All the physical processes and even the mental processes that take place in our bodies are influenced or made possible by chemical reactions. The metabolism is basically the sum of all the chemical reactions that take place in the body. People use the term metabolic rate to indicate the rate at which these chemical reactions take place.

The proper function of the metabolism vitally depends on the proper functioning of the body's enzymes. Enzymes are proteins that catalyze (they're catalysts) virtually all the chemical reactions of the body. Catalysts make it possible for certain chemical reactions to take place in a way they otherwise wouldn't. For example, when one uses epoxy glue to make a repair, it is necessary to mix the two parts together before it can be used. One part is the resin and the other is the hardener. Separately, they are useless as glue because they will not harden. But when the hardener is added to the resin, a chemical reaction takes place enabling the glue to do what it is designed to do. Here the hardener is acting as the vital catalyst. In the same way, if it were not for the important catalysts of the body known as enzymes, the body could not survive.

So, at the very heart of the metabolism are the enzymes. As it turns out, how well an enzyme functions depends on its shape, and its shape depends on its structure. Enzymes are long chains of amino acids that are assembled according to the genetic code of the DNA. Depending on how the amino acids of the enzymes are arranged, the enzymes will take on a particular shape. This shape can change at different times and under different conditions. In fact, this ability to change shape in a characteristic way is precisely what gives them their function. They're like a twisted telephone receiver cord that will untwist when you answer the phone and pull the cord tight, and then twist back into its previous shape when you put it back on the hook.
 

The shape of an enzyme also depends on its temperature. When enzymes get too warm, they get too loose. And when they get too cold, then they get too tight. When they are just the right temperature, then they are just the right shape and the chemical reactions that they catalyze take place at the optimal rate and with the most ease. When the temperature is too hot, too cold, or unsteady, the enzymes will spend less time in their optimal shape which simply translates into having a less than optimal metabolism.

An interesting example of how this works can be seen in the Siamese Cat. Its coloring depends upon the production of a certain pigment which is the result of a chemical reaction that depends upon a particular enzyme. Since the function of this enzyme depends on its temperature, the chemical reaction will only take place when the temperature is just right. Interestingly, the only places where the temperature is cool enough for the chemical reaction to take place are found in the cat's extremities. These are the coldest parts of the cat and include the cat's paws, tip of the tail, tips of the ears, and the nose and mouth area of the face. That's why these parts are dark with the rest of the cat being light colored, and thus the characteristic markings of a Siamese Cat. It is said that one might adversely affect his investment in a show quality Siamese Cat by letting the cat be exposed to unusual temperatures. For example, if the cat is exposed to weather that is too cold, too much of the coat may turn dark.

So we can see that temperature plays a major role in the function of enzymes. For this reason, doctors have long been concerned about patients having very high fevers. If the temperature goes too high, the patient's brain enzymes can denature (get malformed) which can cause delirium and can even be life-threatening. Doctors have also long been concerned with the opposite extreme when the body temperature is too low (hypothermia). This is equally dangerous and also can be life-threatening. It is difficult to understand why we have been very concerned about extremely high or extremely low temperatures, but frequently appear to not even consider the effects of milder aberrations in body temperature. If fever and hypothermia are two life-threatening extremes of a continuum, then it is only logical and reasonable that less severe alterations can cause less severe, but never-the-less significant problems.

Studies have shown that when an enzyme-dependent chemical reaction is monitored for how well it takes place at various temperatures, the lower the temperature, the slower the chemical reaction. As the temperature is increased, the reaction rate will go faster with each increase until it reaches its optimum reaction rate. If the temperature is increased too much, the rate of reaction will diminish due to denaturing or change in shape of the enzyme. (See Diagram 2-1).

98.6 Is About Right
Why is it that 98.6 degrees Fahrenheit is usually the best temperature for people? The best temperature is the temperature at which the body's enzymes function at peak efficiency. Different enzymes work best at different temperatures and the functions of some are more greatly affected by changes in body temperature than others. As it turns out, the enzymes that are most affected by changes in body temperature are also often the enzymes that catalyze some of the more expendable bodily functions. Therefore, when the metabolism slows down, people often develop dry skin, unhealthy nails, dry hair, hair loss, irritability, poor recall, fluid retention, decreased sex drive, and up to 60 other puzzling and, until now, baffling symptoms. This is the body's way of insuring that depleted energy reserves are used to maintain the most important functions, such as vision, hearing, heart function, breathing, and all the other bodily functions necessary for survival. The enzymes responsible for these more vital functions aren't as affected by changes in body temperature.

The temperature at which a particular enzyme functions the best depends on its structure. And its structure depends on its coding as dictated by the genetic code found in the DNA of the chromosomes. The genetic code is what permits the great variation in hair color, height, appearance, weight, hand size, etc.

