Questions & Answers

Please feel free to send me your questions and I’ll do my best to answer as many of them as I can. Please use your first name when you sign your letter so I know if I'm responding to a woman or a man. I appreciate your interest in learning more about your heatlh issues and options for treatment.

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"Do you still make house calls? A friend of mine from New York came to see you last summer and you evaluated her at her hotel room. I didn't think doctors still made house calls. -Marilyn Z., December 2008

Nearly a year ago I made my first house call for a client who was so chemically-sensitive that she rarely left her home. She desperately wanted me to measure her resting metabolic rate (RMR) because her symptoms added up to poor thyroid hormone regulation of her tissues.  During our initial telephone consultation I gathered enough information to agree with her.  Her immune system deregulation was one of her symptoms that could easily be explained by poor thyroid hormone regulation. I also suspected suboptimal production of cortisol by her adrenal glands; I arranged for salivary testing to evaluate this possibility.

If we could prove that her metabolism was impaired, her primary care doctor was willing to prescribe thyroid hormone and cooperate with my recommendations. While I assured her that I don’t use any noxious chemicals in my clinic, she was worried about encountering something along the way to get there. 

As much as I wanted to help her, I felt reluctant for her come in if we knew that her test would probably be of poor quality due to her anxiety.  When I interpret RMR data I take into account a person’s anxiety or ability to work well with the test process.  I’ve watched the RMR increase during the test process when a cell phone rings, for example.  Several clients have told me after their RMR measurements that they were angrily ruminating over how other doctors had missed the entire issue of thyroid hormone regulation. This emotional engagement can increase RMR, and sometimes quite significantly.

When I write a report for the client I make a note about any factors that could have impacted the quality of the RMR measurement.  However, I’m not willing to report a “corrected” number for the measured RMR values based on my best guess of how anxiety may have elevated the RMR.  If I did, objective data would shift into the realm of subjective perception and nullify the reason we bothered to collect the data at all.

So, I’ll do my best to design the most comfortable testing process that I can. I have portable versions of my diagnostic equipment, including an indirect calorimeter, so I packed it all into my car and evaluated her in her home. Her RMR was 48% below normal, she was prescribed the thyroid hormone that she needed. She followed my recommendations to restore her metabolism and significantly improved. 

I suspected that our test results were even more valid than hospital-based basal metabolic rate testing (BMR).  With that system, you will be admitted to the hospital the evening and your BMR will be measured the next morning. The purpose of this is to be sure you fast overnight and to assure that there is no impact of activity on your metabolic rate. In the morning you’re loaded onto a gurney and wheeled to the testing machines.  Lots of luck on resting well overnight and avoiding feeling anxious in a hospital bed these days! 

I made more house calls and I am convinced that they provide a superior test result compared to clinic or hospital-based testing. You can easily manage to fast at home, or hotel for travelers, and your only energy expense is to open the door to let me in.

I only make house/hotel calls if I’m going to perform the full evaluation which involves four hours of time.  I strongly advise that you have a telephone consultation with me before making travel plans to Boulder to be sure that a metabolic evaluation is appropriate for your needs.

Please call the Center at 303.413.9100 for information on how to arrange a house or hotel call for your metabolic evaluation. 

"What do I have to do to get well with metabolic rehab?" –Anna D.

Metabolic rehabilitation is a process of adopting healthy behaviors as well as using thyroid hormone and other therapies appropriately. The metabolic rehab protocol is well-researched and I’ve been guiding patients through the process for nearly eleven years. My goal is to teach you how to use metabolic rehab so you can achieve optimal results quickly and safely. The four main components are:

1. Wholesome diet and nutritional supplements
2. Exercise to tolerance
3. Physical treatment as needed (chiropractic adjusting and myofascial therapy)
4. The right type and amount of thyroid hormone.

If any one of these components is missing in your treatment process, your results are likely to be compromised. Just imagine if you remove the leg of a table, you’re going to have a wobbly result. Put it back in place and you’ll have a sturdy support that will serve you as long as you keep all the parts in place. One of my strengths is in helping you find ways to be sure that you are participating fully in the protocol so you can get well and stay well.

"What lab tests do you want to see to know if I’m on the right thyroid hormone dosage? My doctor says that lab tests, particularly my TSH, are the only way to know if I need to change my thyroid medication." –Bob L.

While the standard thyroid lab tests including TSH, free T4, free T3, and thyroid antibody group are necessary for your initial evaluation, I do not recheck them to see if you’re on the correct dosage. However, if either the thyroid peroxidase antibodies or thyroglobulin antibodies have been elevated I certainly will recheck them to be sure they are being suppressed by your thyroid hormone therapy.

The usual system of diagnosis and adjusting thyroid medication dosages keeps so many people undiagnosed and under-treated that I consider it a threat to public health. I’ve participated in research projects that have proven that the TSH, free T3 and free T4 do not correlate with patients’ metabolic rates. These articles that I coauthored about these studies can be found online at no cost so please feel free to copy them and share them with your prescribing physicians. You can find the studies at these links:

Medical Science Monitor
Thyroid Science online journal

Your prescribing doctor may insist on checking the lab tests since that is the standard of care to which they are held. I’m always glad to discuss this research and my metabolic rehab protocol with your other physicians. The best way to know if you’re on the optimal dosage of thyroid hormone is to monitor your responses according to the metabolic rehab protocol and recheck your resting metabolic rate at intervals. Be sure to use my “Are you overstimulated?” form to watch for signs or symptoms of excessive dosing with your thyroid hormone. Please share these forms with your prescribing doctor to let him or her know that you are carefully watching for this possibility. Some doctors have asked for permission to use my copyrighted form with all of their patients on thyroid medications and I’m always pleased to share this with others.

"What do you mean by “monitoring your responses”? –Jana M.

Monitoring is a simple and essential way to get feedback on how your body is changing as you participate in metabolic rehab. As your body achieves better thyroid hormone regulation, your symptoms will generally decrease in frequency or intensity. All of the tissues of the body don’t change at the same rate of time and it’s easy to lose track of what has changed since you began treatment. Metabolic rehab is a data-driven protocol, meaning that we have to gather information about which of your symptoms have changed and to what degree have they changed.

Precise monitoring lets us keep track of what has happened and directs us toward what we need to do next. For example, a patient’s pain may be getting better but her brain fog isn’t. Her constipation is resolving but her hair is not yet growing back. When I ask her how she’s doing, she may say “lousy” because all of her symptoms of poor thyroid regulation have not resolved. We can look at her monitoring forms and graphs and see that she is improving, and we are on the right track with her treatment.

There are two ways to do your monitoring. One is the traditional way where you fill out standard forms, snail mail or fax them to us, we score and graph them. Then we have a 15-minute telephone consultation to discuss recommendations. The cost for this is only $75.00. I call the other way “do-it-yourself monitoring”. You decide which symptoms you want to track, mark the 0-10 visual analog scales (VAS) and graph the numbers you collect. Fax or snail mail your VAS and graphs to us and we’ll schedule a telephone consultation with you to discuss recommendations. You need to use my “Are you overstimulated?” form regardless of which style of monitoring you choose. Either style of monitoring can work, but the first system tends to give us more precision when we’re troubleshooting your treatment process. Just remember, if you are not monitoring your responses, you are not doing metabolic rehab.

"I started metabolic rehab because of the same symptoms as a friend of mine, but she’s on a much higher dose of Cytomel than I am, and she’s not getting well as fast as I am. Do you think she’s doing something wrong?" –Maureen R.

