Thyroid | thrive

Thyroid:

Hyper/

hypothyroidism

Wholistic Perspective |

An Wholistic perspective

Thyroid Dysfunction
and Treatment Text by Kelly Brogan, MD

So, what got me so into Functional Medicine? About 9 months after the birth of my first daughter, I was 7.5 months back to work at the hospital and in my private practice.

I was long back to my prepregnancy weight and loving motherhood, but I locked myself out of my office on several occasions, and had to, more than once, mail a cab driver a check because of a forgotten wallet (compassionate souls). One day, I stood at an ATM, at a total loss for what my PIN had ever been. I’d gone through an excessive amount of cocoa butter lotion that winter and remember trying to reassure myself about the tremendous and unrelenting hair loss.

On a routine physical, there it was, in black and white: Postpartum thyroiditis or Hashimoto’s with a TSH (Thyroid Stimulating Hormone) of 20 and antibodies in the thousands.

Having been robustly healthy my whole life, I was not about to sign up for lifelong treatment of a chronic disease. I went to a wonderful naturopath who reached out a hand and ushered me into the gentle, hopeful world of self-repair.

Four and a half years and one pregnancy later, I am prescription free with normal antibodies and optimal TSH…I’m allowed to brag because it required persistence and commitment to a new lifestyle, and I’ve never looked back. Here’s a bit of what I’ve learned:

Thyroid Disease as a Psychiatric Pretender

So Much More Than Synthroid: The thyroid is responsible for producing T4, T3, T1, and T2 and cells are responsible for converting the storage form of hormone, T4, into its active form, T3. This is a process dependent on optimal cortisol and nutrient availability such as iron, iodine, zinc, selenium, B vitamins, C, and D.

It’s The Immune System Dummy: Autoimmune thyroid conditions such as postpartum thyroiditis are not fundamentally thyroid problems – they are manifestations of a dysfunctional immune system; one that is misrecognizing the body’s tissues as foreign. Many doctors don’t even screen for antibodies because their presence doesn’t change the intervention, which is typically a lifetime of varying dosages of synthetic T4.

Are You Really A Mental Patient? Thyroid imbalance can cause anxiety, depression, cloudiness, weight gain, poor concentration in addition to cold and exercise intolerance, dry skin, and hair loss. You’re wearing socks to bed, pooping once a week, and penciling in your eyebrows. In postpartum thyroiditis, this presentation is typically preceded by a period of hyperthyroidism where women can feel over-energized, suffer from insomnia, diarrhea, anxiety, and precipitous weight-loss – these are the women who “bounce back” quickly after the baby only to be peeling themselves off the ground 9 months later.

Whole Body Ills: Low thyroid function impacts the ability of cells to use energy (hence low body temp), metabolize cholesterol, and to properly use B vitamins for an important cellular process called methylation. Thyroid dysfunction can cause or be the result of other bodily imbalances.

Pregnancy/Postpartum: Reportedly, 10% of women develop postpartum thyroiditis. In my practice, it’s about 85% of my patients who come in with postpartum complaints. A number of interesting studies like this, this, and this have implicated autoantibodies in the development of postpartum mental illness. Psychiatry has a well-established precedent for the use of active thyroid hormone, or T3, for the treatment of depression, so we have bidirectional reasons to consider appropriate screening in this population.

Healing The Body

Heal the gut! Elimination of food allergens, but always gluten. The premise of Functional and Naturopathic Medicine is healing the gut first.

The seat of >70% of our immune system and our most vulnerable interface with our environment, the gut is a powerful site of communication about what is “ok” and what needs to be attacked. Fascinating research by Fasano et al has helped to elucidate just how wheat/gluten grains can promote intestinal permeability or “leaky gut” allowing peptides through this precious barrier where they go on to stimulate the brain and immune system. A concept referred to as “molecular mimicry” underlies the direct relationship between these peptides and immune response agents that end up attacking tissues that share amino acid sequences with the offending intruder (i.e. bagel).

This is not about celiac disease (it’s usually about “non-celiac gluten enteropathy”) although the link between celiac and autoimmune thyroiditis has paved the way for our understanding. An elimination provocation diet is the best way to determine what foods your body hates, but I focus on processed dairy and gluten for the purpose of initiating gut healing. Believe me, raised on homecooked Italian food, and addicted to dairy, kissing lasagna good-bye was not easy.