On the other hand, some factors differ very little from one person to another, such as the important enzymes for life. This is evidenced by the fact that some of the routine blood tests doctors do in an annual physical include tests for liver enzymes. These tests are specifically for enzymes that are normally found in every person's body. The enzymes are extremely similar in structure and therefore, are similar with regard to optimal operating temperature. So, in a sense, an enzyme's ideal temperature is dictated by the coding of that enzyme, which does not vary a great deal from person to person. And it just so happens that most of the important bodily enzymes function best at or near 98.6 degrees Fahrenheit.

It is hard for some people to imagine that most people operate optimally at a particular body temperature, often thinking to themselves, "everybody is different." It is a little hard to grasp the wondrous design of it all. It's helpful to remember that it is the nature of all things to move toward disorder. This tendency is called Entropy. That's why objects tend to equalize in temperature.

An example of this would be, if you take a gallon of milk out of the refrigerator and put it on the counter top, you would not expect that three or four hours later it would be the same temperature as when it was removed from the refrigerator. It would be much closer to room temperature. Likewise, if a pot of boiling water is taken off the stove and placed on the counter top, it would cease to boil and in a short time would be close to room temperature.

Ambient temperature is the term used to identify the surrounding or environmental temperature. It is the nature and tendency of all things to approach ambient temperature. If you are in a room, then the ambient temperature is the room temperature. If it weren't for your metabolism, then your body temperature would tend to move toward the room temperature.

Let's suppose that the room temperature is 75 degrees. Given the Law of Entropy, one might expect that eventually your body temperature would also be 75 degrees. We know, of course, that this does not happen. Instead, you will most likely be very close to 98.6 degrees. That would be 23.6 degrees above room temperature! In fact, this characteristic is one of the things that distinguishes the living from the dead, hence the term "warm bodies" that is sometimes used to refer to living people. When we die, our bodies stop fighting Entropy and cool to room temperature. If there were no specific reason that people should be close to 98.6 degrees, you would expect to find some people running around 78 degrees, others 85 degrees and some perhaps 98 or 105 degrees. But we know that this is not the case, and so we have what is considered to be normal body temperature.

It is far from coincidental that people run about 23.6 degrees above room temperature, especially when you consider that all humans normally maintain a body temperature that is extremely close to 98.6 degrees within a plus or minus of 1.5 degrees. A variation as small as 1.4 degrees above normal (or 100 degrees), is considered adequate reason to be excused from work. Such a situation is about as coincidental as throwing a deck of cards in the air and having them land forming a card house.

We are all familiar with the symptoms that can be associated with fever, including headaches, achiness, fatigue and flu-like symptoms. These symptoms can be distinct symptoms brought on by an abnormally high body temperature in and of itself, and are not necessarily related to the underlying illness that brought on the high temperature. For example, a patient might have a sore throat generating a fever and fever symptoms. The patient's fever symptoms can even be generated without underlying illness, such as the foggy mindedness that can sometimes be brought on by spending too much time in a steam bath or hot weather.

If very small elevations in temperature can cause symptoms familiar to all of us, then it is easy to understand how slightly lower body temperatures can also cause symptoms that are familiar to almost all of us. The same special reason that causes people to run 23.6 degrees above room temperature is the same reason that there is a temperature at which each person's body functions best. It is the same reason that for most people that temperature is 98.6 degrees. And it is for this reason that abnormal body temperature can cause faulty enzyme function resulting in a multitude of seemingly unrelated symptoms characteristic of Wilson's Syndrome. Therefore, we can see that body temperature is of prime importance in the proper function of enzymes and therefore of the human body. The symptoms of Wilson's Temperature Syndrome are preeminently and foremost symptoms of Multiple Enzyme Dysfunction (MED) that are caused by aberrations in body temperature patterns.

One way to understand this is to consider a radio. If you want to listen to a radio station with a frequency of 99.7, you carefully tune the radio to that frequency. If it is set a little too low, or too high, or the dial is loose (so that it drifts about easily), then part of the radio program might be received, but it might not be optimal because of static. If the radio is properly tuned, then the static disappears and the reception is clear. So too, if we are not at the optimal temperature, we may still be able to function at some level, but we won't be at our best and may experience characteristic complaints and problems. Our performance will suffer when our temperatures are not tuned for optimal enzyme function.
 

Let's talk about how the thyroid system affects the body temperature and the metabolism. My patients and I are continually amazed at the effects proper T3 therapy can have in the treatment of Wilson's Temperature Syndrome. I'm often asked, "How can this one medicine make such a big difference and how can it affect so many things?" It is not hard to understand the far-reaching and pervasive effects of liothyronine (T3) when we remember its critical role in controlling the metabolism - the sum of all chemical reactions in the body. To understand this critical role, let us look more closely at the thyroid system. The following diagram (diagram 2-2) will be referred to as we discuss more fully the thyroid system.

