It is unfortunate that Dr Jack Kruse had to miss the cruise due to a twitter incident, but he published his intended keynote in his blog (http://jackkruse.com/ct-12-getting-back-on-board-with-my-message/). It would be extremely interesting to see Dr Kruse's program adopted by the broad low-carb community and especially in the TYP program.
Dr Davis, would you recommend Dr Kruse's Leptin Rx and cold adaptation program to your patients? Was it in any way discussed on the cruise in the absence of Dr Kruse?

Did you give Jimmy Moore any tips on his inability to stop gaining weight no matter how low carb he goes? It is just frightening to think that this can happen to even the most staunch and informed low carber.

Hi Doc,

Just heard the tail end of a story on the BBC this morning where a researcher from Oxford Univ. was recommending that everyone in the U.K. over the age of 50 be put on a statin as a prophylactic measure - arguing that based on all relevant research, the rewards dramatically outweighed the risks.  Any thoughts?

"Good" HDL cholesterol may not protect heart after all, study suggests:
http://www.cbsnews.com/8301-504763_162-57436495-10391704/good-hdl-cholesterol-may-not-protect-heart-after-all-study-suggests/


Doubt Cast on the ‘Good’ in ‘Good Cholesterol’:
http://www.nytimes.com/2012/05/17/health/research/hdl-good-cholesterol-found-not-to-cut-heart-risk.html

This recipe is a filling and nutricious breakfast and you would never know you are eating low carb.

Pam's Veggie Skillet Breakfast for Two

1 Bunch of Asperagarus cut into 1-2 inch pieces
1 Large red, green or yellow pepper or 3-4 small peppers diced into 1 inch pieces
1 bunch green onions thinly sliced
2 cloves garlic
3 small partially cooked and diced red potatoes (or leave out if you have a very restricted carb intake or add more if you can tolerate more carbs)
1 TBL apple cider vinegar
3-6 eggs
1 TBL Grape Seed Oil
1TBL Olive Oil
Sea Salt and Pepper

Saute all the vegetales in a 12 inch skillet for three to five minutes with the Grape Seed Oil.  Add sea salt and pepper.  Do not over cook the veggies as they will continue to steam witth the eggs.  Add 3 to 6 eggs to the top of the vegetable bed being carefull not to break the yolk.  The trick is to gently lay the egg on top of the vegetables.  Cover the pan and let the veggies and eggs steam together until the eggs are done to your liking.  This is usually about three to five minutes for a softer egg that mixes well into the vegetable bed.  

Serve on plates and add more salt and pepper.  Sprinkle with the apple cider vinegar and olive oil.

Hi,

I have a quick question about your blog, do you think you could email me?

Jillian

Sounds yummy, though I'd replace the grapeseed oil with coconut oil.  

A cup of grapeseed oil has 218 mg Omega-3 fatty acids and 151708 mg Omega-6, so is a pretty bad oil to use if you value your heart health.  Most of your veggie oils are this way, WAY too much omega 6 for heart health.

I'd insist on pastured eggs (for nutrition) and freshly ground black pepper (for taste).  

Also, this sort of thing, you don't need a recipe, this much of that veggie, this much of the other.  Basically, just whatever you have leftover in your fridge is good.  I'd need an allium of some sort (onion, shallot, scallion), but otherwise... chop and throw into a skillet whatever you've got hanging about or leftover.

The big trick with fresh produce is using it up before it goes bad, and this is a great recipe to use stuff up with.

I don't know enough modern biochemistry to follow the logic of the letpin reset and haven't researched the cold stuff enough to have formed an opinion yet.

But about HIM - Google for his TED talk, where he claims to have gained 20 lbs on purpose, gone for plastic surgery to remove it, and injected himself with MRSA prior to the surgery, but it was all OK cause he soaked in a tub of ice water for hours afterwards.  

There may be something to his ideas, but... his behavior at that talk did not elicit respect for his ideas.

Thanks for posting, Pam!

On the other hand:

Low levels of HDL cholesterol lead to an increased death rate
This study was published in the Journal of Lipid Research 2012 Feb;53(2):266-72

Study title and author:
Fifty-three year follow-up of coronary heart disease versus HDL2 and other lipoproteins in Gofman's Livermore Cohort.
Williams PT.
Lawrence Berkeley Laboratory, Berkeley, CA 94720, USA. ptwilliams@lbl.gov

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/22128321

This study assessed the relationship of high density lipoprotein (HDL) cholesterol levels with total death rates and heart disease death rates. The study lasted for 53 years and included 1,905 men.

