I am re-posting a classic Wheat Belly Blog post from a few years ago. Despite all our discussions about thyroid issues, there continues to be an enormous information gap: undiagnosed hypothyroidism, gross mismanagement sufficient to impair weight loss and increase cardiovascular risk, dismissing the importance of iodine, and ignorance among healthcare providers. This Thyroid Tune-up is therefore an updated version of the previous post.
Imagine that all the cars in your neighborhood run poorly because nobody bothers to tune-up their autos. I show you how to tune the cars and, lo and behold, 80% of the cars now run great. But 20% of cars still run poorly because their transmissions are bad. In other words, tuning the engine works when that’s the only problem with the car; if something else is wrong, then your car will not run properly.
So it goes with eliminating wheat and grains from the diet. It works right out of the box for the majority of people: substantial weight loss and shrinking waist size; reduced blood sugar and blood pressure; relief from arthritis, leg edema, acid reflux, irritable bowel syndrome symptoms, etc. But some people complain that, despite saying goodbye to all things wheat, they still have problems. Obviously, as big a problem as modern wheat and other grains are, there are other causes for health conditions. There are nutritional deficiencies, infections, injuries, sensitivities to other foods, inherited conditions, etc. While wheat and grain exposure are causes for an incredible amount of human suffering, it is not the only cause.
How about weight loss? If all things wheat and grains are eliminated, most people can expect substantial weight loss. We also need to reduce exposure to other carbohydrates, especially if a lot of body weight needs to be lost and/or pre-diabetic or diabetic patterns are present. I cannot say “eliminate wheat and eat all the ice cream and candy you want.”
By “thyroid dysfunction” I am referring to various degrees of hypothyroidism, i.e., low thyroid hormone levels. (I’m going to ignore hyperthyroidism, since this is much less common and does not impose any limitation on weight loss.) This is a big issue, so I’m going to cover it as a check list, a series of bullet points that you can run down to cover as much territory as possible. There are three blood tests that everyone should have assessed to even start thinking about thyroid dysfunction: TSH (thyroid stimulating hormone), free T3, and free T4. Optionally, a reverse T3 and thyroid antibodies (to identify thyroid inflammation/autoimmunity) can also be helpful. You do not need all the other nonsense often run, such as total T3 and FTI; these are outdated and often misleading.
Important issues to consider in deciding whether hypothyroidism is contributing to stalled weight or other health problems:
Hypothyroid symptoms–Beyond stalled weight loss, the most common symptoms of low thyroid hormone status include cold hands and feet; low energy; mental “fog;” loss of hair and eyebrows; constipation; leg edema.
Low first a.m. oral temperature–An oral temperature immediately upon awakening can help you decide whether a thyroid question is present or not. Using a digital thermometer, take your oral temperature immediately upon arising. If it is consistently below 97.3 degrees F, then hypothyroidism is likely; the lower the temperature, the more likely and severe the thyroid dysfunction. However, note that disruptions of cortisol can do the same, as can anemia and failure to take in prebiotic fibers. (Contrary to some older discussions from the 1960s, axillary temperature should not be used due to excessive temperature variation.)
Iodine deficiency–Though it’s not even on most people’s radar, iodine deficiency is a common and under-diagnosed cause for inadequate thyroid hormone production. The thyroid requires iodine to manufacture thyroid hormones, T3 and T4, the “3” and “4” referring to the number of iodine atoms per thyroid hormone molecule. Iodine deficiency was a huge public health issue up to the last half of the 20th century, pretty much solved by the introduction of iodized salt. Now that salt overexposure in some populations has been fingered as a potential health problem, the FDA and other “official” providers of health advice tell us to reduce salt and sodium. But what about the iodine? Everyone forgot about the iodine.
Many people, including physicians, assume that iodine intake from diet is sufficient. Nope. Even the federally-funded NHANES data have uncovered substantial deficiency in some demographic groups, such as women of childbearing age, using a relatively lax definition of iodine deficiency. I’m seeing iodine deficiency and even goiters (enlarged thyroid glands due to iodine deficiency) frequently. Beyond having a goiter, a low free T4 and highish TSH (e.g., 3.5 mIU) is suggestive of iodine deficiency.
