acquired a self-image that causes her to regard the world as her personal oyster.

She's wrong about her friend in a lot of ways.

First of all, it isn't diet alone that is responsible for the drastic improvement in the friend's shape. And it isn't newfound confidence that makes that lady get up and go. It is the medication I prescribed for her previously undiscovered ailment that is responsible for all the changes. Taking that medication, she would have emerged from hibernation even if she hadn't been fat and lost weight. Her friend has hypothyroidism.

Marie clearly doesn't know the whole story. She's hoping I have some sort of magic diet that will finally get the weight off of her. Unlike her friend, she doesn't need her psyche altered. She has enough motivation to do things and she would do them if she weren't so tired all the time. Of course, she blames that on the extra weight she is carrying.

She isn't going to find a magic diet at my office. She has already been on too many diets. She's hostile toward her last doctor because his diet didn't work. She followed it faithfully for almost a month and lost barely four pounds. At that rate it would take her forever to get thin. He didn't seem to listen to her when she told him that she loses poorly even on the strictest of diets.

Now she's trying again. What she's telling me is that there's something wrong with the way she handles food. It's her "metabolism or something." I sense that she isn't sure of this. After all, the last doctor spent a fair amount of her money at the medical laboratory and proved to her that there's nothing wrong with her metabolism. He said that her thyroid was fine and then explained to her that "thyroid" and "metabolism" were sort of the same thing. In making his explanation, he used such mysterious terms as TSH and T3 and T4. Who can argue when such scientific proof is presented? Does any ordinary mortal dare question TSH, T3, and T4?

Like Marie, at least half of my new patients believe that something has gone wrong inside of them. They declare that, given their eating habits, they shouldn't be as fat as they are.

Many of these people have been to other doctors and have had various laboratory tests intended to show whether there was some sort of metabolic problem. More often than not, the tests come back with the results quite normal. The lab asserts that there's nothing wrong with this person's thyroid. This is one of the few instances in which a patient is truly disappointed to find out that the lab tests rule out some disease. Were the tests to have suggested a metabolic abnormality, the patient's own character would nicely be off the hook. That would prove that the obesity isn't from a lack of discipline or from some character flaw. It would show that the patient's metabolism was the culprit. No such luck for the lady sitting across from me.

On the basis of laboratory tests, doctors often form their opinions. The problem is that many of them have more confidence in laboratory results than in their own good sense. Too often, they ignore the basic principles they learned during their training and rely upon high-tech innovations to show them the way. If we doubt our own perceptions when they are inconsistent with the output of high-tech procedures, we increase the chance for a faulty diagnosis. Consequently, I believe that a large number of people suffer from an ailment that causes them to be overweight and that this condition isn't diagnosed, or perhaps it is even ignored, by a lot of physicians. The ailment is hypothyroidism.

It might not be possible to find another doctor in my area who has done more thyroid testing of patients than I have. After all, I have forty years under my belt and each patient during that time has had at least a potential thyroid problem. By the time I had perhaps seen my five thousandth or ten thousandth patient, I was already pretty disillusioned with the value of thyroid tests. Today, years later, I regard those tests as practically useless. This awareness was the major motivation for my writing this book.

Since my particular interest is the patient's weight and how to get her to part with the excess portion, the subject of metabolism and the thyroid gland has become my passion. The problems that are associated with an improperly functioning thyroid gland and the resulting abnormal metabolism extend way beyond weight. After all, the thyroid gland is a major controller of how we feel, how we act, how we look, and how we function.

People know I'm obsessed with my patients' weight. That's what brings the patients to me in the first place. As with any other complaint, an early step in the process of managing weight is establishing a diagnosis. When I make a correct diagnosis of hypothyroidism, the weight problem is on its way to being solved, and the fallout from this success extends far beyond the pounds that are lost.