HDL cholesterol is made of HDL 2 and HDL 3. HDL 2 is larger than HDL 3.

After analysing 53 years of data the study found:
(a) Those with the lowest HDL 2 cholesterol had a 22% increase in total death rates.
(b) Those with the lowest HDL 2 cholesterol had a 63% increase in total heart disease death rates.
(c) Those with the lowest HDL 2 cholesterol had a 117% increase in premature heart disease death rates.
(d) Those with the lowest HDL 3 cholesterol had a 28% increase in total heart disease death rates.
(e) Those with the lowest HDL 3 cholesterol had a 71% increase in premature heart disease death rates.

The results of the study show that low levels of HDL cholesterol, especially HDL 2 cholesterol, are associated with higher total death rates and higher death rates from heart disease.

The best dietary way to raise HDL cholesterol levels is to eat a diet high in saturated fat. See here.

since i don't see ferritin, iron stores, or transferrin in your index, i'm going to assume you don't buy into the hypothesis that high iron stores in men can lead to CVD.  please correct me if i'm wrong.

My focus is strictly on his ideas and how they change lives of other people when they follow his example and advice. While some people may see his behavior negatively, I respect him for taking time to reply to every single comment to his blog posts, of which he receives many hundred per post.
I don't have a background to reason about Dr Kruse's conclusions and recommendations, but given that they are mostly consistent with the recommendations of other unorthodox doctors such as Dr Davis and Dr Eades who I trust, and go further extending those recommendations, and given that I have been following these recommendations with good consistent results, I don't need to worry about Dr Kruses's behavior when he has to deal with detractors.

I don't care about his detractors particularly either; I'm not a member of the Paleo community and haven't been a member of the low-carb community for some time, so have no horse in this race.

However, his behavior in that video is pretty irrational; I don't need a detractor to tell me this; my own judgment is that messing with MRSA is just flatout STUPID.

Dr. Davis and both of the Dr. Eades differ from Dr. Kruse in that they haven't behaved like stark raving lunatics.  I don't agree with everything they say, but respect them and have learned a lot from them, and from other sources as well.

I've read Dr. Kruse's ideas, and as I said, I've not researched them.  They may well be valid as I haven't spent the time on PubMed to figure it out.  Similarly, I haven't researched the ideas of the folks who hang out at the Philly Amtrak station talking to invisible people.

I can't spend my life researching, as I have to eat, sleep, exercise, talk to my husband, pet my cats, work in my garden, go to the Farmer's Market, etc.  So there must be some method of determining what to look into in depth and what to ignore; watching Dr. Kruse deliver his TED talk limited my interest in further researching his ideas.

If his ideas ARE valid, his behavior is not earning them a hearing from me.

How about acupuncture and chinese medicine? Anecdotally, they will be able to help you through monitored use of chinese herbs and acupuncture.

I'd also like to add that if one can't get good thyroid care inside an HMO network or "universal" healthcare system, it can be money well spent to go "outside" the system  for private care.  Granted, paying for non-reimbursable care isn't cheap and one has to do a lot of investigating to make sure one isn't paying for more of the same inadequate care (or worse care).  But I think too many people who can afford to pay for private care suffer needlessly by doggedly sticking to inadequate care because alternatives cause a financial dent.  But in the long run, if one can find good care even though there is added expense, it can save a tremendous amount of suffering, as well as saving money.

When I was seeing a thyroid doc out of my HMO network, I was still able to get my lab work done by the HMO approved lab  and covered by my HMO insurance (the lab faxed the results to the out-of state doc without question), though the results did go into the computerized file at my HMO network, so was visible to any HMO doc.  And my HMO insurance Rx plan covered the conventional meds prescribed by the out-of-network doc without question (but not the compounded Rx).  Yes, it cost me a few hundred dollars a year to see the doc once year, a few telephone consults, and the non-covered compounded Rx, but it well worth it.  I was finally feeling and functioning better.

