T3 for accelerating weight loss

Supplementation of the thyroid hormone, T3, is an underappreciated means to lose weight.

Thyroid health, in general, is extremely important for weight control, since even subtle low thyroid hormone levels can result in weight gain. The first step in achieving thyroid health is to be sure you are obtaining sufficient iodine. (See Iodine deficiency is real and Healthy people are the most iodine deficient) But, after iodine replacement has been undertaken, the next step is to consider your T3 status.

I've seen T3 ignite weight loss or boost someone out of a weight loss "plateau" many times.

Endocrinologists cringe at this notion of using T3. They claim that you will develop atrial fibrillation (an abnormal heart rhythm) and osteoporosis by doing this. I have yet to see this happen.

Adding T3 revs up metabolic rate at low doses. The idea is to push free T3 hormone levels to the upper limit of normal, but not to the hyperthyroid range. While an occasional person feels a little "hyper" like they've had a pot of coffee, most people just feel energized, clear-headed, and happier. And weight trends down much more readily.

Taking T3 by itself with no effort at weight loss generally yields only a modest weight reduction. However, T3 added to other weight reducing efforts, such as wheat elimination and exercise, accelerates the weight loss effect considerably. 5 lbs lost will likely be more like 8 to 10 lbs lost; 10 lbs lost will likely be more like 15 to 20 lbs, etc.

It's also my suspicion that more and more people are developing a selective impairment of T3, making it all the more important. I believe that you and I are being exposed to something (perchlorates, bisphenol A, perflurooctanoic acid, and others?) that may be impairing the 5'-deiodinase enzyme that converts the T4 thyroid hormone to the active T3. Relative lack of T3 leads to slowed metabolism, weight gain, and depressed mood. While avoiding or removing the toxin impairing 5'-deiodinase would be ideal, until we find out how to do this, taking T3 is a second best.

The tough part: Finding a prescriber for your T3.

Comments (57) -

  • Ellen

    4/24/2010 9:15:07 PM |

    How much would one need to take to achieve this?

  • David

    4/25/2010 3:02:18 AM |

    Mercury interferes with 5'-deiodinase and is often an under-appreciated factor.

  • Myron

    4/25/2010 3:12:56 AM |

    I live in Hawaii where I believe there exists a subtle thyroid or metabolic down regulation as an adaptive compensation for the constant warm ambient temperature.
    Cold adaption is known to enhance metabolism to keep warm.  The body seems to either be in a phase of maintaining body warmth, warming up by enhancing metabolism  [brown fat, shivering] or tending to cool down by down regulating metabolism to be more able to dissipate heat, not overheating.   This concept is supported by the extreme cold sensitivity seen when the temperature drops below 70 degrees F.

  • Jenny

    4/25/2010 1:35:40 PM |

    "The tough part: Finding a prescriber for your T3."

    My doctor refuses to do anything since my TSH level is "normal" despite the additional symptoms I've told her... says I'm being hypochondriac, yet has no problems prescribing statins and other useless and expensive drugs that I don't need..

    So, what does you do if your doc won't prescribe or even test correctly, and other local docs are not accepting any more patients, and it particularly doesn't matter who you go to anyway, as you have no insurance?

  • Valtsu

    4/25/2010 1:40:07 PM |

    Hi Dr. Davis! About iodine:

    What do you think about Ray Peat's comment? ( http://www.thyroid-info.com/articles/ray-peat.htm )

    "Mary Shomon: Do you think the majority of people with hypothyroidism get too much or too little iodine? Should people with hypothyroidism add more iodine, like kelp, seaweeds, etc.?

    Dr. Ray Peat: 30 years ago, it was found that people in the US were getting about ten times more iodine than they needed. In the mountains of Mexico and in the Andes, and in a few other remote places, iodine deficiency still exists. Kelp and other sources of excess iodine can suppress the thyroid, so they definitely shouldn't be used to treat hypothyroidism."

    Strange guy... If I understand what he's writing, he tells that all the PUFA (fish oil also) is toxic, that we shouldn't consume protein containing much tryptophan and cysteine and that high serotonin causes problems... And that fructose isn't bad.

    He keeps telling strange things but usually with very long reference lists... Strange o_O

  • susie1688

    4/25/2010 4:48:44 PM |

    Is there an OTC T3 supplement? Would the product Atomidine work?
    As Always - Thank you!

  • Tonya M

    4/25/2010 5:12:46 PM |

    Dr. Davis,

    Does kelp help boost thyroid?  I would love to find a doctor like you in my neck of the woods.

    Thanks for a great blog,

  • Dr. William Davis

    4/25/2010 5:50:04 PM |

    I remain undecided on what the ideal dose of iodine should be. While I am personally "experimenting" with a 12,500 microgram per day preparation, I generally suggest 500-1000 mcg per day. I suggest kelp because it provides a mixture of iodine forms.

    For T3, the dose depends on your level, sensitivity, and perhaps your level of reverse T3. I usually have people start 10-12.5 mcg per day, since this is how it comes. Alternatively, T3 can be part of an Armour or Naturethroid type preparation, now that they are back on the market.

  • Anonymous

    4/25/2010 9:59:04 PM |

    Concerning the appropriate level of T3 supplementation, my own endocrinologist, Dr. Kenneth Blanchard, has more experience with T3 than almost any other physician I'd imagine (that's one of the reasons I chose him). I'd suggest to Dr. Davis and anyone else interested to read his book if you have not already done so:


    In his book, he suggests what most doctors using T3 would consider a very low dose: approximately 2% of the hypothyroid patient's T4 dose (by contrast, Armour Thyroid contains, I believe, more like 20% T3). Since then, he has concluded from experience with how patients feel that the optimal dose tends be even lower, approximately 1.5% of the T4 dose. But he says it does seem to vary quite a bit from person to person.

    He generally uses compounded, time-release thyroid extract (Armour), or sometimes synthetic T3, formulated to provide the desired T3 dose. He has found most people do better using the extract, presumably because of T2 and/or other compounds present.

    He has a new book coming out soon which will explain his methods in greater detail after treating thousands of hypothyroid patients with combined T4/T3 therapy.

    By the way, I recently started experimenting with seaweed consumption and have been able to reduce my T4 dose by >30%, which is apparently highly unusual. I am now (with the help of a holistic physician) experimenting with pharmaceutical iodine supplements (Iodoral, 12.5 mg per day) to see if further progress can be made. Dr. Guy Abraham and a few other doctors who believe in high dose iodine supplementation often use even higher doses, 50 mg or more, but only with regular lab monitoring, most importantly a 24 hour urine iodine loading test.

  • rhc

    4/25/2010 10:22:26 PM |

    My organic Egg-land's Best Eggs list "iodine" 40% per egg. I was very surprised to see this since most eggs don't mention iodine. I love eggs (unfortunately have no access to free running eggs but switch among the organic ones) and easily eat 2 a day - sometimes more. Do you consider this another good and safe alternative source?

  • Heather

    4/25/2010 10:45:40 PM |

    Is there a list of docs who would be willing to prescribe T3? I think Dr. Blanchard is in my area, but from my understanding, he does not take insurance, so the cost is prohibitive.

  • Ailu

    4/26/2010 1:14:16 AM |

    My hubby is using a OTC dessicated thyroid supplement as a replacement, since his tests are in "normal" range but his body temp is very low (96) and he gains weight easily on the slightest bit of carbs.  So we decided to try it, given all we've heard.  It has really made a difference in him, he has energy when he used to be sluggish, and his weight holds steady when he takes it. Does this have the "T3" you are referring to?

  • Anonymous

    4/26/2010 2:39:24 AM |

    I started 5 micrograms synthetic T3 about a month ago.  My hypo symptoms are slightly better, but I am disappointed. I expected more improvement.

    I was experimenting with iodine drops prior to starting T3. I titrated up from 500 micrograms to 12 milligrams/day over 2 months and then ordered Iodoral. I decided not take it due to the new T3 prescription as I did not want to start 2 new therapies at once. Do you think I should start Iodoral now or wait longer?

    I recently read on STTM [http://www.stopthethyroidmadness.com/ferritin/] that ferretin levels should be greater than 50 for adequate T4 -> T3 conversion. My level was 11 (considered normal by the lab). I am considering an iron supplement for 3 months.

  • Ellen

    4/26/2010 9:22:09 AM |

    Yeah, a friend of mine saw Dr. Blanchard.. did not have much luck with him. He's too conservative.

  • Anonymous

    4/26/2010 2:22:00 PM |

    I have struggled with weight loss since my 20's
    T3 sounds great to aid in  weight loss.
    I would be interested to hear what people think about optimizing thyroid with lower insulin levels.
    since low carb diet=low insulin diet
    How about discussing Metformin for insulin control for a synergistic effect for weight loss. There is some interesting research using this med in non diabetics.

  • Anonymous

    4/26/2010 4:43:17 PM |

    People can check out the doctor finder feature upon Armour's website, if they are seeking a doctor who may prescribe T3.

    Once concern I have regarding supplementing T3 regards longevity, as animal (and some human) studies show lower T3 in the elderly = longer lifespan.

    I'm curious if Is there any longterm longevity data in people who supplement T3 vs those who don't -- excluding those with definite thyroid disease.

