Q&A: Fatigue and That Pesky Belly Fat

A member recently wrote us in response to my recent post, Paleo for the Active Person, and I thought some of you might be able to relate.


I’m stuck. I haven’t lost weight (belly fat) in two months. I strictly eat Paleo via the plan everyday… week after week and now month after month. I walk and was even going to the gym… until the low energy got the better of me. I have hypothyroidism… and according to my blood tests, my meds are right. I feel like I can’t function without a nap by mid afternoon. The nap helps make it though the day (if I can squeeze one in)… but then I can’t sleep through the night. Do you think that more carbs will help me? Would sweet potatoes and squash everyday resolve these issues?


All right, this may be grounds for an individual consult with holistically oriented health practitioner, since you may have some complicated issues going on here, but here are my initial thoughts.

1. If you’re hypothyroid, you probably struggle with blood sugar imbalances, particularly blood sugar crashes, which means you may want to add a snack between breakfast and lunch if you don’t already. Or maybe just cut your breakfast in half and eat half in the morning and half 2 hours later. That’s what I do.  Explaining the thyroid’s functions is a blog series in itself, but here’s a little primer.

When you spend many years eating sugar, then having a blood sugar crash, then eating sugar, then having a blood sugar crash, and on and on, it stresses out your adrenal glands.  The reason your adrenals get overworked is that when you have blood sugar crashes (due to overeating refined carbs), your adrenals are forced to pump out cortisol, which puts sugar into your bloodstream so that you don’t pass out (or worse).  Your adrenal glands and your thyroid gland are both controlled by the pituitary gland.  So when your adrenals are demanding more energy from your pituitary than they should, the thyroid gets the short end of the stick and we end up with hypothyroidism (lethargy, weight gain, body temperature craziness, skin problems, low immune function, etc.).  It’s not fun, but it’s very common.

Healing your blood sugar imbalances (and helping your hypothyroid) means, for many, eating many times per day so as to avoid using cortisol to control blood sugar.  You use food instead. The beauty of the Paleo diet is that you cut out the refined carbohydrates, so your chances of having blood sugar crashes are less than if you were eating a normal American diet.  You can still have them, though, if you don’t eat often enough.  How often and how severe those crashes are depends on your genetic make-up and how much you’ve messed up your body by eating an American diet over the years.

2. Are you drinking caffeine? If so, try to cut it out as it really messes with blood sugar and causes crashes.  I especially find morning coffee drinkers to be the people who are fatigued in the afternoon…

3. Try exercising again. I know you’re incredibly tired, but it seems like there are times during the day that are better than others, right?  Try to go for a walk in the morning (or whenever your energy is the highest), even if it’s only for 20 or 30 minutes. It can help improve your overall energy levels, sleep quality, weight loss and hypothyroidism in general.  Once you start feeling better (and you will), you can start doing more fun and intense workouts.

4. Are you drinking enough water? Water, of course, is our life blood.  I kind of doubt this is your issue, since your fatigue sounds pretty intense, but I have to ask.  Even if it’s only part of the problem, it’s worth looking into.  Try drinking more water for a few days and see if it makes any difference.

5. I know you said you are eating strictly Paleo, but once again, it’s my job to ask: are you having sugary snacks throughout the day? Or are you having cravings? If you’re having cravings for sweet things, it either means you’re not getting enough protein and fat (which you probably are since you’re on Paleo Plan), you’re not getting enough carbohydrates, or you have food sensitivities (more on that later).  Sometimes when we deny our bodies carbohydrates, we go into starvation mode, where we can’t lose weight anymore because our body is holding on for dear life to the body fat it has.  If your body really likes using carbohydrates for fuel, this might be the case for you. The answer is to eat more good, Paleo friendly carbohydrates, at least sometimes.

I would try that and see if it improves your weight loss or your energy levels.  However, do not replace carbs with protein in the morning, whatever you do.  Since you’re bonking in the middle of the day, I’d say keep your protein and fat intake high in the morning and add some carbs to your breakfast in the form of sweet potatoes, tapioca crepes, yucca, plantains, squash, fruit or any other Paleo friendly carb heavy food.  Eat again 2 hours later, then eat lunch, snack and dinner as normal.  You may need to eat a little something at night – like a few nuts or something – so that you keep from having a blood sugar crash in the middle of the night, which can wake you up.