And when I went back to my HMO eventually (mostly because of travel scheduling difficulties in seeing the out-of-state doc), I was in a better position to make a case for similar care with the HMO endo (I told him flat out I'd had trouble getting good thyroid care from primary care physicians in the HMO and so went "private" for a couple years, but wanted to find someone local in the HMO for convenience) .  He doesn't do compounded Rx, and typically prescribes only Synthroid, but he accepted that I prefered T3 with the T4 (and he "accepted" the "odd" way I adjust my T4 dose with different amounts of 50 mcg Levoxyl on different days to get an overall weekly dose that works - the 50 mcg tablet has no dyes added and he accepted that I preferred Levoxyl over Synthroid).  So for the first time with the HMO system, I feel my thyroid care is more of a team effort that includes my input, instead of being at the mercy of whatever is dished out to me.  And if the situation changes, I will promptly go outside the HMO again.

I would also suggest using the Armour site to look for prescriber's.  Their site has a little 'doctor finder' feature.

It doesn't mean they'll necessarily treat you, but they tend to be more open-minded that doctors who prescribe Synthroid only.

Most doctors won't use body temperature as a guide, by the way. And most won't treat Hashimoto's unless your TSH is >5. I know it's wrong, but that's how it is.

Supplementing iodine may be helpful, unless you do have Hashimoto's, then it could make it worse (so you know). But you won't know you have Hashimoto's until you get your thyroid antibodies tested.

A couple of other suggestions:

Ask your doctor for Free T3/T4 AND thyroid antibodies. If your TSH >3 and your anitbodies are high, it really improves your odds of getting treatment. Many doctors ignore antibodies, but some do pay attention to them.

If your TSH or antibodies are high at all, ask your doctor for a thyroid ultrasound. If the ultrasound is abnormal at all, it improves your odds of getting treatment too.

Just going to a doctor with a TSH of 1.5-2.0 and normal T3/T4, it'd probably be close to impossible to get treatment. It really helps if you have the antibodies or ultrasound or something else to show the doctor.

No person should break the law.

However, there might be people within the arctic circle who don't have easy access to a physician who is willing to prescribe natural thyroid, including armour thyroid.

What to do in a situation like that?

One solution:  Find a site on the internet that provides for ordering and shipping thyroid, including Armour Thyroid, without a prescription.  There is at least one site that can be found via google that will do this.

Warning:  There are significant dangers in supplementing thyroid without being under a doctors care.

Thanks, Anna.

Regarding the thyroid issues Dr. Davis has been commenting on lately, and wondering why it seems so prevalent, have you considered the possibility that diet is playing a role.

And when I say diet, it's probably not in the way you think --

Carbohydrate restriction can lower thyroid hormone output, especially conversion of T4 to T3. Those who practice caloric restriction tend to have lower levels of T3 too.

If Dr. Davis is seeing somewhat low, but still in 'normal' range T3/T4, with perhaps sluggish T3 levels, in patients AFTER they change to a no wheat, low carb diet, perhaps that is the reason why? Or perhaps that's why Dr. Davis' own thyroid had somewhat sluggish numbers?

But if people all have high thyroid antibodies too, or all have crummy thyroid levels while eating tons of carbs, that wouldn't be a reason then.

Just throwing that out there to think about.

for those who are willing to do the research and check their tsh levels then ordering online is an option. start with a low dose 15 to 30 grains and then ck your tsh. Increase dose to normnal tsh levels.  There are multiple sites for armour and synthoid that do not require a prescription. When you take this road to self medication you must realize you are toally responsible for your actions and well being. Be sure you know what you are doing
Don

Lately I've been giving a lot of thought to the LC packaged foods that many people turn to when they first embark on a LC diet, such as low carb breads, crackers, etc.  For me, it was LC pita bread a few years ago, before I essentially went grain-free.  These products, in addition to usually having a lot of soy in them, also have added wheat gluten, to reduce the starch and boost the protein content.  Low carb they are, and generally will help with the BG control and overall weight reduction or maintenance.

Both gluten-containing and soy foods are relatively new foods to the human diet (only consumed since the age of agriculture) and modern industrial processing bypasses many of the steps that earlier humans took to render them safer to consume.  Soy can be a powerful thyroid inhibitor (goitrogen)  and gluten can trigger an auto-immune response in susceptible people (genetic predisposition to gluten sensitivity is much more common than previously thought, though how widespread is subject to debate).  There does seem to be a strong connection to autoimmune thyroid conditions and issues with gluten.

So people who eat a lot of soy and gluten-enhanced LC foods might be literally be shooting themselves in the thyroid, especially those who overconsume  consume them (dieters don't ever become overzealous, do they?  ), instead of foods that are naturally low carb and/or have a longer history in the human diet.

