Impact of dietary intervention devoid of probable endocrine disruptors among hypothyroid obese women consuming Levothyroxine -A Case study

 

Swapan Banerjee, Sulagna Ray Pal*

Department of Nutrition, Seacom Skills University, Kendradangal, Birbhum, West Bengal, India.

*Corresponding Author E-mail: sulagnain@gmail.com

 

ABSTRACT:

Background: Hypothyroidism among obese women is one of the concerned endocrine disorders nowadays. Data shows that at least one female member suffers in almost every family in some metro cities. Iodine deficiency was one of the main factors, but it is no longer a significant cause for two decades due to its sufficient availability. So the expected risk factors are obesity and endocrine disruptors available in foods and the environment.

Objective: The study aims to determine the association between obesity and hypothyroidism among housewives living in Kolkata. Further, to evaluate hypothyroid to the euthyroid state through endocrine disruptors free dietary intervention.

Methods: This qualitative study was based on purposive sampling, including BMI, thyroid profile tests, and relevant blood reports. The dietary intervention was considered for 120 obese hypothyroid housewives within 35-45 years in Kolkata city and peripherals. The study was conducted for March-August in 2019 with Levothyroxine treatment for the 1st three months, followed by the next three months without this medicine but only dietary interventions. SPSS version 16 has been applied for the data analysis.

Results: The study revealed no such insufficiency of supplements that raised TSH and changed normal or subnormal T4 among the participants. The correlation coefficient for BMI and hypothyroid type was r = 0.524 and r = 0.425, p=.000 (p< 0.001 or p=0.000 or p<0.0005); BMI with TSH r = 0.554 and 0.437. So there was a significant relationship between obesity and hypothyroidism in association with comorbidities. Further, nine participants became normal weight, and fourteen progressed into mild status due to dietary interventions.

Conclusions: The study showed a positive association between hypothyroidism and obesity and their comorbidities. Further, the hypothyroid diet plan devoid of endocrine disruptors worked remarkably without Levothyroxine.

 

KEYWORDS: Hypothyroidism, Obesity, Comorbidities, Dietary interventions, Levothyroxine, alternative therapy.

 

 


INTRODUCTION:

Endocrine abnormalities are widespread among obese women worldwide, and India is one of the significant examples. Hypothyroidism is one of the most common and concerning endocrine disorders, often associated with obesity, mainly diagnosed in sedentary women1. Hypothyroidism is one of the secondary causes of hormonal deficiency, or maybe the reason for the PCOD and other metabolic syndromes.

 

These may result in obesity, one of the significant causes of diabetes and/or endocrine disorders2,3. High leptin, a reliable fat hormone, results from hyperthyrotropinemia, increases susceptibility to thyroid pathology and subsequent glandular diseases4. Iodine deficiency is one of the contributing factors for hypothyroidism, although most countries, including India, have shown iodine sufficiency for the last two decades5. TSH influences the level of Thyroxine (T4) and triiodothyronine (T3) by stimulating the thyroid gland. Further, the entire hypothalamus-pituitary-thyroid-axis model directs all three hormones. In a hypothyroid patient, it is generally observed that TSH and free T4 are increased and decreased, respectively6. In subclinical or overt hypothyroidism, the standard western medication protocol is Levothyroxine (LT4) treatment, recommended in all patients as per the diagnosis. However, there is no specific information on overweight people with a variable degree of significance7. As per the American Thyroid Association, the euthyroid TSH level should be 0.4 -2.5 mIU/L, and T3 and T4 are normal. In early or SCH (subclinical hypothyroidism) condition, TSH level is 3.0- 5.5 mIU/L and T4 normal 8. Further, mild hypothyroidism is closed to 5.5-10 mIU/L, and the T4 level decreased by 20%-30% (when T3 may remain normal). In moderate conditions, TSH level should usually be within 10-20 mIU/L and a low T4 and /or T3. At a severe stage, Myxedema Coma, when the level becomes TSH >30 mIU/L, with low T4 and T3 8,9. TSH and antibodies to Thyroid Peroxidase (TPOAb) by electrochemiluminescence immunoassay (ECLIA), a 3rd-generation assay, are a sensitive minimum of 0.001 mIU/L is commonly used for the clinical assessment in laboratories. Sometimes patients are observed with subnormal TSH values and normal TPOAb, but in the subclinical state, they usually found subnormal TSH but a raised TPOAb 5,9. In modern medicine, dose-dependent levothyroxine therapy is generally recommended for patients suffering from hypothyroidism 10,11. Hence, the obvious question arises regarding hypothyroidism with obesity for sedentary women living in metro cities, whether practicing improper dietary habits or lifestyles leading to the disease and its associated comorbidities12-14.