In the course of attacking my patients' obesity, I've seen the most fortuitous "cures" you can imagine. I've been given undeserved credit for benefits I never even contemplated. I've seen a moderately obese woman who was resigned to the fact that she was sterile become pregnant in her later years. What joy! All I was trying to do was get twenty-five pounds off her. Of course, such surprises were more dramatic in those early days. Today, I've come to expect these little miracles, even though I'm really not looking for them. I focus on my patient's weight problem. Whatever else happens is medical serendipity.

I have seen years of excruciatingly painful periods disappear in a flash as if by magic.

I have seen phlegmatic, depressed individuals who could barely motivate themselves to get up in the morning suddenly become upbeat dynamos.

I have seen debilitating pain that flits from one location to another, pain that had confounded a bevy of specialists over the years, quietly depart without fanfare.

I have seen hair come back, anemia disappear, memory return, laxatives discontinued, and chronic fatigue become a bad dream.

I don't mean to suggest that I'm the only doctor who knows about all of this. Plenty has been written about the miseries of hypothyroidism. There are even quite a few doctors who specialize in the thyroid gland alone. They and I do part company when it comes to the method of determining who has the ailment and who doesn't, and to a certain extent, what to do about it when we find that it exists.

As I've said, I specialize in treating overweight problems. Because I've seen so many patients over the years, I've developed some very definite and perhaps unique opinions on the subject. In the course of treating thousands of patients, one may change his opinion about ideas that he had previously believed to be incontrovertible.

It is my belief that when it comes to diagnosing problems involving metabolism, the laboratory not only fails us, it even gives us deceptive information about the patient. As a result, many of the patients who consult me have been told that their metabolisms are normal even though they display many of the signs and symptoms of a low metabolism.

The signs and symptoms of hypothyroidism are well known to most doctors. The subject has hardly been ignored in the literature that doctors read. I too read the literature. I'm sure that many doctors intuitively consider hypothyroidism when the patient gives them a history of her complaint. When my own intuition suggests to me that a patient has this affliction, I would naturally like some corroborating evidence. This is the point where doctors turn to the laboratory for help. The laboratory could supply the information that would confirm the diagnosis, but the fact is that it doesn't. I've come to mistrust the laboratory when it comes to the thyroid. Where, then, can I turn for help?

Years ago we had machines that were supposed to help us medical men with metabolic testing. I did thousands of basal metabolism tests with one of these machines, but I always regarded the results as suspect. There was another curious gadget that tested the response time of the Achilles tendon reflex in the ankle. It was an attempt to measure the known connection between the speed of our reflexes and thyroid function. I can still see that look the patient got when my nurse tapped her foot with a rubber hammer. Both of these machines were eventually discredited and yet as I look back, as imprecise as they were, they were probably more reliable than today's lab when it comes to hypothyroidism.

I haven't given up on the laboratory approach, but the search for adequate laboratory tests of thyroid function must continue.

In the 1970s there was a doctor who wrote on the subject. He also mistrusted the laboratory. He had great confidence in a test that he himself had developed. It was simple and easy to perform. Observing that those with hypothyroidism seemed to have a low body temperature, his patients were required to use the thermometer to help establish the diagnosis. I agree that the method has some value, but body temperature can be quite variable for a variety of reasons. I didn't feel that his test by itself could be relied upon as definitive.

Over the years, my own test evolved. Like so many nice discoveries, it was right "under my nose" all the time. It isn't as though one day I decided to invent a test for hypothyroidism. For a long time I had been aware that the inconsistency between what some people weighed and what they actually ate pointed in the direction of hypothyroidism. This knowledge, combined with other factors I observed in the patient, would lead me to make the diagnosis. What gradually emerged was a step-by-step approach to organizing that information so it would serve as a test applicable to all patients. With the testing method I now use, I feel I have at least a 90 percent chance of diagnosing hypothyroidism correctly. What's more, now you can actually do this on yourself, and in a later chapter I'm going to show you exactly how to do it. Stay calm. I'm not going to ask you to puncture yourself or to cause yourself any discomfort. You're going to be asked to eat certain things and to jot down some numbers. When you've completed the task, I believe that you will have a better idea of the state of your metabolism than you might receive from any medical laboratory.

