Oprah is creating a lot of buzz after gaining forty pounds and simultaneously claiming she solved her thyroid problem. Her statements sent internet bloggers into a frenzy. How did she get off her thyroid medication? Did she really solve her thyroid problem? Isn’t this just a temporary break from a sinister and permanent thyroid illness? If her thyroid is in such great shape why did she pile on forty pounds? Her website was quick to react with clarifications. In Oprah’s own words, “When I said I was cured, I meant I don’t have the thyroid problem anymore because my thyroid levels are all in the normal range and my doctors have taken me off of any medication.” That’s great Oprah, but it doesn’t answer any of the questions people are asking. And it certainly doesn’t mean you don’t have a problem with how thyroid hormone is functioning in your body. She called on the Wizard of Oz for help in explaining her situation. He weighed in with a ridiculous description of thyroid function, “Well, just to be clear, your thyroid problems aren’t the usual thyroid problems. And by that I mean although the ailment itself is common, there’s two issues that can happen with your thyroid. It can underperform – that’s hypothyroidism – or it can overperform – hyperthyroidism. But your issue, Oprah, and you’re so unique, is that you were having a frat party in your thyroid. You were having a bunch of different things happen at once. And so you have these two ailments: One was stimulating the thyroid with antibodies; the other one was actually waging war on the thyroid. And so when these two level out, they actually bring you to a place of peace – which interestingly is where you are right now.” And with one stroke of his magic wand Dr. Oz has now created his own brand of thyroid science, one where competing medical problems wage war to produce a state of peaceful balance. The truth is, Oprah isn’t unique at all. Her type of thyroid problem is faced by many. And even though she apparently does not need any medication, it is far from solved (and would not necessarily be solved by taking medication). And for the record – thyroid autoantibodies directly wage war on the thyroid gland and are never turned off by a competing hyper or hypo thyroid problem.

Thyroid 101

In the world of simplicity, the pituitary gland in your subconscious brain signals your thyroid by making TSH (thyroid stimulating hormone), which sends an order over to your thyroid gland to make thyroid hormone (T4 or thyroxin). Your thyroid gland responds to the order, and produces the T4 hormone. Most of the T4 produced in your thyroid gland is converted to the biologically active form of thyroid hormone,T3, by your liver. Your kidneys, muscles, and your brain can also convert T4 to T3 for a variety of reasons. T3 then goes into cells and tells them how fast their idling speed should be set, which establishes the basic metabolic pace of your body – or basal metabolic rate for cellular energy production. As cells make energy they also make heat, meaning that if thyroid is set too low then you are more likely to be cold. Some of the active T3 in your body is also present in your blood, which travels to your subconscious brain and is “sensed.” This is called negative feedback, because if your T3 levels are higher, then your brain lowers its orders to make more thyroid hormone (by lowering TSH secretion). Conversely, as T3 levels drop then your brain senses this and increases the output of TSH instructions for your thyroid to make more hormones. Thyroid hormone levels do not fluctuate a lot in any given day, and overall levels are gradually adjusted by your body on more of a weekly basis. Classic hypothyroid is reflected by elevated TSH (meaning excessive orders to make thyroid hormone) and low levels of T4 and T3 (meaning not enough hormones are being made and/or activated). Thyroid autoantibodies are made by immune cells that have infiltrated an inflamed thyroid gland, and have started to react against thyroid tissue. This can cause T4 hormone to not be made at the proper rate (Hashimoto’s thyroiditis) or the antibodies can also take on the function of thyroid-hormone-producing cells and begin secreting excess thyroid hormone on their own (which is one way to cause hyperthyroid or Graves’ disease). Thus, thyroid autoantibodies are a wild card in the equation and can cause thyroid hormone production to go either in the hypo or hyper direction. The medical profession has extreme difficulty dealing with anyone who has elevated autoantibodies (and normally don’t even bother testing for them due to cost). If lab tests are showing a hypothyroid situation they invariably throw medication at the problem and hope for the best, which is hit and miss. Or they want to eradicate the thyroid (in the case of hyper). Or they simply say the scores aren’t bad enough and even though you have all the symptoms of hypothyroid, why don’t you just take an antidepressant. Almost never are comprehensive thyroid tests done to fully understand thyroid function. Even worse, the numerous life-related and environmental factors that influence thyroid function are not taken into account for any one patient, which would require time and intelligent thinking, two things many doctors are short on. So what happens when Oprah Winfrey, a complex patient with thyroid-like issues shows up at your door? If you are the typical doctor, you try the basic drugs, and when they don’t work you punt.

