The issue of weight is an important one. Doctors are continually advising patients of the importance of maintaining a normal weight. And, in our society, all manner of praise, reward, criticism, and disrespect are ascribed to people according to their weight. How people are seen by themselves and others can sometimes be greatly influenced by the issue of weight. Health and life insurance premium tables are often determined in part upon height and weight charts. Apparently, it is felt that abnormal weight can increase the chances of one having adverse medical conditions and can decrease life expectancy. Excessive weight has been seen to aggravate certain breathing and heart problems, and can contribute to the onset and interfere with the treatment of diabetes.

It is well known that decreased thyroid system function can lead to inappropriate weight gain. With decreased levels of active thyroid hormone at the site of the cells, the resulting decrease in the body’s metabolism can lead to an increase in one’s weight, even if there is no change in a person’s diet, exercise, or life style patterns.

This inappropriate weight gain is easy to understand in light of DTSF. No doctor is surprised by a patient’s inappropriate weight gain when it is accompanied by fluid retention, fatigue, depression, migraines, dry skin, dry hair, hair loss, decreased memory, constipation, cold intolerance, and thyroid hormone blood tests that are outside the “normal range.” In such cases, physicians might feel a great urgency in correcting the patient’s thyroid hormone deficiency and tell the patient, “No wonder you gained so much weight so quickly and so easily.”

It is very odd that many of the same doctors react much differently when the thyroid blood tests are found to be in the “normal range.” Even when the patient is suffering from even more dramatic inappropriate weight gain coupled with even more severe fluid retention, fatigue, depression, dry skin, dry hair, hair loss, constipation, heat and cold intolerance, and decreased memory. The doctor might completely dismiss the possibility of DTSF based solely upon the “normal” results of some currently available thyroid hormone blood tests. It seems very odd in situations such as these that physicians seem to reach such definite conclusions based on a few currently available thyroid hormone blood tests. Many physicians seem to act as tests directly measure or directly reflect (predictably and reproducibly) the interaction of the thyroid hormone at the thyroid hormone receptor in every cell of the body, which, of course, is not necessarily the case. Currently, the thyroid hormone blood tests available can be useful in showing that there probably is a problem that could cause DTSF. They are not, however, useful in determining that there definitely is not a problem present that could result in DTSF. This distinction is made when one considers the percentage of false negatives, false positives, true negatives, and true positives of a given test as discussed in chapter 4.

To illustrate the point, one may easily conclude as one approaches a pay telephone with a severed receiver cord that the phone is probably out of order. However, just because the receiver cord is intact does not necessarily mean that the phone is not out of order. Likewise, just because a patient has no problem that is immediately obvious with currently available tests does not necessarily mean that the patient has no problem. Hence the old medical adage: “Treat the patient not the blood tests.” This adage discourages doctors from being too closed-minded and discourages us from being lead to faulty conclusions by blowing the significance of tests out of proportion to their obvious limitations.

For the sake of discussion, let us say that almost all physicians are familiar with the signs and symptoms characteristic of DTSF. Let us also say that they are familiar with some of the causes of DTSF (such as hypopituitarism and hypothyroidism). Many physicians, however, seem to have overlooked the most common cause of DTSF (Wilson’s Temperature Syndrome) and aren’t yet well familiar with it.

Of course, not everyone who feels that they are gaining too much weight in relation to their diet and exercise level is suffering from DTSF. But DTSF is more than enough to explain why someone may have difficulty with their weight. Easy weight gain has long been associated with DTSF, but the most common cause of DTSF (Wilson’s Temperature Syndrome) is often overlooked. It is easy for most doctors to understand how a patient could gain weight on 800 calories when the patient is suffering from DTSF. It seems odd then how some physicians can boldly declare that it is impossible for a particular patient to be able to gain weight on 500 to 800 calories based solely on the results of a few far-less-than conclusive blood tests.