  • Anonymous

    4/27/2010 12:48:51 AM |

    There are many websites and forums dedicated to treating reverse T3 hypothyroid syndrome.  The treatment is T3 only.  There are legal ways to obtain T3 without a prescription and self-treat.  I am currently taking 50mcg per day, and I have seen great improvements in hypothyroid symptoms. I did, by the way, try the traditional route first and was told by different doctors that my thyroid levels were all "normal" despite increasing fatigue and low body temperatures.  Now my temperatures are up to 98.6 average and I feel SO much better.

  • Dr. William Davis

    4/27/2010 1:28:54 AM |


    Can you tell us more about how you got the T3 without a prescription?

    (Remember: This is anonymous. I'm not tracking your IP address or anything.)

  • Anonymous

    4/27/2010 2:06:51 AM |

    Dr. Davis-

    I originally found the information about how to treat T3 from two websites that were mentioned in the comments section of Dr. Eades' blog:


    There is a forum affiliated with the second website that you can find at the bottom of the page.  If you join this forum, you can find sources for T3.  There is absolutely no cost to joining the forum, and nothing is asked of you.  The moderators are just regular people who have been through the medical maze and come up with a protocol that works for them.  

    The focus of this forum is not taking T3 for weight loss, but using it to heal a damaged thyroid.  The ultimate goal for many (myself included) is to restore a normal metabolism and come off of T3.

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  • Anonymous

    4/29/2010 5:38:56 PM |

    Can 7-keto help this? I have Hashi's, am iodine sensitive - I can't take a multi-vitamin with iodine because it causes my thyroid to swell. My T3 totals are low (102, 109, etc. in a range of 76-181). I'm having an extremely difficult time losing the 22 pounds I put on since this started 2 years ago. I am on synthroid but my doctor won't prescribe any T3. I've read that 7-keto will help but not increase the T3 out of range. I'm too scared to self-treat!

  • scall0way

    5/1/2010 10:54:36 PM |

    Yeah, finding a prescriber is the hard part. I've talked to a few doctors. Every single one is *totally opposed* to any sort of treatment other than Synthroid and its clones.

  • David M Gordon

    5/5/2010 2:55:02 PM |

    I asked a research pathologist friend about your notions re T3, etc. He replies...

    "Several problems, although superficially it all makes sense.
    1. I likely am incorrect, but T3 is available only as an iv injectable (in UK, Australia). Furthermore, it is short acting, so theoretically you might need more than one injection/day.
    2. T4 (thyroxine) or T3 bind to proteins in blood (99%) and only a small amount (<1%) is the free T3, which is the biologically active hormone. The bound and the free form are in equilibrium with each other. So if you take T3 or T4, it will go and bind to proteins (ie, inactive), and only a small constant amount of free hormone is available for action.
    3. T4 converts to T3 (via deiodination), so why not take the cheaper T4?
    4. T3/T4 therapy might work for a short while, but then your body will become used to it and endogenous hormones will be secreted in lesser amounts, so that the final amount of free hormone available to you will be more or less what you secrete now. This is because of something known as "feedback inhibition", ie high levels of T3/T4 will reduce the secretion of TSH, which will reduce endogenous T3/T4 secretion.
    5. You could, of course, overpower the body's feedback inhibition loop, by taking excess amounts of hormones, but then you will stress your heart etc. There is a theory which says everyone is born with a given number of heart beats (similar to the idea that women have a given number of ova), you can use your quota pretty quickly with excess T3. Reduction of weight will occur, but at a price.
    6. There is a lot of deiodinase in the body, the only time there is not enough is when someone is sick or has liver disease, but its not a consideration for most people.

    So yes, it might prove difficult to find a prescriber..."

    As always, I appreciate your blog and its included insights. Thank you!

  • Dr. William Davis

    5/5/2010 3:14:37 PM |

    Hi, David--

    I think your research pathologist friend should probably stick to researching pathology.

    I take oral T3 as liothyronine, since it was temporarily out of supply as Armour or Naturethroid.

    Perhaps he is relying on a textbook copyrighted 1984.

  • David M Gordon

    5/5/2010 5:26:38 PM |

    Thank you, Dr Davis

    Over the course of a few weeks recently, I read all your posts on this site. You offer a heck of a lot of excellent information. I appreciate that you repeat many topics; e.g., niacin, its attendant flush, and how to deal with it.

    I also appreciate that you are on the leading, but not bleeding, edge on health topics. An example: my doctor  bemoaned the sorry state of my D3 level and I was befuddled: "But I ingest 1500IU/day!" She suggested an endocrinologist... and THEN I read your post re tablet D3 vs gel capsule. I corrected my error immediately, and now I cannot wait to re-test my D3 level.

    Which brings me to my question. After reading all your posts, I find that you do not collate all your recommendations into one post or FAQ. Such an item would be helpful for all your readers. Which specific lab tests should I, or any reader, request?

    And returning to this post, I assume no doctor will prescribe T3 -- without first testing your thyroid levels. Whether high, low, or perfect, what is the appropriate dosage of T3 to achieve the results you indicate?

    Thank you!

  • jpatti

    5/7/2010 6:40:10 AM |

    Anonymous is correct that http://www.thyroid-rt3.com/ is a very good resource.  There is a Yahoo! group associated with that web site for rT3 problems specifically and an associated group for adrenal issues.  

    I have an rT3 problem.  I've done very well on 100 mcg T3 per day and no T4 at all.  This was after getting cortisol sorted out and it took several months to titrate to my current dose.  

    By temperature, bp and pulse, this is an appropriate dose for me.  And yes, I have lost weight on it, without really trying - as when disabled, weight loss is pretty low on the list of priorities.  I lost 17 lbs the first two months, and have no idea since then as I don't have a scale.  

    It's not FOR weight loss.  It certainly helps weight loss, as trying to lose when low on T3 is an uphill battle.  But I don't think it's appropriate to say it's FOR weight loss.  T3 is for treating hypothyroidism... and IMNSHO, no other use is appropriate.

    That being said, I have a much looser definition of hypothyroidism than most doctors.  Most people feel best and achieve normal temperatures with FT3 near or just over the top of the range if on both T3 and T4 as with natural thyroid; those on T3 only tend to do best at quite a bit over the FT3 range (you need more T3 when T4 is totally suppressed as when treating rT3).  

    Where Anonymous is a bit off is the legality of self-treatment.  It's a fuzzy area.

    Self-treatment can be done, as it's legal to import 3 months of medications from an international pharmacy for personal use.  Some of these pharmacies do not require a script, and no one from customs shows up at your house to doublecheck your prescription.  

    But I think it's overstating a bit to say it's entirely legal.  It seems the assumption is you're importing stuff you have a script for; that this isn't enforced and self-treatment is possible doesn't mean it's entirely legal.

    However, it's certainly not near insurmountable if you don't have a good doctor and don't mind bending the law a bit.

    The NTH Yahoo! groups are very good sources of advice for those interested in self-treating.  

    But it is not about just ordering some meds, I seriously doubt a moderator on any of the groups would tell you where to get even an aspirin without asking you for your labwork first.  

    Hormones are serious stuff and while correcting imbalances is definitely necessary to health,  it's not something you do just to drop a few pounds more easily.

  • P. Hentermine

    5/26/2010 5:24:36 PM |

    How about discussing Met forming for insulin control for a synergistic effect for weight loss. There is some interesting research using this med in non diabetics.

  • Anonymous

    6/1/2010 6:50:05 AM |

    That T3 is so easy to get a hold of. Ive been taking it w/o a prescription for years for weight loss. Ive gone up to as much as 125mcg a day for 6 weeks of T3 for weight loss, you loose alot of muscle going that high too. I have foud that ramping off very slowly also allows your normal thyroid level to recover faster too. Always remember to "pyrmid" when using this stuff. It allows your body to adapt to it w/o shock and come off easily with no thyroid damage aswell. You wouldnt wanna be using this stuff for life now would you!

    Here a little example of how i used it during the 6 weeks for weight loss-


    Each margin represents a day. The tabs are dosed at 25mcg each.

    Dr. drugs are so easy to get a hold of now a days, a child could order meth over the internet if he knew how. Why do all you "Dr's" fail to realize that? The internet can teach you anything.

    Here are a list of sites in which you can order T3. YES with out a prescription, T4 too even if you wanted too..

    and alot more..

    And here are a list of forum boards filled with experienced body builders and trainers who can tell you how to successfully and safely use these hormones and steroids to achieve your goals.

    and a whole lot more.
    -just be sure to go to the sites, type in T3, or anything you wish to know, into the search bar, and you'll have all kinds of threads filled with information, pop up.

    Hope i taught you guys all something usefull.

    -Dr.knowitall. =)

  • P. Hentermine

    6/7/2010 7:03:45 PM |

    I will manage my thyroid hormone as it is responsible for weight gain and I want to reduce my weight very soon.

  • Anonymous

    6/11/2010 10:36:19 PM |

    www.iron-dragon.com has t3 also, very reliable.  not too sure on the other site posted here.

  • Anonymous

    6/14/2010 3:34:08 AM |

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  • Anonymous

    7/24/2010 6:52:33 AM |

    I have been taking T3 for over two yrs and there is no weight loss benefits. I was on 120mcg per day and I started to develop heart palpitations and my face looked swollen. I don't think any one should be taking T3 for weight loss because it can also make you Extra hungry when taken with other meds.