Briefly, the thyroid system begins in the brain. At the bottom of the brain is the hypothalamus, which is the part of the brain that secretes TRH (Thyrotropin Releasing Hormone). TRH travels to the pituitary gland at the base of the brain and stimulates the pituitary gland to produce TSH (thyroid stimulating hormone). TSH enters the bloodstream, travels to the thyroid gland at the base of the neck and stimulates it to produce T4 (thyroxin). The T4 produced in the thyroid gland is

then converted to the physiologically active thyroid hormone T3 (liothyronine). T4 is converted to T3 by an enzyme called 5'-deiodinase, which is found in many of, if not all, the tissues of the body. By far, most of the T3 of the body is produced from the conversion of T4 to T3 that takes place outside the thyroid gland in the body's tissues. T3 has its action at the nuclear membrane receptors in the cells of the body. There, the T3 initiates a cascade of chemical reactions within each cell and thereby affects each cell's metabolic rate. The metabolic rate of the cells determines the metabolic rate of the body. The metabolic rate of the body, together with the surface area, activity level, sweating, environmental conditions, and other factors, determines the body's temperature. The body's temperature affects the function of the enzymes which are largely responsible for the most important chemical reactions in the body. These chemical reactions, in turn, are the key to the body's functions. This is the reason that the thyroid system is so vitally important. It affects every bodily function. Indeed, a complete absence of the thyroid system's function is not compatible with life.

It should be pointed out here that not only can T4 be converted to T3, but also it can be converted to Reverse T3 (RT3). T4, RT3, and T3 look very similar as is demonstrated in the diagram below.

They are like three keys that look the same with each key having one notch that's different. All three keys may fit into the lock, but they might not work the same. In the same way, T4, RT3, and T3 each have greatly different capacities to stimulate the thyroid hormone receptor. T4 has a small amount of activity at the site; T3 is four times more active than T4; and RT3 has no activity at all. Since T4 and RT3 look so similar, they both can occupy the active site of the 5'-deiodinase enzyme, thereby competing for the enzyme's attention. It should be noted that stress, fasting, illness, cortisol, and some medicines can also inhibit the action of 5'-deiodinase.

The Inertia Of The Thyroid System
Inertia is the tendency of a body to resist change in its motion. It is the tendency of a body in motion to stay in motion unless acted on by an outside force.

I have paid close attention to the thyroid system (especially the relative levels of T4, T3, and RT3) while treating thousands of patients. Through these observations I have come to believe that the relative conversion of T4 to T3 and RT3, the competition of RT3 and T4 for the deiodinating enzyme, and the relative effect of RT3, T4, and T3 on the nuclear membrane receptors, provide the thyroid system with a great deal of inertia. This means that once the thyroid system is set in a certain pattern, there is a great tendency for it to remain in that pattern. I believe that it is designed this way for a very special purpose.

It would be difficult, within the limits of this book, to convey all the experiences that have led me to this conclusion. But maybe it will help to point out a few observations. Let's remember that T3 is four times more potent than T4, that it is the most active thyroid hormone, and that it has a half-life of 2 1/2 days. (The half-life of a hormone is the amount of time required for 50% of the hormone present at any given time to be eliminated by the body). Let's remember that T4 is less potent than T3, and has a much longer half-life (7 1/2 days), and therefore is more "stable" than T3. And RT3 (Reverse T3) has no activity at all and is rapidly broken down by the body soon after it is produced.

Let's refer to diagram 2-2. Since stress can decrease the amount of T4 converted to T3 by inhibiting the deiodinating enzyme, which causes more T4 to be shunted towards RT3, and since T3 is extremely active and RT3 is completely inactive, it is easy to see how stress can decrease the amount of active thyroid hormone available to the cells.

When the stress passes, there is less direct inhibition of the deiodinating enzyme, which encourages greater T4 to T3 conversion. And there should be less shunting of T4 to RT3, which should result in more T3 being produced. With RT3 being quickly broken down, there should also be less indirect inhibition of the enzyme from competition between T4 and RT3 for the activity of the deiodinating enzyme. These changes should allow the T4 to T3 conversion to return back to normal. Our systems are designed this way to allow the body to slow down under conditions of stress, and then return back to normal when the stress has passed.

Remembering that T4 is a longer-acting and less-potent stimulator, you can see how it can have a stabilizing influence. If T4 had no effect, then the unmitigated influence of T3 at the nuclear membrane receptor might cause a system that lacks sufficient stability. However, since T3 is the physiologically active thyroid hormone, if it did not have its effect, then the much weaker influence of the T4 would almost certainly be insufficient to provide for an adequate level of metabolism. So, we see the beautiful balance of how T3 can provide sufficient levels of metabolism, and T4 can help provide the desired stability. Another factor to remember is that when T4 is broken down, a portion of it is converted to T3. So T4 also serves as a steady, constant supply of the more active T3.

Even RT3, although it is short-lived, seems to play a role as a recent article in a Japanese medical journal suggests. It states that RT3 may play a biologically causative role in decreased thyroid system function. (Nippon Geka Gakkai Zasshi; Shigematsu, H.; October, 1988, 1989; pp. 1587-93). Reverse T3 may play this role by interfering with the T3 / thyroid hormone receptor interaction and/or by competitively inhibiting the deiodinating enzyme. When T4 to T3 conversion is impaired, there is less T3 to stimulate the receptors powerfully, and relatively more T4 to stimulate them weakly. With less T4 to T3 conversion, more T4 may be shunted to RT3, which results in more competitive inhibition of the deiodinating enzyme. This may result in even less T4 to T3 conversion, more shunting towards RT3, and so on. And so a vicious cycle can be started that can contribute to a persistent T4 to T3 conversion impairment that can remain even after the original cause of the impairment has passed. Such a cycle could last for years, and could get worse in stages with subsequent stresses.

An analogy comes to mind that may help one to visualize the inertia of the thyroid system. Let's imagine a small sailboat placed in a flowing stream. The stream is flowing at a constant speed, but there is a fan placed downstream in front of the sailboat that is blowing upstream. As the sailboat floats downstream and comes closer to the fan, the blowing of the fan keeps the boat at a certain distance, and the flowing water keeps the boat from moving further away from the fan.

Now, if the stream flows more slowly, there is less pressure on the boat to remain close, and it moves upstream, further away from the fan until it settles into a new stationary position. This is because the further the boat moves away from the fan, the weaker the fan's influence, until the influence of the fan and the influence of the stream equalize again.

But when the flow of the stream increases, the sailboat settles into a new stationary position that is closer to the fan as the two forces again reach equilibrium. So, even though the fan is always flowing, and the stream is always flowing, the sailboat has a tendency to settle into a certain position and stay there as long as the influences remain balanced.

The thyroid system behaves similarly, but is more complex. T4 is converted to T3 and also to RT3. RT3 affects the conversion of T4 to T3. Stress can also affect T4 to T3 conversion. In addition, T4 can interact with the nuclear membrane receptor, as can T3 and possibly RT3. So there are at least six or seven influences at work which are constantly moving, but tend to add up in such a way that the thyroid system settles into a certain position and stays there in much the same way that the sailboat finds equilibrium.

The design of the peripheral (outside the thyroid gland) conversion of the thyroid hormones is set up to provide a great deal of inertia. This is no accident. The peripheral conversion design is probably of far greater importance in the regulation of the thyroid system's ultimate influence on the metabolism, than the glandular feedback mechanisms (involving the thyroid gland, pituitary gland and hypothalamus) that are currently thought to be most important in this regard.

When You Hear "Thyroid," Think System Not Gland
How people use the word "thyroid" has led to confusion that has contributed to WTS being overlooked.

For some reason, decreased thyroid system function is not commonly suspected when one is considering possible sources of physical ailments in people who are ill. Since it is not often considered as a problem, it is not commonly talked about or discussed. When the topic is brought up, people will often be heard saying that "so-and-so" has/had a "low thyroid problem." Most often, people (even doctors) will automatically tend to think of the word "thyroid" as being used as a noun in this context to refer to the thyroid gland. This tendency is reinforced if the first statement generates the question "What's thyroid?" One would often tend to answer, "The thyroid is a very important small butterfly shaped gland at the base of the neck that ..." and so on. This tendency draws attention away from the fact that the thyroid gland is only one part of the whole thyroid system and not even the part with which there's most commonly a problem. As odd as it may seem, I feel that it may be this simple tendency that has caused Wilson's Temperature Syndrome to be overlooked by some of the best doctors in the world for decades (by so many for so long). For this reason I recommend that in the phrase "low thyroid problem" the word "thyroid" would best be thought of as an adjective used to describe the entire thyroid system. This would help us all to remember that the thyroid gland is again merely a part.

Which link in bicycle chain is the most important? Without any one of the links, the chain could not perform its function. Would the link that most often breaks deserve the most attention? I recommend in order to keep the proper perspective that we use instead of the phrase "low thyroid problem," the phrase "decreased thyroid system function" or DTSF. Using this phrase may help us (lay people and doctors alike) from getting too fixated on the gland only. Because when we do this, then we are often led down the wrong path while overlooking some very obvious problems. All the causes of decreased thyroid system function (DTSF) all generate the same symptoms of Multiple Enzyme Dysfunction (MED) that result from body temperature patterns that are too low, but not all causes of DTSF involve the thyroid gland itself.