The tests you will be performing will be the same tests that I use every day on my own patients. Whether your thyroid is at fault or not is information that could be invaluable to you if you've had difficulty losing weight, but the benefits could also extend far beyond simply regulating your weight. After you've done the testing, I shall instruct you as to what to do with that information. A low metabolism is correctable and reversible, but that will require the assistance of an attentive physician. I'm going to help you get that information to your doctor or help you find a sympathetic doctor.

If you learn that your thyroid is normal, and you have a weight problem, the testing will still be of value. You need to know that it is normal so that you may settle down to a serious diet with the confidence that it will certainly work.

Hypothyroidism is the medical term that is applied to an underactive thyroid, a gland that doesn't secrete sufficient hormone to allow the body to function normally. In many cases but not quite all, hypothyroidism results in an excess of weight. However, there are a host of other conditions and symptoms that also result from low thyroid function. Many who suffer from excessive fatigue are mistakenly told that they have chronic fatigue syndrome. A sizable number of women going through complicated and expensive treatment to facilitate pregnancy might have immediate success if their underactive thyroid glands were properly treated. Likewise, many menstrual abnormalities are the result of low thyroid function. Psychological problems are another manifestation of hypothyroidism. In general, a hypothyroid patient who receives proper treatment can experience an across-the-board improvement in her general sense of well-being.

For whatever reason, and the reason is often the laboratory, many physicians seem to go off in other directions when patients present themselves with the characteristic signs and symptoms of hypothyroidism. An October 1996 article in McCall's magazine, "The Disease Doctors Miss," did a good job of explaining this phenomenon. It listed many of the symptoms that accompany hypothyroidism, and it was an appeal to the reader to prod her doctor into delving into the problem. This book has essentially the same general purpose, but it also invites you, the reader, and perhaps the victim, to take a very active role in determining whether you have a metabolic or thyroid problem.

Doctors particularly seem to ignore the patient's weight as a significant sign of hypothyroidism. This is probably because of the general tendency of the literature to downplay metabolic problems as the cause of obesity.

Of the many systems I could use to categorize my overweight patients, the simplest would place each of them in one of two categories:

1. Those who eat too much.

2. Those who don't eat too much.

As simple as that sounds, it isn't. In a sense, they all eat too much. But too much for what? The answer is too much for one's body to maintain its weight. One patient might think she eats only one-third the calories her best friend eats, but it is still too much because she's overweight and her friend isn't. If the standard by which "too much" is to be judged is the amount necessary not to create obesity, then everyone who is obese eats too much.

But "too much" may not be that much at all. I'm sure you know that each of us requires a somewhat different amount of food to maintain our respective weights. In some instances the variations among us are impressive. That is the essence of the differences in metabolism among various individuals of similar size. We do seem to burn up our calories at different rates.

When the body fails to burn sufficient calories, I choose to define that condition as hypothyroidism. The trouble is that no one has yet invented a simple gauge that we can attach to ourselves that will read out how many calories we're burning at a particular moment. Until such a device comes along, we're forced to infer how many calories we burn from some rather unreliable tables.

The questions of how many calories we need, how many we eat and how many we should eat, how many calories we burn and how many we should burn, have occupied me for a long time. When I find someone who is out of kilter with what should be, I know I'm dealing with a thyroid problem.

The thyroid gland is located in the front of your neck below your Adam's apple, and normally it takes very trained fingers to feel it. If you do feel it easily, or, more important, if your doctor feels it, it could mean that there's a problem there. If it is readily felt, then it is probably enlarged, and that could mean one of various abnormalities. If what your doctor feels are lumps or nodules, it is mandatory that you undergo further studies. But that isn't the subject of this book. A generally enlarged thyroid gland could mean an underactive thyroid gland. Let's leave it at that.

This little gland is terribly important to your welfare. Let's examine what it does and what happens when it doesn't do what it is supposed to do.

Since the thyroid gland supplies a couple of hormones that regulate our metabolic processes, abnormalities of the gland's function are present with both overproduction of the hormones and underproduction. What is interesting and yet troublesome is that some of the symptoms of both conditions can be remarkably similar. Fortunately other symptoms aren't, and that tends to differentiate clearly between the two. We generally speak of overproduction of hormones as producing hyperthyroidism, a serious condition where bodily processes are speeded up. The typical hyperthyroid individual is the nervous irritable individual who seems "keyed up." Everything from eye problems to severe heart problems may accompany hyperthyroidism. The hyperthyroid sufferer is generally not overweight, and we shall not delve further into that condition.

Of course, there are a number of other diseases of the thyroid gland. There are what are known as autoimmune diseases, where one's own body attacks itself, and in this case the attack is on one's own thyroid gland. One of these is Graves' disease, a condition that got a lot of press when it was revealed that both President Bush and Mrs. Bush suffered from it. There are cancers of the thyroid and there are various nodules that can form and cause trouble. Everyone knows someone or has seen people with "goiter," which is extreme enlargement of the thyroid, usually but not always caused by too much thyroid hormone.

As I've pointed out, it is the underproduction of thyroid hormone that will concern us within these pages. More symptoms can be attributed to this single ailment than to virtually any other in the entire medical repertoire. Soon we shall review what they are. Perhaps in an effort to confound us, the disease usually displays only a few for each individual. Yet different individuals with the ailment may have virtually no symptoms in common with one another. This makes diagnosis very confusing for the doctor, and it is easy to go off in the wrong direction, suspecting other ailments.

The hyperthyroid patient often appears to be a bundle of energy; the hypothyroid one is the opposite. Slow movement, depression, and apathy are some of the qualities that are readily noticeable. In females, infertility and various menstrual abnormalities are common. The person may often feel cold (and actually may be cold!). The skin is dry, the hair lifeless, the cholesterol elevated, and, of more interest, obesity is often present. When you put these things together, you can almost bet that this is someone who has repeatedly tried to lose weight and failed.

If you are one of those for whom the diagnosis of hypothyroidism has already been correctly established, there may be real benefit in concentrating on Chapter 7, "Natural or Synthetic Treatment?," which deals with the medications used for treating hypothyroidism. Here again I'm at odds with the status quo. I believe that the drugs in standard use today for this malady aren't the best choice. I will tell you why my experience has brought me to that conclusion. It may be an uphill battle trying to convince your doctor that another approach might be better, but it is worth the attempt.

You will come across Chapter 15, which is intended to be read by your doctor. It is not strictly just for him or her. I won't mind if you choose to read it. It is essentially a condensation of what is contained in the rest of the book. It is included in the hope that you can convince your doctor to consider seriously what I have learned from my experience with these thousands of patients. I expect that there will be resistance on the part of the doctors who tend to reject ideas that don't come from their customary sources. Old habits die hard. If you can get your doctor to contact me, I will endeavor to convince him. I will even keep a list of those physicians who are willing to embrace what we know to be true. I will make the list available to readers who would like the information.

Because those who treat thyroid problems are so influenced by the dictates of the ivory-tower authorities who have ordained a rather monolithic approach to hypothyroidism, you may expect to hear, perhaps in the media, that what I have dared to include in this book is akin to heresy. I've preempted my critics by becoming my own critic, in a sense. I know what the criticism will be, and so I've constructed an imaginary conversation between one such expert and me. The debate ensues in Chapter 16, "Debating My Position."

Let's get started.

Copyright © 2000 by Sanford Siegal
Excerpt posted with permission from http://www.twbookmark.com

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