Transcription
So today, our topic in the Metabolic Classroom is, uh, is your thyroid lost on a low-carb diet? So I'm going to turn the time over to Ben.
Yeah, yeah. So this is a topic that we almost couldn't avoid, at least for too long, because it's one that just comes up so often. And I think it's because, in general, we have put thyroid in a very lofty position as a hormone. And, and I, and because of, I think, some misinterpretation of data, and that has, that has really put the target on thyroid hormone in any conversation of, of body weight, body fat, for sure. But also in, in the context of a low-carbohydrate diet.
So, very briefly, um, thyroid hormone is really two hormones. And I'm just going to say thyroid hormone just for the sake of kind of keeping a common vernacular or use the words everyone else does. So there are two hormones that are produced from the thyroid gland, and, uh, T4 and T3. And T3 is really where the rubber meets the road. That's the hormone that when we classically think of thyroid hormone, that's the one that goes and gets the job done. And T4 really acts more as a reservoir of future T3, where T4 is flowing through the blood, and then when the body needs more T3, the tissues, mostly it's the liver, will take in that T4, convert it to T3, and then release it as T3, which can then go and do what thyroid hormone does.
And what thyroid hormone does is also very misunderstood. It is essentially a hormone that sets the, the throttle of the cellular engine. It kind of sets the idle of the engine, or, or how busy the cell is. When thyroid hormone is up, cells are simply more active. They will be going through their cell life or the cell cycle just more rapidly than before. And this would include things as well known as say, autophagy. Thyroid hormone wants to stimulate that kind of stuff. It just pushes the cells to be a little busier, which is why metabolic rate does go up when thyroid hormone is up. And that's why some, so many people are so fascinated by thyroid hormone, because we're so collectively fascinated with metabolic rate.
And then, in contrast, of course, if thyroid hormone is down, then it's like we're just sort of depressing, um, we're pressing the brakes a bit, and we're slowing things down a bit. And so the cell slows down its actions. And there, and as you can, as you consider then all the cells of the body, because all of the cells of the body respond to thyroid hormone, then we have that depressant, depression in metabolic rate.
Now, I would refer anyone to a previous discussion that we had, a previous Metabolic Classroom, where we spoke about the effects of thyroid hormone on the fat cell specifically. And those are, I believe, very relevant effects, in so far as thyroid hormone does influence the level of insulin receptors that you see on, on fat cells. And I think that is very relevant in any discussion of body weight regulation.
Now, one other sort of physiological nuance when it comes to thyroid hormone. Thyroid hormone is under the control of another hormone that comes from the anterior pituitary, tucked up into the brain. And that hormone is called thyroid stimulating hormone, or TSH. So anyone who's gotten a blood test of thyroid hormone, you would have T3, T4, and very, very likely, you would have TSH as well. Because TSH gives us an idea of how well the thyroid gland is working. And it does so through a process that, that we call negative feedback.
Very briefly, uh, if, if thyroid hormone production is low, so if the thyroid gland is producing less thyroid than the body needs, the brain would sense this and it would increase its release of TSH. And TSH's job is to stimulate more thyroid hormone production. And so that would push the thyroid gland to make more TSH. And, sorry, to make more thyroid hormone. The brain would sense this increase and then it would stop releasing TSH. So you can see that there's this kind of ebb and flow, there's this balance between these two hormones. But all of it is acting as a negative feedback. And again, if thyroid hormone is too low, TSH will go up in order to try to stimulate it.
In contrast, if thyroid hormone is too high, like for example, if someone had a thyroid releasing tumor of the, of the thyroid gland, then TSH would be really low because the brain is swimming in a sea of thyroid hormone and it would be thinking, I need to turn the thyroid gland off to try to stop making thyroid hormone. And it would do so by lowering the TSH. So understanding the role of TSH in this process is, I believe, essential to really get an idea of what a low-carb does with regards to thyroid hormone.
Now, the pop culture myth, it seems, is that thyroid is down, that the thyroid gland is somehow damaged in a low-carb setting. That appears to be absolute nonsense, to put it politely. So they're up to this point of the, the sum of all the clinical studies that have looked at low-carb and ketogenic diet diets, um, we probably have somewhere on the order of, I don't know, a hundred year, 100 people years, or 100 study years. So when you consider every single subject in every clinical study and how long they've been on that, it's at least decades long now of studies, or worth of data that we have. And there has never been one single mention of hypothyroidism in any one of these clinical trials that has ever been published. And they do this sort of thing, they report negative outcomes. They will often say things like, this study on this subject had to be withdrawn from the study for this reason, or we noted this many instances of, of hypotension, you know, their blood, you know, whatever it may be, or hypoglycemia. Something. There has literally never been one single mention of hypothyroidism in any of these single studies that, again, to this point, is at least decades worth of, of study data. When you look at sort of people study years in these studies, not a single shred of evidence to show, again, that there's a clinically relevant reduction in thyroid hormone.
However, having said that, and this is where I think some of these characters in the low-carb space are getting their information from, there are a handful of studies, and I have links in the show notes to some of this, that show a reduction in T3. So there are studies to show the thyroid hormone is lower than it was before, but not TSH. And TSH is sort of the brain's way of sampling the body's needs and basically asking, do we have enough thyroid hormone? And if the body were hypothyroid, TSH would be high because the brain would be telling the thyroid gland, hey, we don't have enough thyroid, this lack of carbs is killing us, and we need more thyroid hormone. So I'm going to push up TSH, that'll push up thyroid hormone. It doesn't happen. TSH stays normal, T3 drops. So this more, sort of useful, the practical side of thyroid hormone goes down.
Now, lest someone think that's a problem, let's present an analogy. Let's imagine we had someone who was overweight and unhealthy, and they had high levels of insulin because they were insulin resistant. Would we say that a low-carb diet is damaging the pancreas because their insulin levels drop? Of course we wouldn't. Any rational clinician, or any rational person at all, if I may be a little insulting and bold to these people who claim otherwise, I would, I, they would say, no, it's a good thing. That is universally a good thing. You're becoming more insulin sensitive, and you have less insulin, you need less insulin as a result. So that's my analogy, and I think it's very apt.
There is such thing as instances of thyroid resistance. And it's entirely possible that the reduction in thyroid hormone that we see when someone adopts a low-carbohydrate diet is perhaps a result, really, of the thyroid hormone working better. And now they just simply don't need as much. Now, I am speculating here, you know, there's no solid, hard fast evidence to confirm my theory, but I think it's accurate. And I think looking at it, um, as sort of analogous or a parallel to insulin, and how other hormones, not just insulin, there are multiple hormones that will come down, um, with adoption of a low-carbohydrate diet. Why would we then say that thyroid hormone coming down reflects thyroid damage? There is truly no evidence to support it. And again, I believe there's a lot of available evidence we can point to that would have, by this point, um, have reflected a thyroid problem if it were real.
So that's it. Those are my thoughts. Um, I, it's, I, I admit this is a bit of a departure from typical Metabolic Classroom, because I'm not just relying on showing figures or hard and fast data from a study, because no single study has really tried to put a finger on this. But again, studies have shown reductions in T3 that I believe is what some have used as evidence to claim that a low-carbohydrate diet damages the thyroid gland. And I think that is poor logic. And rather, it perhaps just simply reflects an enhanced efficacy or sensitivity of thyroid, just like we see with insulin. And just like insulin levels come down, and we don't claim that's damage to the pancreas, we claim it's an improvement in insulin's actions. I think we should use the same dialogue and language with regards to thyroid hormone. T3 does appear to come down in many people, although it, it, it, it never goes outside of a normal range, it stays in a normal range, but it comes down. That's no more evidence of thyroid damage than low insulin is evidence of pancreas damage.
Great. Love it. Wow. Yeah. And that's it. We get so many questions about, about this, don't we, coaches?
Yeah. So I have a question for you. When you're thinking of, when you're looking at Hashimoto's, kind of an autoimmune thyroid problem, um, have you ever seen any data to show that you can improve that condition by doing low carb, like other autoimmune issues?
Yeah, yeah. I don't know of a study that is in the context of low carb. But there are studies to point out the very strong connection between celiac disease and Hashimoto's. And I'm reluctant to say that only because gluten has become an easy villain in too many lazy, casual conversations. And I'm not one of those people. I was very cynical when I first heard a, a neighbor actually tell me how this person's thyroid gland had improved so much once they cut out gluten. And I just rolled my eyes and thought, oh, my goodness gracious. Uh, here we go again. Gluten is as, Isaiah, when Isaiah talked about the, of all the earth, he must have been talking about gluten in the Old Testament. Um, but, but in fact, the results in this individual were so dramatic that I thought, I have to take this seriously. And literally within minutes on PubMed, which is kind of a database of biomedical publications, I found multiple resources identifying this, this connection. And so there's some, uh, I guess, what's relevant there, if I, this may seem like a bit of a tangent, but it is still relevant to Hashimoto's. Um, almost every autoimmunity has an environmental trigger. And so it's someone who has a genetic predisposition to have a heightened immune system, or a more, an overactive immune system, then there's something they expose themselves to that, that actually pulls the trigger. The genetics loaded the gun, and then, and then the lifestyle pulls the trigger. And when it comes to Hashimoto's and low carb, I, although I don't know of a study to support this, but I do know people who, so this is anecdotal, who report an improvement in Hashimoto's with a low-carb diet. I wouldn't be surprised if in many of these people, it's that they have, by avoiding carbs, they've avoided gluten. And that ends up helping them rather than, you know, the carbohydrates per se.