It is well known that different people have different caloric requirements to maintain their health and body weight. Some sources suggest the average woman needs approximately 1700 calories per day and the average man approximately 2300 calories per day. Of course, a person’s caloric requirements can change under various conditions. Under starvation conditions or during fasting, the amount of calories utilized can decrease because of the body’s compensation to the conditions. To some extent, this is accomplished through the compensatory decrease in T4 to T3 thyroid hormone conversion. This was well demonstrated by a study done by A.G. Vagenakis (University of Massachusetts Medical School, Journal of Clinical Endocrinology and Metabolism; 41, 191) who showed that under fasting conditions the level of T3 in certain patients dropped by 50% as their levels of RT3 increased by 50%. Also, a decrease in the amount of calories burned per day during fasting conditions, and persistently even after fasting conditions ended, has been documented. (Adaptation of Energy Metabolism of Overweight Women to Low-energy Intake, Studied with Whole Body Calorimeters, American Journal Clinical Nutrition 1986; 44:585-595.)

The amount of calories burned per day can vary tremendously. How this is possible can be understood by considering the difference in energy required to make a car, as compared to the energy required to drive a car. To make a car one needs to dig up ore that can be refined into metal, one needs to drill oil wells to have the oil necessary to lubricate the cars, one would need to get the vinyl and other materials to make the car’s upholstery. One would have to design and make molds to fabricate certain parts, hire the necessary labor to put the parts together, build the factories necessary to make the car, obtain the rubber for the tires, and assemble the parts into the proper order so that the car functions. All these activities take a huge amount of energy to accomplish. The energy required to drive and operate the car is far less. Once there is sufficient gasoline in the gas tank, one must sit behind the wheel, turn the ignition key, put the car in gear, press the gas pedal, and use the steering wheel to direct the car. So one can operate a car, traveling all over the country, on a similar amount of energy required to make, for example, just the transmission. In the same way the vast majority of the energy used in the affairs of the human body are used in producing and maintaining the molecules, cells, and tissues of the body. In other words, the energy to make hair, skin, and teeth is a great deal more than the energy necessary to brush hair, brush teeth, and wash the skin. To make heart muscle, skeletal muscle, and bones takes a great deal more energy than is necessary to walk around the house or through the mall. To make and maintain babies, ear drums, eye balls, throats, etc. takes a great deal more energy than does exercising in a spa for two hours every other day or week. A great deal of energy is also necessary to make memories, good moods, ideas and emotion. The body can greatly adjust or change the amount of energy that it uses by affecting how much energy is used at any given time in the production and maintenance of tissues.

Under periods of stress, the body can decrease the maintenance of tissues to conserve energy that instead may be necessary for operation of the body. It can do this by impairing the conversion of T4 to T3, thereby dropping the body temperature. When the body temperature drops, the function of the enzymes that are most susceptible to temperature changes can be impaired. It is interesting that the body chooses the most expendable tissues to sacrifice under periods of stress to ensure the survival of the organism. For this reason these patients will first complain of dry skin, decreased hair growth, brittle hair, hair loss, peeling and splitting fingernails, thin eyebrows, decreased sex drive, etc., as opposed to functions more vital for survival, such as vision, hearing, heart and muscle function, etc. Under severe conditions (fasting for days, weeks, and even months at a time), the body’s maintenance of tissues can decrease to a very low level, enabling a person to survive even on 300 to 500 calories per day. When times are better and when the stress is relieved, the body’s metabolism returns to normal leading to regeneration and renewed maintenance of the tissues that have been neglected.