There is no way to predict how one person will respond to metabolic rehab compared to another. We all have individual responses and there’s no magic in a particular dosage of Cytomel or other thyroid hormone medications. Your friend most likely has a greater degree of cellular resistance to thyroid hormone, meaning that she may have a greater number of thyroid hormone receptors that are not working properly. I can speculate about the reasons this can happen, but the greater value is in your friend continuing to persist with her treatment. She needs to be sure she is using all parts of the protocol. Sometimes people decline to take nutritional supplements, for example, and this compromises their treatment outcome. She may have other health issues to address at the same time she is dealing with her hypometabolism.

What is NED? I read this term in one of your newsletters and I’m not sure what it means. –Caroline E.

I use NED as the acronym for neuroendocrine disruption. Here’s an excerpt from my January ‘07 newsletter that will help explain NED and why I find the topic so interesting. It’s a long answer to your short question, but it’s a complicated topic that deserves our attention. You can click on Newsletter Archives to learn more.

“I've been deeply concerned about the welfare of Planet Earth since my teenage years (such a long time ago!!) and am distressed by the damaging effects of the loads of petrochemicals that have been dumped into our air, water, soil, and food. There’s a lengthy list of such chemicals that have the potential to harm our health in various ways. Chapter 12, page 262 of “Your Guide to Metabolic Health” has a list of chemicals that are known to lower thyroid hormone levels.

Neuroendocrine disruption (NED) is a general term for the effects of chemicals such as polychlorinated biphenyls (PCB's), DDT, and dioxins on our brains, endocrine glands (such as the thyroid), and hormone receptors. These chemicals did not exist in nature before humans manufactured them and then allowed them to filter into the air, water, soil, and food. While some of them such as PCB’s and DDT have been banned, they linger in the environment from previous use.

The thyroid system, whether we’re considering central regulating mechanisms in the brain, thyroid hormone production by the gland, transport of thyroid hormone in the blood, or utilization at the receptor level, seems to be particularly affected by NED. When I did a literature search for neuroendocrine disruption (NED), most of the research articles I found discussed the damaging effects of PCB’s on the thyroid hormone system. Since adequate thyroid hormone is so important for the optimal functioning of nearly all of the tissues in the body, a multitude of symptoms can result when there’s a breakdown in that system.

The Agency for Toxic Substances and Disease Registry (ATSDR) issued a report in 2000 that points out that we all have some level of PCB's in our bodies. There are numerous studies showing that breast milk in women across the USA has significant levels of PCB's. If you’re breast-feeding, please don’t let this information deter you - the benefits of breast-feeding far outweigh the fears of even PCB exposure. This is just an example of how pervasive these petrochemical toxins are in the environment.

An adequate amount of thyroid hormone is critical to the normal structure and chemistry of our brains. Impaired cognitive function, depression and anxiety can be linked to poor thyroid regulation of brain tissue. The production of neurotransmitters like serotonin and dopamine are affected by thyroid regulation. How many people do you know who are taking antidepressants? Particularly disturbing were the multitude of articles discussing the damaging effects of PCB’s on the brains of developing fetuses and infants through the first two years of life. How much of the ADD, ADHD, and autism that are so common in children today can be linked to poor thyroid regulation of the brain? How many children are medicated for behaviors that may be related to NED?

What Can We Do About NED?

While I sincerely hope that we clean up the planet quickly, we're most likely going to be at the effect of these chemicals for the rest of my lifetime and yours. Some people seem to have the physical constitution to buffer against these contaminants and don’t seem to have any significant health impact. Others have subtle but significant problems that defy usual diagnostics. They modify their lifestyles and diets to try to be well in spite of their "mysterious illness". Some people have devastating health problems because of NED and are sidelined from full participation in their lives. How much human potential is undeveloped because of impaired thyroid regulation due to NED?

The ray of sunshine in this dismal prediction is that you can still be well, regardless of the level of impact you may currently experience. If NED has disrupted your thyroid production or utilization, metabolic rehabilitation effectively addresses the cause of the symptoms.”

Thank you for asking about NED, and please feel free to ask more questions. --Dr. Honeyman