Questions on Tests and Thyroid hormones

[Goose]

Hi all, I began have a variety of health issues a year ago (fatigue, vision, balance problems... that have persisted over a long period of time) and have seen a bunch of different doctors to no real resolution. Also started a Paleo/LC diet about 9-10 months ago and have been pretty low carb and in and out of ketosis. As I have been looking into a bunch of information and found danny roddy (I also am having hair loss issues ) and ray peat and had some further thyroid tests that indicate some hypothyroidism. Here are some details from blood work I had done:

TSH 1.25 mIU/L (0.27 - 4.2 Reference Range)
FREE THYROXINE 12.4 pmol/l (12.0 - 22.0)
FREE T3 2.7 pmol/L (3.1 - 6.8)
Thyroid peroxidase antibodies 8.4 IU/ml 0 - 34

TRIGLYCERIDES 79.71656 mg/dl (< 203)
CHOLESTEROL 270 mg/dl (Optimum < 193)
HDL CHOLESTEROL 69 mg/dl (35 - 58)
HDL % of total 26 % (20 and over)
LDL CHOLESTEROL 186 mg/dl (Up to 116)
C Reactive protein <0.6 mg/L (<5.0)

So, my FT3 is low and cholesterol is high. I have been keeping my temperature and pulse average around 36.3 C/97.3 F and 55-60 bpm. I went to a endocrinologist who didn't think anything was wrong and recommended exercise... However, given my research in Ray Peat and his articles I do think this is one aspect to my syndrome. My question for the community is what other tests do you think would be warranted? I have seen a bunch of recommendations but I have to pay for these out of pocket so I want to avoid 50 tests that would cost me quite a lot of money. Is Reverse t3, parathyroid and prolactin enough? Others? Do the indication above indicate that a thyroid supplement is warranted? Just t3 or a combo as my t4 is on the lower end as well?

Note I focused more on carbs in the last month, and have been incorporating much more cheese and fruits that I was earlier. I do think my energy has come back a bit but still not where I want to be. I dont think I was doing myself any favors with the LC diet, but still staying away from grains and generally eating real foods, just more fruit and dairy as well as veg, eggs and meat.

 

[Katty]

Hi Goose!
I'm not as well versed on some of the testing, so maybe someone else will chime in. But you might already have enough info to work with. You know some of your thyroid numbers are low. And you know your temp and pulse are low. I know Danny Roddy has recommended getting more tests, but I think you could first work on trying to increase your temp and pulse and see how that goes. You probably want to work a little more with diet/lifestyle changes before jumping in with taking thyroid meds. The meds don't always work right unless you're properly nourished. But I'm sure others will chime in if they think thyroid meds could help right away... depending on some of the info I ask below, you may benefit from using some.

If you can provide us with some more info about your diet that could be helpful. Do you track your calories? Do you track macronutrient grams (proteins, carbs, fats)? If you can tell us your gender and age and how many calories you are eating that could be a good place to start. Coming from low carb you might have to go slow when adding carbs back in. Maybe determine a certain number of grams you want to add in and increase every couple days or every week, etc. I can't really give you an exact number to aim for-- maybe if you give us your current daily carb intake in grams, your calories, your activity level, etc, etc, then forum members can give you an idea of how to tweak.
Also, the ratio of protein to fat to carbs can be important-- but the ratio that is optimal will vary for each person. I've heard a general starting point on the ratio is 50/25/25 of carbs/protein/fat. But again, you don't have to jump in with that ratio immediately-- if your carbs are super low still you might want to slowly titrate up.

Sleep is also important. I'm sure if you've been fatigued you already know a lot of this, but don't push yourself too hard with physical activity if you're exhausted and not feeling well.

Also, was there any particular life event that seemed to spark the fatigue and other problems? If there is an ongoing stress situation, is there a way for you to work on defuse the situation/stress (such as meditation, taking walks, stretching a bit each day, talking to therapist, taking mini-vacation, etc). I'm not saying meditating (or whatever technique you choose) is going to completely solve anyone's issues - but finding a way to de-stress can be a piece of the puzzle.