Suffice it to say that the more you learn about processed dairy and gluten-containing foods, the less tasty they become.

Endocrine disruptors

Another primary theory behind epidemic rates of autoimmune dysfunction in our population is the prevalence of environmental pollutants, pesticides, and household chemicals that are “endocrine disruptors”. What gives them that name is the fact that they stimulate our immune systems and act as hormones in our systems.

Some lock into hormone ports like pesticides do with estrogen receptors and others, like fluoride, interfere with production of hormones. My post here is a good starting point for cleaning up the house with a focus on filtering water, air, eliminating pesticides, and plastics.

Adrenal Repair

When trying to resurrect thyroid function, you can’t ignore the adrenals. Adrenals are little glands that sit over your kidneys and make a variety of hormones that help you respond to every day demands including cortisol, dhea, aldosterone, norepinephrine, and epinephrine. There are stages of response to stress, acute and then chronic, that describe exaggerated and then diminishing returns on adrenal hormone functioning. To respond to thyroid hormone well, the pattern of cortisol over the course of the day must be optimized.

This requires stress management, low sugar diet, and sometimes, B5, B6, and vitamin C. Adaptogenic herbs like Rhodiola can also be helpful in balancing the body’s response to stress.

Check the right labs and body temp In my practice, I test for TSH, freeT3, free T4, reverse T3, total T3, and thyroglobulin antibody, thyroid peroxidase antibody, and thyroid receptor antibody to get a more complete picture of thyroid functioning.

I also listen to the patient above and beyond the labs. There are known limitations of these lab parameters.

Checking body temps 3 times a day and looking for a temp below 98 can also be an indicator of hypofunction.

Helping the body correct with supplements and prescription hormones. Supporting the immune system’s correction and thyroid hormone production is truly an exercise in holistic medicine. That said, zinc is essential to the conversion of T4 to T3. Zinc at 30mg with 2mg of copper is a typical dose. Selenium is critical to antioxidant enzymes and immune reactivity. 200 mcg/day is a typical dose. Iodine, while somewhat controversial in high dose applications (>3mg daily), is essential for the production of thyroid hormone, and when used with selenium, can play an instrumental role in recovery. Other agents for immune system balance include Beta glucan, a friendly yeast, saccharomyces boulardii, curcumin, N-acetylcysteine are other more personalized considerations. Some patients opt for hormone replacement in the form of compounded T4/T3 or a prescription called Nature Throid or Armour, and others are interested in protocols like this which flush out reverse T3 and stimulate proper glandular functioning.

Some pioneering work has also been done with immune modulation through a low dose prescription of naltrexone.

Perhaps one of the most important reasons to correct thyroid dysfunction and associated autoimmunity is the heightened risk of developing other autoimmune disorders. We live in a very “stimulating” world and it is difficult to predict whose system is going to rebel against it. Once you address diagnoses like these from the ground up, your entire body, hormones, gut, neurochemicals, and immune system are primed for optimal performance – taking control of your health for future vitality.

patterns

5 Thyroid Patterns That Won’t
Show Up On Standard Lab Tests

Chris Kresser

In medicine, the key to choosing the best treatment is an accurate diagnosis. If the diagnosis isn’t correct, the treatment will be ineffective – or even cause harm.

Unfortunately misdiagnosis is common in the management of hypothyroidism. If you go to a doctor with hypothyroid symptoms, you’ll simply be given replacement hormones without any further inquiry into the cause of your condition.

Even worse, if you have hypothyroid symptoms but your lab tests are normal, you’ll be told you’re “fine”. If you insist you’re not, you might be sent home with an antidepressant, but no further clue about the cause of your symptoms.

The problem with this approach is that thyroid physiology is complex. The production, conversion and uptake of thyroid hormone in the body involves several steps. A malfunction in any of these steps can cause hypothyroid symptoms, but may not show up on standard lab tests. It’s incorrect and even negligent to assume that all cases of hypothyroidism share the same cause and require the same treatment. Yet that’s exactly what the standard of care for hypothyroidism delivers.

In this article I’ll present five patterns of thyroid dysfunction that won’t show up on standard lab tests. If you have one of these patterns, your thyroid isn’t functioning properly and you will have symptoms. But if you go to your conventional doctor, you’ll be told there’s nothing wrong with your thyroid.

