The Thyroid Link to Potbelly Syndrome

by Ron Hunninghake, MD

Originally published in the April 2012 Health Hunters newsletter.

Potbelly Syndrome (PBS) evokes a rather benign, almost humorous, image of someone who has simply overdone the cheesecake or beer.  A ‘little gut’ can’t hurt much…can it?

Perhaps a more sinister name such as ‘Potbelly Plague’ would better convey the urgency of what the World Health Organization is now recognizing as “the global epidemic of obesity.”

In America alone, 68% of us are afflicted. Look around: almost all of our friends, family, coworkers and neighbors carry some degree of a potbelly.  Strangely, having a potbelly has become a new norm.  Many of my thin patients have actually been accused of being sick or anorexic!

The potbelly is not due to subcutaneous fat that can be “crunched” away with intense calisthenics.  This is persistent visceral fat situated deep in the abdomen, surrounding the visceral organs. All manner of diets, contraptions, calisthenics, weight training, liposuction, and total body makeovers will not exorcise this demonic GUT!  Numerous studies have repeatedly shown that a potbelly “loss” is inexorably followed by potbelly “regain” in over 90% of cases.  The latest U.S. statistics bear this out: frankly obese people now outnumber overweight people!

The problem with potbelly is not just a fat belly.  With it typically comes a rising blood pressure, high cholesterol and lipids, blood sugar problems, inflammation and pain, fatigue, orthopedic issues, compromised immunity, reflux esophagitis, depression, sleep disruption, sleep apnea, CPAP machines, irritable bowel issues, higher cancer rates, type 2 diabetes, polypharmacy side effects, lost work days, interpersonal stress, increasing financial burdens and a pervasive loss of self-esteem and self-acceptance.

Potbelly Syndrome, which begins innocently as “just a few extra pounds,” will slowly mushroom into the daunting prospect of life-long disease, expensive debilitation, and an increased risk of premature death.  With over 100 million of Americans PBS-afflicted, medical experts are predicting that our current sickness care system will soon be swamped with the pervasive devastation of this disease.

In a previous issue of the Health Hunters Newsletter, I reviewed Mr. Russell Farris and Dr. Per Marin’s intriguing book:  The Potbelly Syndrome – How Common Germs Cause Obesity, Diabetes, and Heart Disease.  Their thesis is direct and simple:  could Potbelly Syndrome be triggered and sustained by an invading germ?

In contrast to the medieval images of plague with people literally dying in the streets, PBS may start simply as a bad cold, a persistent cough, or even a moderate set of flu-like symptoms that are slow to clear. Several rounds of various antibiotics rarely solve the lingering problem.

Farris and Marin believe that the infecting germ targets weakened hosts. Chronic stress, lack of quality sleep, poor diet, toxic overload, and concurrent stealth infections such as Cytomegalovirus (CMV) compromise the immune system.  Although germs in general seek suitable human habitats such as this, Farris and Marin argue in favor of one germ in particular as the root cause of the “potbelly plague.”

Without going into the details of their book, they point to the infectious culprit as Chlamydophila pneumoniae – which is abbreviated CPN. CPN belongs to a class of germs sometimes referred to as middle-path germs.  There are germs that kill the host or those that coexist in a symbiotic relationship such as the friendly flora of the intestinal tract.  Middle-path germs exist somewhere between these two extremes.  They are smart enough to not immediately kill the host, but their tendency is to progressively infect cells, slowly causing cellular dysfunction and disease, thereby insidiously robbing the host of its inherent health.

Indeed, medical research has connected CPN to a long list of health-robbing conditions that slowly develop in the unsuspecting host.

Alzheimer’s disease




Giant cell arteritis








COPD (emphysema)

Immune suppression



Interstitial cystitis

Prostate cancer


Kidney failure







Multiple Sclerosis

Lung cancer


Prostatic hyperplasia


Syndrome X



 CPN Infections Lead to a Potbelly

As the CPN-infected host gets progressively sicker their inflammatory response escalates.  Too much inflammation can harm the host, so the body attempts to counter-regulate this mounting inflammation with an adrenal hormone called cortisol.  As the illness lingers on, more and more cortisol is pumped out by the sick host’s adrenal glands.  The result mimics Cushing’s syndrome – a disease produced by a benign adrenal tumor that over-secretes cortisol.  Excess cortisol causes weight gain, central obesity, fatigue, diabetes, depression, insomnia, and irritability to name just a few of the more salient symptoms of this syndrome.

