Hashimoto's Trainee

Medical Q&A [Moderated]
1

Hello Doctors,

My wife is a 26 and has Hashimoto’s. I don’t know what her labs are, but her doctor has her back in the normal range. Her anti-body count is still high. She takes NatureThroid.

She wants to lift but has become thoroughly convinced that she needs to “take it easy”, and that any vigorous exercise will result in an autoimmune flare up (there is a lot of fear and anxiety that revolves around this). There’s no shortage of “literature” on the internet saying people in her situation need to be extra careful “not to overdo it”. She’s currently limiting herself to light cardio a few times a week if anything, and feels fairly fatigued a lot of the time. For reference, she’s a very strong woman. Before the disease, she LP’d her squat to just over 200 lbs.

This is more for my own curiosity, as I’m not overtly pushing her in any direction. How would you all approach this type of trainee? My bias is that she can and should lift. That the lifting would likely improve her hormonal profile, and potentially help her feel better emotionally and physically. Someone with her condition seems like the perfect candidate to use RPE, as fatigue is a very real/legitimate concern for her.

My recommendation would be to start a LP very light, with low volume, and move on relatively quickly to The Bridge. For example (squats only for brevity):

Week 1
Day 1: 1X5 @6
Day 2: 2X5 @7 (5 lbs more than day 1)
Day 3: 3X5 @8 (5 lbs more than day 2)

Weeks 2-4 standard LP, use this time to get a feel for RPE

Week 5, switch to The Bridge or continue LP depending on how she feels.

Questions:

  1. Her primary motives are first (understandably), not feeling like shit, and second, weight loss. Is the lifting prescription I have laid out above a reasonable place to start?
  2. Do you approach a trainee with Hashimoto’s significantly differently than a healthy person? i.e. Do you expose them to less stress than you otherwise would or do you try to expose them to progressively more stress to make them more exercise tolerant (like anyone else)?
  3. She believes she has a compromised ability to recover, and therefore will not respond to progressive overload the way a healthy person would. In other words, the stress, recovery, adaptation cycle does not apply to her. Do people with this disease have a reduced ability to recover from training?
  4. Do you have any other thoughts/opinions or is there something I’m not considering?

Thank you for time, I’m incredibly grateful for the content the BBM crew puts out there.
-Erik

2

There are certainly many physical symptoms someone in this situation can experience, but It sounds like she should probably stop reading fearmongering internet websites, and her fear / anxiety is going to present a substantial obstacle here that needs to be addressed. See my recent article on fear, catastrophizing, and training for more details on this as it pertains to fatigue (and she may benefit from reading this too). If she has adopted the idea that “I’m a disabled Hashimoto’s patient” as her identity, this will be even more difficult to deal with.

I agree that RPE is a good idea here, rather than forcing more weight on the bar at all costs. Your general plan is reasonable, though the specific timeline and subsequent programming (E.g. bridge) May need some modification depending on her response.

3

Here’s the training log of a woman with Hashimoto’s https://www.exodus-strength.com/forum/viewtopic.php?f=5&t=1562. She describes her condition at Programming for autoimmune disordered trainees. HALP! - Exodus Strength It certainly seems possible to train.

4

Thanks Austin. Your article is definitely helpful.

As it happens, this topic came up over the weekend, without prompting from me. She wants to start lifting again and self identified that the anxiety she’s created around it is something she needs to overcome. I’ll share that article with her.

Thanks for the links quark. Good to know there other people who manage in this way.