Iodine is not optional; it is necessary for health, including breast health, oral/gastrointestinal health, and the health of a developing fetus. The RDA for non-lactating adults is 150 mcg per day, the quantity required to not have a goiter, but not necessarily ideal thyroid health. I’ve therefore been advising 300-500 mcg per day from an iodine supplement, such as kelp tablets (dried seaweed), available at health food stores. The only adverse effects of iodine arise in people who have autoimmune thyroid disease, such as Hashimoto’s thyroiditis, unsuspected thyroid nodules, or longstanding and severe iodine deficiency. In most cases, very low doses of iodine, e.g., 50-100 mcg per day, can be introduced and increased gradually over months after wheat/grain elimination and vitamin D has been restored (factors that allow autoimmune thyroid inflammation to recede) . Ideally, this would be undertaken by your healthcare provider, but good luck finding one knowledgeable about iodine.
Ideal TSH–Notice I didn’t say “normal” or “reference range” TSH. I look for ideal TSH. Contrary to the values often cited as “normal” or “reference range” on laboratory values, ideal TSH is in the range of 2.0 mIU or less. This is the level at which thyroid dysfunction no longer contributes to stalled weight loss, as well as distortions of lipid (“cholesterol”) values and cardiovascular risk. The higher the TSH above 2.0, the greater the hypothyroidism.
Ideal free T3 and free T4–The upper half of the “reference range” quoted by your laboratory can serve as a reliable guide to desirable or ideal levels of these thyroid hormones. In particular, low free T3 levels are becoming a common problem and a frequent cause of stalled weight loss. It is not clear why T3 levels are impaired, but potential explanations include disturbed circadian variation of cortisol levels and exposure to organochemicals such as perchlorates (residues of synthetic fertilizer in your produce and water), triclosan in your antibacterial hand soap and hand sanitizer, and others. Unfortunately, the endocrinology community (which is woefully unhelpful with thyroid issues) sooner prescribe antidepressants than treat low T3 levels, which they regard as a non-issue.
Reverse T3–Less commonly, some people develop a T3 thyroid hormone mimic, reverse T3, or rT3, that blocks the activity of T3 in the body. In this situation, it is worth more seriously considering disrupted circadian cortisol variation and using higher doses of T3 thyroid hormone to overcome the blockade.
Should prescription thyroid hormone replacement be chosen, most people do best by including the T3 thyroid hormone, liothyronine, along with T4, levothyroxine. They can be taken separately or as a single tablet in desiccated thyroid gland preparations like Armour Thyroid or Naturethroid. If you already take a T4 preparation like Synthroid or levothyroxine but have stalled weight loss or persistent symptoms of hypothyroidism, then adding T3 nearly always solves the problem.
Unfortunately, the biggest hurdle in obtaining helpful feedback on your thyroid is usually your doctor, who will declare your thyroid status normal usually by just looking only at TSH and seeing whether it is in the “reference range” quoted by the laboratory–if he/she even bothers to check it at all. Lately, the functional medicine and naturopath communities have been very helpful to many people in my area eager to have their thyroid status intelligently assessed. As a last resort, you can purchase fingerstick test kits to obtain thyroid measures, such as the ZRT test kits you can purchase through Amazon and other online retailers.
Once properly corrected, the majority of people enjoy resumption of weight loss, not to mention feel happier, more energetic, with improved overall health, including reduced cardiovascular risk. Add that to the health and weight benefits of wheat/grain elimination, and you can make substantial strides in regaining ideal health.
Hélène
January 6, 2019 at 8:20 pmWhat would be an “increased dose” of T3 to overcome the high rT3?
I took 10mcg of T3 alone for months and it did nada. I tried upping it to 15mcg even and got some heart racing, etc. I only took that much about 2 days and said, ok— nvm.