 

Endocrine disruptors chemicals (EDCs) or substances in our environment and foods are also the probable cause of hypothyroidism or other endocrine disorders.  There are insufficient data on endocrine disruptors; however, goitrogenic substances, flavonoids, thiocyanates, etc., are the disruptors shown in current studies 15,16. These substances synergistically may affect the thyroid gland and thyroid hormones. Perhaps, these are some of the affecting factors for hypothyroidism. According to the Indian Journal of pharmacology, 2012, the major hypothyroid disruptors containing foods are thiocyanates, gluten (available in wheat products), goitrins, flavonoids, and cruciferous vegetables (Goitrins + Thiocyanates) 17-19. The influenced vegetables are broccoli, brussels sprouts, cabbage, cauliflower, kale, mustard greens, rapeseed, rutabagas, spinach, turnips, sweet potatoes, and rapeseed oil 19,20. As per the study, soy-based foods (goitrins), tofu, tempeh, soy milk, starchy plants like cassava, corn, lima beans, linseed, millet are also partly responsible. Among fruits and nuts, peaches, peanuts, pear, pine nuts, strawberries, and under the flavonoids group, some citrus fruits, tea, berries, apples, legumes, etc., are other expected thyroid disruptors 17,25. Environmental factors, also treated as endocrine disruptors, are as follows: poly-halogenated phenolic compounds-polychlorinated biphenyls (PCBs), synthetic chlorinated hydrocarbon compounds consuming a few contaminated fishes, meat, and some dairy products22,26.  Polybrominated diphenyl ethers (PBDEs): Environmental pollutants, BDEs 47, 49, 99, and 209, are rich in some fishes, seafood, and some dairy products 21. Cyanide from pollution: water, air, environmental tobacco smoke (ETS) 22. Some pesticides like acetochlor, fungicide (amitrole), considered EDCs, are indirectly present in our daily foods .23,24

 

As per the study published in 2013, in the Indian Journal of Endocrinology and Metabolism, out of 466 participants, 101 participants were hypothyroid, which was the highest prevalence (21.67%) hypothyroidism found in Kolkata compared to other cities 24. There are various influencing cum linking factors to hypothyroidism 25,26. Considering that, our observational study was conducted to determine the relationship between obesity and hypothyroidism. Subsequently, dietary intervention conducted by thyroid disruptors free diet plan for the participants only based on home-based low-calorie foods. Our potential diet plan to avoid or remove hypothyroidism devoid of EDCs could be a supplemental therapeutic intervention 27.

 

MATERIALS AND METHODS:

Participants:

A total of 120 obese, hypothyroid female housewives were enrolled for this study within 35-45 years. All the participants attended the private Diet Clinic (proprietorship consultancy) in Kolkata for the diet consultation. Every participant tested the TSH and T4 hormone only but not mandatorily T3 by the ECLIA method9.

 

Study design and duration:

A qualitative observational study with a purposive sampling method was conducted on all the participants who visited for consultations. Four visits were from March 2019 to August 2019 (six months) with the common complaints of obesity-associated hypothyroidism. The study also considered one or two diseases as comorbidities, like PCOS, HTN, CVD, DM-II.

 

Tools and techniques:

Questionnaires, laboratory reports, BMI records, dietary intervention, endocrine disruptors as existing literature, and data analysis through SPSS-version-16 software28,39.

 

Questionnaires:

Data were collected through semi-structured questionnaires and on-site consultation based on socio-demographic information, food frequency, cooking, and eating habits 28,35. As per interviews, the counseling at the first visit, we realized no such practice of yoga, walking, or separate physical exercises anytime. The participants were not willing to spare exercise time due to their full-time engagement in the family. However, we found the reason might be a lack of motivation.

