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Thyroid School, Issue #21// Thyroid + Exercise


The topic of exercise in the hypothyroidism ruffles a lot of feather. I get it though. When an OB/gyn, personal trainer, sports medicine specialist, orthopedist, chiropractor, neurologist, or any other expert I sought out to help me figure out why I felt so crummy told me that my hours of cardio and marathon training were likely contributing, I refused to believe them. In fact, I dug my heels in more and signed up for even more races and triathlons just to prove them wrong. My thoughts: “Gosh, if I feel this way from spending this much time and energy on my exercise, imagine how bad off I’d be without it!” 

Fear kept me in the cycle of eating less and exercising more, but that’s sort of how the diet industry works, right? Scaring you into compliance. I was tricked into thinking that lifting weights wasn’t right for women and that the only way to achieve my physique goals was through hours of cardio. All that got me was an autoimmune disease, irregular periods, acne, and extra pounds I didn’t ask for. 

Many of us have been misled to think super high-intensity workouts are the only way. The price of beauty, right? If I wasn’t drenched in sweat with make-up melting off my face, it wouldn’t work. The weird thing was that the harder I tried, the less my body responded the way I wanted it to. I was trapped in a cycle that made my health spiral out of control. My pants would fit tighter, so I’d work out harder and eat less, only to make my pants tighter than before.

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I viewed this reaction from my body as my body being disobedient and not listening, when in fact is was listening and responding accordingly to the message I was sending it through the choice I was making around food and exercise. My body was adapting exactly how it was designed to do— I just didn’t like what that adaptation looked and felt like. If there is one takeaway that I hope is marbled through every single newsletter, blog, Bootcamp, visit, and social media post, it is this: your body is on your side. Our bodies are incredibly adaptive and will do whatever it takes to survive. The body’s survival tactics rely on energy conservation, which translates to more fat storage, less fat burning, decreased digestion, and prioritizing stress hormone creation instead of sex hormone creation (hello, period problems!). The message my body was receiving from under-eating and over-exercising: “I am unsafe”.
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When what you’re doing yields the opposite result than you intended, this is your call to action to make a change. Your body is responding to the message you’re sending. It took a while, but I realized that in order to feel different, I had to do things differently. Letting go of my “if it’s less than 60 minutes it doesn’t count” mentality took a lot of mindset shifting. Letting go of my toxic relationship with the treadmill was scary. Being okay with doing less was a constant challenge to my “go-getter” personality. Changing not just my beliefs but my habits was really uncomfortable. 

Hours of brain-numbing exercise to the point of exhaustion was my only outlet for stress and anxiety at that time (which, it turns out, added to my stress and anxiety load). And, even more difficult, telling my husband (the personal trainer and functional movement coach) he was right all along 😉 Logically, it’s easy to see why the whole work-out-more, eat-less approach is so popular. But, as the old adage goes,  just because it’s popular doesn’t mean it’s right! 

Sharing this insight into exercise is to help you make empowered and educated decisions about how you choose to move your body. It’s not a lecture or an instruction manual. Rather, it’s a translation device that allows you to bridge the gap between how your body is feeling and functioning in response to how you’re treating it. Is what you’re doing working for you? If not, hopefully this explains why and gives you steps to take in a different direction that may serve you better. 

If you’re anything like me, knowing WHY to make changes is just as important as HOW to make them. The science and understanding of why the extra effort to adjust habits is worth it keeps the fire burning. Let’s review a little bit about the human body and why muscle mass is so important— not just for looks, but for overall functionality both physically and metabolically. 

What makes exercising with hypothyroidism so tricky? 
First, just getting started can be tough. Hypothyroidism causes extreme energy dips, exhaustion, and can really tank motivation. Mustering the energy to work out can seem impossible. Thyroid hormones play a big role in muscle tissue creation, repair, and maintenance, which can make recovery especially challenging if you’re in a hypothyroid state. Next, weight gain is a super common side effect of hypothyroidism. Naturally, one would think that shedding those pounds requires exercising off any excess amount of calories consumed. Unfortunately, it isn’t that simple. Our bodies are more like a thermostat than a calculator. When energy intake is consistently lower than energy output, metabolic rate is down regulated to compensate. Continuing this practice will continue to damage your metabolism. For this of us with hypothyroidism, it is crucial to always balance stress load so that the stress from exercise doesn’t trigger the adaptive stress response.
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Ask yourself these questions when deciding on the intensity of exercise for the day:
Have I eaten enough food?
Have I slept well?
How is my stress level?

If any of those are “iffy”, then you would want to reconsider how intense of a workout you engage in. Also, here is a gradient you can reference for deciding what exercise should look like depending on your day/season.
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What type of exercise is best?Well, there isn’t one. In fact, all types of exercise have a place, purpose, and benefit. That said, understanding the benefits of each and how to balance the different types can help to make a routine that gives you the most bang for your buck. A simple rule of thumb: the more intense the exercise is, the less often and the shorter its duration should be.
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 Exercise benefit is more influenced by consistency in engaging in activity versus the intensity. In fact, studies show that consistently engaging in activities that exceed 70% of intensity can negatively impact the level of free T3 hormone available for use. Low T3 levels lead to hypothyroid symptoms. This doesn’t mean never doing high-intensity exercise, rather be wise about how often you engage in it and whether or not it is stressing your body too much! 

From an efficiency and benefit standpoint though, we (Nicole the Dietitian and David the Personal Trainer) believe that muscle building activities are going to get you the most benefit in the long term. Why? Because muscle = metabolism. 

In fact, the amount of LBM (lean body mass) on your body is a direct indicator of your overall metabolic health. 

Muscle is important for:
Conversion of T4 to T3 (yep, some of this conversion happens in muscles!)
Setting the Basal Metabolic Rate (BMR)
Improved glucose/insulin sensitivity
Improved mobility & functionality
Decreased visceral fat (associated w/ insulin resistance, heart disease, liver disease, cancer)
Improved blood flow
Neurological benefits (including mood boosting)
Reduced risk of injuries 

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Beyond “muscle building”, having daily movement throughout the day is highly important for enhancing your metabolism while not sacrificing your metabolic health. I know first-hand how challenging it can be to pause and take a break to move your body, but it’s worth it.

You can see from the diagram below that exercise calories don’t account for as much of your Total Daily Energy Expenditure as you may think! Another way to view it– if you’re working out 1 hour per day, that’s only 1 hour out of 24 hours. What you do for the other 23 hours matters more. (Of course, some of that time is spent sleeping, working, etc., but we burn calories even when not exercising!). 
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Why is exercising TOO much bad for hypothyroidism?It goes back to the theory of adaptation. Exercise is a stressor for the body. It can be stress relieving, sure, but can be a double-edged sword if it’s overdone… especially in the presence of under-eating, poor sleep, and/or higher stress overall.27996847_1652202037bMP2.png 
Structuring workout routines is part having a plan and part being an intuitive exerciser.
Being an intuitive exerciser means taking inventory of where you are in your recovery and rest and adjusting workouts accordingly. Gone are the days of “no pain, no gain”. That is a recipe for further hormonal chaos. Instead, listen to your body and don’t push the limits if you’re feeling sluggish, tired, or know that you’re not eating enough (or not enough nutrient-dense foods). In fact, rest and recovery from exercise is just as important as the exercise itself!

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Recovery from exercise allows for:– Muscle repair and rebuilding- Prevention of injury and overuse- Allows for waste byproducts from exercise to be excreted- Gives time for exercise induced inflammation to settle Simply put, balancing stress (exercise) and recovery (rest) allows for optimal hormone and immune balance which metabolic health.
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How to get started with a workout routine: “Routine” can refer to both the individual exercise session, but also the overall rhythm in which you exercise over the course of weeks and months. So, while you may not hit each one of these pillars (see below) in every work out, trying to look at the bigger picture and assessing whether you are getting this variety can help set you up for success. Meet… The PowerFour
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1. Core: Because “core” work involves WAY more than crunches and sit-ups. Your core is the great connector of the body that provides stability for your upper and lower body to work at full capacity. Optimizing your core isn’t just about getting a flat tummy and abs (yes, please!), but all-over body strength is only as good as your core strength. A weak core is like having a water-hose with holes all in it– the force is much weakerCore strength plays a role in pelvic floor health, breathing, lifting, carrying, pushing, pulling… pretty much EVERYTHING!
Examples: Kettlebell carries, planks, anti-rotation, wall presses 

2. Metabolic Conditioning: A combination of high and low intensity workouts to tap into the different metabolic fat burning pathways… because there are several! If you’re only doing one style of work out, you’re missing the mark! Metabolic conditioning is crucial if you’ve been on the “I run 3 miles every day” bandwagon and haven’t seen any physique changes!
Examples: sprints + recovery (cycling, running, KB swings), jumping jacks, Tread-mill pushes 