Some tissues can maintain their function quite well for long periods of time, even after their maintenance has been drastically reduced (for example much of the protection afforded by the skin can be attributed to layers upon layers of cells that have actually already died, which makes those layers less dependent on maintenance of living cells for considerable lengths of time, even weeks, while still providing function). The unfortunate thing is that sometimes after the stress has passed, the metabolism does not come back up and does not regenerate the tissues as well as it should, resulting in a persistence of the classic symptoms of DTSF. This can explain the phenomenon that has been observed many times in many places all over the country. Many times I have seen patients who have tried to convince others that their weight problem was not caused by them eating too much. To get to the bottom of the matter, many of these patients have been hospitalized, with their doctors giving the nursing and hospital staff strict instructions to observe the patient and to monitor everything that enters the room and every bite that enters the patient’s mouth. Under strict conditions of observation, some of these patients have been observed to take in less than 500 calories per day, and have actually gained weight. This scenario has left many a doctor scratching his head, yet none of these doctors would have difficulty understanding this phenomenon if it was associated with a cause of DTSF that could be detected with available blood tests.

As strange as it may seem, the overlooking of one small point (which is no great leap in reasoning) has caused this phenomenon to remain such a mystery: Thyroid hormone blood tests are not adequate to detect every cause of DTSF or to fully assess the functioning of the thyroid system. It is difficult to understand how this point has been overlooked by so many for so long, especially since the presentation of decreased thyroid system function is so reproducible and recognizable. It is hard to understand how it can be concluded that a patient with a very typical and classic presentation of DTSF, necessarily has normal thyroid system function based only on the far less than predictive and reproducible information afforded by thyroid blood tests. It’s like concluding that “even though this bird looks like a duck, has webbed feet like a duck, floats like a duck, paddles like a duck has a bill like a duck, waddles like a duck, and quacks like a duck, it cannot be a duck, because I have taken one of its feathers and it looks to me like some of the feathers that I have removed from these turkeys.” “I can’t accept the possibility of this bird being a duck just because it has all the characteristics of a duck, but I can accept the impossibility of this bird being a duck solely because it has one similarity to a turkey.”

Contrary to popular belief, it is possible to gain weight on less than 500 calories a day. It is also possible, as many people can attest and as more and more people are coming to realize, that one can actually sometimes gain weight by decreasing one’s caloric intake. As discussed previously, when a person diets, their body can respond with a compensatory lowering of the metabolic rate. For example, if a person is eating 1400 calories per day and maintaining his or her weight, it stands to reason that the amount of calories burned is equal to the amount of calories taken in so that there is no change in the person’s weight. However, if that person chooses to try to lose some weight by cutting his caloric intake to 1100 calories, he or she is likely to lose weight. But, in some cases the body can respond to that decrease in caloric intake by slowing down the metabolic rate and can sometimes even over compensate. So the body might cut the caloric expenditure down to say 900 calories per day by decreasing the amount of energy devoted to tissue (hair, skin, etc.) maintenance, in order to cope with the condition of fasting. In this way, a 200 calorie per day excess can be realized enabling a person to actually gain weight under dieting conditions.

Persistent impairment in the conversion of T4 to T3 can also explain the common phenomenon observed in patients who lose weight by dieting, only to gain it back and then some. Because the caloric deprivation might incite the body to further compensate and enter further into the conservation mode, causing further impairment in the conversion of T4 to T3, setting the metabolic rate at an even lower level than previously. This can also explain why many patients who undergo a diet notice a worsening of their symptoms of Wilson’s Temperature Syndrome, with these symptoms frequently remaining persistently worse even after the diet is over. For example, they may find their skin becomes more dry during the diet and remains dryer even after the diet is over. Their dry skin problem may persist together with a rebounding of their weight. The well observed phenomenon of gaining back weight lost during a diet after the diet has been discontinued is sometimes referred to as “Yo-Yo Syndrome.”

Wilson’s Temperature Syndrome can also explain the frustration that some people experience when they are doing everything that is accepted as being correct while the weight still doesn’t come off, and their symptoms still do not improve. They have read every book, they have tried every exercise program, they have read every diet, they have tried every diet-following them to the letter strictly without variance – and still have not been able to achieve a normal weight. If they have been able to get to a normal weight, they are frequently unable to maintain it, and frequently suffer continually from the symptoms of MED. Indeed, some of their symptoms may worsen in spite of their best efforts. This can all be explained by T4 to T3 conversion impairment.