Now, I just told you to eat more carbohydrates, but I did not tell you to eat copious amounts. Eat the extra carbs for one, maybe 2 meals per day, and in moderate quantities.  Try starting out with a cup of boiled or baked sweet potatoes at breakfast (29 precious grams of carbs and 114 calories).  Or a tapioca crepe (23 grams carbs and 180 calories).  Don’t overdo it, and know that the energy that comes from carb sources like sweet potatoes, tapioca, squash and yucca will last longer in your body than fruit or honey, in general.

6. If all of these things fail, it may be that you have one or more food sensitivities. Maybe you’re sensitive to olive oil or coconut or even beef.  You could have an immune response to any food, and any food sensitivity can cause energy drops.

For now, try eating more carbs at regular intervals and look at all the other things I mentioned. If you’re still having trouble, check into these 14 ways to bust a weight loss plateau.


  1. Hi Neely,

    Thank you for this detailed, important response. I sent you a private email with additional details. I will be adding a slice of sweet potato to my menu at my mid morning and mid afternoon snacks and I will be splitting my breakfast and lunch so that I can eat the same amount that I usually eat but I will stretch it so that I will be eating every two hours. This seems to make sense. I have been a ‘grazer’ in the past. But, since starting Paleo I have been satisfied enough, hunger-wise to eat three squares and a snack. I drink lots of water (pretty much exclusively) and do not drink coffee or pop… so I’m cafiene free.

    I know that the Paleo plan makes sense for my ‘issues’. I always thought that eating whatever I wanted (I’m a former sugar junkie) and staying thin and healthy would be a lifestyle that I could take into my old age. Not so. I’m 51 years old and it all caught up to me two years ago. I think I’ve punished myself enough with unhealty eating and I’m happy to find a lifestyle that can eventually get me back to feeling my old healthy self.

    I’m trying to be patient with the process!

    Thanks again,


  2. I recently found out that I have Hashimoto’s disease. Basically, I had an extreme case of hyperthyroid that is slowly making its way toward hypothyroid and meanwhile I get the side effects of both. Within the last two weeks I have made signifigant changes and done a ton of research. I know I’m not a doctor and this is new to me, but after signing up for this and seeing a lot of great recipies, I’ve also found some ingredients in them that I was under the impression we should stay away from as hypothyroid?? Cabbage, broccoli, cauliflower, and nuts mainly but a few others too that maybe you should look into substituting something for because to my understanding it suppresses the thyroid gland, which may be causing you to still be tired and thus causing weight to be stubborn. Again, I am not a doctor, just a concerned thyroid victim myself and this is what I have come across. Just a thought.

    1. Good observation. Those foods that you mentioned are thought to be goitrogenic, meaning they suppress the thyroid function by interfering with iodine uptake. The (MANY) foods that are in this category can be found here. Here’s a podcast by Chris Kresser in which he discusses the lack of a threat of goitrogenic foods to the thyroid. There hasn’t been much research that provides any support against eating these foods when you have thyroid issues. In fact, many of the nutrients (and there are a lot of them) in those foods are highly beneficial to your thyroid function, so while they may have some effect on iodine uptake, they nourish your thyroid at the same time. I think researchers sometimes look to everything but the obvious when they’re trying to find answers to health problems because the truth is that grains pose a WAY bigger threat to your thyroid than those nutrient dense vegetables ever could. Especially gluten grains. If you want more information and research on this topic, Datis Kharrazian, a forerunner in thyroid research, has a fantastic book Why Do I Still Have Thyroid Symptoms? when My Lab Tests Are Normal: a Revolutionary Breakthrough in Understanding Hashimoto’s Disease and Hypothyroidism
      that you should read. He says the same thing as I do about goitrogens, which is go ahead and eat them if you have thyroid issues. Just stay away from grains.

  3. BREAKING NEWS!! So, I walked from the garage to my office instead of taking the shuttle this morning… about a mile. Then, I ate according to the plan that I laid out earlier: eat every two hours… higher protein in the morning and a bit more carbs later in the day including adding a little sweet potato twice during the day. Guess what?! I had the energy to walk back to the parking garage this afternoon! I can’t believe it. Now the to wait a week to see if I actually start losing weight… sigh…

    Well, I’m off to make some Paleo muffins… cuz I have energy. It’s a good day!

    Thanks, Keely.


  4. I love this information!! I have Mixed Connective Tissue Disease, so suffer from fatigue certain days as well. This is so informative! Thanks!!

