December 14, 2015

Why Am I Not Losing Weight on LCHF? (Pt.3b - Thyroid)

Testing & Interpreting Thyroid Hormone Levels

If I really wanted to do justice to the topic of testing and evaluating lab values for thyroid and associated hormones, I could write approximately 85 posts and probably still not cover all the nuances. So we’re going to do the quick & dirty overview, and then I’ll point you toward some resources for more information.

Remember: the reason we’re taking some time to delve into thyroid function is because we’re exploring reasons for difficult (seemingly impossible) fat loss, even on a good LCHF diet. And thyroid dysfunction is very near the top of that list.  

It is a freaking travesty that so many doctors run one test, and one test only, when a patient requests a thyroid test. This is for thyroid stimulating hormone (TSH), which, as I mentioned in the previous post, is not a thyroid hormone at all, but rather, a signaling molecule produced by the pituitary gland. The reasoning behind testing TSH is, if TSH is elevated, then something is wrong with the thyroid gland, because if the thyroid gland were responding normally to TSH, then TSH wouldn’t be elevated.

If your TSH is high, a doctor might put you on some sort of thyroid hormone, without ever digging deeper to try and ascertain WHY your TSH is high, and without ever testing other hormones. They will give you medication without actually trying to solve the problem. (Modern medicine is profoundly excellent when it comes to trauma and emergency care. But when it comes to this stuff, it is somewhere in the realm of COMPLETELY USELESS.)

The problem with testing only TSH is that, if it’s high, the doc will probably give you levothyroxine (the most common brand name of which is Synthroid®). Levothyroxine is T4 only. I have had a few clients who were on Synthroid® and still felt like garbage. (One client didn’t even know the medication she was on was T4-only. Did she never even ask her doctor what she was being told to put into her body? People boggle my mind…) It’s no wonder they still felt like garbage: Like I explained last time, T4 is the far less potent thyroid hormone. As Janie Bowthorpe, the powerhouse behind the book and website, Stop the Thyroid Madness, wrote: “T4-only medications […] have never done the job, any more than an elevator which only rises to the 5th floor in a 50 story building ‘does the job.’” SO TRUE!

T4 is important, but T3 is generally the one that brings people “back to life,” so to speak. So if T4 production isn’t the problem, then giving T4 in pill form probably won’t help. (And if you have only your TSH levels tested, you'll have no idea what your T4 level is anyway.) What about the conversion of T4 to T3? What about thyroid hormone receptors? What about an autoimmune attack on the thyroid gland? The point is, the TSH test that is often the only one performed, tells you JACK SQUAT about how your body is producing and utilizing thyroid hormones.

For all of these reasons, a good, comprehensive thyroid panel should include the following (as a minimum):

Reverse T3
Free T3
T4 antibodies
Free T4       
Thyroid peroxidase antibodies
Women: You might want to see if your doctor will test estrogen levels, too. (More on this later.)

As just one example of the things these different values can tell you, my own TSH is low. (So are my T4 and T3.) This suggests that the problem is likely not with my thyroid gland, but rather, upstream of the thyroid, either in the pituitary or the hypothalamus. Of course my T4 and T3 are low; my pituitary is not sending my thyroid gland the message to make T4. (And if T4 is low, then it’s only logical that T3 would be low, too.)

All I know is, I’ve had several clients who were on thyroid medication, but who had no noticeable improvement in symptoms. If this describes someone reading this right now, NEWS FLASH: Your meds ain’t workin’! Get with your doctor and try something else! If your doctor won’t work with you on this, find one who will. It’s your body, your money, your misery, and YOU WANT TO FEEL BETTER!

Last time, we talked about nutrient deficiencies that affect thyroid health. Today, let’s cover…

Other Things That Interfere with
Healthy Thyroid Function

Stress Soup

Reverse T3 may be elevated when cortisol levels are very high. Reverse T3 basically “mimics” T3 at the receptor level, but it doesn’t perform the action of T3. In fact, reverse T3 blocks the action of T3. Think of reverse T3 as a “T3 imposter” – it fits into the thyroid hormone receptor, but it doesn’t do anything. It just sits there, blocking the real hormone’s access. This is the body’s way of not burning out and completely falling apart and/or shutting down. I have said this to numerous clients, typically the “Type As,” and typically women, who are burning the candle not just at both ends, but at five ends: stressful job, raising kids, doing the lion’s share of the cooking and household chores, and still finding time for intense workouts a few times a week—ALL WHILE TYPICALLY UNDER-EATING. (To all the hardworking fathers out there, yes, I know there are plenty of men who fit this description. The difference is, you typically still manage to feed yourselves sufficient food.) Since the adrenal glands can only keep up this ridiculousness for so long, their primary way of getting these people to slow the heck down—since they won’t slow down on their own—is to pull on the thyroid and force them to slow down, by making them tired and depressed. (I’ve had many clients with signs of adrenal hyperfunction coupled with thyroid hypofunction—i.e., the adrenals working overtime at the expense of the thyroid. I see this All. The. Time.)

This is why general hormonal mayhem ensues. It’s rare that someone with a thyroid issue only has thyroid lab values that are off. If they work with a knowledgeable practitioner who knows which tests to order, they’ll likely see that several other things are off, too—usually cortisol levels, but sometimes other hormones as well. Remember what I’ve said in past posts: biochemical input—be it in the form of food, medication, supplements, or lifestyle practices—does not occur in a vacuum. The human body is not a static entity. It is a dynamic, responsive organism whose internal workings are constantly in flux. You can’t provide an input somewhere and not have it adjusted for somewhere else—for better or worse. 

Moving along to the antibodies: elevated thyroid antibodies may be indicative of Hashimoto’s thyroiditis or Graves’ disease—hypo- and hyper-thyroid, respectively. (Your symptoms will tell you which, but, if you’re here, reading a post about stubborn weight loss, most likely you do not have Graves’.)

Aaaaanyway, my point is, knowing only TSH tells you approximately nothing about what’s going on with your thyroid, nor about how the rest of your body is responding to thyroid hormones. My feeling is that T4-only medications are mostly useless. I have attended seminars on thyroid function from some very experienced functional MDs who specialize in thyroid, and they agree. Even giving a T3-only or T4/T3 combination pill isn’t always enough to get someone feeling better. Optimizing thyroid function and the body’s response to the hormones often requires nutritional supplementation in addition to exogenous hormones, and it doesn’t always fix things quickly. It can take months before someone feels better, but if they’re on a protocol that’s suitable for them, eventually things will kick in.

Halogen Havoc

Iodine is a halogen element. Meaning, on the snazzy periodic table you probably haven’t seen since high school chemistry class, it belongs to the halogen/halide group. This is group 17, the second in from the right, and in addition to iodine, halogens include fluorine, chlorine, bromine, and astatine. I know absolutely nothing about astatine, so I’m going to sheepishly ignore it.  (Plus, according to that paragon of trustworthy info, Wikipedia, astatine has no known biological role.) Elements that fall into the same group have somewhat similar chemical properties, owing to details about electrons, chemical bonding, and other scary stuff we don’t need to go into detail with here.

The halogens are circled in red, second column from the right.

The reason this is important is that, having similar chemical reactivity means that some of these elements are known to displace iodine in the body. That is, instead of iodine being able to get where it needs to go and become part of an enzyme, other molecule, or fit into a receptor, bromine or fluorine might go there instead, and said enzyme or molecule will not interact with its receptor properly, resulting in all the weird & wacky things that can happen when biochemical reactions go awry.

There may be a beneficial role for topical fluoride when applied to the teeth, but this does not mean we should be ingesting it via our drinking water. On the grand scale of time, fluoridation of public water supplies is brand-spanking-new. It’s only been going on since just after the Second World War. Massive amounts of fluoride were basically a waste product of the weapons/munitions industry, and rather than finding a way to dispose of said waste, a couple of geniuses got the nifty idea of putting it into the water. As far as I’m concerned, this is a total disaster. Has there been a huge drop in the number of cavities and the amount of overall tooth decay since mass fluoridation become a “thing?” Doubtful. Has there been a huge increase in the incidence of thyroid dysfunction? Yes. Can we say, conclusively, that this is due to the fluoride? No, but I think we’re kidding ourselves if we think it’s not contributing on at least some level. (And if everyone in a particular municipality is drinking the same fluoridated water, why doesn’t everyone have a thyroid issue? I dunno…how come I can eat half a jar of peanut butter in one sitting and be just fine, but if a kid ate a PB&J sandwich yesterday and accidentally breathes near little Billy in kindergarten, Billy passes out and someone needs to inject him with an epi pen? People are different, folks. It would be nice if our government officials would give us the choice of whether we’d like to ingest fluoride or not, but in many places, this isn’t the case. [And a whole-house fluoride-removing water filtration system is just not economically or logistically feasible for some people.])

But I digress. My point is, I believe fluoride is bad thyroid juju. You can buy fluoride-free toothpaste, but frankly, I’m far less concerned with toothpaste—which we don’t swallow—than I am with fluoridated water, which we are encouraged to drink multiple glasses of daily. (Do I have a fluoride removal system in my home? No. Do I lose sleep over this? No. Am I still annoyed? Yes. But will I let this rule my life? No.) If you’re interested in the seedy underbelly of fluoridation, I highly recommend this book: The Fluoride Deception. (It blew my mind about fluoride the same way Tripping Over the Truth blew my mind about cancer.)