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  • Helena

    12/2/2010 11:50:33 PM |

    I'm a little lost... I have been walking around thinking that I have a bad thyroid with me gaining so much weight (15-20 lbs in the last 15 months)and I have a morning temp of around 96.6 F; and then today I get my test results back:

    TSH 0.32
    T4 FREE 1.4
    (Levels that point for 'Subclinical Hyperthyroididm")
    Do I stop taking Kelp supplement?
    I was taking between 150-450 mcg per day for about 1 year.

    Also found that my A1c was at 5.7% (slightly high)

    B12 borderline low

    HDL 46 (low)
    LDL 139 (high)
    TriG 226 (high)

    And on top of that my Vitamin D has dropped from 78 last year to 40!!!

    What the heck happened? Could this be related to taking synthetic hormones (birth control pill) for 11 years? (Stopped 14 months ago) Or is it just me hitting the big 30??!


  • Anonymous

    12/11/2010 2:58:02 PM |

    www.alldaychemist.com. No I'm not an employee/owner, but a customer. This is where I get my T3, T4, and that glaucoma medicine that makes your lashes grow.

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  • Anonymous

    1/27/2011 4:50:50 PM |

    T3 or any form of Thyroid medicine just for weight loss is highly dangerous. I have been doing this for over a year, starting with T4 and now mixing the two (worried about RT3). Unfortunately I am suffering severe side effects, angina, breathlessness, atrial fibrillation arrhythmia and many other things, i am too scared to come off them but I have and am doing my body alot of damage, which could be fatal (I should never had started). My advise is to only take the hormones via a doctor and only if you suffer from hypo.  


  • Anonymous

    2/5/2011 6:13:58 AM |

    I have taken both Clen, Anavar and T-3. I have seen moderate results with clen, extreme muscle mass gain with anavar, and the most leaning out and weight loss with the t-3. My only concern was that it took 4-5 months taking t-3 to lose 15 pounds and I was taking what I thought was the maximum. How can I lose 20 lbs of fat in 2-3 months and still maintain muscle? Should I switch to anavar from clen when I notice muscle loss?

  • Anonymous

    2/5/2011 6:30:15 AM |

    Last post above by a 31 year old female that works out, eats right and wants to go from about 20% body fat down to 10% by April/May. I use to be a fitness model and have been off t-3 now for about a year, but still cycle clen. I hear alldaychemist is a good site.

  • robrob

    2/5/2011 7:02:24 PM |

    I was under the impression that t4 gets converted to t3 what at the liver or cellular level? if your insulin resistant (or suffering from what some term the famine feast cycle from a history of reduced caloire diets or poor quality diets) you not converting to t3 or are t3 resistant you can be leptin resistance and insulin resistant you can be thyroid resistant to.

    I would think one would need to get at the root of the problem, rather than treat the symptom, it could be caused by some chronic nutritional deficiency, regardless of cause, as long as your on the famine feast cycle (look it up) you will not lose weight permanently. nor cure metabolic syndrome or low thyroid that has no known cause.

    there is a strong genetic compeonent I think some call it the thrifty gene, I call it the survival instinct myself which encompases more than just energy in and out.it encompases all metabolism, reactions to enviromental changes mental and physical adaptations and what not.

    and I wouldn't be surprised if the real culprit for hypo or hyper thyroid for those not suffering a weight problem or metabolic synrdome is due to malnuturtion as well like vita d, cal, vita k, a, magnesium and other minerals defiencies.

    these control the immune system dont they? maybe the genetic component is that your unable to absorb them as well and need to over compensate via taking in excess via foods.

    but then I wonder about how nutritious our food really is. sure maybe the toxic enviroment may play a role like increasing the nutrient needs of the body in order to detoxify them. but I don't believe they directly cause a problem. everyone has these toxins in ther bodies in usa, but not everyone suffers health problems from it.

    could be their genetic and nutritional status that determines that. but the only thing I know who takes t3 are those who suffer wilsons syndrome, stress induced reduction tha doesn't resolve itself after the stressor has past.

    and then they only take it for a short time to get the body back into balance not as a weight loss tool.

  • Anonymous

    2/9/2011 1:27:55 AM |

    Can you use T3 for weight loss w/o losing muscle?  I have a prescription for 10 mcg a day that I haven't been taking, so I can start ramping up a bit.

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  • Michelle

    7/7/2011 3:40:06 PM |

    I am on t-3/t-4 therapy for hypothyroidsim.   T-3 was added a month ago and although I feel better than I have in the past 3 years, I have had NO WEIGHTLOSS!!!  I am an active female and eat well, I bike 15 miles daily.  Confused as to why I am not seeing any results....

  • Robert

    10/2/2011 12:32:59 AM |

    I was just diagnosed with hypothyroidism. My TSH was 5.4. Which is high on both the old and new scale. I weigh 384 lbs., do not sleep well, have swollen legs, and am sluggish and tired. I can loose weight when I eat right and exercise. My blood pressure and sugar are normal. I am also going for a sleep test for sleep apnea next week. Also just for info I had a ct scan just before my blood test and they did give me the contrast, (iodine). My doctor put me on t4,  25mcg per day. (levo) At the beginning of the year I started a diet and lost 50lbs in about 6 months. Then kinda got off the wagon and gained all my weight back. I was in the hospital a couple years ago and the doctors told me my sodium & potasium was really really low. Also I have access to cynomel. I am afraid to start the t4. And have some questions:
    1. Is 5.4 that high for TSH? 2. What could have caused this to be so high? From everything I read it looks to me like 5.4 is very high. Why then would my doctor only put me on 25mcg? Everything I read says most people are on 75 to 125 mcg per day and their TSH is much lower than mine. 3. Should I ask my doctor to prescribe t3 also? If he will not should I start my own that I have access to? If so I would start very low dose say around 12.5 mcg along with my 25mcg of t4. 4. Could the ct scan caused my TSH to be high? Could having low sodium and potasium cause my TSH to be high? 5. Should I have another test done? Also have my t3 & t4 levels checked this time? He did not do those test the first time. I am afraid because I cannot gain any more weight! I am maxed out! My body cannot take any more. And just five pounds would be really bad. I do not want to take the t4 alone if there is any chance that I might gain additional weight. 6. One more question, is there anyway I can get my thyroid back to normal with out taking a bunch of medication? Like eating right, exercising, loosing weight. Or is the high TSH causing the weight gain? Because my diet is terrible.

    Thank you.


  • Dr. William Davis

    10/2/2011 2:37:56 PM |

    Hi, Robert--

    Iodine is the only way to restore thyroid function; since you got iodine-containing x-ray dye recently, it seems unlikely that iodine deficiency is at the root of it.

    My personal view is that very few people should take T4 without T3--people feel better, are happier, lose weight much more effectively. The problem: the endocrinology and primary care community will fight you tooth and nail. This may sound cynical, but I attribute this to the fact that much thyroid "education" comes from the sexy sales rep who was hawking Synthroid.

    Your T4 dose is low because it is wise to start gradually, else you can get hyperthyroid symptoms. Your TSH, by the way, is indeed in the hypothyroid range, sufficient to account for substantial health problems, including weight gain and heart disease.

  • Eliu

    10/30/2011 10:53:31 PM |

    Jenny i have found an offshore supplier from turkey of T3 (Tri-lodothyronine)  & T4 (thyroxine) i personally have bought T3 & T4 and it is Amazing, the medication manufacturer is Bitiron which are notorious for quality, Bitiron combines both T3 & T4 into one 62.5mcg (Microgram) pill, yielding 50mcg of T4 and 12.5mcg of T3, each box of 100 pill are $22, i have personally bought it and recieved within 10 days and shipping is free, they deliver through USPS and accept paypal payments for a more secure peace of mind, they also sell T3 alone, T4 is generally much weaker than T3 so usually people wont consider it for weigh loss, but what many dont know is that T4 serves as a shuttle for T3...A Normal male will intake 50mcg of T3 up to 100mcg of T3 anymore can cause hyperthyroidism which isnt healthy, i estimate a female should never excede 50mcg of T3, so taking 2 daily will yield 100mcg of T4 and 25mcg of T3 which i believe is a healthy dose for a female, when you take this medication you should always do a pyramid cycle this is where you start off with half a tab, after a week increase to one tab, after 2 weeks increase to 1.5 tabs and after 2 weeks increase to 2 tabs, and keep it steady at that rate for a while then down to 1.5 tabs for 2 weeks and 1 tab for 2 weeks then half a tab for 1 week, i suggest yout take Iodine and L-Tyrosine (Amino Acid) pill after you are finished to help the body naturally produce natural Thyroid hormones once again, NEVER stop taking the pill in the middle of the regiment and NEVER skip a dose.. please do further research to learn more about Thyroid hormone control and its weight loss benefits before doing any regiment.
    (this is the website to get the T3 & T4) http://www.anabolix.eu/
    or Contact the supplier directly at this email:
    Please tell them Eliu Quesada Reffered you to their service, good luck and best wishes in your weight loss journey

  • James

    11/9/2011 7:26:16 PM |

    T3 is an excellent supplement for weight loss.  I have used this in a prescription capacity and had great results.  Some sites sell this as a "research chemical".  I have a blog that discusses research chemicals however we do not sell them.  