I think ordering prescription medication over the internet from a less than reputable pharmacy, without a prescription, is a real bad idea. And if they don't require a prescription, that pretty much automatically makes them less than reputable.

And don't assume thyroid medications are completely benign. They can have side effects too.
And especially in patients with heart disease. You have to be titrated slowly and need to be under a doctor's care.

DIY Armour/NTH treatments can be troublesome. If you are suffering from adrenal fatigue, starting immediately on thyroid replacement can cause heart palpitations and other symptoms of physical and mental anxiety. If you have low cortisol and DHEA (they invariably go together), you will probably need to take a low-dose steroid and/or DHEA replacement for a month before beginning thyroid. It is best to get these things tested first, even if you have to do it on your own. I think the Stop The Thyroid Madness author has put together some lab test packages for people to get the right things tested. And when you're taking the replacement steroids and hormones, you need to keep monitoring your levels every month at first, then every three-four months once you stabilise.

Google for the "Top Thyroid Docs" list by Mary Shomon for sympathetic doctor suggestions/review.

I forgot to add, the thyroid books by Dr Broda Barnes are good reading, easy to understand if you're a layman too. He had one on incidence of heart disease in patients with corrected thyroid function which is very interesting. I don't recall he mentioned wheat, but he certainly believed that we should eat good old saturated fats like butter, lard, coconut, etc, to support good health and thyroid.

Anecdotally along with the iodine I've heard a brazil nut per day suggested for the selenium. Where I live is not selenium deficient, thanks to the end of the Ice Age glaciation: this is reputed to be one reason for the longevity here. Next time I catch a doctor I'll ask if there's much thyroid disease here (they will diagnose and treat here, my TSH was 0.99 so something is working!)

That iodine dose may still be too low. Remember the RDA was set at a level just to prevent goiter, not for optimal health. Check out www.breastcancerchoices.org.
Healthy Japanese get 12.5mg (12500 mcg) of iodine per day. Probably we are all low in iodine and bromine competes for binding sites. Bromine is ubiquitous in our chemically laden environment and is used as a dough conditioner by commercial bakeries---they used to use iodine. The thyroid gets the bulk of our low iodine but it turns out that iodine is also concentrated in our gonads, adrenals and especially the breasts. Our epidemic of breast cancer and fibrocystic disease may be due to iodine deficiency.

If you cannot get this treatment on HMO, then you should look at going private. Believe me, it is not something that you can ignore

Dr. Davis,

I realize that you aren't in the business of diagnosing ailments or conditions via the internet, but I've recently experienced some hypothyroidism symptoms (low body temp. average of 96.7, fatigue, weight gain, hair loss, etc..) that my Doctor insists are unrelated to the disease.  In addition, he has also just put me on a combination of Crestor and Trilipix for an abnormally high triglyceride reading, despite this reading being a one-time fluke.

My labs are as follows:
TSH:       2.761
Thyroxine (T4): 6.4

He was not interested in doing any more thyroid testing beyond these two.

Lipids:
Total Cholesterol: 165
Triglycerides:     415
HDL:               22
LDL:               N/A

After a week on the Crestor (10mg) / Trilipx (135mg) combo, I was stricken with muscle aches and pains, tinnitus, popping ears, dizziness and a foggy out-of-it feeling.  After two weeks and finding your site, I discontinued the use of the two cholesterol medications against the Doctor's advice.  I've since starting taking an Omega 3-6-9 supplement three times daily along with my daily multi-vitamin.  I also take diazide/HCTZ for slightly elevated BP (130/96) and have recently begun following a strick low-carb diet and exercise routine.

Again, I don't expect a diagnosis from you, but would appreciate if if you could voice your thoughts on the viability of me continuing to find a doctor willing to be more open minded to thyroid issues as well as pursuing more natural remedies to lipid issues.  

Thanks for providing such a valuable resource for those of us who are getting fed up with the flawed standard of care that is currently being forced on so many people.



My labs show the following.

I agree on the iodine dose question.

The difficulty comes in trying to generate conversation through the blog for people who may or may not, for instance, have underlying Hashimoto's thyroiditis or thyroid nodules, in which case taking higher doses of iodine can trigger extreme excesses of thyroid hormone.