Patients are sometimes accused of “cheating” on their diets by their doctors (apparently because their doctors are unaware that it is possible for some patients to gain weight on 500 to 800 calories per day. It is often concluded that there is no possible way that patients could be adhering strictly enough to their diet, because if they were, they would be losing weight. However, patients with DTSF and low body temperature patterns can sometimes gain weight on less than 500 calories per day, and will sometimes respond poorly to protein sparing modified fasting liquid diets and even to stomach stapling. One patient I treated had undergone a stomach stapling procedure and her stomach was so small that she was unable to hold down more than three or four ounces at a time and she had the misfortune of vomiting up to eleven times a day. Through the course of a day it was physically impossible for her to retain in her stomach more than 400 calories/day, yet she was gaining weight in spite of it. Many patients with Wilson’s Temperature Syndrome that are treated with protein sparing modifying fasting diets have found that they are able to lose weight with the liquid diet. However, their symptoms of MED often worsen while the diet is in progress. And, once the diet is over, their symptoms of MED often remain persistently worse and they have a tendency to gain all their weight back and then some. This is understandable since it may prompt the patient to enter more deeply into conservation mode and the more deeply one is in conservation mode, the more likely one is to get stuck in that position, causing an aggravation of one’s Wilson’s Temperature Syndrome.

I’m not saying that every person who has trouble losing weight is suffering from Wilson’s Temperature Syndrome. I am merely pointing out that DTSF has long been known to be more than enough explanation for a person’s inappropriate weight gain. Wilson’s Temperature Syndrome and its treatment is not the answer underlying all people’s weight problems, just as dieting, exercise, liquid diets, stomach stapling, or other approaches aren’t the solution to all people’s weight problems. The issue of weight is a multifaceted one since people’s weight can be affected by many different variables. It can be affected by female hormones, adrenal hormones, thyroid hormones, dieting (including caloric intake and composition of food ingested), exercise, stress levels, psychological attitudes, surface area to volume ratio, and other variables. For this reason, no one approach can be used to help all people, in all circumstances, maintain an appropriate weight. There never will be one approach that works for everyone. The approach that works best will depend on the underlying problem.

Certainly, a change in diet helps some people to maintain a normal weight. However, there are others who may make the exact same change and gain weight. Some people are able to use exercise to get in shape, and maintain a normal weight. However, there are those who can exercise several hours a day, seven days a week and still be unable to control their weight. The resolving of one’s psychological issues surrounding food may help a person to overcome his weight problem, whereas the resolving of such issues in another may be inadequate to address the problem. It is well known that the weight problems of many have been eliminated once their underlying hormonal imbalance was corrected. DTSF does not, in and of itself, account for the weight problems of all people; but it does represent one more obstacle that can hinder the maintaining of a normal weight, thus, a person’s weight problem can be an extremely complicated one. In addressing the problem, the best that one can do is to favorably influence each variable that can affect the person’s weight as maximally as possible (do the best you can with what you have). Of course, the best approach will depend most on the underlying problem. Unfortunately, the underlying problem is sometimes difficult to determine (because many of the processes that influence a person’s weight involve some of the most fundamental levels of organization of the body – as discussed previously).

I would like to point out more fully the importance of a certain variable discussed previously, especially as it pertains to the issue of weight: surface area/volume ratio. Of course, the body’s weight depends on the amount of calories taken up by the body and how many calories go out of the body. Calories “go in” by the body absorbing and processing nutrients from the digestive tract, and calories “go out” by being used in maintaining body tissues, providing for body functions, providing for body movement and activity, and by the amount of heat that passes from the body to the atmosphere. We have discussed previously the importance of the surface area to volume ratio. We have pointed out that the shape that holds heat the best is a ball because it has the smallest surface area to volume ratio. So the less one looks like a ball and the more one looks like a stick, the easier it is to dissipate calories. And if it didn’t make a significant difference, then people wouldn’t tend to ball up or curl up in cold weather.