 

[Goose]

Hi Katty, Thanks for the quick reply! To answer a few of your questions, I am a 35yo male and the health problems stemmed from a few factors. I had a stressful period that combined with some exposure to environmental toxins in a new home (I have since moved from) caused me to go into a pretty bad state healthwise. I looked for a lot of different approaches to get my health back, one of which was moving to a Mark Sisson style Primal diet a few months afterwards (about 8 mos ago) and I generally eat pretty good - although much less on the carbs and more on the veg than Ray Peat would endorse. I would get marginally better and then relapse and I think the low carb thing was hindering me. So a few weeks ago I shifted to the Peat school of thought and introduced fruit which was virtually excluded from my diet (too high in carbs). Honestly, before I got this illness (which multiple neroligists and other doctors cannot agree on what it is) I had no idea 1) how poor the standard american diet was and 2) how many conflicting/contradicting points of view there are on what the "right" diet is - Peat, Paleo, Veg/Vegan, Low Fat, High Fat, Low Carb, VLC/Ketogenic, etc. I consider myself pretty educated now but there is still so many contradicting viewpoints its all a bit much.

So I am shifting more Peat at the moment as it makes sense to me. I feel like I have the typical hypothyroid symptoms. I am much less pro-drug than I was pre-illness (I am all for using diet to fix this) but outside of adding some carbs dont see a huge difference in the diet to where I am now. I was about 10%-30% carbs before (around 30-75 grams of carbs a day) but havent really tracked since adding more carbs through fruit. Also I probably consume more meat and the wrong kinds (pork, chicken, high in PUFA) than Ray would suggest. Trying to shift to leaner cuts of ruminant meat.

Sleep and stress. I have too little and too much. However, I am working on it and have gotten better. I was on amitriptyline (low dosage 20 mg at night) for a while to address some of the which helped the sleep but really didnt help anything else and made the fatigue worse. Definitely has looked into other stress reduction techniques and have tried metitation and think it could help but really find it difficult to keep up with. In short I realise this is part of the puzzle and need to work on it.

As for activity level I have been able to increase it a bit over the last months. I was pretty much doing nothing for a few months and had to take a leave from work. But have been able to build up over the last months and do a lot of walking and lift about 1 or 2 days a week. Light running and yoga as well, but still havent been able to get to my prior level energy wise, and also have relapses into bad days and recurrences of other symptoms like blurry vission, balance issues and other more annoying things like cramps, constipation, etc.

Havent really gotten much help from doctors outside exclusion of bad things like MS.

 

[Katty]

Hi Katty, Thanks for the quick reply! To answer a few of your questions, I am a 35yo male and the health problems stemmed from a few factors. I had a stressful period that combined with some exposure to environmental toxins in a new home (I have since moved from) caused me to go into a pretty bad state healthwise. I looked for a lot of different approaches to get my health back, one of which was moving to a Mark Sisson style Primal diet a few months afterwards (about 8 mos ago) and I generally eat pretty good - although much less on the carbs and more on the veg than Ray Peat would endorse. I would get marginally better and then relapse and I think the low carb thing was hindering me. So a few weeks ago I shifted to the Peat school of thought and introduced fruit which was virtually excluded from my diet (too high in carbs). Honestly, before I got this illness (which multiple neroligists and other doctors cannot agree on what it is) I had no idea 1) how poor the standard american diet was and 2) how many conflicting/contradicting points of view there are on what the "right" diet is - Peat, Paleo, Veg/Vegan, Low Fat, High Fat, Low Carb, VLC/Ketogenic, etc. I consider myself pretty educated now but there is still so many contradicting viewpoints its all a bit much.

So I am shifting more Peat at the moment as it makes sense to me. I feel like I have the typical hypothyroid symptoms. I am much less pro-drug than I was pre-illness (I am all for using diet to fix this) but outside of adding some carbs dont see a huge difference in the diet to where I am now. I was about 10%-30% carbs before (around 30-75 grams of carbs a day) but havent really tracked since adding more carbs through fruit. Also I probably consume more meat and the wrong kinds (pork, chicken, high in PUFA) than Ray would suggest. Trying to shift to leaner cuts of ruminant meat.

Sleep and stress. I have too little and too much. However, I am working on it and have gotten better. I was on amitriptyline (low dosage 20 mg at night) for a while to address some of the which helped the sleep but really didnt help anything else and made the fatigue worse. Definitely has looked into other stress reduction techniques and have tried metitation and think it could help but really find it difficult to keep up with. In short I realise this is part of the puzzle and need to work on it.

As for activity level I have been able to increase it a bit over the last months. I was pretty much doing nothing for a few months and had to take a leave from work. But have been able to build up over the last months and do a lot of walking and lift about 1 or 2 days a week. Light running and yoga as well, but still havent been able to get to my prior level energy wise, and also have relapses into bad days and recurrences of other symptoms like blurry vission, balance issues and other more annoying things like cramps, constipation, etc.

Havent really gotten much help from doctors outside exclusion of bad things like MS.

Thanks for all the info!

You might already know this, but you need glucose to convert T4 to T3. If you're not getting enough carbs, you can become hypothyroid. Also under-eating can lower T3 levels, so you want to eat enough food as well.

I just plugged in some numbers to guesstimate how many calories you were eating, based on your info that 75 grams of carbs was 30% of your diet. Just to plug in some figures, I used a steak, which was 75grams of protein and about 30g of fat. (If you plug those numbers into cronometer or any calorie tracking program you'll see how I got these numbers to make 75g of carbs 30% of your diet). With these numbers, you're only eating a total of about 1,000 calories per day. That's crazy low for any adult, let alone a 35 year old male. Of course, if carbs are as low as 10%, then your calories start to look a bit more normal- Eating steak, you can get in 12% of calories from carbs (at your high end estimate of 75g) and still get up to 2400 calories in. That might be enough, but it's possible as a 35 year old male you need closer to 3000 calories. Of course, eating 2400 calories is a high estimate if you're eating a fatty steak. If you eat low fat fish like sole, then 75g of carbs would be about 13% and your total calories would be about 2100. Still likely a bit low for you.

In any event, 75g of carbs is way too low. You said you started adding in fruit and more carbs. I think it would be a good idea to start tracking carbs and try to get closer to 50-55%. I can't speak for all the males on the forum and how many grams of carbs they are eating, but from what I've read, It's often somewhere between 300-500g of carbs per day (possibly more if you're super active). You don't have to jump up that high on one day, but you should work up to it- I would think at least 250-300g of carbs is a good starting point for you to try to reach. If you have digestion problems from being so low carb, things like sugar syrup are probably going to be easier to digest than really fibrous fruit. Cooked fruit would be easier than raw. But if you're doing ok with raw fruit, keep it up and add in more.

The other thing you might want to consider is changing types of protein. How do you do with dairy? Though certainly Peat is concerned about PUFA consumption (in chicken, etc)... but also worried about phosphate to calcium ratio. Seems you've been doing lots of muscle meat for a long time- so you might want to increase calcium, either with dairy or start taking some egg shell calcium.
Also, do you eat gelatin? It's a good way to get some protein in and cut down on all the muscle meat.

If you're really feeling awful, you might want to cut down on the lifting sessions and running. They'll only add to your body's stress levels, especially if you're under fueling.

There could be some other tweaks. If you track your food in cronometer you can get an idea of certain vitamins or minerals you might need to pump up in your diet. However, I think your first concern should be eating enough calories and carbs. Then you can worry about tweaking some of the details.