I had been on Sythyroid for a few years but no one had ever mentioned or tested for Hashimoto's. Still feeling horrible, I found a holistic MD, and was diagnosed with Hashimoto's and started on Armour.
Do I still have Hashimoto's or is it quiet now that I am taking a different hormone?
The holistic said it would "kill" my thyroid and move on to another area, like adrenals.
I did have a positive ANA for many years and tested for Lupus, RA, etc. many times. Then routine testing showed my ANA had returned to normal values.  
Any ideas because my current endo. sure isn't forthcoming with any and doesn't/hasn't tested for antibodies.  He feels I am just hypothyroid.
I appreciate all your information!

To test for Hashimoto's you need your TPO and TGAB antibodies tested. If they are above normal range, you probably have it. The definitive diagnosis is via a biopsy, but without a nodule that isn't usually done. An ultrasound is another diagnostic tool -- if your thyroid looks enlarged, nodular or all lumpy, along with antibodies, it's pretty safe to say you have Hashimoto's.

I have never read, or heard of, Hashimoto's 'attacking' other organs after your thyroid is burnt out. That theory seems a bit out there to me.

Antibodies can fluctuate, and with thyroid hormones usually become lower over time.  Inflammation tends to be reduces with hormones too.

OK I caught one of our GPs yesterday, the selenium in the soil connection appears to be a non-starter. Her experience was that she found hypothyroid "quite often" predominantly in post-menopausal women and with incidence increasing with age. It's impossible to compare numbers with other areas since they actively look for the condition here and don't elsewhere. Also we have a lot of local longevity so more patients with systems wearing out purely through ageing.

I always wonder about something I hear frequently - the issue of "soil mineral depletion".  Not that it isn't possible, but how significant is this and how widespread?  People don't generally eat "locally" produced food anymore; food supplies are distributed from all over the globe now, though agriculture is quite intense in some places, like the Central Valley of California, or cornfield in Iowa.  Wouldn't the shipping of food products all over sort of "average out" the minerals like iodine and selenium?  Or are  all the major agricultural regions of the world growing with depleted soil propped up with little more than NPK replacement?  

I'm actually more into local, seasonal organic food than worldwide food.  LIving near the coast, presumably there is adequate iodine in the soil, but here I am, hypothyroid anyway.  Just wondering...

Hard to tell about the soil mineral depletion thing, there are major regional variations which can show in animal diseases and require supplementation, salt licks etc. as well as human disease clusters. Deficiencies can show before "deficiency diseases"

I trialled several different supplements but none of them made any discernible difference, probably a widely varying diet helps, plus fish, and local farmers who use high levels of organic manure and feed the soil as a whole rather than (increasingly expensive) stuff out of a bag and treat the soil as a sterile growing medium. Grass-fed rather than grain-fed meat, and game, probably helps too in picking up trace elements

The downside of World Trade may be that while you get more trace elements from crops from different regions you are probably also getting more pesticides some of which are banned in the West

I've been doing so great after taking 1 1/2 gr nature-Throid brand of thyroid since october 08 and stopping all statins. Taking the Now D-3 at 5,000 per softgel. Now if I can just get back in the forums again....LOL   Dennis  still no 4th heart attack since 12/04

I wish my family doctor was open to new things. I asked him about Armour thyroid he said that he has hundreds of patients on Synthroid with no problems and I don't want to start a new prescription without my family doctor knowing about it. I'm on 75mcg of Synthroid and would really like to try Armour thyroid...might have to wait until he retires (could be soon) before I see if I can get Armour..

What about supplementation with tyrosine along side the iodine? Tyrosine is a precursor to thyroxine, and there have been a few interesting studies, like this one:

Psychoneuroendocrine effects of combined thyroxine and triiodothyronine versus tyrosine during prolonged Antarctic residence. Sure, the tyrosine may be working indirectly (going into neurotransmitters more than thyroxine) ... but at the end of a day, it seems to reduce TSH by about a third, while raising free T3 by 6%, while improving mood.

Dr. Brownstein (Family physician, holistic doc in Michigan) in his book, "Iodine, Why You need it, Why You can't live without it" makes an interesting case for temporarily increased TSH (5-30mU/L higher) after correcting iodine deficiency.

In addition to just stimulating thyroid hormone production, TSH also increases the production of the iodine transport cells (NIS). Without more NIS available, iodine couldn't enter the cells and be utilized. Therefore, increased TSH makes sense during the initial phase of iodine correction.

As one increases their iodine consumption, they could experience this increase in TSH for as long as several months. As long as the T3 and T4 levels are normal, then the TSH elevation probably isn't a sign of hypothyroidism.

If you haven't yet read this book, it's worth the 2 hours it took me to get through it.