Oprah’s Dilemma

Beginning in February 2007 she was unable to sleep for days and her legs started swelling. The lack of sleep caused her to be tired during the day, yet she pushed her body through a grueling schedule. She started gaining her weight back, and the more stress she felt the more likely she was to indulge in an entire bag of potato chips or corn chips. Things got worse, whenever she tried to work out she had rushing heart palpitations. Her mantra of eat less and exercise more was in full reverse – and the weight piled on. She went to a number of doctors before being given the questionable diagnosis of hyperthyroidism that was now moving into hypothyroidism. She took this diagnosis as a complete defeat, “I give up. I give up. Fat wins.” She was now placed on thyroid medication, heart palpitation medication, blood pressure medication, and salt restriction. She continued to eat in excess and gain more weight. Oprah got to experience first hand what millions of elderly Americans are stuck in – the Big Pharma-medication straightjacket. “Being medicated…made me feel as if I were viewing life through a veil. I felt like an invalid. Everything was duller. I felt like the volume on life got turned down.” Oprah, you are not alone. Not liking the way she felt she called her doctors and told them, “All this medication is making my life feel like a flat line.” While many doctors ignore or negate patient complaints about how medications make them feel, how can you ignore Oprah? Her doctors immediately weaned her off all her medication – meaning none of it was addressing her problems in the first place or she would not have been able to wean off of them. These drugs were given to treat symptoms and numbers on paper, the common approach of Western medicine today. Amazingly, Oprah then said that “getting off the medication was the beginning of my road back to health.” Think about it. A person shows up at the doctor with complex and significant health problems. The doctor pulls out their Big Pharma bag of tricks and makes the person feel so much worse that getting away from Western medicine is now the path to recovery! What about the original health problems? Indeed, Oprah has really continued to struggle. Her mysterious thyroid condition settled down when she took some time off and got some rest (surprise, surprise), and she has done what she thought was best to eat better and avoid entire bags of potato chips and corn chips, and has even gotten back into a better level of exercise fitness – all by pulling herself up by her bootstraps. She has even taken the unusual step of making public pronouncements about her health problems. All the while she continues to limp through life with a sprained metabolism, struggling to drop weight and stay on track. Comically, all the health “experts” that surround Oprah are busy in self promotion, seeking to capitalize on Oprah’s problems. Not one of them has anything meaningful to say to help Oprah (just baby-talk psychobabble). Instead, they diss her on programs like Larry King Live. With friends like that, who needs enemies?

Understanding Oprah

Oprah is not unlike many patients – meaning that she can tell you her exact symptoms and in so doing, if you are a good practitioner, you can then understand what is most likely wrong with her. Lab tests help confirm your hunches, but it is the patient’s own information that should be your priority. The problem for the Big Pharma-trained medical profession is that they don’t understand what many symptoms actually mean – kind of a scary thought if you stop and think about it. Understanding Oprah is not for everyone, as her problems are more advanced than Thyroid 101. Nevertheless, for those of you who would like to know, the following is quite obvious from the information Oprah has made public about her health. As Oprah has stated, her problems started back in February of 2007 when she was unable to sleep for days and her legs started swelling. How can a person not sleep day after day when they are obviously physically exhausted? Any doctor or health practitioner answering and then solving this question would have prevented Oprah from gaining forty pounds. That’s right, Oprah had a sleep problem. But what kind of a sleep problem is it? It’s a highly inflammatory sleep problem. How do I know that? Because her legs are swelling, which means inflammation is causing increased vascular permeability and fluids to “leak” in excess into surrounding connective tissues around her large veins in her lower legs. If I’m a practitioner speaking to Oprah at this point, I’m thinking two things: 1) I need to improve her sleep before her metabolism shuts down, as with her history of dieting problems weight gain is right around the corner, and 2) These are major cardiovascular red flags that need to be addressed (and not with de-energizing drugs), because she just moved into the high risk zone for a stroke or heart attack (symptoms that carry even more weight due to her age and ethnicity). While there is a very small chance that such a sleep problem could be caused by hyperthyroid, that is unlikely in Oprah’s case because she is not losing weight. Almost always, such sleep problems are caused by increased stress; either acute new emotional stress or ongoing physical demands that are too much (her killer schedule), or both. Other common causes are an accident, an injury, the death of a loved one, a divorce/relationship trouble, an acute illness, or a chronic low-grade infection.

How Your Brain Regulates Thyroid Function

Within the last year major advances in brain science have enabled us to understand what is happening with Oprah and precisely how that would lead to a confused thyroid diagnosis. However, to understand this we have to leave Thyroid 101 behind and delve into a more sophisticated understanding of the subconscious brain and how your brain regulates thyroid hormone in the first place. The hypothalamus gland in your brain is your subconscious command and control center, it regulates millions of things on a daily basis that you would never want to have to think about (such as breathing and your response to stress). It has only one goal – survival. Sometimes it gets confused, and that’s when trouble sets in. Such confusion is most often caused by excessive ongoing inflammation which throws gene switches into inappropriate settings. Your hypothalamus gland has numerous departments. One is involved with keeping you awake, another is involved with helping you sleep, yet another is sensing thyroid (T3 levels) in your blood and telling your pituitary gland what to do. There are many overlapping input signals within this gland, as there are many variables that might occur in your life. Doctors barely understand what is going on in this gland, although it is central to your health and solving your health problems. Once again, doctors generally try to treat symptoms with a Big Pharma tool box. Their state-of-the-art treatment for your hypothalamus gland is to knock down its function with sedatives, sleeping pills, and anti-anxiety medications any time it starts acting up – which quite frankly is really stupid (Heath Ledger is one example). When a person is not sleeping night after night it means they are in a hyper-aroused state, even though the rest of their body is tired. Believe it or not, this is an inappropriately activated survival mechanism. It is designed to work in times of famine wherein sleep time is reduced and sleep is not as deep – so that no hunting opportunity will be missed. This is accomplished by setting the arousal thermostat to a hyper-alert level, sort of like setting your house thermostat to 90 degrees instead of 70 just to be sure you are warm. This arousal thermostat does not physically reside within the usual sleeping and waking departments of your hypothalamus, rather it exists alongside them and is based on nerves called hypocretins. Thus, technically, Oprah was suffering from inflammation-driven hypocretin excess (that would be an accurate diagnosis). In order to calm down hypocretins you can either convince them that your life is really much calmer than it appears to be (which is actually what Oprah did by taking a month off once she realized medications were a dead end). Before she did this she was lying there night after night with her hypocretin system way too active. Sure, you might eventually fall asleep and get a few hours – or you may not. Besides figuring out better lifestyle ways to relax and be calmer, the only other way hypocretins calm down is by getting a major surge of pleasure, as they are wired directly to dopamine-related nerves. This means you can eat, have sex, drink alcohol, smoke pot, or take some other drug that feels good. Indeed, hypocretin-excess problems underlie almost all addictions and are typically preceded by sleep problems. As Oprah says, her drug of choice is food. Eating actually calms down this hyper-hypocretin feeling. Remember, one of the basic reasons for it is to be more vigilant so as to not miss a hunting opportunity. In modern times, all Oprah had to do to hunt was walk to the kitchen and wolf down an entire bag of corn chips – and now she can sleep. Unfortunately for Oprah, hypocretins are wired to many different aspects of nerve function. They provide input to the primary department in the hypothalamus gland that controls the production of TRH (thyroid releasing hormone), which has control of the pituitary (which makes TSH), and thus has overall control of thyroid hormone production. The message hypocretins deliver is as follows, “We are in a state of high stress alert wherein our brain must remain hyper-vigilant, however, to conserve fuel so we don’t perish, turn down the production of thyroid hormone in the rest of the body (a self preservation strategy, especially during times of famine or infection).” So now Oprah finds herself in the situation of eating food to cool off her stress, having a