Interesting. Uh, typically, I would say we don't see a lot of people who, um, have improvement or, um, you know, see their thyroid condition get worse. But recently, I have a client who has Hashimoto's, has been on medication for 20 years. And within the last year and a half, she's changed her dose twice, minimizing her dose of medication from being on a low-carb protocol. And she's still continuing to lose weight and see improvement to her metabolic health. So it's kind of cool.
Yeah, it's awesome. Well, I, I wouldn't be surprised if the absence of, of maybe, maybe of gluten or some environmental trigger is helping improve the production of thyroid. But I also wouldn't be surprised if, um, you know, if, if my theory is a little correct, then she doesn't need as much. Her body's responding better to thyroid hormone. And I think that's what's reflected when someone in these studies that do show a reduction in T3, it's just that T3 isn't as needed, um, as it was before. There's a lower level in order to maintain homeostasis. And so the little bit that she's getting is just working better.
We have, we have some questions coming in about, uh, the topic that we, that you just finished. Dr. Pickman, from Carolyn, what is the ideal TSH level in general?
Oh, gee. Um, I'm afraid I don't know. I don't know normal levels for the thyroid hormones. Uh, I, I can't answer that. I'm not sure.
No worries. Uh, for Marcus. But, but I would say, sorry, Jack, to that question, I would say I don't know of any evidence to suggest that the cl, the typical clinical range is somehow wrong. I would, I would be quick to add that. So anyone who's gotten a blood test, um, almost every blood test, everyone I'm aware of, it'll give you a number and then it gives you a range of what's acceptable. I know of no evidence to suggest that that range that you would get on a typical, on any blood test, um, is going to be somehow wrong. You know, like I make the case that the range given for insulin is terrible, and it is skewed in, in absolutely the wrong, the worst way. I won't make the same statement with regards to T3, T4, or TSH. So I don't know what the levels should be. It's not something I'm, I have my finger on the pulse of well enough. But I would say whatever the, the lab values that you're given on that same blood test, um, those are probably the best ones to go with.
Now, Ben, if those are low, what do they do? If TSH is low?
Yeah, yeah. So if TSH is low, um, you have to look at this in context of T3 as well. So, yeah, there's, there's a couple different ways to look at at this. And I don't want to, I don't want to get off. You guys pull me back if I start going too far. So when someone presents with the, and I'm not a clinician, so I'm saying this is purely an academic. But if someone were to present with a thyroid disorder and actually had it confirmed, and I emphasize the word confirmed, because so many people will blame their weight gain on their low thyroid without actually having any evidence that their thyroid hormone is actually low. So I do think thyroid is too often thrown under the bus when it's a perfectly innocent pedestrian trying, minding, you know, its own business on the sidewalk. But nevertheless, if someone had, what they will notice, what they'll feel, if they have a clinical symptom, then it's a result of, of the thyroid hormone that's out of, out of whack. You know, if they're tired, they're, they, they're very tired, they're always cold, and they're gaining weight, well, those are classic symptoms of hypothyroidism. If they're losing weight, and they're hot, and they sweat very readily, sweaty palms, those are clean, they're jittery, those are classic symptoms of hyperthyroidism. So what someone will feel is not going to be a difference in TSH. What they feel will be a difference in thyroid levels, hypothyroid or hyperthyroid. And then at that point, you look at TSH in order to try to tell where the problem is.
And at the risk of going into too much detail, I'll try to be brief. If someone presented with hyperthyroidism, but TSH was low, that suggests the problem is at the thyroid gland itself, which we would call a primary problem, because the brain, with low TSH, is trying to tell the thyroid hormone to turn off thyroid production, but it's high anyway. So the thyroid gland is not listening to the master, to its master, the pituitary gland. So high thyroid and low TSH would reflect that there's a fundamental problem at the thyroid, perhaps something like a tumor, a thyroid producing tumor.
Alternatively, if someone has hypothyroidism, and they come in, in fact, let's stick with the hyper. If they had hyperthyroidism and TSH is high, well, that's probably not a problem with the thyroid gland. It's a problem of the pituitary gland, because TSH is high, and the thyroid gland is obeying the high TSH. So the thyroid gland is obeying its master, in this case, the pituitary. So the problem's at the pituitary gland, very likely. And that would, that would be called a secondary hyperthyroidism.