    Great article on T3 for weight loss.  You are actually the first result on Google for that term.  That is how I found you...


  • Lisa

    12/15/2011 1:23:26 AM |

    Dr Davis,
    1)  My thyroid was radiated twice due to Graves disease 15 years ago.  Since my thyroid is no longer functioning, would there be any benefit to taking iodine along with my synthroid and T3?  
    2) With the Graves disease, I developed thyroid eye disease, pretibia myxedema and Acropachy. Will taking T3 effect or aggravate those conditions?

    Thank you,

  • Wendy

    12/25/2011 9:27:50 PM |

    Dr. Davis, I envy your patients!  I'm a post meno-hell 56 year old female who, until five years ago, has always been thin; underweight according to all height-weight charts.  Over the last 4-5 years I've gone from 110 lbs. to nearly 150!  I've always been able to cut back on intake and weight would fall off; now a normal for me day's intake is a chicken breast or fish fillet/day and a cup of hot chocolate at bedtime (skim milk).  Sure, I realize that as we age we tend to gain weight but this is way over the top and unhealthy.  I've also been suffering from virtually all hypo symptoms except no difficulty conceiving and problem periods (for obvious reasons).  I've been unemployed for years and have no health insurance so obtaining medical care is virtually impossible.  Around 2 years ago I went to a low cost clinic; they said my thyroid numbers were within normal ranges but didn't give me the numbers.  They did send my cholesterol number, OVER 300, with instructions about diet and exercise.  Not exactly news, duh.  When the lbs. really began coming I began walking/jogging 2-3 miles/day, zero weight loss.  I'm sick of freezing feet!  I was stumped about why the corners of my eyebrows have disappeared until I began researching hypo.  I've been on nearly antidepressant known to man.  I finally located a free clinic last spring.  The first Dr. I saw ordered lab work and said if it wasn't definitive he would refer me to an endo.  Drs. at the clinic rotate once/year.  When I returned I saw a different Dr.  He insisted my lab work was normal but, to shut me up, he put me on 25 mcg. of Levo.  After 3 days I felt great but it wore off within two weeks.  I returned to the clinic, the next Dr. said I'm definitely hypo and increased my dosage to 50 mcg.  He wanted to titer me up to 125.  Awesome... I thought.  No change, I was still symptomatic.  After a couple months I increased it to 75.  Despite my raging symptoms the next Dr. decreased it because my TSH was very low.  He's a resident and will be a regular at the clinic until he's finished with his residency.  And, on each visit my weight has steadily increased.  The next time I went in, my most recent visit, my weight had increased at an alarming rate.  He told me to run 6 miles/day.  When I was his age I did run, I had young knees!  I'm sick of the blame the patient game.  At the rate I'm gaining weight this woman, who has always been the skinny one, is going to weigh 200 lbs.  UNACCEPTABLE.  Clearly I'm the only person concerned about my health.  I've scrimped and saved money when possible and ordered some T3 online last week.  I'd rather die than be yet another morbidly obese American at risk for Type II diabetes.  I'm sick of freezing year round.  As I type my feet are so cold they're almost numb.  I'm scheduled to return to the clinic in a few weeks.  They never give me my numbers but this time I'll DEMAND them.  I didn't learn until November that my lab work from April did, indeed, indicate that I'm hypo.  Most patients at the clinic are poor, unsophisticated, uneducated people who don't challenge the Drs.  I'm poor too but I'm a well-informed law school graduate with top-notch research skills.  Yes, lawyers lose jobs too, age discrimination is pervasive.  I don't anticipate having begun taking my self-prescribed cytomel before my upcoming appointment.  Hope springs eternal that if I do benefit from it I will eventually be able to convince one of the rotating, overall apathetic, Drs. to prescribe it.  Ordering online will quickly become financially prohibitive if it really does help.  A little cooperation from the medical professionals sure would be helpful.

  • Wendy

    12/25/2011 9:44:30 PM |

    I forgot.  I've suffered from constipation since entering my 20's.  Bad pins and needles in hands and legs; arthritis since my 20's that has become much worse over the years.  Insomnia, physicians have been throwing antidepressants at me for decades.  I've been told I have a "low normal" body temp since I was a kid.  My mom was diagnosed with hypo last year at age 82 after developing an enormous goiter.  Her Dr. said she's probably been hypo for decades even though it never showed up in her labs.  The list of why I need proper treatment soon is infinite.

  • Belinda

    1/7/2012 9:06:00 AM |

    Wendy, I read your post and I saw myself because I share both your symptoms and your experience. I gained 50 pounds in one year and cannot get it off, although people remark that I don't eat much and they don't understand why I am 184 lbs. I am fatigued all the time, I have difficulty losing weight, I have difficulty concentrating, and yes, I have cold feet (I have to wear socks to bed in the SUMMER). I have been trying to get multiple doctors to recognize that there is something wrong with my thyroid since 2007. I have been tested so often I feel like a pin cushion, and they always tell me my numbers are normal. I ordered copies of all my lab results and I can see that the numbers are going up, and I can feel that my symptoms are getting worse. I am a biochemistry student who would like to go to medical school eventually, and I cannot afford to keep listening to doctors tell me that the problem is not my thyroid when I know that it is. I was laid off from my job and spent a large chunk of my savings on an endocrinologist who insisted that my symptoms were due to a sensitivity to wheat, although I had been tested for 100 different allergens and the results all came back negative! I could not afford to continue paying him to not give me what I asked him for, which was a 1 month trial on thyroid medication. So I did it myself. I researched online, ordered T3, and gave myself a pyramid dosing schedule. I made sure I was aware of the side effects so that I would be able to recognize when to lower my dose. About a week or two after I started T3, I felt like my old self again. I had energy, I was losing weight, and I could concentrate. When I stopped taking the T3, all of my sympoms came back and I immediately put the weight I lost back on.I have been to 3 doctors since I completed my self-administered T3 trial, and I have specifically told them that the medication made me feel better, but they told me that it was because it would make anyone feel better because, as my last doctor told me, "it's like speed." However, my own research has indicated that if you are taking a dose that is unhealthy for your body, it tends to give you headaches and heart palpitations. So obviously my body responded favorably to the T3 since I did not experience those side effects. You should go to the website that the anonymous poster listed called thyroid-RT3.com to see how to pyramid dose and you should try it and see if you feel better. Then you can go back to those doctors and tell them that the T3 made you feel better and you would like to try that. Hopefully, you will get farther than I have. I am going back on T3 on my own. I would have liked to have it monitored by a medical professional but I refuse to live the rest of my life feeling like this. Right now I'm just trying to decide how long to cycle on the T3 and how long to cycle off without making my thyroid worse.

  • tess

    4/29/2013 7:44:49 PM |

    Lisa, this is way too late but....

    what a lot of nutritionists don't seem to realize is that the whole body uses iodine, not just thyroid tissue!  it is the opinion of many TRUE specialists that the RDA is way too low, also.  so unless you're a seaweed fanatic, supplementing iodine is probably a good thing -- but make sure you balance it with selenium -- the two work as a team, and people who have had problems with iodine are frequently selenium-deficient.

    good luck!

Small LDL particles and increased HbA1c--An evil duo

Small LDL particles and increased HbA1c--An evil duo

Small LDL particles are triggered by consumption of carbohydrates. Eat more "healthy whole grains," for instance, and small LDL particles skyrocket.

Increased hemoglobin A1c, HbA1c, a reflection of the last 60-90 days' blood sugars, is likewise a reflection of carbohydrate consumption. The greater the carbohydrate consumption and/or carbohydrate intolerance, the greater the HbA1c. Most regard a HbA1c of 6.5% or greater diabetes; values of 5.7-6.4% pre-diabetes. However, note that any value of 5.0% or more signifies that the process of glycation is occurring at a faster than normal rate. Recall that endogenous glycation, i.e., glucose modification of proteins, ensues whenever blood sugars increase over the normal range of 90 mg/dl (equivalent to HbA1c of 4.7-5.0%). Glycation is the fundamental process that leads to cataracts, arthritis, and atherosclerosis.

Put the two together--increased quantity of small LDL particles along with HbA1c of 5.0% or higher--and you have a powerful formula for heart disease and coronary plaque growth. This is because small LDL particles are not just smaller; they also have a unique conformation that exposes a (lysine residue-bearing) portion of the apoprotein B molecule contained within that makes small LDL particles uniquely glycation-prone. Compared to large LDL particles, small LDL particles are 8-fold more prone to glycation.

So glycated small LDL particles are present when HbA1c is increased above 5.0%. Small, glycated LDL particles are poorly recognized by the liver receptor that ordinarily picks up and disposes LDL particles, unlike large LDL particles, meaning small LDL particles "live" much longer in the bloodstream, providing more opportunityt to do its evil handiwork. Curiously, small LDL particles are avidly taken up by inflammatory white blood cells that can live in the walls of arteries, where they are oxidized--"glycoxidized"--and add to coronary atherosclerotic plaque.

The key is therefore to tackle both small LDL particles and HbA1c.