hypocretin-driven racing feeling that causes sleep problems (and results in the misdiagnosis of hyperthyroid), while at the same time turning off thyroid hormone production for self preservation. Being given thyroid medication in this condition actually aggravates the underlying problem AND CAUSES UNCONTROLLABLE FOOD CRAVINGS. In other words, this is not a simple case of Hypothyroid 101. This is a situation where the thyroid problem is secondary to a more serious underlying problem. Many people are on thyroid hormone when they should be relaxing their hypocretin system instead. Taking thyroid hormone will invariably make them more jittery, hungrier, and tired (not the textbook response to taking thyroid hormone for an apparent low thyroid). This situation actually gets more complex, as hypocretins are not even the primary signal that determines TRH production. That primary signal is the fat-hormone leptin. As Oprah gained weight, leptin resistance set in which really locked in the hypocretin problem and apparent thyroid issue, as leptin resistance invariably causes a “false state of starvation” and further disruption of thyroid function by also turning down TRH activation. Other important signals entering this same TRH pathway, as secondary inputs, include ghrelin (your stomach’s hunger signal), agouti-related protein and neuropeptide Y (which cause food cravings), and CART and MCH (which turn off cravings and activate metabolism). Oprah locked herself into a pattern of leptin resistance, elevated hypocretins, elevated ghrelin, elevated agouti-related protein, and elevated neuropeptide Y. Hunger haunted her, while thyroid hormone went on vacation. While these health problems are all bad enough, hypocretin excess is like driving your nerves at 90 miles per hour 24 hours per day. Eventually the relaxed reserves in your nerves are going to deplete. Your heart requires that you have adequate relaxed reserves for normal heart rhythms. Oprah was on the verge of using up her nervous system’s credit line for relaxed reserves, a very serious health problem in its own right. In this condition, when she tried to exercise (which requires higher adrenaline output to move muscles), she got a very uncomfortable racing heart. Doctors responded by putting her on beta blockers and blood pressure medication, which as a temporary solution to help her calm down is not out of line. However, doctors don’t understand her actual problems and thus don’t address them – rather they think their meds, which are like putting her cardiovascular system in a straightjacket, are a solution that should be done indefinitely. They never think to fix her depleted nervous system which requires magnesium, glycine, and GABA-supportive nutrition – along with life-style stress management and relaxation strategies. Oprah’s instincts led her to the only solution she could think of: take a month off. Luckily, she did. This enabled the excessive inflammation to calm down and her hypocretin system to chill a bit, which then permitted her thyroid system to come back on line. This is why she no longer needed medication for thyroid and why her lab scores became normal. Oprah’s problems are far from solved. Once your body goes into hypocretin excess, it is prone to doing it again any time you get too stressed or work too hard. Minimally, Oprah will have to spend energy within her means – she does not have a limitless supply – she will have to master the art of saying “no thank you” to her overload of obligations. As she said, she has to put herself back on her own priority list. However, that is just a start, not a permanent solution. In the future, the more often she overdoes it or gets too stressed about something, the greater her cardiovascular risk, the greater the number of thyroid-like symptoms will emerge, the greater the risk she will gain weight eating hardly anything, and the greater her tendency to go back to eating bags of potato chips and corn chips – which will really pack on the pounds. Hypocretin excess is lurking in the shadows, along with leptin resistance and functional thyroid problems. Oprah can no longer get by with the simple idea of eating less and exercising more – the same problem faced by millions of struggling and “hypothyroid” overweight Americans who don’t really understand how their bodies work. For more information on how to solve this type of health problem please consult my feature article on Leptin, Thyroid, and Weight Loss.