I thought we need to resolve the rT3 etiology? Not just throw more T3 on the rT3 bonfire? Or in the case of rT3–NONfire…
Bob Niland
January 6, 2019 at 9:21 pmHélène wrote: «…high rT3? I took 10mcg of T3 alone for months and it did nada.…»
I personally have no particular insights on rT3, but anyone who does is apt to want some further context, including the status of various thyroid markers that the program considers material. And that of course further presumes being on the Undoctored or 2014+ Wheat Belly program.
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Nicole
January 7, 2019 at 2:24 amI recently discovered that dental X-rays can effect thyroid and should be covered while having a dental X-ray ??
In all my 45 years I have never had it covered !!
Bob Niland
January 7, 2019 at 8:40 amNicole wrote: «I recently discovered that dental X-rays can effect thyroid…»
Do you have a link or title for that discovery?
Something explains the modern pandemic of hypothyroidism, and the needless rise of certain dentistry and dental health practices are as likely as several other theories.
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Nicole
January 7, 2019 at 9:03 amThis is the article sent to me by a friend !
Thyroid Cancer
On Wednesday, Dr. Oz had a show on the fastest growing cancer in women, Thyroid cancer. It was a very interesting program and he mentioned that The increase could possibly be related to the use of dental x-rays and mammograms.
He demonstrated that on the apron the dentist puts on you for
Your dental x-rays there is a little flap that can be lifted up and wrapped Around your neck. Many dentists don’t bother to use it.
Also, there is Something called a “thyroid guard” for use during mammograms.
By coincidence, I had my yearly mammogram yesterday. I felt a little Silly, but I asked about the guard for the thyroid guard and sure enough, the technician had one In a drawer. I asked why it wasn’t routinely used.
Answer: “I don’t know. You have to ask for it.” Well, if I hadn’t seen the show, how would I have known to ask?
We need to pass this on to our daughters, nieces, mothers and all our
Female friends and husbands tell your wives.
Please remember to ask for “Thyroid Guard” when you go for Dental X-ray or Mammogram.
Someone was nice enough to forward this to me. I hope you pass this on To your friends and family.
Bob Niland
January 7, 2019 at 11:56 amNicole wrote: «Dr. Oz…»
Mehmet is not necessarily a ringing endorsement for any particular bit of health news. By the way, he never had Dr. Davis on when the Undoctored book came out. The theory is that the book was way too threatening to the sponsors.
re: «…on the fastest growing cancer in women, Thyroid cancer.»
The top thing to do about cancer is adopt a low-risk profile, which is this program. That said, avoiding what triggers it can makes sense.
re: «…but I asked about the guard for the thyroid guard and sure enough, the technician had one In a drawer.»
Interesting that those are out there. Asking for that device might have some benefit (except in cases where the target of the actual Xray is the upper chest or throat). But without having researched it extensively, I have no idea what the relative hazard level is, compared, say, to: TSA scans, flying generally, or living in Colorado.
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Stuart
January 7, 2019 at 6:26 pmThe lack of attention to patients’ exposure to radiation displays a cavalier attitude to patient health. You can be sure that the dentists and radiographers have a different attitude to their own radiation exposure.
Bob Niland
January 7, 2019 at 7:02 pmStuart wrote: «The lack of attention to patients’ exposure to radiation displays a cavalier attitude to patient health.»
Perhaps more a question of: why would we expect a dentist to have a more nuanced appreciation for thyroid health than supposed specialists for that organ, who routinely mis-test, mis-diagnose and mis-treat it?
re: «You can be sure that the dentists and radiographers have a different attitude to their own radiation exposure.»
Yes, but they are pushing the rad button multple times a day, whereas the individual patient is exposed only once or twice a year.
Perhaps the more impertinent question might be: is 99% of what current dentistry does avoidable? If we correct diet and lifestyle, cannot we eliminate cavities and gum disease going forward, and prevent tooth crowding in future generations?
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Karen Hawkins
January 7, 2019 at 9:56 amOn thyroid issues. For many years I was on Armour Thyroid and it worked well. Then it stopped working and at the same time, the price went up by more than double. I did some research and discovered the formula for Armour was sold to another lab and they changed it, end result – price increase and performance decrease. My doctor switched me to NatureThyroid which works very well. I am not advertising for NatureThroid but I was very angry about how Armour Thyroid had changed and it affected my health to a great degree and there was no “big announcement”. Please be careful in recommending Armour as I have read that many people have abandoned them to go to NatureThroid as well. Unless they have changed back to the old Armour, I would stay away from using their product.
Bob Niland
January 7, 2019 at 1:41 pmKaren Hawkins wrote: «For many years I was on Armour Thyroid and it worked well. Then it stopped working…»
Armour issues were a source of significant consternation in 2015.
re: «…price increase and performance decrease.»
Not just. We have also, in recent years, seen certain preparations, and dose tiers, become completely unavailable for periods of time.
As people wake up to both the hypothyroid pandemic, and that T4 monotherapy fails for the majority of patients, demand for NDT is only going to increase. I’m not sure that supply can keep up with that. A reliable synthetic T3+T4 compound might become necessary, and I’m not sure it exists today. Compounding pharmacies exist, but may not produce a consistent product.
re: «I am not advertising for NatureThroid…»
It seems to work.
In any case, whenever changing brands or changing doses, wait 4-6 weeks and retest at least fT3, fT4 and TSH to see where you are. Even once dialed-in (which can take 6-9 months), re-check periodically, particularly where an autoimmune thyroid is also being managed — if the AI titer recedes, the dose may need adjusting.
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Karen Hawkins
January 7, 2019 at 2:44 pmThanks Bob. I do have it re-checked at the minimum annually and more often if issues arise to rule out any relation to thyroid. Fortunately my physician will always try a natural remedy before prescribing pharmaceuticals. For the longest time in 2014-15 I could not figure out why I didn’t feel well, after all I was on the trusted Armour. This went on for some time and I did the research after a long period of unavailability and a big price increase for Armour, that I discovered that Armour thyroid really wasn’t the old Armour thyroid. My health and wallet paid for that.
I am really enjoying the comments of others and other professionals on this site regarding many health issues. Thank you to all.
Bob Niland
January 7, 2019 at 6:26 pmKaren Hawkins wrote: «I do have it re-checked at the minimum annually and more often if issues arise to rule out any relation to thyroid.»
I’m not surprised. Do keep in mind that my remarks are often semi-rhetorical, for the benefit of lurkers.🕵
re: «Fortunately my physician will always try a natural remedy before prescribing pharmaceuticals.»
Excellent.
re: «…in 2014-15 I could not figure out why I didn’t feel well…»
It was a moment in history that with any luck we’ll not see repeated.
re: «I am really enjoying the comments of others and other professionals on this site regarding many health issues.»
Well, the only healthcare professional I know for sure is here is Dr. Davis. I do endeavor to make it clear that I’m not one.
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Brenda McNicol
January 7, 2019 at 10:06 amSome people (me being one of them) have fatty liver, this causes my liver not to be able to effectively convert synthetic T4 into the usable T3. Here in Canada there are very few doctors that will put patients on NDT. After 36 year of being on only Levothyroxine from an Endo I talked to my GP and he agreed to let me try NDT. Switching over is a slow process as the thyroid takes about 3 months to fully respond to changes in medication. My body temp has started to climb upward and my pulse is getting a little faster. I am also sleeping better and longer. I also had an IgG Food Tolerence test done to find the foods that I am sensitive to, animal milk in all form was a big one and so were wheat, barley and rye. since eliminating the sensitive foods and changing the meds I have dropped 10 pounds without even trying.
Bob Niland
January 7, 2019 at 12:43 pmBrenda McNicol wrote: «Some people (me being one of them) have fatty liver,…»
If NALFD, that’s one of the conditions that is commonly arrested (if not reversed) by following the Wheat Belly or Undoctored program.
re: «…this causes my liver not to be able to effectively convert synthetic T4 into the usable T3.»
Poor T4 conversion seems to have multiple possible causes, and appears to be a problem in about 60% of hypothyroid cases.
re: «Here in Canada there are very few doctors that will put patients on NDT.»
This is a problem everywhere, and where people are further subject to Universal Sickcare Regimentation and Rationing, their options may be limited.
re: «I am also sleeping better and longer.»
Some additional sleep tips.
re: «I also had an IgG Food Tolerence test done to find the foods that I am sensitive to…»
It might be worth mentioning that the Wheat Belly and Undoctored program don’t encourage these tests, particularly at the outset of following the program. The problem is that people on/coming off standard diets have “leaky gut” (for more than one reason), and on a typical food reactivity test, may be expected to light up the markers like a casino marquee.
re: «…animal milk in all form was a big one…»
Reactions to dairy can often subside on the program, or be avoided, if the precise dairy antagonists are identified (such as A1 casein beta, whey fraction, lactose, hormones).
re: «…and so were wheat, barley and rye.»
The top three grains we avoid, completely, forever (if not longer).
re: «…since eliminating the sensitive foods and changing the meds I have dropped 10 pounds without even trying.»
That’s how it can work, and as the blog article leads off, correcting thyroid is often a key element in breaking out of a weight loss plateau.
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Stuart
January 7, 2019 at 7:11 pmI have been doing some reading up on hypothyroidism because my 92yo mother has seemed to have deteriorated mentally just in the last few weeks and is complaining of feeling cold all the time even though it is summer here and we’ve had a heatwave over the Christmas-New Year period. I plan to ask her doctor to test her thyroid but first want to get my info together and do the temperature test as I anticipate the “TSH is within normal limits” response.
In reading up on the symptoms it struck me how similar they are to what are regarded as “normal” aging – confusion, weakness, frequent napping, joint and muscle pain, thinning hair, feeling cold, increased cholesterol, heart disease etc. I wonder how many elderly people who’ve been told by their doctor “you’re just getting old” are actually suffering from low thyroid.
Also I read that in addition to needing iodine to make thyroid hormones we also need zinc and selenium to convert T4 to T3. These are 3 nutrients for which there is rampant deficiency in the population, yet it seems that doctors rarely test for nutrient adequacy before reaching for the prescription pad to prescribe Synthroid. Surely it would be better to correct the deficiencies and let the body regulate its own thyroid hormones if possible rather than take a pharmaceutical for life. Ah but then there would be no need for constant visits to the doctor for monitoring and repeat prescriptions, and no business for the pharmacy and pharmaceutical manufacturers.
Bob Niland
January 7, 2019 at 7:56 pmStuart wrote: «I plan to ask her doctor to test her thyroid but first want to get my info together and do the temperature test as I anticipate the “TSH is within normal limits” response.»
How much trouble do you expect to encounter in getting the tests identified in: Thyroid Optimization Quick Reference
re: «…how similar they are to what are regarded as “normal” aging…»
I’m expecting the definition of “normal” aging to change for those choosing dissident diets (but not for advocates of consensus diets and sickcare, who can expect the consensus definitions to remain true for them).
re: «Also I read that in addition to needing iodine to make thyroid hormones we also need zinc and selenium to convert T4 to T3.»
It’s for that reason that the program tells people that just correcting iodine deficiency can resolve some cases of hypo.
I’m personally not clear on just how significant a role Zn and Se play in hypo, on this lifestyle. Zinc has been discussed on the blog (here). Just switching to a real-foods diet is a big help with Zn. You and I engaged on Se here. Personally, I take a multivitamin that has Se & Zn (and that specific product may not be available on your side of the planet).
Everyone needs to attend to diet and iodine. For anyone facing a major battle in getting competent hypothyroid care, first adding Se and Zn is easily worth a try. Do not overdo the Se.
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Stuart
January 8, 2019 at 9:19 amBob Niland wrote: “How much trouble do you expect to encounter in getting the tests identified in: Thyroid Optimization Quick Reference”
Although my mother’s GP is quite competent (in fact more competent than some of the specialists we’ve seen) he is also quite conventional. For example, I had to request he add B12 and Homocysteine to the standard blood test. He remarked that homocysteine was only relevant in young people but complied with my request. That’s the consensus position, but you and I know that high Hc is associated with dementia, macular deterioration and heart disease. B12 came in at 198 just below the minimum reference range of 200, a level which Bredesen points out causes brain and nerve damage but the medical establishment in Australia and the USA are just fine with. Homocysteine was also high. No reaction on these results from the doctor.