PBS closely resembles Cushing’s syndrome and has been described as Metabolic Syndrome X with elevated cortisol levels.  The increasing waist line, high blood pressure, high serum glucose, and the high blood lipids of Syndrome X develop in the presence of ongoing inflammation, fatigue, stress, mounting malnutrition.  It is the rare physician that suspects that a persistent middle-path germ like CPN is acting as a silent terrorist inciting the genesis of the Potbelly Syndrome!

When the early stages of the infection wane, the infected individual is left with a pervasive sense of fatigue.  Unexplained night sweats, generalized muscle achiness, and other low-grade inflammatory symptoms slowly emerge, ranging from strange new inhalant and food allergies, dry skin, and irritable bowel.  But the hallmark symptom that resists all forms of physical, medical, nutritional, and even psychological intervention – is the notorious potbelly.

The temptation is to run to the pharmacy for an even more powerful antibiotic to try and kill the CPN germ.  There are protocols at that will steer you in this direction.  This is like spraying for mosquitoes…without draining the swamp. Attacking the germ without addressing the web of host susceptibility factors is only half the battle…and seldom successful.  To eliminate the CPN habitat, you as the germ’s host must confront and correct the underlying causative factors that are forming a VICIOUS CIRCLE of chronic illness!

The Thyroid Link

When a chain of cause-and-effect events forms a circuit or a loop, these events are said to feed back on one another.  Thus, a feedback loop is a self-perpetuating sequence of recurring events that keep repeating. In the field of medicine, this is called a vicious circle, i.e. a condition in which one disease or disorder causes another, which in turn aggravates the first condition.

In the chart below the next figure, I list all the conditions, situations, and disorders that form a rather large vicious circle that I believe is perpetuating the Potbelly Syndrome being discussed here.  My intention is to show how these causes acting alone or together converge on the inhibition of the 5’deiodinase enzyme pictured below. This serves as the thyroid link that underlies the entire PBS scenario and all of its consequences.

4.20 LEAD ARTICLE chart

As strange as is to believe, ALL of the conditions, situations, and disorders listed in the chart above INHIBIT the 5’deiodinase enzyme that is necessary to make the conversion of the less active T4 to the more effective and metabolically active T3.  Otherwise, inactive Reverse T3 gets made.

This thyroid conversion step is crucial; because when it is inhibited the formation of the metabolically active T3 goes down.  This slows down the metabolism, setting the stage for ongoing weight gain, fatigue, and the whole downward spiral of functioning that PBS patients inexorably experience.  This phenomenon is called “thyroid hormone resistance.” Standard thyroid blood tests do not detect it.  Most doctors will test the TSH level and it will generally be in the normal range.  You must ask for a Reverse T3 level.  If it is elevated, think about the thyroid link phenomenon as a cause of your PBS.

What is a Syndrome?

A syndrome is defined as “the association of several clinically recognizable features, signs (observed by someone other than the patient), symptoms (reported by the patient), phenomena or characteristics that often occur together, so that the presence of one or more features alerts the healthcare provider to the possible presence of the others.” 

          Syndromes are a constellation of “recognizable features.”  An observer does not have to see all of the stars in the Big Dipper to recognize it as such.  When a pattern is evident, the identification or “diagnosis” can be made.

In the history of medicine, syndromes are often named before the underlying cause or the elements within the causative loop are clearly identified and a treatment is found.  The Potbelly Syndrome is just such a syndrome.  Though you are unlikely to find it in a medical textbook, the general public almost universally resonates with the term.  It clearly describes the biggest medical dilemma facing modern civilization today.

This article proposes an explanation for this syndrome…though not one that will be satisfying to most conventionally trained doctors.  There is no drug or surgery to correct this illness…and I doubt there ever will be.  That is because it is a lifestyle disease based upon environmental factors we are all exposed to, dietary choices we all must make, and modern societal consequences we must all live within and attempt to cope with.  There is no magic pill or fix-all solution for this one.

At best, it is my hope that we will begin to approach modern chronic illnesses from a bigger perspective that encourages the individual patient to become more involved, more informed and more responsible for their overall life choices.  What we seem to need more of is not “health care reform” but “self care reform.”  Hopefully the ever growing problem of PBS will lead us all in that enviable direction.

If you, or someone you know, could benefit from the self care reform that is recommended in this article or would like to learn more about the health, hope and healing the Riordan Clinic provides, call 316-682-3100 today.