Comments (53) -

  • Linda

    10/30/2011 4:00:13 PM |

    What do you consider to be ideal cholesterol readings? I am about to visit a new doctor, a D.O., and I am sure she is going to insist on blood tests for cholesterol plus stress testing, etc. My thyroid TSH was 2.70, but she is already showing reluctance to prescribe any thyroid meds. It is going to be a battle.

  • John Lorscheider

    10/30/2011 4:32:57 PM |

    And it is not just about the wheat either.  It’s all carbs.  Fructose, oats, rice, pasta, potatoes and certain fruits, etc. all drive up HbA1c and small LDL.  Just for a reality check I bought a can of and made a bowl of “properly prepared” Scottish oatmeal yesterday according to Nourishing Traditions.  Those are the minimally processed chewy steel cut oats soaked with warm water and kefir overnight and served with butter and cream.  Yeah, they were good alright, but my fasting BG was 88 and one-hour PP was 158.  A fast 5-mile run and it was back down to 84.  The container is in the garbage can now.  This morning was two pasture raised eggs and bacon with ½ cup of blueberries and Greek yogurt.  Fasting BG 89 and one-hour PP was 88.  My HbA1c went from 5.8 to 5.1 in less than a year and hope to get below 5.0 soon.  The stubborn small LDL percentage dropped during same time period but still have a way to go in that regard.

  • Buddy

    10/30/2011 8:12:20 PM |

    I'm not completely sold on HbA1C < 6.0% being a useful metric for anything but populations.  The problem is that the current HbA1C tests do not control for erythrocyte age and I see wide variations among piers on simialr  grain free lowish carb healthy diets.

    There has been much more research on this effect as it pertains to diabetics that have falsely low HbA1c:  http://www.ncbi.nlm.nih.gov/pubmed/9773739

    There is some evidence out there that it works the other way as well, and it makes intuitive sense that the lower inflammation and oxidation associated  with a healthy diet would increase erythrocyte longevity.

    Of course observational studies about any topic (small LDL or HbA1c) are always to be taken with a grain of salt.

  • Rosanne

    10/30/2011 8:30:42 PM |

    I wonder if you have ever experienced with any of you patients  what is going on with my husband?  He has very few small LDL particles, at least according to a VAP test - he is type A with lots of large, fluffy LDL.  But his HbA1c is 6.1.  His fasting glucose is 80, 1 hour post-prandial it's 1685, triglycerides are 60.  This is all on a grain-free, very low-carb Paleo diet.  Do you have any clue what is causing the HbA1c to be elevated?  Could it be anything besides carbs?  He gets lots of exercise and is very fit and lean.  

    Some have suggested that too much protein can also cause elevated HbA1c, due to gluconeogenisis causing higher levels of glucose.  But why would the body make more glucose than it needs?  And why would that excess glucose not show up in his fasting and post-prandial glucose numbers?

    Is there any other factor, besides blood glucose, that can contribute to elevated HbA1c?  No doctor yet has been able to answer this question for us.

  • Rosanne

    10/30/2011 8:32:55 PM |

    Sorry for the typo, his 1 hour post-prandial glucose is 85.

  • Dr. William Davis

    10/30/2011 9:08:02 PM |

    The most common explanation, Rosanne, is that the HbA1c can stay high long after blood sugars have come under control.

    It may be due to the extended longevity of RBCs that occurs in the setting of low-carbohydrate diets that allow a previously high HbA1c to stay high for an extended period.

    There's also the possibility of a hemoglobin variant that allows this.

    I would put more stock in the blood glucose values by fingerstick than the HbA1c.

  • arlene

    10/31/2011 12:42:56 AM |

    Thank you for explaining this.  I just had my blood work done for the first time since quitting wheat and going low carb in April.  Since I've lost a lot of weight, and a lot on my waist, I am very curious to see what my numbers are.  This will help me compare the important stats.  What is an ideal HbA1c?

  • pjnoir

    10/31/2011 7:37:40 PM |

    I can't go near oatmeal, steel cut or any other type.  Its just eggs and avocados for breakfast these days with a lot of Asparagus in the spring with my yolks.  Oatmeal has been banished for good.

  • Bob Sparkes

    10/31/2011 10:46:27 PM |

    Your article discuses how the combination of small LDL particles  and high blood sugar
    results in plaque. Is the article cited below  by University of Washington at St. Louis useful here? The article points out the role of low Vitamin D in plaque formation with LDL  and high blood sugar. Or am I confusing two separate mechanisms in plaque formation.


  • Dr. William Davis

    11/1/2011 2:01:29 AM |

    Hi, Bob--

    Yes, I believe it is two unrelated mechanisms. However, this is a fascinating finding to tell us why people do so well from a heart standpoint when we correct vitamin D deficiency.

  • learn chinese

    11/1/2011 4:05:55 AM |

    Thank you for explaining the topic. i learn more about Small LDL. great post.

  • Jeanne

    11/1/2011 5:36:29 AM |

    Dr. D,  
    Can this be related to the lysine- arginine balance in the body? Would taking arginine supplements affect the amount of lysine residue causing problems in any way?  Just thinking out loud ...



  • Amit

    11/1/2011 8:01:31 AM |

    HI Doctor Davis,

    I know its not the right place, but I could not find your email.

    I read "wheat belly", it was revolutionary for me,  and I am persuaded it can bring much relieve to many ailments.

    I also wrote several posts about this issue on my health blog (in Hebrew)  based on your book and your Blog.

    Thank you for the great service you are offering in your work!


  • Janis

    11/1/2011 2:40:01 PM |

    Hello Dr. Davis,
    I'm new to your blog. Just finished reading Wheat Belly. Excellent book! I also listened to the podcast with Robb Wolf. That's how I heard about you. Not to get off topic (didn't know how else to contact you) and this is probably a silly question, but would like clarification if you could help. I've been purchasing the 85% Lindt chocolate bars until you mentioned that you eat the 90%. I read the label and it said that it is pressed with alkali. You mentioned to avoid this process as it removes the healthful flavonoids. By saying "pressed" is that a different process? The chocolate was very good, but I want to make sure I'm getting the healthful flavonoids, especially when we don't eat too many sweets. Thank you so much for your time.

  • Might-o'chondri-AL

    11/1/2011 6:44:50 PM |

    Hi Dr.,
    I am confused how to  reconcile  HbA1c details  from J Am Coll Nutrition 2005, Vol.24(1):22-29
    "Dietary Carbohydrate and Glycated Protein in the Blood in Non-Diabetic Subjects"
    (and their relevant references no. 10 -  19 & 34-39 )

  • Rosanne

    11/1/2011 7:15:17 PM |

    This has been going on for 2 1/2 years and in fact, the longer he has been low-carb Paleo, the higher the HbA1c has gotten.  When he started, it was 5.5 and has slowly
    crept up to the 6.1 reading.
    Thanks for the mention of the hemoglobin variant, I guess that's must be it.  Can we stop worrying about the HbA1c since his glucose values are so good?

  • STG

    11/1/2011 7:34:13 PM |

    Dr. Davis:
    What do you you think of Jenny Ruhl's advocacy of the 5% club at Blood Sugar 101? Your guidelines appear to be more aligned with Dr. Bernstein's and Dr. Ron Rosedale's? Do you think that all individuals ( including prediabetics, daibetics and glucose intolerant ) should strive for a HbA1c below 5%?

  • Dr. William Davis

    11/2/2011 1:36:45 AM |

    HI, STG--

    That is precisely what I aim for, also: HbA1c of 5.0% or less. At that level, metabolic consequences of blood sugar essentially disappear. This is, of course, at variance with conventional guidelines.

  • Dr. William Davis

    11/2/2011 1:37:19 AM |

    That would be my vote. Ask your doctor, also, about fructosamine, another sugar markers.

  • Dr. William Davis

    11/2/2011 1:39:24 AM |

    Hi, Might--

    Were you referring to their conclusion about polyunsaturates?

  • Dr. William Davis

    11/2/2011 1:42:08 AM |

    My bar says "processed" so, yes, the flavonoid content can be expected to be reduced in this bar. The best way to get a full dose of cocoa flavonoids is in undutched cocoa powder.

    I still think you can enjoy your dark chocolate, but you just might not expect full benefit from this particular bar.

  • Dr. William Davis

    11/2/2011 1:44:08 AM |

    Thank you, Amit!

    What is the wheat situation in Israel? Is it pushed there as much as it is here by official agencies and food companies?

  • Dr. William Davis

    11/2/2011 1:44:43 AM |

    Sorry, Jeanne, I don't believe the answer is known.

  • Might-o'chondri-AL

    11/2/2011 3:35:43 AM |

    Hi Dr. D.,
    Authors in this report say glycated protein & HbA1c do not interact  with blood glucose in same way (ref #17) and that it is glycated albumen rather than glycated hemoglobin that is very senstitve to blood glucose levels (ref # 18,19); especially since 60% HgA1c is genetic (ref #61).
    AGE (advance glycation endproducts) they say is more indicated by fructosamine level from high blood glucose. Although diabetics with high fructosamine also have high HbA1c. whereas for a non-diabetic  high fructosamine does not relate to their HbA1c level (ref#16).
    This impies that (since most obese individuals never will become diabetic &  longevity/cognitive function of the overweight is good) a lot of the risk factor of small LDL with HbA1c depends on genetics/ epigenetics.
    My confusion is if your insistence on HbA1c for non-diabetics is misdirected or just due to it being a common first test people can do.

