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 gap: undiagnosed hypothyroidism, gross mismanagement sufficient to impair weight loss and increase cardiovascular risk, 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 your car 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 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. Some people will 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.”
Then there are people who do all that and still cannot lose weight. This is when it’s time to give serious consideration to thyroid dysfunction.
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. (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 national 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 500-1000 mcg per day from an iodine supplement, such as kelp tablets (dried seaweed), available at health food stores (not pharmacies). The only adverse effects of iodine arise in people who have inflammatory 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.
For most people, restoration of iodine usually develops over 3-6 months with gradual relief from hypothyroid symptoms (but only if iodine deficiency is the cause).
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 1.5 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 1.5, 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 except in the most severe cases) sooner prescribe antidepressants than treat low T3 levels, which they regard as a non-issue. (I had low T3 personally with normal TSH and free T4, along with flagrant symptoms of hypothyroidism and a body temperature of 94.6 F, all corrected with thyroid hormones that included T3.)
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 and Naturethroid. Alternatively, 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 naturopath community has 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 elimination, and you can make substantial strides in regaining ideal health.
Is there a chart of desirable vitamin/mineral amounts [not just RDA] ? I am new to this
re: Is there a chart of desirable vitamin/mineral amounts [not just RDA] ?
Not that I’m aware of, speaking as a follower of this blog for years, and being a member of the Cureality subscription site (but not a member of the Wheat Belly Lifestyle Institute site).
The Wheat Belly Total Health book has intake recommendations in the discussions of each micronutrient and supplement, but I’ve never seen it distilled down to a single list or chart.
Keep in mind that it isn’t a simple matter of “get 3.7 milliburps of rebiotics per day”. The specific form of the nutrient often matters, and a cautious buyer needs to cross-check the available products against consumerlab dot com test results (not to mention avoiding adverse “inert” fillers like sugars, calcium, soybean oil and wheat by-products). Dosage can vary with sex, age, weight and genotype. It will also vary with specific health conditions being addressed or compensated for.
A comprehensive list would also include things you don’t need to take, or actively want to avoid, so that you don’t get exposed to them in multi-vitamins.
And then we have the question of how much you actually get from normal food intake. Consensus diet is pretty deficient in a lot of important stuff. But a seaside Wheat Belly follower who, for example, takes full advantage of local seafood, might need no DHA & EPA supplements at all.
Finally, any such list will be obsolete shortly after publication, due to new data and product churn in the marketplace. It’s not a one-time thing, and would need continuous maintenance.
I’ve started building a spreadsheet for my family when time permits. It’s a lot of work, and not even in a useful form yet.
I could see day when you could plug your information and meal plan into a web form, and get a shopping list. I suspect that only a subscription or fee-per-report scheme could support the effort and professional expertise required.
In the distant future, customized supplements might have a place. Market experiments with that to date, alas, have not been successful. Just doing standardized supplements is a market challenge, as quality ingredients are expensive. For example, based on user remarks on his blog, it appears that Dr. Perlmutter lately discontinued his Empowering brand supplements.
I found you through someone who mentioned you on Lorna Vandehaege’s site … Sooo happy!
I have 2 sets of blood work I’m comparing and was hoping for your insight.
Apr 2013 my ferritin was 38(normal 11-291), free thyroxine was 13.0 (normal 11.5-22.5) and TSH was 3.06 (normal .55-4.78)
Oct 2014 my ferritin was 32 (normal 11-307), and my TSH was 1.55 (normal .34-5.6)
They weren’t specifically testing for anything but I’m wondering if these could be a reason to take a thyroid support and iron supplement. Having not changed much, why would my TSH drop so much in 6 months? Could these numbers be the reason I’m having difficulty losing weight and the cause of thinning hair? I’m 40 and while I did lose 20 odd pounds a couple of years ago nothing seems to change my weight.
Thanks for the insight … Heading back into the site!
Hello! I feel like I really need some help. I have been on Wheat Belly since November 3, 2014. While I don’t weigh myself, I believe I have lost around 8-10 pounds. I have eliminated all carbs, sugars and grains from my diet. The only dairy I consume is heavy cream in my coffee in the mornings and the occasional 1-inch square of cheddar as a snack. My diet is all veggies and proteins. I just got the results of my thyroid tests and would like some input:
free t4: 1.07
TSH: 2.63 (up from 1.70 a year ago)
free t3: 3.2
I am waiting to receive the results of my reverse T3. I am getting so frustrated with so little weight loss! I have seen noticeable improvements in my sleep and skin quality, and total elimination of acid reflux. I know that the improvements I’ve seen are awesome, but the weight-loss thing really bothers me. Should my thyroid be corrected at all? Any help will be appreciated!
I’m no expert on this, but anyone who is is likely ask the questions I’ve raised here.
Re: My diet is all veggies and proteins.
And do you have any idea of your iodine intake?
Re: I just got the results of my thyroid tests and would like some input
What reference ranges were provided for the fT3 and fT4?
Re: TSH: 2.63 (up from 1.70 a year ago)
That seems to be worth further inquiry, just based on the article above and the discussions I’ve see on this blog.
Re: … but the weight-loss thing really bothers me.
Leaving the thyroid as an open issue (and obvious suspect) here, where are you on the various loss-stall checklists linked back here from:
For example, have you done anything about gut biome?
re: Should my thyroid be corrected at all?
If it’s in need of correction, sure, and that’s even ignoring any role in weight loss.
I’m looking forward to any information in response to @clarika’s request for “known results for person who already have had their thyroid removed”.
Was wondering if there are any known results for persons who already have had their thyroid removed? and if there were any effects one should be aware of while on the wheatbelly lifestyle?
re: … results for persons who already have had their thyroid removed?
While awaiting any insights Dr. Davis might have on this, I suspect that the main challenge for anyone without a thyroid gland is dealing with the dangerously useless malpractice of consensus medicine on thyroid issues. Be sure to be aware of:
You can use their search on “thyroidectomy” to find some information. My impression is that you no longer have to worry about diet elements interfering with thyroid function, because you don’t have a thyroid. You instead have to worry about getting a prescription for an effective replacement, such as NDT, and fine tuning the dosage.
However, you still need to worry about diet messing up other things, including adrenals.
I have no idea what iodine intake might be ideal for someone without a thyroid. I would certainly avoid needless exposure to other non-native halogens (bromine, fluorine, chlorine).
I have been diagnosed in the past with benign nodules on my thyroid. My thyroid apparently runs pretty active as my TSH was always borderline too low indicating my thyroid was already going full speed. I almost never eat extra iodized salt on my food so I wonder if I should be trying to consume foods with iodine or if that would cause my thyroid to be overactive?
Would “SeaSnax” (organic seaweed, organic olive oil & sea sale, doesn’t list iodine amount) found at most grocery stores be a good source for the iodine?
re: Would “SeaSnax” … be a good source for the iodine?
SeaSnax appears to be mostly porphyra seaweed (aka nori). Based on iodine content (by weight) for standardized sheets of nori in Japan, it appears that one serving (half a packet) of SeaSnax might provide about 160 mcg of iodine. If so, that would make a suitable low starting supplement dose, but hitting the suggested target of 500-1000 might test your tolerance for nori.
And then I recalled that nori and iodine had come up on he blog previously:
Dr. Davis: “I’m not so confident of nori as a source of Iodine, Jill, as its unusually thin nature means the iodine, which is exceptionally volatile, may dissipate into the air within days.”
Question about iodine and hashimotos. 100% Wheatbelly since October 2011. My thyroid blood tests are
Free T3. 3.06
Total T3 81
Free T4 1.05
Total T4 6.30
T3 Uptake 36.90
Free Thyroxine Index. 5.80
TPO 128 on a normal range of .00-6.80
Thyroglobulin Abs 1000 on a normal range .00-1.00
My doctor has me on Eco Thyroid and Iodoral and Selinuim. I’m confused about the Iodoral. I’ve read that taking iodine with hashimotos is like throwing gas on a fire. I have moved to another state so I don’t have contact with my doctor anymore so would like to know your opinion of this. I have all the symptoms of hashimotos and have gained 10 lbs this year all around my belly. I also have high inflammation markers and high ferritin levels with low iron. The doctor suspects candida low hydroclaric acid. Do you recommend prebiotics before you kill off the candida or along with the treatment? He has me on Black Seed Oil to kill the fungus. Any suggestions would be greatly appreciated.
It is VERY odd to suggest taking Iodoral because 1) it will indeed activate Hashimoto’s (and perhaps accounting for your hyperthyroid range TSH), and 2) it is toxic after a few months of supplementation.
Every case with overgrowth of one sort or another, including Candida, has to be taken individually. Some people can manage with high-potency probiotics and prebiotics, while some cannot. It helps to have an informed practitioner.
Thank you very much. I have quit taking the Iodoral about 2 weeks ago hoping it would help. I will continue to research and get my body back. I love everything you have taught me and will continue on.
Thanks again for all you do.
Dear Dr. Davis,
I am 30 years old and I have eliminated wheat, grains, and sugars from my diet. I also have dramatically lowered my daily carb intake (usually below 30g). I have been living this way since January 26th, within the first month I lost 18 pounds, since that month I have only lost 2 additional pounds. I feel better, but I am 40 pounds over weight and need to continue losing weight. What should I do? The thought of having a thyroid issue never crossed my mind, but am wondering if I should have it checked?
re: … and need to continue losing weight. What should I do?
Check off all the items that are common roadblocks. A list of articles on this blog is linked back from:
re: The thought of having a thyroid issue never crossed my mind, but am wondering if I should have it checked?
Everyone needs to have it done, but typically all we get is mis-testing (just the nearly useless TSH), mis-diagnosis (reliance on the incorrect reference range) and mis-treatment (nothing or T4 only). A semi-diplomatic screening question you can use with the physician is:
“Although it might not be indicated in my case, do you ever prescribe T3 or compounds containing T3?”
If the answer is “no”, find a competent provider.
It is ALWAYS worth having your thyroid checked, as thyroid dysfunction is exceptionally common.
Also, see the 3 videos on this Blog that discuss the common impediments to weight loss.