Saturday, March 30, 2013
This month I've gained 4 pounds. The only times I've gained 4 pounds in one month is when I've needed an increase in my thyroid meds (I'm hypothyroid).
A month ago, my lab tests were "normal" (TSH 1.26) although I was symptomatic (in many more ways other than just inability to lose weight) and my TSH was higher than when I feel good (right around .5). My family doctor agreed to increase my dosage slightly, even though he and the endocrinologist agreed that my numbers were fine and that I should just dress warmer, eat less, and exercise more.
There's the problem: I can't eat less nor exercise more. My RMR is very low, just 1010 (normally should be around 1400). The nutritionist has recommended an 800-1100 calorie diet with my current level of exercise. I cannot fathom going below that. In fact, I'm having trouble getting down to 1100 calories. I've been at 1424 this month because a) I'm hungry, b) all this time at the gym has taken away from my ability to cook and eat before 10pm, and c) my husband is TIRED of me eating so little and affecting his diet (he needs more than 300 calories for dinner!). My composition of macro- and micro-nutrients is fine with my nutritionist. Some days it's as "easy" as not having a latte or ice cream, others it's a bit more difficult because it's very hard to eat out for only 300 calories (and salads and fish are not options).
My current level of exercise is approximately 3300 calories per week in 2.5 hours of strength training and 5-7 hours of cardio (run, cycle, swim) per week. That doesn't count the wait times for a cycle (must show up 35 minutes prior to class time 2-3 times a week) or the wait time for a swim lane (as much as 20 minutes 3-5 times per week). And the time spent driving to the gym, changing, showering, and laundering all these clothes with 8 or more workouts per week!
Level of effort? Cycling classes have my heart rate zone at 21% aerobic and 53% anaerobic for the 45 minutes (yes, you read that right, and my instructors monitor me closely by watching my HRM's display). Swimming is laps of mostly freestyle with some backstroke and breaststroke, and the swim watch notes that 4-5 minutes of each 30 minutes are spent resting and my 100 yard time is 2:12 -- so I'm not loafing and just paddling around in the pool. I'm lifting 50 - 211 lbs (depending on machine) in two sets of 10-15, until the muscles fatigue. I could lift a lot more last December, but I've been taking weights off the machines, not increasing, which is depressing.
No two weeks are the same as far as workouts go. I'm changing things up: the order of doing weights, which days I do cycling class, what drills and strokes I do in the pool, the amount of time spent -- all is monitored by a personal trainer. Each month since last September (SIX MONTHS AGO), I have been adding another weekly workout until I've reached what I'm doing now. I think I've given this plenty of time. (I've actually been tracking food and exercise for almost 35 months!)
Per SparkPeople, my net calories are 948 this month -- slightly below where my nutritionist and other doctors want it to be to lose maintain weight (above where they want it to lose weight), yet I'm GAINING weight. It's about 25 calories per day lower than last month, and I lost weight last month. My 33% body fat has not changed appreciably (gone up, actually, but we're attributing that to measurement error). I've lost a whopping half-inch off my waist and thigh and no change in my arms or hips. My resting heart rate is 43 and my blood pressure is usually around 100/65 -- those are numbers are already very low. My triglycerides and cholesterol are slightly elevated. I'm freezing when others aren't (is it normal to wear two pairs of socks, fleece pants, a long sleeve shirt, and a fleece jacket to bed underneath a comforter and blanket?). All of these are indicative of hypothyroidism, including the very low RMR. But my endocrinologists (I've tried 4) and family doctor say I'm "fine" and there's nothing that I should worry about. Just exercise more, eat less, and bundle up.
If you're reading this and you're hypothyroid, you know that there are plenty of other tests that can be run other than TSH. I can't get them to run them ("You're TSH is normal. They're not necessary.") I can't get them to see if something else is wrong other than the TSH test.
I just don't know what to do next. Since I know my RMR, I know that a net of calories over 1010 - 1200 (RMR to RMR*1.2 for sedentary) will cause weight gain, so the typical "you might need to eat more" will not apply here (and I tried that last year and I'm still trying to lose that weight). There is no medical or nutritional reason to try diets that give anything up (e.g., low carb, low fat, gluten free, dairy free, etc.), and there's absolutely no desire to further limit my food choices.
I really feel this is hormonal. Has anyone had this problem and found a way to effectively talk to their doctors to get them to realize there's a problem? I can't quantify how cold I am, but I can quantify diet and exercise, low heart rate, and insanely low RMR. How do I get a doctor to look at something other than my TSH and help me find a solution?