(Also, let's not forget that tubes of fluoride toothpaste are usually printed with warnings about calling a poison control center if you accidentally swallow more than is typically used for brushing. Why? Because anything more than itty bitty trace amounts of fluoride are poisonous, that's why.)

Another halogen that is very problematic for displacing iodine is bromine. You might not think you come into contact with a lot of bromine, but au contraire, mon ami. It’s everywhere. As a low-carb, Paleo, or Primal eater, you generally avoid most dietary sources of bromide. (It’s used to keep the artificial coloring looking nice and not separating out in such choice beverages as Mountain Dew and Gatorade. I think Gatorade might have been reformulated to phase it out, but it used to be in there, and some bottles of Mountain Dew and other freakishly bright-colored soft drinks still list “brominated vegetable oil” among the ingredients. You might also see it on labels as simply “BVO.”)

The other source of bromine in food is potassium bromate, which is used as a dough conditioner, so if you consume little to no commercially prepared/mass produced bread, no worries. How interesting is it, though, that big commercial bread makers used to use potassium iodate (i.e., from iodine)? They used it not only because it was good for the final product, but it was seen as a way to increase people’s intake of iodine, which they knew was insufficient. (Kind of like why they iodize salt. Too bad the "experts" are always harping on us to eat a low-salt diet, though. We're gonna put something you really, really need in salt, but then we're going to tell you to avoid salt. Nice, huh? I swear, folks, you can't make this stuff up. Are you familiar with the acronym BOHICA? Bend over; here it comes again...) Also interesting to note that potassium bromate has been banned in the UK and Canada (and the state of California requires warning signs for foods that contain above a certain level of bromate). With regard to toxicity and carcinogenicity, studies are mixed, as usual, but according to the thyroid experts whose lectures I’ve attended, bromide excess does occur, and it is not uncommon in people with thyroid problems. (There are ways to do a bromide “detox,” if necessary, and get it out of your system.)

Our largest sources of bromide exposure come from products we are exposed to and surrounded by daily. Bromide is used in flame-retardant materials (clothing, carpet, vehicle upholstery), in some plastics (including car interiors), etc. Y’know that new car smell we all kinda like? Um, yeah. Lots of stuff is outgassing, and we are breathing it in. Same thing with new carpet. There’s a reason you’re supposed to let it air out for a while before you shut all your windows and resume living your life indoors with it. 

Okay, look. I’m not trying to be alarmist. I’m not Joe Mercola, and you will never see headlines like this here on my blog. I don’t have some nifty, proprietary gadget to rid yourself of fluoride & bromide, that you can get only through my website, for the low, low price of $29.99—but only if you ACT NOW, because THIS DEAL WON’T LAST! All I’m saying is, we are surrounded by “stuff” that could potentially interfere with the proper shuttling of iodine in the body. And we couple this with what is typically a very low iodine intake in the first place, creating a double-whammy situation. (Good info on the seriousness of iodine insufficiency here and here.) Just something to be aware of, that’s all. (And while I am generally completely understanding -- encouraging, even -- of people not being 100% “clean” with their diet, I will say this: if you think you’re eating LCHF, Paleo, or Primal, but you regularly consume Mountain Dew, you are doing it wrong.)  ;-)

Estrogen Interference

Some of you might be aware that complications with thyroid function affect women far more than they affect men. Plenty of men experience thyroid dysfunction, but the majority of cases are women. One reason is, autoimmune conditions, in general, affect more women than men. (Not all thyroid issues are autoimmune, but Hashi’s and Graves’ are.) A second reason is the adrenal thing I talked about earlier. Men can have adrenals that are going crazy, too, but again, more common in women. The third reason is, not surprisingly, hormones—estrogen, in particular.

According to Dr. Jorge Flechas -- whose lecture on whole-body iodine issues you most definitely want to listen to if you have a thyroid issue or fibrocystic breasts -- high circulating free estrogen interferes with the thyroid gland’s ability to concentrate iodine. And “estrogen dominance” is becoming almost as common as thyroid dysfunction these days. It should come as no surprise that the signs & symptoms of estrogen dominance have significant overlap with those of hypothyroidism. (Estrogen dominance is also relative: it could be that your estrogen levels are just fine, or possibly even on the low end; the problem is that your progesterone is in the basement, so the estrogen is basically “unopposed.”)

It is beyond the scope of this post for me to get into the details about high estrogen levels. Just know that if that is an issue for you, chances are, it’s causing or exacerbating your hypothyroid symptoms, and you might not have a thyroid issue at all. Fortunately, clearing up the estrogen/progesterone imbalance is not terribly difficult to do, provided you have a physician or naturopath who is knowledgeable about this. (There are even some nutritionists, hint, hint, who know a thing or two about it and might be able to help.)

Boy, was that more than you ever cared to know about thyroid function, or what? I apologize for wandering so far off the trail here, but I thought it was important to go into a bit of detail with thyroid, considering it’s such a huge player in metabolism and body weight/weight loss, and that’s what this series is supposed to be about. We’ll get back on track next time, when we’ll look at some of the lifestyle factors that might help break a weight loss stall/plateau, or help those among us who haven’t yet lost any weight at all.

If you have a thyroid issue and your medical and/or nutrition professionals have been utterly useless to you, you owe it to yourself to check out these two sites. You will find more helpful information than you ever could have hoped for. (Warning: wear sunglasses. So many lightbulbs are going to go on over your head; you’ll need protection, haha!) 

I also encourage you to watch the iodine video and you might also want to check out the book, The Iodine Crisis: What You Don’t Know About Iodine Can Wreck Your Life. (A sensationalist title, for sure, but if you are experiencing debilitating thyroid dysfunction, then you know only too well it’s not an exaggeration.)

Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition.


  1. I tried a short trial of Cytomel (T3) to augment the Synthroid, which boosted my energy levels marginally in the afternoons, but D/C'd after dire warnings from my doctors...
    In order to feel functional, I must keep my T4 at upper limits of normal range, w/TSH partially suppressed.

  2. "Dire warnings"? What, pray tell, were the dire warnings? When my total cholesterol zoomed to 296 my doctor did additional tests and found I had Hashimoto's. Naturally she reached for the prescription pad for Synthroid. I had already been researching thyroid and asked about Armour natural thyroid. She would not even consider it so referred me to an endocrinologist.

    At sites like stopthethyroidmadness they say if you want decent thyroid treatment the last person you want to see is an endocrinologist, lol. I had hopes, though, as she was a DO rather than an MD and I had heard they can be more open to alternative treatments. Not!

    She would not even consider Armour, said she would never prescribe a DANGEROUS drug (which has been used safely by thousands for generations.) But she was more than happy to reach for a prescription pad to give me statins, and was not happy when I said I would not take them unless she put a gun to my head.

    Went on like this for almost two years. So frustrating to know what you want and to have to go through a gatekeeper who refuses to give it to you.

    Then, in a way so amazing it almost felt like Divine Intervention, I learned of a holistic nurse practitioner who used Armour and went to see her. She didn't take insurance of course. Those who do seem to be Synthroid only types! But she gave me Armour and within a couple weeks I was feeling better. Within four weeks my total cholesterol and LDL had both dropped over 100 points.

    What is the good of pumping T4 (Synthroid) into your body if your body is having problems converting T4 to T3 (of which elevated cholesterol is a classic symptom). If I could not get Armour I would certainly consider Cytomel.

    1. Right on, Debbie! So glad you found someone willing to give you the help you needed. I've found a very helpful & understanding NP as well> I tried Nature-Throid, but it didn't seem to do me much good. Possibly I needed a higher dose than I was trying, but I've been doing my own thing the past couple of weeks (without Nature-Throid) and actually feeling better! I still don't feel *great,* but it's noticeably better than I was not long ago.

  3. Hey Amy,

    I just recently found your blog and have really been enjoying the content. Thanks for all your hard work!

    I wanted to follow up on your thyroid struggles and see how you have been progressing? Have you been able to resolve your thyroid issues? If so, what steps did you take to correct them, and what was the initial issue (low FT3 and normal TT4; low FT3 and low FT4, etc.)?


    1. Hi Tim,
      This would be a little too much for me to get into in the blog comments. If you want, feel free to email me directly (tuitnutrition [at] gmail [dot] com) and we can talk about it privately. I am doing better in some ways; in others I have a long way to go and am still trying to find something that works well for me. I am doing much better than I was several months ago, but things definitely still aren't ideal. As for the labs, I basically had low EVERYTHING -- but also some were low/normal. Above all, my TSH was LOW, not high, so the problem really isn't my thyroid gland, per se, but further upstream, in the pituitary or hypothalamus. It's like my whole body was running slow, not just the thyroid. The thyroid can only take orders from the pituitary, and if my pituitary wasn't pumping out and TSH, well, no wonder everything else was compromised. Oy!!

  4. Is there a... uh part 4 or this?

    1. Yes: