December 7, 2015

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

In the previous post in this series on stubborn weight loss, we talked about nutrient deficiencies as possible roadblocks to losing body fat, even when someone is faithfully following a low-carb, higher-fat diet. I left off saying that there are nutrients we typically associate with thyroid function, and thyroid function is a huge player, not just in fat loss, but in metabolism and energy generation as a whole. If your thyroid is on the fritz, or forces outside the thyroid gland are making it go on the fritz, fat loss will be very difficult. So this post and the next one will focus on nutritional factors that help the thyroid, as well as dietary and lifestyle factors that hurt the thyroid.

I have had many clients who were on thyroid medication of one kind or another. It was obvious to me, however, that whatever medication they were taking was not helping, because they were still overweight, depressed, fatigued, and had other signs and symptoms of low thyroid function. To my astonishment, these people were typically dumbfounded by my asking them, “Do you think the medication is working? Do you actually feel any better?” (Apparently, none of their physicians had ever bothered to inquire, and the clients had never stopped to ask themselves if they were feeling better.) The answer, which required no hesitation or deliberation on their part whatsoever, was an unqualified NO. Of course it was no. If they did feel better, and they were losing weight, they would not have sought my help in the first place. This isn’t rocket science, folks. If you are “on thyroid medication,” but you still feel like dog-poo, then either the dose is not optimal for you, or the type of medication is not right for you. Before we can get into detail on medication, though, we need to talk a little bit about thyroid function in general, and then we’ll see where nutrients and meds fit into the picture.

Thyroid & Metabolism

The reason why healthy thyroid function is so crucial for effective fat loss is that it is one of the primary things that controls your resting metabolic rate. This is the number of calories you burn amount of energy your body expends WHILE YOU DO ABSOLUTELY NOTHING. It is the amount of energy your body requires just to keep you alive. (If you were a building, it would be like paying rent to keep the lights on, the plumbing working, and the heat on. The bare minimum to make the place habitable.)

And this is why I get so annoyed about the whole “calories in, calories out” thing. Differences in resting metabolic rate account for why one person’s body “burns,” say, 200 calories while they sit on their arse watching TV, and someone else’s body only burns 50. If you have struggled with fat loss at any point in your life, you have witnessed this time and again: friends and loved ones who eat far more than you do, and who exercise far less than you do (perhaps not at all!), yet they weigh less than you do. It is PAINFUL. It is FRUSTRATING. It is NOT FAIR. And some of it—maybe not all of it—but some of it, has to do with your thyroid.

As I have written about in other posts, dedicated physical exercise burns startlingly few calories. You might feel like you’re expending a ton of energy, but anything you accomplish in the gym (or playground, park, or basement workout area) is small potatoes compared to how your body is processing and partitioning energy the rest of the day—all the hours upon hours during which you are not actively engaged in running, swimming, lifting, tennis, s-e-x, etc. This is what the CICO-paths never seem to acknowledge when they talk about the need to “eat less and move more.” Especially the “move more” part. Why should I have to move more in order to expend the same amount of energy someone else’s body expends by default?

Why is it that some people’s bodies burn more calories use far more energy than others’ all day long, regardless of how much physical activity they engage in? (Looked at this way, people with sluggish thyroids have bodies that are actually more energy efficient than those who “burn” through calories at a high rate. Use tons of energy = not efficient. These are the folks who would likely die in short order during a famine, while the rest of us would fare just fine, because our bodies seem to need less energy. This is probably why there are so freaking many of us low thyroid folks these days. We were the “evolutionary winners,” and our metabolisms that are hell-bent on conservation and running a little slowly are only problematic in the modern obesigenic environment and dietary milieu. [Not to mention the aesthetic preferences of modern Western society, wherein somehow, we think it’s healthy and attractive when we can see a grown woman’s jutting hipbones and count her ribs.)]

Some of our thermostats are just set a little cooler. Our bodies run slower, and this includes all the unseen cellular processes going on inside us all the time (i.e., the resting metabolic rate). After we cover the ins & outs of thyroid in this post and the next one or two, we’ll look at another way to increase the metabolic rate, but for now, let’s stay in thyroid land.

Here are some signs & symptoms you might experience if your thyroid—or the accessory glands that send regulatory feedback to/from the thyroid—are not functioning optimally. (There are many more; this is the short list):

Always cold (especially the hands & feet)
Low body temperature (oral or axillary/armpit)
Low heart rate (“bradychardia”)
Fatigue; low energy levels
Low blood pressure
Chronic constipation
Dry skin
Elevated LDL
Weight gain (or difficulty losing weight)
Hair loss
Deep voice (in females)

The cold body temperature, constipation, low blood pressure, low heart rate, and, of course, weight gain/difficulty losing weight all point to the critical role of thyroid hormone in controlling the basal metabolic rate. As I explained way back in this post about the large intestine, we tend to think of metabolic rate in terms of “burning calories” or losing our spare tires and saddlebags. But metabolic rate really means the rate at which the body does just about everything. People with low thyroid tend to experience sluggishness/slowness all over their body: low energy levels, low resting heart rate, low blood pressure. As for always feeling cold, the body is so sluggish that it fails even to heat itself efficiently. The constipation shows us that the movement of waste through the colon is yet another thing that slows down from low thyroid. Depression is likely the result of reduced mental energy, which goes hand-in-hand with the physical fatigue. The elevated LDL is due to thyroid hormone being required for proper functioning of the LDL receptor. Sub-optimal receptor function √† LDL will accumulate in the blood.

PLEASE NOTE, HOWEVER: You don’t have to have all of these symptoms to have low thyroid function. A few of them, if they are particularly debilitating and you know you simply don’t feel your best, should be enough to warrant getting your thyroid hormone levels tested. (More on this next time, because, unfortunately, very few physicians have any clue at all when it comes to interpreting thyroid lab values.)

How the Thyroid Works

These days, it seems like you can’t walk ten feet without bumping into someone who is either already on exogenous thyroid hormone, or who thinks they should be on thyroid hormone. However, it’s very rare for something to be wrong with the thyroid gland, itself. Like any other glands—the adrenals, the pituitary, the ovaries, the testes—the thyroid doesn’t do a whole lot on its own. It kicks into action upon receiving signals from elsewhere in the body. In the case of the thyroid, which is located in the anterior region of your throat/neck (actually, it wraps around the windpipe, just below the Adam’s apple), these signals come from the hypothalamus and the pituitary gland (both located in the brain). The hypothalamus secretes thyrotropin releasing hormone (TRH), which tells the pituitary to release thyroid stimulating hormone (TSH), and TSH tells the thyroid to secrete thyroxine (T4) and tri-iodothyronine (T3). The thyroid gland secretes mostly T4, and just a small amount of T3. T3 is considered “active thyroid hormone.” (T4 is far less potent.) The majority of T3 is generated outside the thyroid gland, when other tissues convert T4 into T3.

In order to start getting an appreciation for nutrients involved in these processes, let’s break things down a bit.

Most hormones and neurotransmitters are proteins. As such, they are made out of amino acids. For example, tryptophan is the building block for serotonin and melatonin; phenylalanine and tyrosine are building blocks for dopamine, adrenaline, and noradrenaline. Tyrosine is also the building block for thyroid hormone.

The “4” and “3” in T4 and T3 come from iodine. T4 contains 4 iodine atoms; T3 contains 3 iodine atoms. (Sweet! I bet at least one person out there didn’t know this. Ya’ learn something new every day!) The enzyme that removes one iodine atom from T4, thereby turning it into T3, requires selenium as a cofactor. Now you know why iodine and selenium are mentioned when thyroid function is discussed.

Another nutrient required for healthy thyroid function is vitamin A. I just learned this, myself. I had read here and there that vitamin A was important for thyroid health, but I only recently took the time to research the details. (Mostly out of self-interest. Yours truly is experiencing some seriously infuriating thyroid “stuff,” and if there is one thing that could possibly get me to choke down some horrid, horrid cod liver oil [high in vit A], it is the prospect of feeling better.)

Here’s a little bit of what I found:

Vitamin A is required for activation of thyroid hormone receptors, and insufficient vitamin A may depress thyroid function. (So it’s a double-whammy.) Animal models have shown that vitamin A deficiency interferes with thyroid health starting further upstream, in the pituitary gland. Vitamin A insufficiency increases pituitary synthesis and secretion of TSH, increases the size of the thyroid gland, and reduces uptake of iodine by the thyroid gland. (We’ll talk more about TSH in a bit.)