 

Laboratories reports:

USG, FSH, LH, Estrogen, testosterone for PCOS, blood sugar level (PP, fasting), HbA1C for diabetes considered secondary data. Further, LDL, HDL, TGL for dyslipidemia, lung function test reports, BP (periodical checkup), environmental exposures, and other available test reports were also noted from participants as secondary data. All the diagnostics tests (laboratories) reports, including physician prescriptions, were collected as duplicate/photocopies for medical history purposes. TSH, T4 reports, and Levothyroxine tablets were also considered based on the Thyroid peroxidase antibody (TPO ab) < 60 U/ML. The value is as per the American Thyroid Association, and this process is mainly followed by all leading testing/diagnostic centers in Kolkata6.

 

Body mass index:

In the study, apart from TSH, T4, comorbidities, height in centimeter, and kilograms were directly measured on the spot both pre and post dietary interventions to calculate BMI. BMI is equal to weight (kg.) divided by height in meter2. BMI ≥ 23.0 was considered overweight and obese ≥25 in the Asian population as per WHO cut-off value 16. The methods were incorporated in the study to find out the relationship between weight status by calculating BMI. The BMI was the assessment of obesity that is indirectly related to hypothyroidism and its associated comorbidities 4,16.

 

Dietary intervention:

This intervention was performed in two phases (2 visits at each phase). For the first three months, 25mcg-100 mcg levothyroxine was recommended by each participant's respective physician/endocrinologist as per the clinical condition. Subsequently, during the 2nd three months, all were without this medication as per the doctor's consent and following a revised diet. All meals were planned by the inclusions of those foods, endocrine disruptors free 29-32. At the first visit of the 1st phase, we recommended an average 1400kcal/day diet plan for weight loss without hypothyroidism. Participants who visited for consultation informed the relevant details that they were consuming Levothyroxine as per prescriptions in the last few months.

 

Diet plans:

In the diet plan (1st phase), the components of major nutrients were 55%-60% carbohydrate as cereals for staple foods, 25% or per kg body weight as protein, and 15% cooking oil in the form of unsaturated fat. Rest 5% is considered other nutrients like vitamins and minerals by consuming more fruits and vegetables30. This phase intends to assess the relationship between obesity and HT through observations. The same diet plan continued until the first phase, as per the Harris-Benedict formula18. Based on this formula, the plan was designed for the women participants in the form of uncooked (calculated as raw) foods: BMR = 655 + (4.35 X weight in pounds*) + (4.7 X height in inches) - (4.7 X age in years) and for sedentary lifestyles, calculated BMR X 1.2** = (average 1400) kcal. *1 Kg = 2.20 pounds **appropriate activity factor 18 BMR in both phases has been considered per the Harris-Benedict formula. As we mentioned in the first three months, the diet plan was for general weight management, but the next three months, during their two visits, a diet plan was designed in a new way where some foods as thyroid disruptors were restricted or omitted 19, 20. The intention was to observe the hypothyroidism recovery in addition to weight reduction at the end of this study.

 

Endocrine disruptors:

As per the studies and few available data, these following foods were considered in the study as endocrine disruptors, and that may be termed as thyroid disruptors29-34; Cyanogenic foods: kernel foods, almonds, apricots, cherries, peaches, plant seeds, cassava, including some more stems, roots contain lectin28,30. Goitrogenic foods: cabbage, kale, cauliflower, soy, spinach, rapeseed, mustard, oil, broccoli, millets, peanuts, sweet potatoes, turnip, strawberries, pear, peaches26,31. Thiocyanate rich: cigarette smoke, cruciferous plants, cabbage, cauliflower, mustard (seeds and leaves), turnip, radish, brussels sprout. Genistein, glycitein, and daidzein as Phytoestrogen: Available in Isoflavone found in soy, coffee, fava beans 29,31. A recent systematic review of environmental research and public health showed that caffeine-rich coffee might impair thyroid health 31. Synthetic/ halogenated flavonoid: some tea, a few citrus fruits, citrus fruit juices, berries, red wine, some red apples, legumes, etc.30-34. The dietary intervention was simple homemade, and home-based. So, all these foods were considered in general and person-to-person variables concerning their physiological effects.

 

Statistical methods:

The statistical analysis was performed by SPSS version -16 as a tool. The following tests were: 1) Paired- samples T-test 2) Bivariate Correlations (Pearson correlation coefficients).