If you read the Hall of Shame page on STTM there are a number of horror stories from Australian patients. The official position here AFAICT is that TSH is the standard test. Our national health program will only reimburse testing for T3 and T4 if TSH is out of range, defined as >4.0, if you’ve already been diagnosed with a thyroid condition or a couple of other minor conditions. Simply having the symptoms isn’t enough without an out-of-range T4. So I don’t hold a lot of hope that my mother’s doctor will order the test. However it appears that we can get it done privately even without a doctor’s order for $A223:
https://imedical.com.au/order/blood-tests/thyroid-private-blood-tests
That includes
TSH
FT3
FT4
Thyroglobulin ab
Thyroperoxidase ab
Reverse T3
TSH Receptor ab (TRAb)
I think these cover all the bases.
Re “normal aging” – given that so many elderly people subsist on breakfast cereal and toast it wouldn’t be a stretch to consider that most are suffering from auto-immune thyroiditis as well as protein, vitamin and mineral deficiencies. Those in nursing and retirement homes or receiving Meals on Wheels are probably only marginally better given the prevailing dogma on a “healthy” diet – chock-full of healthywholegrains and omega-6s. My point is that the medical establishment treats the ills of the elderly with complacency and just lets them deteriorate. To hell with that, I’m determined to fight the deterioration of aging every step of the way.
Re the Se: from what I read in STTM Se is essential to damp down the antibodies in Hashimoto’s, after which the thyroid can make use of increased iodine. Turning that around you might conclude that Hashimoto’s is a consequence of selenium deficiency combined with an autoimmune challenge from grain consumption.
Regarding Se toxicity Wikipedia says:
“This 400 µg Tolerable Upper Intake Level is based primarily on a 1986 study of five Chinese patients who exhibited overt signs of selenosis and a follow up study on the same five people in 1992.[105] The 1992 study actually found the maximum safe dietary Se intake to be approximately 800 micrograms per day (15 micrograms per kilogram body weight), but suggested 400 micrograms per day to avoid creating an imbalance of nutrients in the diet and to accord with data from other countries”
5 people? Not exactly a confidence-building sample size. In any case, Se overdose can simply be reversed rapidly by stopping the Se supplement. Like most of the scaremongering about the “dangers” of vitamin overdose it’s overblown IMO.
Bob Niland
January 8, 2019 at 10:32 amStuart wrote: «No reaction on these results from the doctor. »
Did you check his pulse?
re: «If you read the Hall of Shame page on STTM there are a number of horror stories from Australian patients»
It’s a horror show world-wide. And as with diet, diabetes, heart disease, cognitive ailments and any number of other chronic non-injury non-infectious conditions, the globally gullible guilds are following the American consensus lead. Hello world, that’s a mistake.
re: «Re the Se: from what I read in STTM Se is essential to damp down the antibodies in Hashimoto’s, after which the thyroid can make use of increased iodine. Turning that around you might conclude that Hashimoto’s is a consequence of selenium deficiency combined with an autoimmune challenge from grain consumption.»
Avoiding Se (and Zn) deficiency is easily worth doing. It’s not program core here, perhaps due to needing to keep the supplement list short, providing the greatest return for the effort, and that Se in particular can be tricky.
STTM is a useful site. A major caution I advance on them is that they tend toward megadose Iodine (over 1000µg/day, if not major multiples of that). This is evidently due to the Brownstein influence there. Where this appears to provide benefit in AI thyroid (such as Hashis), what may actually be happening is that the iodine is attacking SIBO. The role of an optimized microbiome has yet to be fully characterized and exploited for thyroid.
re: «Regarding Se toxicity…»
We’ve had a report, on the subscription forum, of a diagnosed case of Se toxicity in a member. I personally would not take more than 200µg/day in supplement form without assessing what I’m getting from diet, and some titer testing. If Se ever becomes a formal topic in the program, however, I won’t be surprised if it’s in connection with thyroid.
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