  • Amit

    11/2/2011 5:15:45 AM |

    Wheat is the most common carbohydrate in Israel. It is eaten almost every meal. I think that the largest source of calories is wheat.

    Regarding Diabetes there is no awareness that whole wheat is especially bad for such patients. Diabetes association (and many more) do recommend whole wheat. Although they are suggesting to avoid eating large quantity of bread at once.

    Wheat is being pushed, though, I don't think that somebody here is pushing wheat deliberately, just coping recommendation from abroad, and using the most cheap and easy carbohydrate.


  • Nora

    11/2/2011 12:10:50 PM |

    I have been on my Wheat Bellies journey for 8  weeks now.  I am trying to follow your suggestions on heart health and I know that you have your plate full right now, but just a request.  Have you ever thought of doing healthy heart retreats?  I would love to have a chance to go away for a long weekend, have all my blood work done right, have it evaluated, talk to a doctor and then maybe have a few cooking classes.  Throw in a few yoga classes or walks for stress reduction and you have a whole picture!!  

    I have high blood pressure that is 'controlled' to some degree with Tekturna (150mg) and Amlodipine (10mg). This morning it was 150/90, so it is often not very controlled. Since 9/1 and going wheat free, I have lost 23 pounds but still have 50 to lose.  My take away from your writings is that plaque is the  main cause of heart disease and that keeping a low blood glucose level is the best strategy, but there is not much about  high blood pressure in your work.  What role does it play and will being a wheat free low carber offer me relief from my high blood pressure?  Or will it stay high since I have a family history of high blood pressure and therefore will probably have to continue on my meds.  While I, of course, am doing everything in my power to lower my blood pressure, is it not really a number I should focus on when trying to control my heart health?

  • Renfrew

    11/2/2011 9:08:47 PM |

    Hi Doc,
    have you seen this? You are prominently featured here:
    Great summary!

  • marta

    11/4/2011 9:48:08 AM |

    Are you going to translate his books into Spanish some day?
    I'm very interested in reading them. thanks

  • Dr. William Davis

    11/4/2011 12:48:56 PM |

    Hi, Marta--

    There has been interest specifically in Wheat Belly for translations. Spanish is at the top of the list.

    When that happens, I will announce here and elsewhere. Thanks for asking.

  • Dr. William Davis

    11/4/2011 12:50:33 PM |

    Thanks, Renfrew!

    Life Extension has been an important supporter of my efforts and vice versa.

  • Dr. William Davis

    11/4/2011 12:53:43 PM |

    Hi, Nora--

    Excellent suggestion on the heart health retreats. I've thought a lot about it and will likely do it in future. Just not quite sure about the details. One hurdle: Few people want to fly to Milwaukee, so we'd have to find an exotic or interesting, probably warm, place to do it.

    Hypertension is indeed a big issue. It is also among the last things to respond to weight loss and diet, often lagging behind many months after weight loss. So it really pays to be patient while you are on this health journey. Given your family history, you still might be left with hypertension, but at least you will have minimized it.

  • Dr. William Davis

    11/4/2011 12:54:43 PM |

    Thanks, Amit.

    By the way, all anyone has to do is check a fingerstick blood sugar 1-hour after consuming anything wheat to observe the astounding blood sugar consequences of wheat consumption.

  • Dr. William Davis

    11/4/2011 12:58:54 PM |

    Hmmm. I'm sorry if I'm being dense, Might, but I'm still not sure I follow.

    I'm not actually advocating anything except to show how glycated small LDL is a really bad player. When viewed from multiple different directions, small LDL particles are looking worse and worse. In this instance, having any measure of glycation phenomena, whether fructosamine, glycated albumin, or glycated hemoglobin, suggests that small LDL particles are also being glycated and thereby gaining heightened atherogenic potential.

  • Sally

    11/4/2011 2:02:44 PM |

    Dear Dr. Davis,

    I am reading your book Wheat Belly and want to thank you so much for writing this book.

    I've avoided gluten for years.  Arthritis and other annoying symptoms vanished...but I started gaining weight!   My blood sugar starting rising!   I couldn't understand it!  It was horrifying!  Well thanks to you, I realize that gluten free breads, candies, flours,  frozen pizzas, pastas and those gluten free "tv dinners" sold at Whole Foods did nothing to help my waist line or blood sugar.  I am now following the wonderfully easy plan in your book and am confident the weight will come off.

    Thank you for such terrific recipes.  Will you be writing an accompanying Wheat Belly cookbook as well?  I certainly hope so.  Please do!   If not, can you recommend some cookbooks that comply with your eating instructions?

    Thanks again for such a life changing book.  Sally

  • HS4

    11/4/2011 9:09:05 PM |

    There are a few people in Israel trying to enlighten others about the dangers of wheat and other 'modern' carbs.  My sister is one of them, has been trying to think of ways to get some essays to the public.  But what Amit says is correct - a lot of wheat is eaten there, many people buy small breads  rolls daily - it's very fresh, delicious, so it will be a tough thing to stop. Many of the best restaurants in Israel serve Arabic food which always comes with freshly baked loaves of pita.  The 'national snack' is pita stuffed with falafel (fried balls of ground chickpeas, onions, garlic and spices), fresh & pickled vegetablesj, hummus and/or tehina sauce. This is available everywhere and always fresh.  Becasue the food is generally very good in Israel and also very fresh it's hard to avoid wheat, which I've noticed every time I visit.

  • palo

    11/5/2011 5:07:43 PM |

    Dr. Davis, the evidence speaks for itself that consumption of carbohydrates, increase small LDL, suggesting an LC diet of less than 50 grams to mitigate the damage.
    But what about endurance athletes (runners, cyclists, triathletes etc.) that work out one and a half to three hours per day and consume copious amounts of carbohydrate to fuel their long workouts.
    Is the exercise neutralizing the carbohydrates' harmful effects? If so, can you suggest a dosage for certain amount of exercise?

  • Might-o'chondri-AL

    11/6/2011 8:26:57 PM |

    Hi Dr. Davis,
    Non-diabetics just seem to have one feature going for them - their platelets don't respond the same as diabetics. I am inclined to think that albumin in our blood is more relevant than the hemoglobin being glycated . (This is not to criticize your preventative approach , since Type II diabetes can go on to develop &  I like what you are teaching us about small LDL.)

    " One common qualitative change in plasma albumin is nonenzymatic glycosylation, which occurs during states of prolonged hyperglycemia....Platelet aggregation ...is enhanced in the presence of albumin that has been incubated in a medium containing levels of glucose that are higher than would be seen in normal patients but are consistent with those seen in diabetics....(Journal of Parenteral and Enteral Nutrition 18:516-520, 1994)

    Once the glycation of albumin fosters more platelet aggregation in diabetics (& the insulin resistant person!) their platelets show more secretion and adhesion leading to the vascular plaque build up that the insidious small LDL can get into. Yet, for the non-diabetic the +/- 570 insulin receptors on each platelet normally respond differently to their insulin exposure.

    Specifically (in non-diabetics) the insulin actually stymies the platelet from becoming "activated" and probably explains how it is that not everyone who eats carbohydrates suffers cardio-vascular insults. Of course there are non-diabetics with genetic variants that adversely affect their plaque dynamics (ex: defect in insulin receptor signalling, that receptor's Beta subunit, G-protein pathways).

    ( For the techno-nerds: proper insulin receptor response on platelet keeps  platelet cAMP level from dropping & so no endoplasmic reticulum calcium floods out into platelet cell cytosol, platelet granule doesn't secrete ATP, platelet alpha-granule doesn't secrete P-selectin & there isn't mitogen-activated signalling to make thromboxane A2 , etc.  Basically, in the diabetic/insulin resistant these processes go forward uninhibited by normal insulin signalling & their circulating platelets don't keep rolling along suspended in the bloodstream .)

  • Adam

    11/7/2011 5:27:55 PM |

    Omega 3 Fish Oil BAD NEWS for Apoe 4/3!!!  

    Ok Dr. Davis, I really need your advice on this one.   In following TYP, I have been taking 3200 mg day EPA/DHA fish oil 1.4:1 ratio.   Recent testing shows I have gotten my HS Omega 3 Index to 9.5,  and my Omega 6 to Omega 3 ratio to 2:9  so this pretty good.   Now for the bad news....ever since I started taking 3200 mg day fish oil...over a 2 month period my HDL went from 48 to 38, a whopping 20% reduction in the critically important good HDL that I need to remove plaque.  I exercise extensively, and I also take 10mg day crestor (crestor is one of the few statins that's supposed to raise HDL not lower it). Now,  I have heard from several sources that Fish Oil (more than 1000 mg day) supplements are actually BAD for Apoe4/3 people because it lowers HDL.  So now I am confused Dr. Davis.....do I follow your TYP advise and stay on 3200 mg day fish oil in order to keep a close to 10 HS Omega 3 Index....but suffer lower HDL and less plaque removal/reversal....or do I stop the Fish oil in order to raise my HDL  but suffer the risks of little to no fish oil??