 

RESULTS:

1)    The results were found in two parts, the 1st phase (first 90days) and 2nd phase (next 90 days). As per the study objective, the relationship between obesity (BMI as the parameter) and hypothyroid type was found significantly positively correlated r = 0.524 and 0.425 phase-wise, respectively. Probability value -Sig.2 tailed, p = .000 (p< .001 or P=0.000 means p<0.0005) and at the same time, body mass index with thyroid-stimulating hormone was also significant positively correlated as, r = 0.554 and 0.437 respectively. p= .000, Sig.2 tailed (p < 0.001).

2)    The study found that comorbidities (other diseases) were equally positively correlated, while the correlation was significant at the 0.01 level (2-tailed). In respect of comorbidities, BMI- p=0.001, weight status -p =.000, TSH level - p =0.005, hypothyroid type -p= 0.010.

3)    According to other relations, participants' remarkable progress was found in the 2nd phase, showing nine nos. Participants progressed from obese to normal, and seven participants were added to the comorbidities improvement list. Fourteen nos. of participants were directly reduced TSH from moderate hypothyroidism to borderline. Borderline and subclinical hypothyroidism state meant here, near about normal TSH as well as expected or subnormal T4.

4)    At the end of the study, the progress was visible for hypothyroidism due to effective dietary intervention at no particular cost but only through the endocrine disruptors-free foods available at home in general due to routine consumptions.

 

Key Findings:

1st-90days (March-May, 2019):-

1) There was a significant average difference between BMI and Hypothyroidism and [(t119 = 82.73, p < 0.001), 95% Confidence Interval 24.962-26.186]

2) The patients' weight loss diet plan is based on levothyroxine therapy as per endocrinologists' recommendations.

2nd-90days (June-August, 2019):

1) There was a significant average difference between BMI and hypothyroidism [(t119 = 75.007, p < 0.001), 95% Confidence Interval 23.243 – 24.504]

2) It was found that even in the absence of medication like Levothyroxine, the interventional diet worked significantly to minimize or overcome hypothyroidism and SCH.

 

Note 1) Statistical analysis for both the stages was done based on total collected and compiled data at the end of each phase (on 2nd and the 4th visit of participants), 2) In the analysis parts, t = the t-statistic and p = p-value (probability value).


 

1st - 90 days (March-May, 2019): Statistical Analysis and Interpretation

Table -1. Correlations - N = 120 – BMI Vs. Weight Status Vs. TSH Vs. Hypothyroid Type and Disease

Parameters

 

BMI

Weight Status

TSH

Hypothyroid Type

Diseases*

BMI

r

1

.831**

.554**

.524**

.237**

Sig.

 

.000

.000

.000

.009

Weight Status

r

.831**

1

.507**

.542**

.249**

Sig.

.000

 

.000

.000

.006

TSH

r

.554**

.507**

1

.916**

.253**

Sig.

.000

.000

 

.000

.005

Hypothyroid Type

r

.524**

.542**

.916**

1

.249**

Sig.

.000

.000

.000

 

.006

Diseases

r

.237**

.249**

.253**

.249**

1

Sig.

.009

.006

.005

.006

 

** r is at the 0.01 level (2-tailed).  *Diseases mean comorbidities

 


The analysis showed a Pearson correlation (r) regarding all the five variables that majorly worked with the study

 

Tentative Diet Plan for all the participants for 1st - 90 days (March-May, 2019)

Daily Calorie Requirement – 1300-1400 kcal/day from home-based foods 36-38 [Calorie Segregation]:

1.     Carbohydrate – 1300kcal x 55% =715 kcal/4 = 178gm (10m+/-)-Prefer not simple carbohydrate (like plain rice/Maida etc.)

2.     Protein - 1300kcal x 25% (excluding supplement) = 325 kcal/4 = 82gm (5gm+/-) –preferably Protein from vegetables sources.

3.     Fat - 1300kcal X 15% = 195kcal /9 = 21ml.< (only cooking oil 2tbsf) – preferably blended Oil.

4.     5% = 65 kcal -some additional fruits cum vegetables. Except for sweet fruits and excess dry fruits.