Vitamin A given alone, even in the absence of increased iodine, has demonstrated a positive impact on thyroid gland function and size. Vitamin A supplementation was shown to reduce serum TSH levels and increase T3 in premenopausal women, including a cohort of obese women, among whom subclinical hypothyroidism is rampant. Among children with goiter (a sign of freakishly severe iodine deficiency), living in areas where iodine deficiency disorders are prevalent, the greater the severity of vitamin A deficiency, the greater their thyroid gland volume and the higher their TSH levels. Compared to placebo, supplemental vitamin A significantly reduced median TSH and the rate of goiter.

Completely lost?
Don’t worry; so are most doctors!
But hold the phone! Before you go running out to buy a vitamin A supplement, be careful. High doses may actually decrease thyroid function. HYPER-thyroid patients have been successfully treated with high doses of vitamin A, resulting in decreased symptoms of an overactive thyroid and a decreased metabolic rate. (NOT what we want if we’re HYPO-thyroid!!) It appears that the effect of vitamin A on thyroid function—like the effect of just about all vitamins and minerals—is a U-shaped curve: too little causes problems, but too much can also be harmful. It is probably close to impossible to “overdose” on vitamin A via foods, although it might be possible with potent supplements. (Forget about that stupid polar bear liver study everyone’s always going on about when they talk about vitamin A “toxicity.” When’s the next time you plan on gorging on polar bear liver?)

Of course, overt vitamin A deficiency is associated with the developing world far more than with industrialized nations. (It’s the leading cause of blindness worldwide.)  BUT, it may well be that a significant portion of the “First World” population is living with some degree of insufficiency. People vary in their capacity to convert plant precursor carotenes (the stuff you find in carrots, pumpkin, sweet potatoes, and leafy greens), into true vitamin A. This may not be an issue for people who follow omnivorous diets and consume adequate pre-formed vitamin A, but it may be problematic for vegetarians and vegans. Obviously, the vegetarian/vegan pitfall likely doesn’t apply to you if you’re following a LCHF diet. (Although there are, in fact, some lacto-ovo vegetarians doing LCHF.) So even if you consume large amounts of foods high in beta-carotene, you might not be making the conversion effectively. Moreover, as if the relationship between vitamin A status and thyroid function wasn’t complicated enough, sluggish thyroid function may impair the conversion of carotenes to true vitamin A, and you need vitamin A for healthy thyroid receptor function, creating yet another double-whammy scenario for a healthy thyroid.

It is possible to consume a LCHF diet and still be a little low in vitamin A. Some foods are higher than others, and some of the animal foods that are considered rich sources might not be as rich as we think, depending on the animals’ diets. (Egg yolks, butter, and other dairy fats come to mind, as do beef and lamb tallow. The yellow color in these fats comes from carotenoids in the grass, which bio-accumulate as vitamin A in the animals’ fat. So even though I stand by what I’ve said in the past about all grass-fed/pastured/organic not being the most important thing in the world, if you are specifically looking to increase your vitamin A intake, it wouldn’t be a bad idea to pony up just a little extra cash for the grass-fed stuff, and be sure to east some of the fat. [Egg yolks from pastured hens will have some vit A, but the yellow is also due to lutein.])

Cruciferous Vegetables:
Don’t Ban Broccoli!

You may have heard something about certain vegetables interfering with thyroid function. There is some truth to this, but before you go excommunicating broccoli, cauliflower, and Brussels sprouts from your diet, let me ‘splain how this actually works in the real world and the human body.

The category of cruciferous vegetables is known to contain goitrogenic compounds that may interfere with healthy thyroid function. Goitrogens inhibit the uptake of iodine by the thyroid gland, leading to decreased production of thyroid hormone. That is a bit of a bummer, because among the cruciferous vegetables are some Paleo, Primal, and LCHF staples: broccoli, cauliflower, Brussels sprouts, kale, and all forms of cabbage. What?! No more cauliflower “rice?” No more Brussels sprouts roasted with bacon? No more kale chips? And we need iodine, selenium, and vitamin A for thyroid function? Amy, are you telling us we are supposed to eat nothing but liver and seaweed, with Brazil nuts for dessert? That’s it; I quit! I’m gonna hit up the nearest Shoney’s breakfast buffet, and there are not enough pancakes and syrup in the world to feed the hole that has opened in my soul!