And then all of the same logic goes if the person were hypothyroid. If hypothyroid, the high thyroid gland is low, thyroid hormone is low, but TSH is high. Well, then the thyroid gland isn't listening to the high TSH. And so it's a primary hypothyroidism. And that can be something as innocent or simple as an iodine deficiency, because if there's not enough iodine for the thyroid gland to pull in and then use that iodine to create the backbone of what will become thyroid hormone, it creates that interesting situation where the person can't make enough thyroid hormone, so they are hypothyroid, but TSH is really, really high, trying to force the thyroid gland into working. But one, not only does TSH tell the thyroid gland to make more thyroid hormone, it also stimulates its size. And so this is where someone can get a goiter, where, but also have, so a really, really big thyroid gland, even though the thyroid gland is producing very, very low levels of thyroid hormone itself.
Anyway, I'm getting off. It's just too deep. This is too much. But anyway, anyway, Rich, so you, the question you asked me was, what's the relevance of TSH? TSH just really acts as a good marker to tell us, is the thyroid gland working well? Is it responding well to the signals? And that's more of my defense of the, the view that a low-carb diet does not hurt the thyroid gland, because TSH levels are always normal. I know of not even a single line of evidence to suggest TSH goes up or down. It just stays normal. And that, to me, suggests the thyroid gland is fine. Because if the thyroid gland weren't normal, in other words, if it were damaged, as, as the hypothesis goes, or the claim goes, then TSH would be high. It's not high.
You mentioned, uh, iodine a couple weeks ago. You talked about the importance of mixing in some iodized salt to make sure you're getting enough iodine, right?
Yeah, and that's why, that's why thyroid hormone is so essential to overall human health. But it is, it is absolutely, it is catastrophic in a fetus or a newborn. Where, in an adult who's fully formed, and our neurological system is fully formed, the reduction, a deficiency in thyroid hormone is going to be very bad. And, um, but, but it's not catastrophic, and it is reversible. The weight gain, the lethargy, all those things are reversible. But if it's a newborn or a fetus, if a baby, if a fetus, first of all, if a woman doesn't have enough thyroid hormone, she very likely won't even be able to get pregnant. Thyroid is so essential to fertility that it's part of the cocktail in the woman's body that must be in place, that must be properly mixed in order to even be fertile in the first place. But if she has enough to get pregnant, and then let's say something happens to her thyroid gland during the course of the pregnancy, first of all, the body, it may be a miscarriage. But if she is able to carry that baby full term, the baby, it is catastrophic. The baby will have severe neurological and physical, um, delays. Uh, and, and so it is catastrophic. Even in the newborn, if the baby develops in a normal thyroid mom, or a euthyroid mom, but the baby's thyroid gland isn't working well, you, you, if you catch it early enough, then it's fine. You just start supplementing with thyroid hormone. But if you don't, then there will be irreversible consequences.
So I'm getting off on a tangent, which I do so often, and I'm glad that the audience allows me. They can, they can, um, tolerate these little tangents. But, but thyroid, Jack, to your question and point, um, iodine. I am very, very, um, I'm a big advocate of iodine, especially in kids. And, and that can come from seafood very readily. But in the absence of seafood, then I do think you need to make sure you are getting some iodine from some source. And especially if this is a very clean home, and by that, I mean the food is very clean, there's not a lot of packaged food that would have iodinated salt, iodine, or iodinated salt in it already, which it very often would. I'm not encouraging you to let your kids eat crackers just to get the iodine. No, but you may do what I've done, which is have a little iodine, little dropper for the kids, or just make sure whatever you're getting, um, has iodine in it. Because, or even something as benign or as obvious as the salt that's coming out. Iodine is essential to thyroid production, and thyroid production is essential to everything, but especially brain health.
Yeah, from Instagram, my thyroid function dropped around the same time I was doing ketogenic eating for two years, and now I have multi-nodular goiter.
I don't think that would have anything to do with the carbs. And again, I only ever make that kind of statement because one, there's no paper to suggest it, and two, I can't think of the cell biological mechanism that would connect those two. So the first part of that statement, I can only assume that this individual really did have confirmed thyroid problems, and it wasn't a matter of of speculating that there were thyroid problems. And that's a delicate thing to say, and I don't mean for it to be indelicate. But assuming that there was, in fact, confirmed thyroid problems, um, how that then would lead into a multi-nodular goiter, I, I don't know. That would, to my, to my knowledge, that would have nothing to do with carbohydrate consumption in any way.
Okay, so multi-nodular goiters, guys, that's like a person has little, it's not one whole goiter, it's like there's one little section here that's growing, there's one little section here that's growing. And that's just typically cancer.
From Jerry, is a carnivore diet too low carb for people with Hashimoto's?
I don't, I don't think so. I mean, that's definitely as low-carb as you can get. And I don't know of any evidence to suggest to be a problem. Okay. But there's just no evidence on that. Such a specific question. So there's no evidence I can cite, um, as a scientist, and I can't think of any biological mechanism that would suggest it would be an issue. Okay. And in fact, I'd just be curious to see what he's experiencing, to be honest. Yeah. If he's already doing it. Anecdotally, we say this all the time, but anecdotally, carnivore seems to really help people with autoimmune disorders. So the less carbs, the better your autoimmune issues seem to be. Yep. And I think that's reflective of what I said earlier, where when you're eating a carbohydrate diet, you have really distilled nutrition to its absolute simplest, where the variety, which is maybe someone would say that's a good thing or a bad thing, the variety of the diet is very narrow. And I know of no one, I know of people who kind of pretend, but I don't believe it's possible to have a, I shouldn't say that. I would say it's exceptionally rare to someone have to have an allergic type response or an immune response to to meat, something as evolutionarily vital to a human as meat. But when you go carnivore, you start cutting out, um, so many of those primary autoimmune triggers, things like grains and, and dairy, and in some people, eggs, I guess, which that would be a problem with some carnivores. But typically, at least to my knowledge, those are the big autoimmune triggers. And in many instances, you end up cutting those, even though you're not cutting them, it's inadvertent that you just end up removing what's pulling the autoimmune trigger.
From Mary Jo, I'm not hypo nor hyper thyroid, but I do have six thyroid nodules that have shrunk two years in a row after eating low carb, high fat. Do you think the cause is weight loss or lessening insulin? The endocrinologist doesn't know.
Well, how interesting. First of all, I'm very happy for the person that they're shrinking. That's wonderful. Um, I would be very curious to see what had been happening to TSH over the same period of time. In fact, I'd ask her to, you know, share that in the comment. Let us know what happened to your TSH. I, I suspect it had gone down, because TSH is such a stimulator of the thyroid gland. The role that insulin plays in promoting, um, a thyroid, um, tumor or a node, uh, I, I don't know. It's, it's tempting to speculate that insulin plays a role, in so far as there are other benign tumors, like of the breast or the prostate, that do become enriched with insulin receptors. It's part of the mutation. And so it's, it is possible that, uh, that the reduction in insulin would help shrink those, because you're just losing that, that growth stimulus that insulin would be providing. But I, I can't really speculate anything beyond that.
Thank you, Rich. Carly, Ben, thank you all. That was awesome. What a great discussion today. I think my head's gonna explode.
I know. Well, hopefully, I mean, to the original point, I do hope that some of our discussion has given some calm and clarity to people that were worried about thyroid, because there's so much myth and misunderstanding when it comes to thyroid hormone and low carb. And it really is just myth. There's no evidence to support the idea that a low-carb diet is going to hurt your thyroid.
Yeah, thank you, Ben, for, what a wonderful episode. And we encourage all of you, if you just don't know much about Insulin IQ or Dr. Bickman, go to InsulinIQ.com. In our navigation, there's a little tab that says About Dr. Bickman. You can learn more about his book, Why We Get Sick. I know many of you have already read his book, but it's amazing. And, hey, the German translation comes out in two weeks. I think. How many languages now is that in, Ben?
Uh, no, no. In fact, I think I actually took a little list. It's German, Korean, Greek, Chinese, Polish, Spanish, Hebrew, Arabic, and Russian.
Awesome. Has to be Russian, or I can't, I couldn't be happier for anyone who speaks Russian. Um, hey, Jack, Ben also has a great article on Health Code.com that everybody should read. It's really, get healthy. Get Health done. Get Health. Yeah. Yeah. For those of you don't know, Ben co-founded a little company called Get Health. It's G-E-T H-L-T-H dot Get, GetHealth.com. He does some great blog posts there as well. So yeah.
Which one are you referring to specifically, Rich? It just goes through the long, short, and medium chain fats and why saturated fat is so beneficial to us, right? Really well written.
Yeah, be sure to check it out. If you're following Ben on Instagram, and you go to his profile, there's a link there to Get Health as well. So thank you, everyone. And thank you to all of our fans and followers for being part of the stream today. And we'll see you next week on Insulin IQ Live. So long.