 

Diet Type: Low carbohydrate, high protein, low fat (USFA), less salt, no spices, and less sugar diet:

All raw, i.e., uncooked calculated. Better to use kitchen weight machine for staple/primary raw foods (under observation for 30 days-Visit No-I) - (Check allergy/intolerance- if any/update soon) Participants can organize rotationally as per convenience but not to deviate quality, quantity, ingredients, and essential advice (This is a standard format style, hence diet plan was customized for the particular patient)

 


Table.2. Tentative Menu cum Meal Plan (30 days; weekly plan)

Time – (30min +/-) and Meal Type

Menu/Meals (1tsp=5gm/ml;1 tbsp=10 gm/ml;1 bowl =50gm or 100 gm)

Calorie

(Kcal)

6.30 am -at bed-start

1 glass of lukewarm water. (Medicine as per schedule, should not be changed)

0

Pre-exercises - 7am

1 pc. cream cracker biscuit  + 1 cup black or green tea

30

Yoga – practice 15min.

Practise 15 min. easy yoga poses

-100

Freestyles/Cardio exercise -15 min.

At the gym or home : (Morning exercises provide better effects)

-130

Walking – 30 minutes or 2km in a safe zone.

Mild to moderate level walking for 30 min. (morning exercises provides better effects); if not possible here then to practice in the evening.

#Trade mill at home provides the same calories.

*Tracking the calories has been advised

-150

Tea/ Milk –(refreshment) 8.30am

 Post work out: 1 glass water or 1 cup black/green tea

0

9 am-Breakfast -Option -1

                           

Plain Oats 50 gm

+ 150 ml(half glass) double toned/skimmed milk or mix vegetables 100 gm (if milk intolerance) + 1 egg white

160+ 120+40

Option -2

Cornflakes  50 gm

+150 ml milk + 1 egg white

110+ 120+40

Option -3

 

Sattu Sharbat -50 gm

added with 2 -3 gm rock salt+ pinch of black pepper+ 2 drops lemon water+ after 15 min to eat 50 gm curd.

170 + 50

Option -4

50 gm Poha /Upma/2pcs roasted brown bread

+ 50 gm curd (either milk or curd) + 1 egg white

180+50+40

10 am –Supplement (if any) Tea/snacks

Mosambi or pomegranate juices 200 ml /coconut water for some hydration (Not mandatory, but if possible).

80/0

11 am –Fruits/Salad preferred – 200gm

Solid  fruits :   Guava/apple/pear - 1 pc/100gm

Citrus fruits :   Mosambi/ Orange/Pineapple/green grapes -1 pc/100gm

To be avoided:

Sweet/high calories fruits:   small Banana/Coconut/Jackfruit/Sapota etc.

Dry fruits group :   Almond/cashew/walnut/nuts/dates/raisin

All sweet juices ex: mango/high-calorie juices

 

40 + 50

12/1 pm – Lunch

(carbohydrate part) +

30 gm white rice (2days/week) or 2 pcs chapathi (3days/week) or 50 gm Brown rice (2 days/week)

70/110

Common items   +

Pulses 20gm; green leafy veg.-50gm; gourds vegs.50 gm (boiled well-cooked, non-spicy)

20+ 105

Advise outside meals

If outside meal, then only 1 egg white/ dry mix vegetables without curry.

100/0

If Non-veg.

50 gm rohu/catla or any fresh fish (3-4days/week) or 1-day chicken 100gm only at lunch in a week.

 

120

*Lunch (all in gram). veg. max days daily at night.                                # (X2 means=2 times Lunch and dinner)  pulses +salad

Total /day:  Cream less paneer:   2 pcs = 20gm / kidney beans 20gm /Tarka-20gm: /yellow peas 20 gm  /Mushroom 25gm/ Nutrela as soya pcs -  10pc;poppy seeds 20gm, pulses: 20 gmX2 (lentil/Moong/Arahar) Green salad: cucumber, beet, carrot, capsicum – total 100 gm/day.                                                                                                                             Mandatory in case veg meals:  Raita/Curd 50 gm/day.

 

110

Post Lunch - 15 min gentle walking.

After mild walking, water enough to drink to avoid gas/acidity – avoid sleep/nap and excess sunlight, chilled water, etc.

-50

 

4 pm – Mid after ->

Fruits 100gm/misc.

(If feeling hungry may have something)

1 fruit /fruit juice half glass / 2 Cream cracker biscuits/ 50gm green salad (any).