Let's discuss the impairments that have been described to date. Rarely mentioned is the possibility of the hypothalamus not producing TRH as it should. This may be referred to as secondary hypopituitarism since it results in low (hypo) function of the pituitary gland secondary to inadequate TRH stimulation. Hypopituitarism can be primary (as in primary hypopituitarism) meaning that the problem is primarily in the pituitary gland itself which results in inadequate TSH secretion. Inadequate TSH secretion leads to hypothyroidism secondary to a pituitary problem (and so primary hypopituitarism is also sometimes referred to as secondary hypothyroidism).

Are we confused yet? The problem may be primarily in the thyroid gland itself which results in inadequate T4 production in spite of normal TSH production (this is known as primary hypothyroidism). The impairments of the thyroid system listed above have been fairly well described to date. However, one may see from the diagram (diagram 2-2) that there is still a long way from the thyroid gland to generation of an adequate body temperature. Impairments of this important portion of the thyroid system have thus far not been well described. One may see from the diagram that there could be a problem with the conversion of T4 to T3. It is known that the conversion of T4 to T3 decreases under periods of fasting and severe illness. It has been shown under these conditions that the level of T4 to T3 conversion can drop by 50%. This change has also been shown to return to normal once the fasting or severe illness is over. When the conversion of T4 to T3 decreases, more T4 is shunted to RT3 causing an elevation in RT3.

These adaptive changes in laboratory findings are not considered to be very serious and are sometimes referred to as "Euthyroid Sick Syndrome." Although this syndrome has not been very well defined, it is usually thought of as an adaptive temporary change in laboratory tests [increased RT3, decreased T3, usually with normal T4 (normal thyroid gland function) lab findings] brought on by severe illness that returns to normal when the illness has passed. There is not considered to be a need for treatment for Euthyroid Sick Syndrome except for treating the underlying illness. For years there has been some speculation in the medical literature about the possibility of a persistent impairment in the conversion of T4 to T3 contributed to inhibition of T4 to T3 conversion by an elevation of Reverse T3 ("Thyroidal and Peripheral Production of Thyroid Hormones;" Annals of Internal Medicine, Schimmel; Dec. 1977). Not only can this happen, but it does happen.

This condition has, up until now, not been named or well described. I have taken the liberty to name it Wilson's Temperature Syndrome and to describe it in great detail in this book. As it turns out, WTS can have a tremendous impact on a person's life causing characteristic and often debilitating symptoms and being quite maladaptive. It can be brought on by fasting, illness, and stress but rather than going away after the conditions have passed, it can persist; thyroid blood tests are often within "normal range," but it is characterized by a low body temperature; it can be treated with proper therapy (with the WT3 protocol being very important). With the WT3 protocol the syndrome can be reversed usually with the correction persisting after treatment has been discontinued (although subsequent stress can cause the syndrome to return again).

The symptoms of Wilson's Temperature Syndrome are essentially the same as the symptoms of other causes of decreased thyroid system function; yet proper treatment of Wilson's Temperature Syndrome has revealed other related symptoms that up until now have not been very much considered to be thyroid (adjective) related (e.g. migraines, PMS, panic attacks, night sweats, ringing of the ears, mood swings, itchiness, allergies, asthma, etc.).

Of all of the causes of DTSF mentioned above, Wilson's Temperature Syndrome is by far the most common. As previously discussed, the symptoms of MED can result from low body temperature patterns of various causes. However, DTSF is by far the most common cause of the low body temperature patterns that cause persistent symptoms of MED. And although there are various causes of DTSF, Wilson's Temperature Syndrome derives its importance from the fact that it is by far the most common of those. It is at least 50 times more common than any other cause of DTSF and therefore is also the most important.
 

There are several factors that can affect body temperature. But whatever does affect it (making it too low, too high, or unsteady) can cause all the symptoms of Multiple Enzyme Dysfunction that are characteristic of Wilson's Temperature Syndrome. For example, people who are exposed to cold weather and become hypothermic will often become sleepy and fatigued. Also, when people eat ice cream too fast, their throats get cold causing the blood going to the brain to be more cold, and they can develop a headache.

Surface Area / Volume Ratio
We've discussed how the body temperature depends upon how much heat is generated within the body itself (which is regulated by the thyroid system). But it also depends upon how much heat goes in and out of the body from or to the environment.

The amount of heat going in and out of the body is determined by a couple of factors, one being what environmental conditions the body is exposed to. For example, the body will retain more heat when exposed to the heat from a shower, a sauna, or hot weather, than it will if it is exposed to cold weather or a cooling thermal blanket such as the ones sometimes used in hospitals to lower a patient's fever. Another factor is the body surface that is exposed to the environment.

An analogy that I frequently use to illustrate this point is that if you had a lump of mashed potatoes on your plate that was too hot to eat and you wanted it to cool faster, you could spread the potatoes out on the plate. The more it is spread out, the faster it cools. The reason for this is that for the same volume of food one may increase the surface area by spreading the food out, thus exposing more of the food or mass to the surface so that the heat more easily dissipates.

The laws of physics tell us that the shape in the universe that holds its heat the best is the sphere or ball because it is the shape that has the smallest amount of surface area per unit of volume. The more a person looks like a ball and less like a stick, the harder it is to dissipate calories. This might partly explain why taller people tend to be thinner than shorter people.

Let's consider how this ratio can be extremely important. Suppose that there are two different animals that live in very different climates. Of course, they would face different challenges. On one hand, animals that live in extremely cold climates need to retain enough body heat to maintain their body temperatures to ensure the proper functioning of their enzymes and bodily functions. However, animals that live in extremely hot climates have the challenge of dissipating enough heat to maintain a body temperature that would be adequate for their enzyme and bodily functions. For instance, the desert mouse and certain desert rodents are in some danger of becoming overheated. The shapes of their bodies are formed in such a way that encourages rapid dissipation of heat. That's why their ears are large, their legs and tails are long, and even their bodies are more slender. Incidentally, their urine is also more concentrated so that they can better conserve water.

The desert mouse can be compared to the seal that lives in a much colder climate. To help them preserve their body heat, they have shapes that provide less surface area per unit of volume. They are plumper or more bulky in shape with smaller ears. Only their relatively short flippers are exposed to the environment.

Another simple way to see the importance of surface area/volume ratio is to observe people who are sitting outside in very cold weather. Notice that they tend to sit huddled up in a ball to conserve body heat. If it didn't make any difference, people wouldn't hold their arms and legs in close in cold weather. So our surface/area volume ratio can be affected by our height in relation to our weight, how we stand or sit, how we dress to an extent, and how much of our body is exposed to the environment.

The body's temperature depends also on how much heat is generated within the body. The heat is generated by the chemical reactions of the body that change raw materials, fuel, or food into the products and functions necessary for maintenance of life. The chemical reactions take place, for the most part, within the cells of the body, and of course, the volume of the body is made up of cells. The greater the volume of cells, the greater the volume of chemical reactions, and the greater the capacity for producing heat. So the amount of heat produced in the body is roughly proportional to the volume of the body. And of course, the heat generated by the body is directly related to the metabolism (the rate or extent to which the reactions take place).

PMS and Temperature
The symptoms of Wilson's Temperature Syndrome are principally the result of aberrant temperature patterns due to impaired conversion of T4 to T3 (thyroid hormones). It should be pointed out, however, that there are other causes of aberrant body temperature which can also cause symptoms.

For example, it is well known that the body temperature will vary up and down during a woman's menstrual cycle, tending to peak at the time of ovulation (useful information for couples who are trying to conceive). The temperature tends to rise just prior to a woman's period and gradually decreases as the period begins and progresses. This explains why symptoms of Multiple Enzyme Dysfunction can change in severity in relation to a woman's menstrual cycle, a problem commonly referred to as PMS or premenstrual syndrome. If one looks at the symptoms of PMS, one sees depression, fatigue, fluid retention, headaches, bloating, irritability, craving for sweets (especially high energy sweets such as chocolate), problems with memory, and essentially the whole list of symptoms associated with Multiple Enzyme Dysfunction. They are termed premenstrual because they are most severe prior to the period. The symptoms of MED can be related to temperature patterns that are too high, too low, or unsteady. Premenstrual worsening of the symptoms of MED are most commonly related to rapid change (usually increase) in the body temperature pattern prior to the period. Interestingly, I have often seen complete relief of the PMS symptoms when the body temperature patterns have been normalized. This observation has made it obvious that the symptoms of PMS are related to body temperature patterns.

Another interesting point is that I have had a few patients whose classic signs and symptoms of "premenstrual" syndrome occurred on a predictable monthly basis just after their period (or only during the period rather than just prior to their period). One might call this "postmenstrual syndrome." And again, in these cases, their postmenstrual symptoms of MED have often resolved with normalization of their body temperature patterns. This makes it more evident that these menstrual related symptoms of Multiple Enzyme Dysfunction are related to aberrant body temperature patterns. These symptoms seem to be related to female hormones only to the extent that female hormones can affect body temperature patterns.

Adrenal Hormone Levels Affect Daily Temperature Cycle
Addison's Disease and Cushing's Disease are diseases that can affect the levels of adrenal hormones. Addison's Disease is caused by insufficient levels of cortisol in the body, and Cushing's Disease is due to excessive levels of cortisol. It is interesting to note that these two diseases can cause symptoms that are similar to those of Wilson's Temperature Syndrome and/or Multiple Enzyme Dysfunction. These include fatigue, fluid retention, weight gain, depression and headaches. It has long been documented that cortisol, which is the hormone that is produced excessively in Cushing's Disease, can directly inhibit 5'-deiodinase (the enzyme that converts T4 to T3). I have seen cases where patients have developed classic cases of Wilson's Temperature Syndrome immediately after having been given injections of cortisone or steroids. Presumably, cortisone can inhibit 5'-deiodinase and set in motion the vicious cycle that results in Wilson's Temperature Syndrome. In such cases the symptoms can be treated with proper thyroid hormone treatment. So it's not really hard to understand why someone, when given an injection of cortisone, can gain weight, retain fluid, get tired and depressed, and develop many of the symptoms of Wilson's Temperature Syndrome. It's interesting that cortisone is produced by the body's adrenal glands under stress. It is also interesting that cortisol levels go up and down in a daily pattern.

It is well known that the body temperature tends to run lowest in the morning, gradually increasing during the day, usually being the highest in the afternoon, and tending to decrease in the evening. So the body temperature can follow both a monthly cycle and a daily cycle. This can explain why the symptoms of MED sometimes follow monthly and daily patterns.

Many of the patients that I see find that their symptoms of Multiple Enzyme Dysfunction are worse at certain times of the day. For example, they might do fairly well an hour or two after awakening and getting started in the morning, and become extremely fatigued between 2:00 p.m. and 4:00 p.m.

In the section dealing with depression we will discuss how symptoms of Multiple Enzyme Dysfunction can also follow a seasonal pattern. This might help explain what is known as Seasonal Affective Disorder or SAD. It might be a type of biological clock phenomenon similar to hibernation in animals.

Pregnancy
It should be pointed out that a fetal hormone known as human chorionic gonadotropin also can affect body temperature patterns. When a woman becomes pregnant, the baby begins to produce human chorionic gonadotropin or HCG. HCG can increase the body's metabolism and body temperature patterns. This can explain why women suffering from Wilson's Temperature Syndrome frequently do their best while they are pregnant. Unlike other women who often feel tired, feel depressed, and gain weight easily during their pregnancy, some women who are suffering from Wilson's Temperature Syndrome actually fare much better during pregnancy, enjoying much more energy, less depression than usual, and often having unusual success at being able to control their weight. Some women actually report that during their pregnancies were the only times that they were capable of losing weight with proper dieting and exercise. Interestingly, HCG has been used in the past as a treatment to help people lose weight.

Blood Sugar
Blood sugar levels can also affect body temperature patterns, and body temperature patterns can affect blood sugar levels. It isn't too hard to understand, then, why the symptoms of hypoglycemia are so similar to the symptoms of MED. It is also easy to understand how nutrition can be an important influence on overall function of the metabolism.
 

The adrenal, female and thyroid hormones can all affect body temperature patterns. the most common cause of Wilson's Temperature Syndrome (a thyroid system problem) is childbirth, which involves the female hormone system; and that proper thyroid hormone treatment can frequently correct the symptoms of premenstrual syndrome which is also female hormone related. We have also seen that cortisol in the adrenal hormone system is known to directly inhibit T4 to T3 conversion which is the most critical step in the thyroid system because it is the step in which there is most often a problem.

I have treated more than 5,000 patients with Wilson's Temperature Syndrome to date. The more I work with these patients, the more apparent it becomes to me that the human body is a highly integrated system. One part of the system may affect another, which may affect others, and so on. So a change in one part of the system may start a chain reaction of events that can affect the whole system. For example, it is well know that proper exercise can help one's whole system to function better. Likewise, lack of sleep can adversely affect a person's muscle strength, digestion, resistance to infections, mental function, and many other functions. In that way, sleep deprivation can help tear down one's whole system. The same can be said for one's nutrition and stress levels.

The system is influenced by sex hormones, adrenal hormones, stress, thyroid hormones, medicines, blood pressure, sleep, nutrition, exercise, infections, digestion, respiration, blood circulation, and many other influences.

One way to visualize this is by picturing many ropes tied to a single ring. The ropes represent the influences and the ring represents the system. Picture the ropes all pulling in different directions. The position of the ring depends on the amount of tension in each of the different ropes. If one is able to increase the tension in one rope enough, one can affect the position of the ring and therefore the position of the other ropes as well. I often see evidence that when more pressure is exerted on any one of the adrenal, female, or thyroid systems the position of the metabolism, in general, and the remaining two hormone systems can be affected. The same can be observed with positive changes in diet, exercise, sleep habits, stress management, etc. When one effects a correction or normalization in one part of the system, the remaining parts tend to follow suit and settle in behind the changes made in the first. So if one's whole system is out of position, then one's whole system may have to change, to an extent, to make things right.