The body maintains its temperature within a very narrow range. It must be that the body has some special means or system to accomplish this exceedingly non-random event. This system can be thought of as a “thermostat” for the body. When body temperature tends to drop too low, then energy absorbed by the body through food stuffs are utilized to bring it back up. When the temperature goes too high, less “fuel is added to the fire” and certain other mechanisms are implemented to increase the amount of heat that passes out of the body. As everyone knows, in the winter time a better insulated home maintains heat better and requires less fuel to maintain a comfortable temperature then do poorly insulated home. Since a ball is the shape that holds its heat the best, the more a person is shaped like a ball, the better they retain body heat (all other factors being equal). If a person retains their body heat better than another (being well insulated in a sense) then less energy or calories will be required to maintain a given body temperature. Although people’s sizes and shapes vary tremendously, as do their abilities to retain and dissipate calories, their body temperatures don’t. There is an extremely small amount of variation in body temperature from one person to the next, with most people running very close to 23 1/2 degrees above room temperature, and with a 1.4 degree elevation (giving a fever of 100 degrees F) being recognized as such a significant indicator of illness that one would be excused from work.

With houses, conserving fuel is usually the goal, but some people and their doctors feel that they are storing too much fuel (fat). And, in some cases, it is apparent that they are storing it inappropriately under conditions that would ordinarily provide for the maintenance of normal weight. The thermostat of a house keeps it at a certain temperature. When the temperature begins to drop, it turns on the heater to maintain the certain temperature. If it begins to go too high, the thermostat decreases the amount of heat produced, to again maintain the temperature. The “thermostat” system of the body works in a similar way to maintain a precise temperature range. How well a body can get rid of excess stored fuel depends, in part, on how well that body can get rid of the heat (calories) generated by its consumption. To the extent the heat is retained in the body, the body temperature tends to rise. But as the temperature tends to rise, the body responds by decreasing fuel consumption and heat production to maintain the precise temperature range. Thus, since the more ball-shaped people retain heat better (are better insulated) than the more stick-shaped people, they tend to dissipate fewer calories before their temperatures rise to the point that their thermostats decrease fuel consumption. More stick-shaped people, like more poorly insulated homes, do not retain heat as well and require more fuel consumption and heat production to maintain the same temperature as the better insulated. So just being more ball-shaped can be viewed as a considerable disadvantage in being able to dissipate calories in order to maintain a normal weight.

Theoretically, a person might also be able to increase their surface area to volume ratio, to an extent, by sitting with their arms outstretched over the back of the couch more often than sitting with their arms and legs folded. So, too, it would be advisable to dress with lighter clothing that exposes more of the body’s surface area.

The principle of surface area to volume ratio explains some unusual situations. For example, a given person might weigh 145 pounds and have no difficulty maintaining 145 pounds at his current level of dieting, exercising, and life style activities. This person may for a time change his eating habits, exercise levels, or lifestyle to the extent that he gains 40 pounds to weigh 185 pounds. Then, that person may resume his previous regimen of diet, exercise, and lifestyle fully expecting to be able to return to 145 pounds, and be dismayed to find that he or she finds it close to impossible to lose even 5 pounds.