 

50

5.30 pm-6 pm - Work Out (If any)

At the home bit of walking, no such excess work out this time if practices in the morning. After walking 1 biscuit + 1 cup black tea (if such interest)

-30

 

6/7 pm –Evening snack

Puffed rice 30gm/ dried ready-to-eat rice flakes 30gm + with 50gm green salad  (avoid fried foods) or 2 -4 pcs Idly/dhokla with sambar ( avoid all chutney/oil pickles) or small veg. Sand witch=50gm filling with vegetables.

40+ 50

110/120

7/8 pm– (If any)

Enough water + 1 cup black /green tea

0

9.30 pm –Dinner – (carbohydrate part in gram) +

Option 1). Dalia 50 gm mixtures with all vegetables (4-5days/week)                         

Option: 2).  2 Pc Roti/ Poha/Upma 50gm (2-3days/week).

The patient should avoid rice and no simple sugar at dinner

100/110

Common items +

Pulses: 20gm; gourds vegs: 100gm. No roots vegetables but a green salad

40+80

Non-Veg - NO

Usually VEG foods or max 1 egg white or 1 pc 50gm freshly cooked fish

130

Special Veg recipes (every day/week) +

*as like lunch – may add paneer 2 pcs/kidney beans/raita/ yellow peas (mentioned above quantity in the lunch part)

80/110

10 min. mild walk

20-30 min yoga and some home-based walk

-50

11 pm

 Go to bed, no late-night, Check sound sleep.

 

 

Remember: No empty stomach for a long time but consume easy foods as fillers on a day, e.g., biscuits/puffed rice/rice flakes/green/fruit salad

Total-1365 kcal

 


Some specific advice/ tips: (generalized)35,41:

It is advisable to use a kitchen weight machine for precise cereal foods like rice/wheat etc. There are no fast foods, street foods full of trans-fat produces, junk, added sugar, or salt-rich foods. Average 7 hours sound should sleep at night only and table salt only for cooking average 5 gm/day. However, instead of refined sugar, sometimes artificial sugar is better.

 

Exercises plan41-43:

Exercises preferably indoors as much as possible and is better to practice 1 hour per day, mainly early morning for good health. However, evening time is the next choice. It is advisable to practice yoga or some fat-burning poses slowly at bed or on the floor for around 20-30 min every day, preferably early morning and bedtime at night. Freehand at the home campus or open ground with a proper cotton track shoot and sports shoe always suggested. It is also essential to track calories. The patients were advised to follow the Indian calories during the exercise time manually, preferably. The calories charts were sent to them through emails/whats app for their basic understanding.


 

2nd - 90days (June-August, 2019): Statistical Analysis and Interpretation

Table -3.    Correlations N = 120 – BMI Vs. Weight Status Vs. TSH Vs. Hypothyroid Type and Diseases

Parameters

Values

BMI

Weight Status

TSH

Hypothyroid Type

Diseases*

BMI

r

1

.901**

.437**

.425**

.298**

Sig.

 

.000

.000

.000

.001

Weight Status

r

.901**

1

.415**

.391**

.332**

Sig.

.000

 

.000

.000

.000

TSH

r

.437**

.415**

1

.782**

.255**

Sig.

.000

.000

 

.000

.005

Hypothyroid Type

r

.425**

.391**

.782**

1

.235**

Sig.

.000

.000

.000

 

.010

Diseases

r

.298**

.332**

.255**

.235**

1

Sig.

.001

.000

.005

.010

 

** r is at the 0.01 level (2-tailed). *Diseases mean comorbidities

 

 

 

The analysis showed a Pearson correlation (r) in respect of all the five variables majorly

 

 

Table -4. Progress of subjects as per BMI

Observation

Normal Weight

Overweight

Pre-Obese

Obese -I

Total

Phase - I

0

5

49

66

120

Phase – II

9

18

46

47

120

 

 

Table-5.   Progress of subjects as per hypothyroidism

Observation     

Euthyroid 

Subclinical

Mild

Moderate

Total

Phase-1    

0

54

52

14

120

Phase-II    

0

68

52

0

120

 

 

Table -6.  Progress of subjects as per comorbidities

Observation

Normal

Asthma

PCOS

HTN

Hyperlipidemia

DM-II

CVD

Total

Phase - I

21

11

28

28

17

4

11

120

Phase -II

27

12

21

24

17

3

16

120

 

All the quantities of nutrients are calculated according to the foods incorporated in the menu and meals/day/participant 36-38.