The ideal whole body system position depends on a proper balance of tension in all the various "ropes" or influences affecting the system. Interestingly, different combinations of tensions may result in the same overall effect. Thus, when trying to improve the body's "position", one should strive to affect favorably as many influences as possible.

For example, if the thyroid system malfunctions, it pulls the entire body system into a new position of functioning which is determined by the new balance of influences involved. If the changes in "rope tension" are mild or short-lived, they may be insufficient to cause a persistent change in the system. However, if the changes are severe or long-lasting, the entire system may settle into a new balance that persists long after the precipitating changes in "rope tensions" resolve.

This analogy can explain a number of situations that are common in, and even characterize Wilson ’s Temperature Syndrome. First, the whole body system or metabolism can settle into positions of functioning that have a great deal of inertia. Second, the body's functioning can change for a time (because of external factors like staying up for 72 hours, or by drinking too much caffeine for two weeks) and return to normal once conditions return to normal (plenty of rest, stopping caffeine). Third, the body's functioning can go down and stay down even after the change (divorce, job stress, death of a loved one) has passed. Fourth, the body's functioning can get progressively worse in stages, and also how it can improve in stages. Fifth, the body's system can be returned to "normal" and how it can stay normal even after the correcting influences (treatment) have been discontinued.

This illustration also explains how symptoms similar to the symptoms of MED can accompany many different influences; depression, female hormones (PMS), adrenal hormone conditions, dietary habits (hypoglycemia), and others. It can explain how some physicians do have some success in treating the symptoms of Multiple Enzyme Dysfunction with female and/or adrenal hormones. For example, progesterone for PMS is sometimes useful if one can find a dosage regimen that works for the patient.

Many things (diet, activity, stress, hormones, illness, sleep deprivation) can knock your whole system out of whack. As a result, you can suffer from MED due to aberrant body temperature patterns. Likewise, these same things (diet, activity, sleep), can improve the function of your system. However, these influences are often insufficient to correct the whole problem. In such cases, the WT3 protocol can often be used to predictably, effectively, reproducibly, and quickly influence the system to return to a normal pattern of function.

T3 is a Temperature Tool
There are other possible approaches to the symptoms discussed in this book but the appeal of T3 therapy for WTS is its simplicity. You get the temperature up and you either feel better or you don’t. With many approaches there is no way of knowing if one is headed in the right direction, but with T3 therapy there is a guide. The body temperature! It's so nice to have a guide. Usually the temperature comes up in a couple of weeks to help patients see if they are on the right track. And when patients do respond, they often remain improved even after the treatment has been discontinued. the WT3 protocol is deliberate and direct.

To illustrate, let us suppose that you bought a computer. The owner's manual states that the computer has a special safety feature that causes its function to slow down when under too much strain. This is to avoid costly damage to the machine. It also states that the computer should only be connected to a certain number of devices, run certain types of programs, be run for only a certain number of hours per day, and be kept in a room at a certain temperature and humidity. During a particularly busy period of time, long after the owner's manual has been stuffed in a closet and you've forgotten many of the do's and don'ts, you notice that the machine's function is beginning to slow down. The screens are becoming dim, the printer is barely working. You retrieve the owner's manual and correct all of the abuses. Although there is some improvement, the computer's function still does not return to normal. Puzzled, you take the printer apart, clean it, inspect it, and reassemble it with no resulting improvement. You replace the software, dismantle the computer itself, and after several weeks you still cannot find the answer to your problem. Being very concerned about your costly equipment and the work you still need to accomplish, you finally break down and call the manufacturer to send a service man. He recognizes immediately that the system has slowed itself down to protect itself. You are very relieved to hear that your $25,000 computer is not ruined. The service man points out that the system will sometimes stay a little slow after it has saved itself from destruction. He also points out that it was for this reason that the manufacturer installed a little green reset button on the bottom of the machine, described on page 127 of the owner's manual. Within one second of pressing the tiny button, the function of the machine "miraculously" surges back to normal. Stunned, you realize at once how much more effective, quick and simple it can be when one directly addresses the fundamental underlying problem.

Similarly, I think many people respond almost miraculously well to proper T3 therapy because we are, in a sense, pushing the “temperature button” on the body and getting all the other functions to respond, or come back.

Other Temperature Tools
In 2001, I met Dr. Michaël Friedman, ND who was then an Endocrinology Professor at the University of Bridgeport Naturopathic Medical School. While we collaborated on a chapter on WTS in a textbook that he was writing. I found out that he was using herbal formulas to complement the T3 protocol (we call it Wilson’s T3 Therapy or the WT3 protocol to distinguish it from different methods of using T3) described in the Doctor’s Manual for Wilson’s Temperature Syndrome. He had found that certain herbal formulas can often be used to diminish the chance of side effects while often enhanc