    Please advise...

    An extremely confused Apoe 4/3

  • Might-o'chondri-AL

    11/7/2011 11:02:03 PM |

    Hi Adam,
    HDL drop can be due to accelerated small HDL's  breakdown/clearance & if that was mostly lingering small HDL then it didn't have much reverse cholesterol transport function left in it anyway. If total HDL drops but small HDL turnover is  now more optimal &/or if it is a greater % of the large HDL then there is better reverse cholesterol transport dynamic despite the total HDL drop.

    ApoE has 299 distinct amino acid positions & the difference between the 3 types are due to which amino acid is in positions 112 & 158 ( respectively ApoE4 @112=arginine & @158 =arginine, ApoE3 @112=cysteine & @158=arginine, ApoE2 @112=cysteine & @158=cysteine). Because ApoE4 has arginine at position 112 this then orientates facing away from the standard grouping of 4 helix at that N-terminal to more closely cozy up to the alpha-helix of the C-terminal that in ApoE naturally overlays the N-terminal. Thus ApoE4 can uniquely feature a "salt bridge" to that C-terminal that affects how ApoE unfolds/functions when ApoE goes to work.
    ApoE's manner of unfolding at it's N-terminal  is crucial to how it deals with lipids, phospholipids (ex: cell membranes)and  proteoglycans on a cell surface. Fish oil alters cell membrane phospholipid composition and then the proteoglycans there must suitably interact with that EPA enriched type of cell surface. Since each ApoE's C-terminal presents an interface that challenges  how that ApoE  works at any target cell the  peculiar ApoE4 "salt bridge" uniquely conditions the way interactions play out. (And each of the separate 3 classic types of ApoE  can get mutations, mostly at positions 136-150, to complicate degree of LDL receptor interaction, etc.)

  • James Buch

    11/8/2011 3:14:01 PM |

    Dear Doctor Davis,

    I am wondering if you can clarify the "oxidized LDL Cholesterol" concept.  Including, of course the Small LDL as well.

    I began wondering if the oxidation is primarily in the package, the LDL wrap, the signaling protein, or the internal body of cholesterol itself. Of course, all of the above is also a possibility.

    The nature of the oxidation could be a good clue as to how it is especially detrimental to health, and so far, I haven't found much easily available on the mechanisms of the detrimental effects. While it is useful to know the harmful nature of oxidized small LDL, some insight into the mechanism of harmful effects would be welcome and minimize the nagging question of "Why" for me.

  • josef

    11/8/2011 5:07:20 PM |

    This might be of interest:

    A large study called the STRRIDE trial looked at the effects of different intensities and volumes of exercise on LDL particle size in sedentary, overweight men and women over eight months [3].  Group A performed 176 minutes of low intensity exercise (walking) per week.  Group B performed 117 minutes per week at a moderate to high intensity (jogging, cycling, or using an elliptical machine).  Group C exercised about the same amount of weekly time as group A, but at the same intensity as group B.  

    As one would likely guess, group C showed the biggest improvement in changing LDLs from small and dense to large and buoyant.  However, a more telling sign was that group B had a stronger effect than group A, despite exercising an hour less per week.  In other words, intensity is more important for improving LDL particle size than volume of exercise.

    A follow-up of the subjects in this study showed some discouraging and encouraging effects on the particle size changes [4].  The discouraging news was that five days of inactivity following the study almost completely attenuated the particle size benefits from the trial.  However, before you start labeling exercise as futile, consider this: while five days of rest basically brought the exercise groups back to baseline LDL particle sizes, they were still much better off than the sedentary control group, who experienced significant digressions in particle size during the course of this study

  • Might-o'chondri-AL

    11/8/2011 7:18:31 PM |

    Hi James Buch,
    The enzyme hepatic lipase's (HL) lipolytic hydrolysis of the phospho-lipids on the LDL surface changes it so that LDL's load of cholesterol esters can get taken out; this reduces the molecule's volume and thus is then small LDL (smLDL). Men have more HL than women, until they go through  menopause, and this propensity toward smLDL ( that can get oxidized) may explain male's earlier tendency of coronary artery disease. Visceral/central obesity trends to upregulate HL & it seems visceral obesity affects men more than women (of course central obesity in both women & men will raise both  genders'  HL enzyme levels). What decreases HL levels are things like calorie restriction & aerobic exercise (sedentary life increases HL).

    Doc harps on avoiding elevated triglycerides after meals that load triglycerides into VLDL  molecules because the enzyme cholesterol ester transfer proetein (CETP) shunts triglycerides from VLDL (& chylomicrons) over to the standard circulating "big bouyant" (large & fluffy) LDL and fosters transfer of cholesterol out of that LDL; the triglyceride takes up less space and thus get smLDL.
    Central obesity usually correlates with elevated triglycerides and increased HL levels. However, if triglyceride genetics (or epigentics from Doc's diet ,etc.)  in the obese without that usual accompanying high triglycerides then that upregulated HL doesn't cause a lot of that individual's standard "big bouyant" LDL to become smLDL. HL also hydrolysizes triglycerides (and phospho-lipids) of chylomicrons, BetaVLDL, IDL, LDL & HDL. Both CETP & HL enzymes being elevated alone, or together, can provoke smLDL - genetic polymorphisms exist for both enzymes.

    sm LDL has less antioxidants left yet it's surface has higher ratio of poly-unsaturated acids which make it's phospho-lipids more at risk of oxidation. And smLDL has less sialic acid left on it's surface which fosters more poly-anion proteoglycan binding that increases the smLDL molecule's transportability across the endothelial lining into the artery wall .
    Doc harps on need for Magnesium because in real time magnesium is what interrupts the oxidation of smLDL from locking into an altered state & then salvaged plain old smLDL doesn't get to go on to be so damaging.

  • Might-o'chondri-AL

    11/9/2011 3:24:05 AM |

    Continued for J. Buch,
    Oxidized small LDL (oxLDL)  has fragments from it's oxidized PUFA (poly-unsaturated fatty acid) that are reactive aldehydes (ex: malon-di-aldehyde & 4-hydroxynoneal-lysine) which then fragment that smLDL's  lipoprotein ApoB.  That peroxidation of a PUFA acyl chain of  the smLDL phospholipid  leaves a type of carboxyl portion that the beta-2-glyco-protein I (Apo H) binds to using a "reactive" ketone as ligand link. Thus it is the position of the "reactive" ketone (keto-cholesteryl-9-carboxy-nonanoate) on the involved cholesterol molecule's spine that determines the % of glyco-protein bonding that occurs (genetics influences ketone placement on a human cholesterol molecule).

    Magnesium (Mg++) in the very early stage of glycated protein (Doc warns against advanced glycation end products) hooking up with LDL reverses the glyco-protein link to the "reactive" ketone. But if deficient Mg allows time to consolidate that contact then only a physiologiclly abnormally high pH will let Mg re-break that bonding.

    Immunological T cells respond (with age & gender differences)  to try to get oxLDL off the artery wall;  and, if there is too much to handle there is the risk of developing a so-called oxidized LDL-containing Immune Complex (oxLDL-IC). And this oxLDL-IC provokes cytokines that perpetuate the inflammation response. Over time and older age there is  less output of a malon-di-aldehyde oxLDL  immune response; which is possibly what leads to long established plaque having less lipid component and more involvement of collagen. It is relatively younger plaque that is unstable and more likely to rupture; the collagen draws in more Calcium and unfortunately provokes artery hardening problems.

    Now the lipid part from this oxLDL-IC gets into an immunological monocyte cell's endosome  and the ApoB gets into that same monocytes lysosome - sub-compartments inside the cytosol (cell interior). Then the lipid part in the endosome triggers heat shock protein (HSP 70/70B) which wrenches things so that the lysosome can't get to work on the lipid and ApoB prevents the lysosome from doing proper interactions at the inside of that cell's membrane to expel  the burdens. Once oxLDL cholesterol esters bulk  up a macrophage (monocyte) due to increasingly futile lysosome  activity  it becomes the notorious "foam" cell. Eventually that macrophage cell dies and the whole load get's polymerized into plaque.

  • Might-o'chondri-AL

    11/9/2011 8:03:57 PM |

    Hi Dr. Davis - with your indulgence:
    Back to platelets( see above Nov. 7): vascular remodeling with age &/or ROS exposes a bit of phosphatidyl serine  that platelets can "snag" onto as platelets flow along. Key to accomplish platelet snagging is signaling by  the promoter P2gamma12 and normally insulin signaling down inhibits P2gamma12. But, notably for Type II diabetics (and assumedly proportional to an individual's insulin resistance) their insulin doesn't inhibit that snag signal. Type II diabetics also have P2gamma12 upregulated in their platelets. And if anyone is of P2gamma12  haplo-type H2 those individuals will have even more of the receptors for it and therefore an  increased risk of peripheral artery disease. Irregardless of haplo-type, the Type II diabetic's propensity for peripheral artery problems are compounded by  their basal level of excess P2gamma12 .

    Adhesion to the artery then physically involves the platelet surface Glyco-protein Ib & vonWillebrand factor hitched to collagen provoking Integrin 2beta1 (GPVI) so the platelet/collagen sets in place. If the level of promoter P2gamma12 in that challenged site is fortuitously low then the rate of adhesion to the blood vessel is poor. So, predictably, for Type II diabetics the adhesion rate (like platelet secretion & aggregation) is higher than normal. GPVI insult also signals a release of ADP & this ADP (like collagen itself) independently induces aggregation of platelets; the plaque recruits to build itself up to be more fibrous. The plaque matrix serves as nesting for oxLDL & dying macrophage foam cells to polymerize with.

    ROS remodeling agents of the vasculature come from mitochondrial activity and  it appears certain (overlooked) relevant gene pheno-types (and their respective polymorphisms) can be pro-plaque (or preventative) - speaking here in the sense of  a primal influence on plaque risk as well as  tendency of the actual amount of plaque. Sirtuin 5 (Sirt5), a mitochondrial Sirt (there are nuclear Sirt too) binds to Uncoupling Protein 5 (UCP5) and governs that (& other) UCP. Sirt (there are 6 types) remodels chromatin (DNA spooled around a histone ) via histone de-acetylase enzyme; while our UCP (there are 5 types) work in the inner mitochondrial membrane governing the proton electro-chemical gradient that is integral to the chain of oxidative phosphorylation (a way to generate ATP, among other functions).

    Sirt action on DNA includes (among other dynamics) the cellular level encoding of how individual fatty acid metabolism fine tunes -  lipid fatty acids included.Sirt action on DNA includes (among other dynamics) the cellular level encoding of how individual fatty acid metabolism fine tunes -  lipid fatty acids included. Doc's diet/protocol may ( I suggest) sometimes  tweak out favorable health response(s) via induced epigenetics, because of remodeling that is induced in the chromation DNA unit packaging . Sirt's histone de-acetylase working depends on NAD- to drive Sirt and Doc's diet/protocol theoretically seems to be capable of altering NAD flow patterns from his weaning of cells'  mitochondria off of glucose.

    UCP5  rules the inner mitochondrial membrane potential & the rate of oxygen use, which can become relevant to ROS levels. Both UCP5 and Sirt5 are upregulated in hypertension and Type II diabetics; the confluence of having geneticly more UCP5 along with Sirt5 are implicated in increased carotid artery plaque. (Of course nothing is linear in humans so haplo-type T- carrier UCP5 polymorphism rs5977238 benefit with less plaque risk and reduced plaque numbers.) Note: I am skipping over other Sirt & UCP; but will add that lots of pheno-typic UCP1 spins out extra amounts of reactive super oxide to drive down nitric oxide and implicated in accelerated aging of the vasculature.

  • Jack Kronk

    11/10/2011 8:13:40 PM |

    Might/Doc - Does this mean that if you DONT have proper insulin receptor response that all of the things listed in the last paragraph become untrue? (meaning bad?)

    Would this mean that you are implying a low carb diet would be the best solution due to the insulin issues?

    I ask because I cannot raise my HDL for the life of me. It is completely stalled at 40. And my LDL is primarily small dense kind. I have only really had this problem since going "LC Paleo" and adding a ton of sat fat to my diet but then I added back in starches and other carbs and became more moderate carb, while still continuing to eat bacon/eggs/cheese/cream/butter/beef/coconut oil/ghee/nuts etc.

    Now I've got people telling me to go back to LC, and exactly the reverse, people telling me that I need to cut out the fats including dairy and go low sat fat.

  • STG

    11/10/2011 11:18:15 PM |

    I have viewed your comments at the Hyperlipid and always appreciate your detailed biochemical/physiological explanations per topic. Your grasp of details and mechanisms is amazing! What is your background? Are you a biochemist by trade?

  • Kent

    11/11/2011 4:34:12 PM |

    A retreat is an excellent idea!  It would be a great time of learning and discussions. I vote for Gulf Shores Alabama Smile

  • Might-o'chondri-AL

    11/11/2011 7:02:07 PM |

    HI STG,
    My hope here is that I never hijack Dr. Davis'  blog ( I never personally posted on Hyperlipid blog).  I trust  Doc's readers know he is not responsible for any errors I make. Being semi-retired from consulting on agro-industrial projects in developing countries I feed my mind by keeping up with health science & commenting here about correlations to Doc's work.

  • Might-o'chondri-AL

    11/12/2011 9:33:23 AM |

    Hi J. Kronk,
    Saw your 11 Nov. query &  feel diet advice here is for Doc to offer (not me). Doc discusses ApoE pheno-types he restricts dietary fat for. You "tagged" me where I  was elaborating on platelets' interaction with insulin & how insulin resistance is a game changer (not sure what confusing).

    If one is insulin resistant then the signaling to build-up (anabolism) from insulin is selectively diminished and consequently break-down (catabolism) signals get  into play. Proteo-lysis is protein cleaving and HDL's protein component can be more rapidly subject to proteo-lysis; which I presume (?) is why/how some people degrade their HDL so quickly. Genetic quirks (& gender) also hit HDL levels notably;  yet  if quick enough turnover the "stale" HDL  might be being replaced by more functional HDL. According to the "HATS" study HDL alone is not a predictor of coronary artery disease mortality.

    Niacin usually decreases rate of catabolism of HDL,  it helps secrete more ApoA1 to make into HDL & decreases amount of  smLDL. Niacin isn't perfect since it alters the extent to which HL (hepatic lipase enzyme) can work on a  HDL molecule to morph  it into the kind of HDL that has the maximum reverse cholesterol transport capability. HL is what hydrolyses the triglycerides in HDL - so, basicly if HDL loaded with trigs it has sparser room for scavenging cholesterol.

    One's genetic response to increased levels of circulating palmitate free fatty acid can interfere with insulin signalling in the liver. Whether clinically insulin resistant or due to a genetic quirk (you?),  palmitate can phosphorylate liver insulin receptors in a manner unlike "normal" individuals do in the Akt process (insulin normally should get Akt going to stop liver gluco-neo-genesis - since insulin has glucose to drive into cells ). Essentially "excess" palmitate, in this example, is causing only a partial phosphorylation of Akt & is how researchers can use very high fat diets to induce experimental diabetes .

    I don't hear you being insulin resistant, so address genetics of Protein Phosphatase 2A (PP2A), which  has components involved in it's regulation and is subject to different structure. How PP2A parts interact with distinct parts of the Akt molecule can  impair some interactions,  yet leave other parts of Akt responsive ( to do what Akt  is normally designed to do). Palmitate can raise PP2A levels in the liver by 30%; so basically the more PP2A  around and/or the molecule's genetic tweaks the weaker a key part of  the liver's Akt response is going to be.

    Since palmitate  being in the liver does not stop insulin there from fostering more trigs there are still post-prandial trigs going into the VLDL . In other words the liver insulin resistance and rogue genetics can leave the part of Akt that governs lipo-genesis still responsive to insulin. Doc warns us about trig enriched VLDL & chylomicrons promptly driving  smLDL that doesn't degrade & small particle numbers measure high; he is more adamant about post-prandial trigs but genetic high overnight trigs can occur.

    I don't think coconut oil acts the same way high animal fat sometimes does on Akt . We internally make palmitate when acetyl-CoA acted on by enzyme acetyl CoA carboxylase  to make malonyl-CoA that fatty acid synthase converts to palmitate. I think most of coconut oil's fatty acids are metabolized before getting into that pathway so maybe coconut oil is worth parsing when genetics or insulin resistance drives up smLDL.

  • STG

    11/12/2011 6:16:07 PM |

    Excuse my error about you posting on the Hyperlipid. I guess I have read your posts elsewhere. In any case, your posts are very educational and explain precisely the biochemistry  Thanks for sharing your knowledge!

  • Mark

    8/14/2012 3:24:54 AM |

    Hi Dr. Davis,
    I’m 47 yrs old. I’ve had migraines since I was a teen and I developed Athsma this past January (hate it). During the process of discovery the drs found I have a 50% blockage in one of the 5, non critical, arteries running along the back of my heart. Scared me, to say the least. I’ve always eaten quite healthfully (for what I knew), am thin @ 6′ 1″/155lbs (was 175lbs in Jan.). Had total cholesterol of 200/LDL of 146/HDL of 50. Drs wanted me to do Lipitor. Researched and said, “No, thanks.” Started exercising 5-6 days/wk (lifting + walk/run), taking red yeast rice, fish oils, fish, no meat, no dairy, no eggs, lots of veggies/fruit, etc., but still eat beans, oats (every AM), occasional wraps. After 6 wks my blood work (VAP) was as follows: LDL=86, HDL=43, VLDL=17, TOT. CHOL=146, Trigycerides=66, Non-HDL (LDL+VLDL)=103.

    Seemed GREAT to me! The dr wasn’t impressed. Said my ‘particle size’ was small: LDL1(a)=8.1, LDL2(a)=0, LDL3(b)=39.5, LDL4(b)=24.9. Density Pattern=B.

    I’ve continued but don’t know how to elevate my HDL and reduce the particle size/change the pattern to the more favorable ‘A’. Getting down about this. Working hard but, seems like I can’t find answers that work, anywhere! What might you would work in my situation? Also, Is niacin ANDRed Yeast Rice a bad idea?
    I’ll hang up and listen. Thank you,

    PS - I left this post on another page, as well.