 

Table no- 7. 2nd phase - Dietary Intervention Based on Average Diet Plan: 1400 Kcal/day/participant

Food Stuff

Portions

Quantity

CHO

Protein

Fat

Cereal and Products -20 gm each

8

160 gm

120

16

-

Pulses and Legumes -25 gm each

3

75 gm

45

18

-

Milk and its Product - Skimmed Milk/

Double Toned (ml)

2

350 ml

16

16

8.7

11

11

Seasonal Veggies -100 gm

2

200 gm

06

4

-

Fruits

1

100 gm

10

-

-

Egg Whites

2

White part

-

7.2

0.1

Fish

1

100 gm

4.4

16.6

1.4

Cooking Oil

3

15 ml

-

-

15

Gross food items

Portions

Total (gm)

201.4 gm

81.5gm

27.5gm/ml

Source: Indian Foods Composition Table – 2017 (NIN-Indian Council of Medical Research).

 


DISCUSSION:

There are many reviews and experimental researches on obesity and other related factors. Similarly, some studies also correlated with hypothyroidism, obesity, Diabetes Mellitus, and other metabolic disorders 44-47. Initially, the study was started with 120 samples as participants because, as per current data, out of the total obese women population, an average of 22% are hypothyroid located in metro areas due to lifestyles. The study showed that 1st three- months, 120 Obese hypothyroid women were consuming Thyroxine tablets (Levothyroxine) 25mcg-100mcg as per the prescription of their physician/endocrinologist 49-52. Each prescription had one tablet per day on an empty stomach for subclinical or other hypothyroidism due to elevated serum TSH and normal or little low fT4. During this stage, the normal weight loss diet (1400kcal/day) was usually recommended and followed by the participants and levothyroxine therapy. As per the observation in the 2nd phase, the study revealed gradual progress in SCH, Mild and Moderate hypothyroidism. Fourteen participants were converted from moderate to SCH (borderline) and expected to recover to some extent by following the EDC-free diet plan. Same way, weight status (BMI) was also improved a lot as data analysis showed, 1st phase:  normal =0, pre-obese = 49, obese- type-1= 66. Still, after the dietary intervention, the figure came out 9, 40, 47, respectively. So, nine patients were improved at normal weight from obesity. Comorbidities level was also reduced mainly PCOD-7, HTN-4, for each.

 

Moreover, 6 participants became normal altogether after a weight loss diet in addition to the hypothyroid diet plan. It was a pilot study based on observations, assessments, and reviews of literature. A simple, cheap, and best homemade typical diet plan was prepared and subsequently implemented 51,52. The 2nd phase helped to some extent to all the female participants, mainly for hypothyroidism and obesity. The study started to help all the obese hypothyroid women associated with comorbidities. As a result of successful interventions, all are now being with euthyroid (normal stage). Further, the study has been carried in the community setting to find more associations with other diseases. More focus has been given on thyroid disruptors and their path to recover or prevent hypothyroidism at any state, subclinical to severe 48-51.

 

CONCLUSION:

The relationship between BMI, Hypothyroidism was significantly positively correlated. If weight is more, the chance of TSH level will be higher (elevated TSH level = hypothyroidism state). So, losing weight may help hypothyroid patients prevent or recover hypothyroidism or say that losing weight for obese women may reduce the risk of hypothyroidism. A weight-loss diet, which started initially and helped weight loss, is usually recommended and practiced by dietitians. Still, at the same time, the positive side was that a tentative home-based simple hypothyroid diet plan also worked remarkably. The progress was observed because of dietary intervention: goitrin and phytoestrogen-free, thiocyanates and flavonoids free; in the word 'thyroid disruptors free diet.' So, partly recovery or progression of hypothyroidism states (up to euthyroid) is possible through a simple home-based well-planned diet but not through levothyroxine treatment.

 

CONFLICT OF INTEREST:

The authors have no conflicts of interest.

 

 

ACKNOWLEDGMENTS:

The authors would like to thank all female participants and Diet Clinic (consultation place) for their kind support.

 

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Received on 10.04.2021            Modified on 24.06.2021

Accepted on 28.07.2021           © RJPT All right reserved

Research J. Pharm.and Tech 2021; 14(12):6579-6586.

DOI: 10.52711/0974-360X.2021.01138