A standard thyroid panel usually includes TSH and T4 only. The ranges for these markers vary from lab to lab, which is one of two main problems with standard lab ranges. The other problem is that lab ranges are not based on research that tells us what a healthy range might be, but on a bell curve of values obtained from people who come to the labs for testing.

Now, follow me on this. Who goes to labs to get tested? Sick people. If a lab creates its “normal” range based on test results from sick people, is that really a normalrange? Does that tell us anything about what the range should be for health? (For more on the problems with standard lab ranges, watch this great presentation by Dr. Bryan Walsh)

The five thyroid patterns

1. Hypothyroidism caused by pituitary dysfunction

This pattern is caused by elevated cortisol, which is in turn caused by active infection, blood sugar imbalances, chronic stress, pregnancy, hypoglycemia or insulin resistance. These stressors fatigue the pituitary gland at the base of the brain so that it can no longer signal the thyroid to release enough thyroid hormone. There may be nothing wrong with the thyroid gland itself. The pituitary isn’t sending it the right messages.

With this pattern, you’ll have hypothyroid symptoms and a TSH below the functional range (1.8 – 3.0) but within the standard range (0.5 – 5.0). The T4 will be low in the functional range (and possibly the lab range too).

2. Under-conversion of T4 to T3

T4 is the inactive form of thyroid hormone. It must be converted to T3 before the body can use it. More than 90% of thyroid hormone produced is T4.

This common pattern is caused by inflammation and elevated cortisol levels. T4 to T3 conversion happens in cell membranes. Inflammatory cytokines damage cell membranes and impair the body’s ability to convert T4 to T3. High cortisol also suppresses the conversion of T4 to T3.

With this pattern you’ll have hypothyroid symptoms, but your TSH and T4 will be normal. If you have your T3 tested, which it rarely is in conventional settings, it will be low.

3. Hypothyroidism caused by elevated TBG

Thyroid binding globulin (TBG) is the protein that transports thyroid hormone through the blood. When thyroid hormone is bound to TBG, it is inactive and unavailable to the tissues. When TBG levels are high, levels of unbound (free) thyroid hormone will be low, leading to hypothyroid symptoms.

With this pattern, TSH and T4 will be normal. If tested, T3 will be low, and T3 uptake and TBG will be high.

Elevated TBG is caused by high estrogen levels, which are often often associated with birth control pills or estrogen replacement (i.e. Premarin or estrogen creams). To treat this pattern, excess estrogen must be cleared from the body.

4. Hypothyroidism caused by decreased TBG

This is the mirror image of the pattern above. When TBG levels are low, levels of free thyroid hormone will be high. You might think this would cause hyperthyroid symptoms. But too much free thyroid hormone in the bloodstream causes the cells to develop resistance to it. So, even though there’s more than enough thyroid hormone, the cells can’t use it and you’ll have hypothyroid – not hyperthyroid – symptoms.

With this pattern, TSH and T4 will be normal. If tested, T3 will be high, and T3 uptake and TBG will be low.

Decreased TBG is caused by high testosterone levels. In women, it is commonly associated with PCOS and insulin resistance. Reversing insulin resistance and restoring blood sugar balance is the key to treating this pattern.

5. Thyroid resistance

In this pattern, both the thyroid and pituitary glands are functioning normally, but the hormones aren’t getting into the cells where they’re needed. This causes hypothyroid symptoms.

Note that all lab test markers will be normal in this pattern, because we don’t have a way to test the function of cellular receptors directly.

Thyroid resistance is usually caused by chronic stress and high cortisol levels. It can also be caused by high homocysteine and genetic factors.

Conclusion

The five patterns above are only a partial list. Several others also cause hypothyroid symptoms and don’t show up on standard lab tests. If you have hypothyroid symptoms, but your lab tests are normal, it’s likely you have one of them.

Not only do these patterns fail to show up on standard lab work, they don’t respond well to conventional thyroid hormone replacement. If your body can’t convert T4 to T3, or you have too much thyroid binding protein, or your cells are resistant, it doesn’t matter how much T4 you take; you won’t be able to use it.

Unfortunately, if you have one of these patterns and tell your doctor your medication isn’t working, all too often the doctor’s response is to simply increase the dose. When that doesn’t work, the doctor increases it yet again.

As I said at the beginning of this article, the key to a successful treatment is an accurate diagnosis. The reason the conventional approach fails is that it skips this step and gives the same treatment to everyone, regardless of the cause of their problem.

The good news is that, once the correct diagnosis is made, patients respond very well to treatment.

The thyroid produces thyroid hormones for which every cell in the body has cell receptors, meaning it impacts every cell.
The Medical fraternity mainly focuses on 3 hormones for testing; T3 and T4 and TSH whereas testing for Free T3 and Free T4 gives us much more information.
TSH is the gold standard of blood work to measure thyroid function.
The only problem is that it's a pituitary hormone not a thyroid hormone and therefore only useful for assessing pituitary function
Added to this, the reference ranges used to asses the levels are outdated and incorrect (often based on a small sample 200 unhealthy people).
TSH levels also fluctuate during the day.
You can actually have all the classic thyroid symptoms and have normal TSH. This is often when the doctor will point to stress, viruses, autoimmune or even worse, it's in your head.
If a problem with the Thyroid gland is diagnosed, the Doctor will usually prescribe Synthroid (Synthroid- levothyroxine or thyroxine) which is T4 - a form that the body doesn't actually use and therefore needs to be converted, which many people can't do efficiently.
A better choice is correctly dosed Armour thyroid is T3 and T4 being a cheaper and natural form of thyroid support (dessicated pig thyroid). This was discredited by the pharmaceutical industry being natural and therefore not profitable.
It takes from 3 to 4 weeks for there to be improvement of symptoms. Doctors will usually medicate until the disease progresses to a point where they decide a thyroidectomy needs to be done (removal of thyroid gland).
With the intention of reducing medication, supporting the body and gut (digestion) with digestive support and the 90 essential nutrients and avoiding harmful foods, it is more than possible to be completely cured from thyroid issues.

Since the body works with minerals and vitamins in a synergystic way, we need more than just selenium, zinc, copper and iodine. We need 90 essential nutirents for all the systems to function harmoniously together and the thyroid is no exception.

Equally important is to avoid harmful foods. watch this to see what 12 of the most harmful ones are (pro-inflammatory).

One final but less obvious issue, concerns the alignment or curvature of the spine effecting the position of the neck and therefore effect thyroid function. Here you would need someone qualified in this area to check your spine and neck.

Why your lab testing

might not be all what

it's cracked up to be

WATCH 12 HARMFUL FOODS

For more on the problems with standard lab ranges, watch a great presentation by Dr. Bryan Walsh - 4 mins

testing

Dr K's excellent post about the importance of proper diet in the treatment of Hashimoto’s. He covers all the bases: the importance of going gluten-free, why gluten-free isn’t enough for most people, how to identify and address food sensitivities, how to balance blood sugar, and how to deal with the psychological and emotional resistance that may arise when making significant dietary changes.

Foods to eat

When confronted with this diet the fist thing people ask is what can they eat. In fact you’ll be eating the way people ate for most of human history—there’s plenty of food that doesn’t come from a factory or an industrialized farm. Of course, if you have an intolerance to any of these foods, don’t eat it just because it’s on this list.

Most Organic Vegetables: including anise, artichoke, asparagus, beets, bok choy, broccoli, cabbage, carrots, cauliflower, celery, chives, cucumbers, garlic, kale, kohlrabi, leeks, lettuce, mustard greens, onions, parsley, radishes, rhubarb, shallots, spinach, squash, sweet potatoes, water chestnuts, watercress, yams, zucchini.
Fermented foods: sauerkraut, kimchi, pickled ginger, fermented cucumbers, coconut yogurt, kombucha, water kefir, etc. You will probably need to make your own or buy one of the few brands that are genuinely fermented and free of sugars or additives. Also, search for information about anaerobic fermented foods in air-tight containers. These ferments do not produce histamines that some people react to (including rashes, digestive upset, inflammation) in aerobic, or open, ferments typically using mason jars.
Meats: including beef, chicken, fish, lamb, turkey. Fish should be ocean caught with a low mercury content. Swordfish, most tuna, and king mackerel are very high in mercury. Select hormone-free and antibiotic-free chicken, turkey, and lamb. Select beef that is grass fed, hormone free, and antibiotic free. Best choice are grass-fed and pastured meats from a local farm.

Second best is organic. Avoid factory-farmed meats that contain antibiotics and hormones. For a source of good meat near you, contact your local Weston A. Price chapter leader, or order using the link on the Resources page.
Low Glycemic Organic Fruits: including apples, apricots, avocados, berries, cherries, grapefruit, lemons, oranges, peaches, pears, plums.
Coconut: including coconut butter, coconut cream, coconut milk, coconut oil, unsweetened coconut flakes, unsweetened coconut yogurt.
Noodles: shirataki yam noodles (sold in Asian grocery stores). Avoid the noodles that also contain tofu.
Herbs and Spices: including basil, black pepper, cilantro, coriander, cumin, garlic, ginger, lemongrass, mint, oregano, parsley, rosemary, sage, sea salt, thyme.
Other: apple cider vinegar, herbal teas, olive oil, olives.

Foods to avoid

Sugars: including agave, candy, chocolate, corn syrup, fructose, high fructose corn syrup, honey, maple syrup, molasses, sucrose, coconut sugar, etc.
High Glycemic Fruits: including bananas, canned fruits, dried fruits, mango, pineapple, raisins, watermelon.
Grains: including amaranth, barley, buckwheat, bulgur, corn, couscous, kamut, millet, oats, quinoa, rice, rye, spelt, wheat, wheat germ.
Nuts and Seeds: including almonds, peanuts, sunflower seeds, sesame seeds.
Gluten-Containing Compounds: including barbecue sauce, binders, bouillon, brewer’s yeast, cold cuts, condiments, emulsifiers, fillers, chewing gum, hot dogs, hydrolyzed plant and vegetable protein, ketchup, soy sauce, lunch meats, malt and malt flavoring, malt vinegar, matzo, modified food starch, monosodium glutamate, nondairy creamer, processed salad dressings, seitan, some spice mixtures, stabilizers, teriyaki sauce, textured vegetable protein.
Dairy Products and Eggs: including butter, cheeses, cow milk, creams, frozen desserts, goat milk, margarine, mayonnaise, sheep milk, whey, yogurt (except coconut).
Soy: including edamame, miso, soy milk, soy protein, soy sauce, tempeh, tofu.
Fungi: edible fungi and mushrooms.
Alcohol: all alcohol.
Beans and Legumes: including black beans, lentils, peanuts, peas, pinto beans, soybeans.
Nightshade Foods: including eggplant, paprika, peppers, potatoes, Tabasco® sauce, tomatillos, tomatoes.
Other: canned foods, coffee, processed foods.

Why no grains or legumes?

Some people with Hashimoto’s give up gluten and feel only marginally better. Many practitioners have found in these cases a diet free of grains, starchy vegetables, legumes, and most sweeteners may be necessary. This type of diet, called a monosaccharide (single sugar) diet, is more commonly known today as the Gut and Psychology Syndrome (GAPS) diet, or the Specific Carbohydrate Diet (SCD). It is based on consuming a diet free of foods that contain disaccharides or polysaccharides, more complex sugars and carbohydrates, such as those in all grains, most beans, and most sweeteners. These complex sugars feed harmful bacteria in the small intestine that prevent its repair or proper function.

Some foods can cross-react
with gluten

Grains and legumes present problems for other reasons. Research has shown that many gluten-intolerant people cross-react with other foods. In other words, their body erroneously recognizes other foods as gluten and reacts accordingly. Not surprisingly, most grains fall into the category of top 24 foods most often to cause cross-reactivity, including less common ones as amaranth and quinoa.

Other common cross-reactive foods include dairy, chocolate, sesame, and instant coffee. Fortunately it is now possible to test which foods might be provoking a cross-reaction to gluten, which you can read about here.

Corn

I tell all my gluten-free patients to avoid corn, even though this contradicts the advice on many gluten-free websites. The gluten protein in corn is similar enough to that in wheat and wheat-like grains that it can provoke an immune response. Also, corn has been bred over the years to resist pests. Unfortunately this bred into corn a compound called fucosamine, which is carcinogenic.

Lectins in grains and legumes

Grains and legumes are also high in lectins. Lectins have been shown to degrade the intestinal barrier. Once in the bloodstream they may bind to insulin receptors and leptin receptors (leptin acts in concert with insulin to control appetite). Some believe lectins may also have the ability to desensitize these receptors, thus contributing to insulin resistance and leptin resistance.

Dr. Kharrazian’ DH Sc, DC, MS

foods

Is your

thyroid
sluggish?

Deeper into Diet

When it comes to addressing hypothyroidism and Hashimoto’s, certain nutritional and herbal compounds are invaluable. All the supplements in the world, however, will fall short if you fail to make the necessary dietary changes to support your condition.

Americans are infatuated with pills, thanks to decades of conditioning from the pharmaceutical industry. It doesn’t matter whether they come from the pharmacy or the health food store, we have a cultural fixation with finding that magic bullet. It’s no wonder—making genuine, lasting changes to your health takes hard work and discipline, the two last things you’ll see advertised on commercials during your favorite television show.

If you want to continue feeling sick, then continue eating the Standard American Diet (SAD). If you want to feel better and you have autoimmune Hashimoto’s, you’ll need to say a permanent goodbye to gluten. Someone emailed recently saying she had Hashimoto’s and wasn’t feeling better even though she was 90 percent gluten-free. When you have Hashimoto’s that’s like being 90 percent pregnant, you need to commit to a 100 percent gluten-free diet, which, thanks to an exploding gluten-free market, is getting easier every day.

You’ll need to repair a leaky gut by removing the foods to which you are intolerant. The worse your leaky gut the longer this list of foods could be. Also, I and many other practitioners are increasingly finding many patients require a diet free of grains, starchy vegetables, and sweets, and need to follow something akin to the GAPS or Specific Carbohydrate Diet (SCD). Newer research shows that healing of the small intestine, the seat of digestion and absorption as well as food intolerances, requires a lengthy abstinence from these foods. I use this diet here.

To support all these efforts you also have to balance your blood sugar imbalances with a diet that is significantly lower in carbohydrates than most Americans are accustomed to, and ditch the unfounded fear of healthy fats.

Going gluten-free is vital first step

Removing gluten is a vital first step if you have Hashimoto’s. Even if you don’t have Hashimoto’s, chances are removing this ubiquitous toxin from your diet will help you greatly. Numerous studies from several countries show a strong link between gluten intolerance and Hashimoto’s. When immune antibodies tag gluten for removal from the bloodstream, where it landed thanks to a leaky gut, this stimulates production of antibodies against the thyroid gland as well. In other words, every time you eat gluten, your immune system launches an attack not only against gluten but also against the thyroid gland. This immune response to gluten can last up to six months each time it’s ingested. It’s just not worth it. Also, as I continue my research and practice in neurology, I never cease to be amazed at how profoundly one’s brain health, a concern for all those struggling with hypothyroidism, can be impacted by removing gluten from the diet.

When gluten-free isn’t enough

For details click here.

Elimination/Provocation diet

People become so accustomed to eating certain foods that they don’t realize those foods are harming them. Instead they think a foggy brain, skin rashes or rosacea, chronic respiratory issues, joint pain, water retention, a distended belly, chronic digestive issues, and more are a normal part of life. Foods that most commonly trigger these reactions are gluten, dairy, eggs, corn, soy, and yeast. Sometimes nuts are a problem. Technically a person can develop an intolerance to any food, especially one that is eaten repeatedly when a leaky gut is an issue.

In the book I outline how to undergo the Elimination/Provocation diet. Basically you eliminate the foods I just mentioned for two to three weeks, then reintroduce each food, one at a time, every 72 hours. Monitor yourself closely for reactions, which can be physical, psychological, or emotional. If you react, then you know that is a food you need to remove from your daily diet. After undergoing the monosaccharide diet or a protocol for leaky gut, you later may be able to add back in one of the formerly offending foods (except for gluten of course). I go over a protocol for repairing leaky gut in the book.

Balancing blood sugar

Gut health is dependent on balanced blood sugar—blood sugar imbalances create stress, which in turn inflames the digestive tract. The nice thing about the monosaccharide diet (GAPS, SCD) is that its low-carb nature automatically makes it conducive to both balancing blood sugar and repairing the digestive tract. Outside of that diet, plenty of books and websites are devoted to low-carb diets and how they can balance blood sugar. The average American diet and even the USDA food pyramid are simply too high in carbohydrates, which is not conducive to good hormonal health. I do not advise people to eat a specific amount of carbohydrates as everyone’s needs are different. Instead I ask you to monitor whether you feel sleepy or crave sugar after a meal. If so, you just ate too many carbs for your system. Other tell tale signs can include insomnia or waking up at 3 or 4 a.m., an energy crash in the late afternoon, feeling spacey, irritable or light-headed if you go too long without eating, constant hunger, constant craving for sweets, and difficulty losing weight. If you have any of these symptoms you may have hypoglycemia, insulin resistance, or a combination of the two