For many people this frustrating reality seemingly defies reason. However, more has changed in the meantime than just the person’s diet, exercise, and lifestyle habits. The person has gained 40 pounds and has become less stick-shaped and more ball-shaped which can sometimes, in and of itself, change the balance of variables. The WT3 protocol can bring a person’s body out of the inappropriate conservation mode in certain cases. Under these circumstances, one can observe an interesting phenomenon which can be explained by the influence of the surface area to volume ratio. A patient with classic Wilson’s Temperature Syndrome who also happens to be overweight, might respond completely to the WT3 protocol except that he may still not lose a pound of weight without a change in diet or exercise (even though the excess weight came on with the onset of Wilson’s Temperature Syndrome without a change in diet or exercise). However, the patient might begin an aggressive diet and exercise regimen and manage to lose 10 or 20 pounds, grow wearisome of the regimen, and go back to his or her old (prior to developing Wilson’s Temperature Syndrome) habits. The patient may find that the weight continues to gradually come off until s/he is once again at their pre-Wilson’s Temperature Syndrome weight. I am convinced that the explanation for this phenomenon rests in the fact that once the patient’s Wilson’s Temperature Syndrome was resolved, the patient might not have automatically returned to a normal weight because of the surface area to volume ratio changes that had changed the balance of variables that were dictating the patient’s weight. However, once the patient was able to get the ball rolling by losing 10 or 20 pounds, and thereby returning the surface area to volume ratio back to more normal levels (I call this “breaking the surface area/volume barrier”), the balance of variables was able to be restored to the extent that the patient could then return to the original weight with the original diet and exercise habits.

It is interesting that even pioneer settlers noticed that during the wintertime they seemed to be able to maintain more body warmth by eating more meat. This may help explain why some patients with Wilson’s Temperature Syndrome (in conservation mode) seem to be able to return to a normal weight more easily through the use of hypoglycemic diets (which include more meats/protein and less carbohydrates). The increased protein may help them to, among other things, more easily maintain more normal body temperature patterns to help prevent the body from fighting itself so much every step of the way.

In summary, the principle of the body’s surface area to volume ratio is an extremely important factor that can have a huge impact on a person’s ability to gain, lose, or maintain one’s weight. The surface area/volume ratio should always be kept in mind when addressing or attempting to understand a person’s weight problems.

We know that the body can be encouraged to enter or remain in the productivity mode through diet and exercise. However, sometimes diet and exercise alone are not sufficient to normalize body temperature patterns and to eliminate the symptoms of MED. To say that the symptoms of MED can be caused by low body temperature patterns, does not mean that everyone who has a low body temperature pattern has DTSF or MED. Nor does it mean that everybody who had any or all of the symptoms of MED, may not be having those symptoms from some other cause. To say that exercising can increase a person’s metabolism doesn’t mean that exercising is able to increase everybody’s metabolism. To say that certain dietary changes can improve a person’s metabolism doesn’t mean that any particular diet can increase everybody’s metabolism. All that is meant is that a low body temperature and Wilson’s Temperature Syndrome and DTSF are more than enough to explain symptoms of MED which may respond to proper liothyronine treatment.

Possibly the saddest twist of fate that I see in some patients is when a spouse will begin to criticize a Wilson’s Temperature Syndrome sufferer for even small excesses of weight. As these criticisms become sharper, the patient may make every effort to diet and exercise. Under the conditions of stress and fasting, the patient’s body may enter more deeply into the conservation mode, contributing to disappointing weight normalization. When the diet is over, such patients may frequently gain their weight back and then some, leading to more criticism (even ultimatums), more dieting, more frustration, and more weight gain.

Of course, if a person’s DTSF is being caused by Wilson’s Temperature Syndrome, the last thing that such a person needs is significantly increased emotional stress or pressure. Through harsh criticism, the spouse can prevent the outcome that he or she is demanding should be achieved. Sometimes when a couple does divorce, the additional stress can further aggravate the patient’s Wilson’s Temperature Syndrome, contributing to further weight problems. By the end of the process, an inappropriately critical spouse can cause almost irreversible damage to the patient’s metabolism, making it sometimes impossible to normalize body temperature patterns and to be able to return to normal weight, with proper diet and exercise, without proper thyroid hormone treatment of the patient’s underlying cause of DTSF (Wilson’s Temperature Syndrome).

In severe cases, correction of the problem can prove to be difficult (especially due to surface area to volume ratio considerations), even with proper thyroid hormone treatment. It is sad that the inappropriate and demeaning criticisms, projections, and predictions of others can sometimes come true in the lives of good people. It is amazing, also, to see the literal physical damage that people can cause one another through verbal, emotional, mental, and social interaction.