It’s all good. Here’s the deal:  

These vegetables are typically not a problem, provided you eat them cooked. And really, a small amount of them raw is okay. If you like coleslaw, or you want to have some raw broccoli and cauliflower dipped in guacamole, hummus, or dip, as a crudit√©, no problem; just don’t go crazy. All the vegans (and even some omnivores) who think they’re doing themselves good by having a raw kale smoothie every day? BAD THYROID JUJU! There’s a reason raw kale tastes so bitter and foul all by itself—probably because we’re not supposed to eat it! (Don’t ask me about raw liver. Whatever floats your boat…) Raw kale smoothies are even worse thyroid juju for vegetarians and vegans because they are at higher risk for iodine deficiency, and the cruciferous vegetable “problem” is really only a problem for people who are iodine deficient. The richest sources of dietary iodine are shellfish, seaweed, and dairy products, with trace amounts in iodized salt. (A vegan’s only choices there are seaweed and salt. Plus, soy is a huge goitrogen, so couple an iodine deficiency with large intakes of soy, and its a recipe for thyroid disaster.) 

However, it is my belief that iodine insufficiency is rampant these days, even among omnivores. (Maybe not overt, goiter-causing levels of deficiency, but certainly insufficiency.) Where the heck is anyone getting iodine anymore? Some people eat lots of shellfish; others eat none. Some people use seaweed in their cooking; others use none. Some people go out of their way to use only “natural” salt, which is not fortified with iodine. Some people eat dairy, but many in the Paleo crowd avoid it. Dairy products are not naturally high in iodine anyway. Trace amounts of iodine that make their way into milk, cheese, yogurt, etc., come from the iodine that is used to sterilize the cows’ teats prior to milking. Trust me on this; I’ve worked on a dairy farm. Beyond this, on some farms, the cows’ feed is supplemented with kelp, which is a great source of iodine. (I like to use this sprinkled in omelets.) On the farm I worked at, the dairy herd was exclusively grass-fed, except for a very small amount of grain that was used to keep them placid and happy in the milking parlor. It is this feed that was supplemented with kelp. I think some farms also use kelp-enriched feed for their laying hens, which would impart a bit of iodine to the yolks of those eggs.

My point is, I simply don’t see how most people are getting sufficient iodine these days. (This is made even worse by the prevalence of other halogen elements that displace iodine in the body. More on this next time.) So it’s not that we should eliminate cruciferous vegetables from our diet. (But if you want to, hey, no skin off my back.) What we could do if we want to continue enjoying yummy LCHF dishes like cauliflower couscous and parmesan roasted broccoli, is eat them cooked and make sure we’re iodine replete. (More on that in a sec.) Also, if you’re taking an iodine supplement, just to be cautious, you might want to take it with a meal that doesn’t contain cruciferous vegetables. For example, take it in the morning if you’re having scrambled eggs and sausage, or a veggie omelet with non-cruciferous veg. Don’t take it at dinner with your steak and a gigantic pile of broccoli. (I don’t think this is that big a deal, though, especially because most iodine supplements are pretty high-dose. It’s just something to think about, if you want to hedge your bets.)

Why would you even want to eat cruciferous vegetables raw, anyway? I mean, coleslaw is easy to chew because the cabbage sits for a while in some type of vinegar or mayo-based dressing, and softens up a bit. But raw kale? Brussels sprouts? Have you ever tried to eat raw Brussels sprouts? Like I said in a guest post about anti-nutrients on Robb Wolf’s site: Have fun chewing; I’ll see you in about a week.

As for assessing your iodine levels, there is something called an iodine loading test. If you request this from your doctor, (s)he will probably stare at you like you just emerged from a spaceship from another planet. If your doctor is experienced in treating thyroid issues, (s)he may know about iodine testing, but most likely, you’re out of luck. (If you’re really interested in doing this, you can order your own test kit online and do it yourself. All that’s required is ingesting a very large dose of iodine and then collecting your urine for the next 24 hours. They measure how much iodine is excreted: the less excreted, the more you absorbed, and therefore, the more deficient you were. [The more your body needed to absorb it.] The more you excrete, the less deficient you were. According to one lab that evaluates these tests, whole-body iodine sufficiency is reached when 90% of the iodine is excreted. [And keep in mind, the thyroid isn’t the only part of the body that uses iodine. Other places where iodine concentrates are the breasts, the ovaries, brain, lacrimal glands (which produce tears), salivary glands, and gastric mucosa. (The latter three are telling: iodine is antiviral, antiparasitic, and antimicrobial, which is why they sterilize your arm with iodine before you donate blood. Saliva, tears, and gastric secretions are three of our strongest natural defenses against invading pathogens.])

