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Frequently Asked Questions

Q. I’m struggling to lose 20 pounds. Your book, Women, Weight and Hormones, recommends that women consume roughly 1600 calories a day and include 30 minutes of exercise. I’ve also read that because women with hypothyroid have excessively slow metabolisms, they should consume 500 to 800 calories per day. Should a hypothyroid patient consume 500 to 800 calories per day, or is the correct amount for effective weight loss 1600 calories?

A. Generally, the very low calorie plans (500 to 800) make the “sluggish metabolism” of hypothyroidism even more sluggish. It’s important to have enough calories coming in to stimulate metabolic rate, and also to have optimal levels of thyroid replacement hormones. I’ve explained this in more depth in Women, Weight and Hormones.

Q. Does your “Hormone Power Plan” diet apply to individuals like me?

A. Yes, the plan was designed to help address the problems you describe.

Q. Women, Weight, and Hormones states that the Atkins diet reacts differently on hypothyroid patients. Do you recommend a low-carb lifestyle for individuals with hypothyroidism?

A. In hypothyroidism, without adequate carbohydrate intake, you risk inadvertently decreasing the amount of thyroid hormones (T3 and T4) in the “free” and active form in your bloodstream. The Atkins Diet is too low in carbohydrates for most people with hypothyroidism, and can aggravate the problems of low thyroid function. But too much carbohydrate intake, rather than of being burned for energy, can overstimulate the production of insulin and cause more fat to be stored. I have explained this in more depth in Women, Weight and Hormones. “Hormone Power Plan” meals are designed to give the balance of carbs needed to address both of the above problems.

Q. I am hypothyroid and take Levoxyl every morning. Is my metabolism at its "natural" level for my age? Is my metabolism working the same way it would if I were never diagnosed with hypothyroid?

A. If hypothyroidism is optimally treated, so that TSH, free T3, and free T4 are in the desirable ranges, metabolism is generally improved to normal unless there are OTHER deficits: hormone, medication, dietary, exercise, mineral, etc. – all factors that cause metabolic rate to slow down. If weight loss is still unusually difficult after optimal thyroid replacement, then other factors need to be evaluated. Turn to the “Getting Tested” section in Women, Weight and Hormones.

Q. I’m a 46-year-old woman. I’ve been taking the pill (Necon 35) for the past 3 years for the primary symptom of brain fog (I’m not sure what else to call it). I feel the pill has really helped. But, inspired by Dr. Vliet’s books, and because I constantly feel fatigued, I got my estradiol level checked on day 3 of what would have been my cycle. It showed under 2 – i.e., the level of a post-menopausal woman. I suppose this could be true, but I’m wondering why the pill didn’t boost my estradiol level. My internist suggested that I switch to a patch called Ortho Evra, which may allow better absorption than oral medication. What do you think of this strategy and what more would you recommend?

A. While I can’t make specific medical recommendations online, the following general information may help explain your situation. There’s a more specific discussion of this particular subject in the hormone chapter of my book, It’s My Ovaries, Stupid!

  1. Estradiol levels will always show low or nearly undetectable, if checked just after you’ve stopped taking birth control pills. This does not necessarily mean that you’re not absorbing the hormones. Birth control pills work by suppressing ovarian production and ovulation and by replacing the ovarian 17-beta estradiol with ethinyl estradiol and progestin, neither of which is measured on the estradiol assay. Women approaching menopause must be off the pill at least a week to see a rise in follicle stimulating hormones. After going off the pill, it takes even longer for a woman’s ovarian cycles to return and her estradiol levels to rise. To determine reliable hormone levels, I usually wait at least a full cycle after a woman stops taking birth control pills.
  2. Necon (similar to Ovcon 35) has a better estrogen to progestin ratio than the OrthoEvra patch. Many women have told me they don’t like the negative progestin side effects – weight gain, bloating, fatigue, low sex drive, depressed mood, etc. (see discussion in the book for more) more common with OrthoEvra. If a particular birth control pill is working well for someone, I usually won’t switch to a product with a different hormone ratio simply on the basis of one blood level. Remember, we need to focus on the whole person, not just a lab test, and different products work for different folks. My approach is to go with a medically sound product that helps a given person feel the best.

Special Note

We’re unable to answer specific medical questions on the internet. If you submit a question to us, we reserve the right to rephrase it in general language and respond to it generally. Should you choose to participate in this forum, you may want to check back for general information in these FAQs to help you in discussions with your physician.

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