  5. Wow! I think I’m in the exact same boat as Barb! I am a triathlete and cut back on carbs except before a long workout. After a few weeks on the Paleo diet, I felt tired all the time. I was about to give up when I decided maybe I really needed more carbs,so I added just a little and boy did I feel better. I also make sure I have snacks at work for those mid-morning and late afternoon hunger urges. I also have a small snack before I go to bed (handful of almonds). I wake up hungry and eat a good breakfast before my workouts. Maybe my body was in starvation mode and that’s why I haven’t lost any weight.

  6. Bonking in the middle of the day??? (middle of #5) does bonking have a different meaning in America.. like fanny?.. or are you being incredibly personal…

    1. Kathryn Butler – Ha ha ha! Bonking means crashing – like as in an energy crash. It’s when your blood sugar plummets and you get tired, cranky, and lethargic. Hope that helps!

  7. Hi neely i am a 27 year old man with weight, energy, and other diet related problems. I am, at 27, five foot ten inches tall and weigh 250 pounds. I do have a thyroid issue that has contributed to this problem but i have recently started taking a thyroid medication to help with that part of the problem but my doctor says that i need to change my diet and exercise more often as well. Well i broke down and bought a total gym for my home and a gym membership to the local hometown gym. The only thing that i am having a difficulty with is choosing the correct diet for myself and sticking to it. I am very interested in the paleo diet as it was suggested to me by a friend of mine who is an extreme athlete who uses mass amounts of energy to do what he does. What are the pros and cons of the paleo diet and how would one get started on this diet without having to go and buy some crazy doctors specified plan for hundreds of dollars just to not get anything accomplished.

    1. anthony smith – The pros of the diet are that it will likely help you lose weight and get stronger, if those are your goals. Along the way, it’ll probably also help with other symptoms you might have. The cons? It’s probably more expensive than a normal SAD diet, and it’s harder to eat at restaurants and with people who aren’t on the diet. But it’s totally do-able, as millions of people around the world can attest to. We have a meal plan subscription service that’s $9.99/mo that you might be interested in. Just click on the “Tour” tab at the top of your screen. And we have an ebook for beginners in the “ebook” tab. Otherwise, just mess around with our recipes and read the blog posts and there’s enough info and resources there to help anyone get started for free. Good luck!

  8. Hello!
    I have been diagnosed with Hashimoto’s and recently with Hypothyroidism.
    I have been eating gluten-free, legumes-free and dairy-free for a few months now without much difficulty, I really don’t miss it.
    But now I’ve been reading up on the Paleo diet for autoimmunity and Dr. Kharrazian’s tips (plenty of extra restrictions for us suffering from autoimmunity) and it’s all really daunting. There are certain foods I really don’t know how to go without (omega3 eggs, wild rice, bio chocolate, mango, almonds, pineapples, watermelon for example). How bad are these foods really for me? Could I stick to my gluten-free, legumes-free, dairy-free diet and still improve my health without these extra changes?

    I’m willing to try these restrictions for a while, but definitely not for the long-haul. So do you have any tips on the best (and maybe quickest) way to figure out which of these foods are actually hurting me and which are fine? Maybe a blood test or something similar?
    Just please don’t say “See how you feel afterwards” because with my extreme fatigue that’s not really a valid indicator for me.

    I would really appreciate any info!

    1. Klavdija – I’m not a huge fan of the current food sensitivity tests out there because they all miss some component or another of the immune system’s reaction to foods. So no, there’s no quick and easy way to find out what you’re really reacting to. These things take time, patience, and a willingness to put some work into it, unfortunately. I’d say you should remove all grains, and that’s what Kharrazian would suggest as well. So the wild rice and whatever other grains you’re eating should be the first things to go. You may very well see a vast improvement in your situation just from that – I know I did when I went from eating gluten-free to grain free.

  9. Thanks for the response, Neely.
    Ok, so I decided to indeed cut out ALL grains, so no more wild rice. Maybe that’ll do the trick.
    If not, I’ll progressively remove other “troublesome” foods (mushrooms, eggs, peppers and bio chocolate) and see how that goes :)

  10. Thanks very much for writing this! I’ve been hypothyroidic since my very early teens (probably the outcome of much processed, high-sugar food at home), and I’ve just started the paleo diet in the past month. I had been wondering if there were additional considerations I should take into account, and I believe this addresses them.

    Is there anything else that should be noted about being hypothyroidic and on paleo?

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