3. Strength: Muscle = metabolism. Gaining strength means gaining muscle, and muscle mass on your frame is highly influential to your BMR (basal metabolic rate) AKA your calorie burn at rest. Strength building activities (body weight, weight lifting, resistance training) is magical for your hormones! Not to mention, strength training allows for more noticable physique changes because of muscle’s density compared to fat (translation: a pound of muscle has a totally different appearance than a pound of fat). Being able to move, lift, push, pull heavy things helps you be confident and independent!
Examples: squats, deadlifts, goblet squats, side-lunges (spoiler: you DON’T have to even use weights for these to be effective!) 
4. Functional Mobility Getting into the nooks and crannies of your muscles to make sure they’re moving and flowing fluidly. Functional mobility movement patterns support  performance of your daily activities and hobbies by making sure all your muscles are communicating throughout the entire muscle chain ROM (range of motion). Think of these types of exercises, like oil for an engine or primer for your make-up. These subtle but mighty exercises ensure you’re moving safely and intentionally.
Examples: Turkish get ups, bear crawls, stretching

These four pillars of your movement pattern hit all the marks for movement needs and support your metabolic health without being overly stressful. You can focus on incorporating each of these PowerFour into each workout or otherwise, making sure you’re engaging in these each week. 28232566_16530741888lZ1.png
Timing of Food around FitnessGetting started on a fitness journey is a bit feat, and structuring meals and snacks around your workouts can seem like a workout unto itself!

Here are a few helpful graphics to give you an idea of how to make it all work. 

Before workout:
-including carbs for energy & to decrease reliance on stress hormones
– minimize fat and veggies close to the time of the workout because they’re a bit harder to digest and can hang in your stomach causing discomfort
– eating close enough to work out to have energy (calories), but not too close that you feel “blah” during 
After a workout:
– prioritizing protein for muscle repair and regeneration within an hour or so (nothing devastating happens at 61 minutes, but try to get it in close to an hour)
– working your way up to harder-to-digest foods as tolerated after working out, since digestion can be a bit wonky during and after workouts.
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Disclaimer: Please note that “Thyroid School” emails from Chews Food Wisely, LLC (and Nicole Fennell, RD) are not intended to create any physician-patient relationship or supplant any in-person medical consultation or examination. Always seek the advice of a trained health professional with any questions you may have regarding a medical condition and before seeking any treatment. Proper medical attention should always be sought for specific ailments. Never disregard professional medical advice or delay in seeking medical treatment due to information obtained in “Thyroid School” emails. Any information received from these emails is not intended to diagnose, treat, or cure. These emails, websites, and social media accounts are for information purposes only. The information in these emails, websites, and social media accounts are not intended to replace proper medical care.
 
Works cited:
Salvatore, Domenico et al. “Thyroid hormones and skeletal muscle–new insights and potential implications.” Nature reviews. Endocrinology vol. 10,4 (2014): 206-14. doi:10.1038/nrendo.2013.238
Thyroid hormone receptor α in skeletal muscle is essential for T3-mediated increase in energy expenditure https://doi.org/10.1096/fj.202001258RR
Baylor LS, Hackney AC. Resting thyroid and leptin hormone changes in women following intense, prolonged exercise training. Eur J Appl Physiol. 2003 Jan;88(4-5):480-4. doi: 10.1007/s00421-002-0737-7. Epub 2002 Nov 22. PMID: 12527982.
Çiloğlu, Figen & Peker, Ismail & Pehlivan, Aysel & Karacabey, Kursat & Ilhan, Nevin & Ozcan, Saygin & Ozmerdivenli, Recep. (2006). Exercise intensity and its effects on thyroid hormones. Neuro endocrinology letters. 26. 830-4.
Altaye, Kefelegn Zenebe et al. “Effects of aerobic exercise on thyroid hormonal change responses among adolescents with intellectual disabilities.” BMJ open sport & exercise medicine vol. 5,1 e000524. 23 Jul. 2019, doi:10.1136/bmjsem-2019-000524
Ciloglu F, Peker I, Pehlivan A, Karacabey K, Ilhan N, Saygin O, Ozmerdivenli R. Exercise intensity and its effects on thyroid hormones. Neuro Endocrinol Lett. 2005 Dec;26(6):830-4. Erratum in: Neuro Endocrinol Lett. 2006 Jun;27(3):292. PMID: 16380698.