Okay. That is way more than anyone wanted to know about nutrients and the thyroid. Next time, we’ll get into testing & interpreting thyroid hormone levels, and I’ll point you toward some resources you can use to educate yourself if you’ve been working with an MD who has proven incapable of helping you. We’ll also look at other factors, apart from nutrient deficiencies, that can interfere with healthy thyroid function. (Example: fluoride in the water? Bromide as a dough conditioner? In my opinion, not among public health’s greatest achievements!)

In the meantime, I highly recommend watching this video on the importance of iodine for the whole body, not just the thyroid. It will give you a strong appreciation for just how deficient most people probably are, as well as the critical role of iodine for overall health, especially that of the breasts & ovaries. (Hyperinsulinemia isn’t the only thing driving breast & ovarian cysts, ladies.) You will also learn about the interaction between thyroid hormone and estrogen, which is among the topics we’ll look at next time, and explains why women experience thyroid dysfunction so much more than men do. (Unfortunately, whoever filmed the video kept the camera on the doctor most of the time, so we miss out on seeing a lot of the slides, but it is still worth watching/listening to.)

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. Great read... and i did not know that about the T4/T3 Iodine connection!

    1. :-) See? I knew there would be at least one person!

  2. Interesting stuff!! keep it coming!!!

  3. Great post!
    However, this hurt "Not to mention the aesthetic preferences of modern Western society, wherein somehow, we think it’s healthy and attractive when we can see a grown woman’s jutting hipbones and count her ribs."
    I am from a family of sticking out hipbones and ribs. Even at 220 lb, 5 ft 7, my grandmother had sticking out hipbones and ribs. We are extremely pear shaped women. Luckily (I guess so), some have found us attractive in spite of the sticking out hipbones and ribs but not at all supermodel body.


    1. This comment has been removed by the author.

    2. Well, I'm sorry if I offended you. Obviously (or maybe not so obviously), I intended that comment more for people who engage in unhealthy and dangerous behaviors with the specific goal of achieving those jutting bones, rather than for people in whom they come naturally.

  4. Thanks for the reminders Amy!! My endocrinologist has done little more than roll his eyes at me over the yrs, as I've complained of,feeling yes, very MUCH like dog poop & have experimented w/a cornucopia of supplements to "assist" those lil' blue Synthroid tablets...
    I'm currently drinking a liquid sea-vegetable based supplement called Body Balance (iodine, scads of other trace minerals) which DOES seem to help if I slug it down consistently.

    1. You're on Synthroid? No wonder you don't feel better. (Not without significant outside help, anyway.) You'll love the next post...more on thyroid, and why T4-only meds, such as Synthroid, are usually completely ineffective. Find a new doctor! ;-)

    2. Also, this is absolutely not medical advice, just information, but most people with underactive thyroid need far higher doses of iodine than come in typical supplements. I'll have more info on resources to check out for proper dosing in the next post.

  5. Maybe iPad will transmit my comment this time - I'll type faster! But yes, I've been on Synthroid for 26 yrs since thyroidectomy in '89. I did alright w/minor weight gain (which I could peel off w/"normal" efforts) for 1st 12-13 yrs, but then suffered terrible hypo-T crash: rapid weight gain, debilitating depression, thinning hair. All while my endo "tsk-tsk'd" my symptoms since "my T4 was normal"...

  6. (OK that went through so I'll add on)
    At any rate, LCHF diet has enabled me to lose 25 lbs that had seemed intractable, but now I've been stuck on another plateau... I appreciate any information you unearth, Amy.

  7. My gp highly recommend s that I take a thyroid hormone medicine which she said will put my thyroid to sleep forever. My suspicion is that this will especially benefit the pharma co. so I'm a little bit suspicious as to whether I need to completely shut down my struggling thyroid or try iodine therapy? Is the iodine best in th form of iodide? Would appreciate your thoughts. Thanks!

  8. My gp told me to take a thyroid med which will shut down my thyroid for good. So that, I thought, will benefit the pharma co. But I don't like to take a med for life. So, pls tell me if a slow thyroid is doomed or salvageable by iodine therapy and diet? I like your getting down to the science of things. Thanks!

    1. I can't really comment without knowing more about the details on *why* your thyroid is not working optimally. Have you discussed that with your doctor? The details on your TSH, T3, T4, reverse T3, thyroid antibodies, etc.? I can't speculate without knowing more. Unfortunately, there is a MASSIVE amount of misinformation and just plain ignorance and incompetence on the part of conventional doctors when it comes to treating thyroid issues. I recommend checking out: