Micronutrient Deficiencies: An Underappreciated Cause of Hypothyroidism

A significant number of our readers have hypothyroidism with normal T4 but low T3. For instance, Kratos:

I followed a strict low carb diet with around 50g of carb per day for over 1 year and I think I have developed hypothyroidism …

TSH 3.4 (0.3-4.0)

FT3 2.2 (2.1-4.9)

FT4 11.4 (6.8-18.0)

This situation can have many causes. Our last post discussed how shift work and disrupted circadian rhythms can cause hypothyroidism. Another often-overlooked cause of hypothyroidism is nutrient deficiencies.

As noted in the book, selenium and iodine deficiencies are classic causes of hypothyroidism. Here I want to look at a few other possiblities.

Copper and Iron Deficiency

Copper deficiency, iron deficiency, and iodine deficiency during pregnancy or infancy generate similar neurological defects, and during adulthood generate similar hypothyroid symptoms:

Cu, Fe, and iodine/TH deficiencies result in similar defects in rodent brain development, including hypomyelination of axons, aberrant hippocampal structure and function, altered brain energy metabolism, and altered neuronal signaling (8–13). In addition, the behavioral and neurochemical abnormalities associated with perinatal Cu, Fe, and iodine/TH deficiencies are irreversible and persist into adulthood (14–16). These similarities suggest that there may be a common underlying mechanism associated with all three deficiencies contributing to the observed neurodevelopmental defects.

Several studies in postweanling rodents show that Cuand Fe deficiencies impair thyroid metabolism. Fe deficiency reduces circulating thyroxine (T4) and triiodothyronine (T3) concentrations (17–20), peripheral conversion of T4 to T3 (18, 19), TSH response to TRH (19), and thyroid peroxidase (TPO) activity (20). Cu deficiency also reduces circulating T4 andT3 concentrations and peripheral conversion of T4 to T3  (21, 22). In addition, Cu deficiency reduces serum and brain Fe levels, which may contribute to the Cu-dependent effect on thyroidal status (23). [1]

In infant rats, deficiencies of either copper or iron cause hypothyroidism:

Cu deficiency reduced serum total T(3) by 48%, serum total T(4) by 21%, and whole-brain T(3) by 10% at P12. Fe deficiency reduced serum total T(3) by 43%, serum total T(4) by 67%, and whole-brain T(3) by 25% at P12. [1]

Note that copper deficiency hypothyroidism reduces serum T3 levels more strongly than T4 levels, the same pattern that Kratos displays.

While We’re On the Topic of Micronutrients and Hypothyroidism …

Hypothyroidism induces the symptoms of riboflavin deficiency. This is because thyroid hormone is needed for production of the enzyme flavin kinase, which is in turn needed to generate flavin adenine dinucleotide (FAD). Riboflavin deficiency and thyroid hormone deficiency lead to the same low FAD levels in both rats and humans. [2]

This suggests that hypothyroid persons may wish to supplement with riboflavin, so that extra riboflavin may help make up for deficient flavin kinase.


I believe that those with health problems should strive to “overnourish” themselves. Micronutrient deficiencies can have insidious disabling effects, yet be impossible to diagnose. In disease conditions, needs for many micronutrients are increased. Many micronutrients are non-toxic up to fairly large doses and can be safely supplemented.

An effort to eat micronutritious foods and supplement micronutrients into their “plateau ranges” to eliminate deficiencies might generate startling health improvements.

Minerals like copper, selenium, and iodine are among the most important nutrients – they are among our eight essential supplements – yet also among the most widely deficient. Most supplementers neglect key minerals; but optimizing their intake can pay large health dividends.


[1] Bastian TW et al. Perinatal iron and copper deficiencies alter neonatal rat circulating and brain thyroid hormone concentrations. Endocrinology. 2010 Aug;151(8):4055-65. http://pmid.us/20573724.

[2] Cimino JA et al. Riboflavin metabolism in the hypothyroid newborn. Am J Clin Nutr. 1988 Mar;47(3):481-3. http://pmid.us/3348160.

Leave a comment ?


  1. The graph labels the left-most bar as “secondary hyperparathyroidism”, but you call it “secondary hypothyroidism”. How did you get from hyperparathyroidism to hypothyroidism? Different gland, opposite direction. Or is the graph mislabeled?

  2. Odd! The abstract says hypothyroidism, the figure says hyperparathyroidism. Looks like peer review failed us. Let me re-read the paper.

    UPDATE: It’s obviously supposed to be hyperparathyroidism, the abstract is a misprint. Somehow once I read the first hypothyroidism every hyperparathyroidism afterward looked like a hypothyroidism.

    I am deleting that section of the post. For the curious the cited paper was: Bener A, Hoffmann GF. Nutritional Rickets among Children in a Sun Rich Country. Int J Pediatr Endocrinol. 2010;2010:410502. http://pmid.us/21048925.

    Thanks, Tom.

  3. What are your thoughts on B12? It seems that deficiencies are more common in all ages than once thought. Also, some forms of it are much better absorbed and used than others, for instance methylcobalamin B12. I haven’t read much into the relationship of B12 and thyroid function, but maybe you have or could chime in on this?

  4. Hi Tyler,

    B12 is a very powerful vitamin that has effects all over the body and on hundreds of genes.

    It is potentially valuable, yet we don’t know the consequences of supplementation. It promotes cell proliferation and differentiation. If you take high doses, you’ll notice your hair grows faster, your nails grow faster.

    My concern is that these effects are very similar to an acceleration of aging. Differentiating stem cells into mature cells may deplete stem cells; proliferation may shorten telomeres and promote senescence. B12 is known to accelerate growth of cancers.

    There are benefits to B12 supplementation, such as higher bone density and improved myelinization of nerves.

    Personally, I think the long-term effects of B12 supplementation are too uncertain to permit recommending it. If you do take it, I would restrict the dose to less than 500 mcg/day.

  5. Hmmm .. thanks for the insight. I’ve just gotten my b12 serum blood test back and my levels are a bit low and close to the deficient range. I’m also low on B1 and B2. I’m not sure if it’s best to just take a B complex or multicap and even supplement B12 additionally. My Dr had given me the methylcobalamin B12 spray which is 500 mcg per spray.

    I know that you do not recommend extra intake of folic acid. Would it be wise to supplement B1 and B2 separate or just take a B complex? I’ve heard that just supplementing a few and not others can deplete others even further.

    Thanks Paul

  6. Hi Paul, I already tryed supplementing copper for 3 months but thyroid not improved.

    I remember 5 years ago when was doing SAD diet I have been tested for carnitine and it was in the low range, now I’m supplementing 3g acetyl-carnitine and 30mg CoQ10 and my energy level increased a lot. I also increased my fat intake from butter and coconut oil.
    My basal body temperature went from 96.4F to 97F, so it’s still a bit low.

    After seeing that carnitine was working I started supplementing vitamin C (2 month ago) and selenium (last week).

    I’m going to repeat my blood tests, I’ll let you know.

    But I doubt it will normalize, if I eat a lot of carbs I feel well so it’s not a problem of the thyroid gland itself but of the body that is trying to save energy for its vital functions.

    I think low carb diets works for someone because they are good fat oxidizer, if we have a broken fats metabolism the body will have no energy to heal itself.

  7. Paul read this:


    “The results suggest that plasma carnitine levels in adults may be regulated by a balance between factors influencing its availability through the diet or its synthesis (availability of precursor amino acids, activity of synthetic enzymes), and utilization (body weight, quality and quantity of fat)”

    So this may be a deficience that develop during low carb dieting (increased utilization of carnitine due to high fatty acid intake).

  8. Paul:

    While talking about micronutrient deficiencies, do you have any recommendations on how to test for mineral status?

  9. Hi Tyler,

    I would recommend supplementing individually. B1, 100 or 200 mg/day; B2, 100 mg/day; biotin, 5 mg at least once a week; pantothenic acid, 500 mg/day (probably not necessary); B6, 50 mg/day; B12, 500 mcg/day or less. No niacin or folic acid, but do eat liver and egg yolks for folate.

    Hi Kratos,

    That’s neat. It is interesting to hear of low-carb deficiency conditions. You know of my experience with vitamin C, so I can easily believe in a carnitine deficiency.

    Hi Thomas,

    Personally I’m not knowledgeable of how useful those tests are for assaying mineral status. Some minerals are found in tissues and the blood levels have little correspondence to tissue levels.

    Some of the more readily available tests can be found here: http://www.lef.org/Vitamins-Supplements/Blood-Tests/Nutrient-Testing.htm.

    My recommendation would be to try supplementing for a month or three and see if anything gets better. But be careful to stay below any possible toxicity.

  10. Does anyone on this forum have any experience or opinions on hair mineral analysis for checking intracellular minerals?

  11. I see normal T4 and low T3 all the time in my practice. This is referred to as a thyroid underconversion pattern. The most common causes, in my experience, are 1) inflammatory cytokines, 2) high cortisol and 3) gut dysbiosis. Each of those three factors suppresses the conversion of T4 to T3, or more accurately increases the conversion of T4 to rT3, an inactive form the body cannot use.

    I imagine micronutrients also play a role, especially in those following a standard American diet. But I do see underconversion frequently, even in people with adequate micronutrient status, so I thought I’d point out these other factors.

    I’ve written more about it here:


  12. Thanks, Chris. Nice post you have there.

  13. Hi Paul,

    Do you plan to do a blog post on the Vitamin D studies that have been in the media recently? Thanks, Jen

  14. Hi Jennifer,

    Do you mean the IoM refusing to raise the RDA for vitamin D significantly? Or some other vitamin D studies?

    I’m not currently planning a vitamin D post, as I haven’t seen anything dramatically new. I do try to monitor the vitamin D literature. But if you have a link to something you’d like me to comment on, post it and I’ll do my best.

    Best, Paul

  15. Thanks Paul,

    I had mentioned your book to several people and they asked about which vitamins you recommended. When I mentioned vitamin D, a few of them talked about this http://www.nytimes.com/2010/11/30/health/30vitamin.html


  16. Hi Jen,

    Well, that story is about the IoM’s new recommendations for calcium and D. I agree with them that old calcium recommendations were too high … and the new lowered recommendations are still too high! I agree that the old D recommendations were too low … and the new raised recommendations are still too low!

    Overall, the panel was just too conservative. On D, they looked only at bone health, not at other health effects; and re bone health they focused on calcium, which is controlled mainly by 1,25D, not 25OHD, and therefore found that minimal amounts of D are needed.

    D is a complex topic and a lot of our knowledge is inconclusive. I can’t fault them for being cautious. But the trouble is they don’t go with the weight of the evidence – rather the old standards were set with almost no evidence, and now they require very high standards to alter them.

    The weight of the evidence, I think, suggests seeking a total of 4,000 IU/day from sun and supplements, therefore for most people ~2,000 IU from supplements, perhaps more in winter, and aiming for 25OHD around 40 ng/ml, less for Africans.

  17. Thanks so much Paul – great to have your voice in this realm. Just got the book for my parents too…have a great holiday season! Jen

  18. Thanks for taking the time to reply to all these questions. We all really appreciate it! Another thing that I am curious about is thyroid function and adrenal exhaustion. Would you recommend any certain combination of micronutrients to restore proper adrenal function? Also, might the perfect health diet be ideal for a person dealing with adrenal issues?

  19. Hi Tyler,

    I believe the Perfect Health Diet is ideal for all organs of the body, including the adrenals and thyroid. However, I don’t have specific evidence for that.

    I do think optimizing micronutrition is very important for healing. I would follow the book recommendations, including the B vitamins listed in the “To B or Not To B” chapter (that is, B1, B2, biotin, and pantothenic acid in high doses, B6 and B12 in moderate doses, and no niacin or folic acid, but plenty of micronutritious foods containing folate and choline).

    Best, Paul

  20. Oddly, my VAP test back in Oct shows T3 ref range as 1.73 – 3.71, and T4 0.70 – 1.48. Much lower than the range you cited for T4. I wonder what’s up with that?

  21. From :

    Hi Paul and All,

    Wondering if I could pick the collective brain here re. Carnitine supplementaiton. I notice in a post above that Kratos has had a positive experience with it thus far. Paul, do you or anyone else here have any thoughts about it?

    The reason(s) I ask:
    – I’m a 42 year old male diagnosed Hypothyroid a few months ago…
    – TSH 4.5 mU/L (0.38 – 5.5)
    – FT4 15.4 pmol/L (10.5 – 20)
    – FT3 3.1 pmol/L (3.5 – 6.5)
    – Doc said T3 was the lowest she’d seen in her practice, and that it was a T4-to-T3 conversion problem
    – Went on porcine thyroid hormone (T4/T3 mix), started at 15mg/day a few months ago, ramped up to 60mg/day over time
    – Had TSH re-tested last week – down from 4.5 to 0.4

    Unfortunately, all is not yet well. Energy levels still not what I’d like. Basal temperature (tested orally upon waking w/ a glass thermometer) still low (36.1 C / 96.98 F).

    After getting latest TSH results and discussing continuing symptoms, Doc suggested mitochondrial function may be a problem, and suggested I take a combination of Carnitine (either compounded Acetyl-L-Carnitine, or Carnitor/Levocarnitine) and Lipoic Acid. (She also recommended a supplement by AOR called ProChondria – which contains Lipoic Acid, CoQ-10, Rhodiola Rosea, Benfotiamine, Oxaloacetic Acid, D-Uridine, Gynostemma Pentaphyllum, and Gamma Butyrobetaine).

    I’ve been low-carb and low-gluten for the last year; gluten-free/Perfect Health Diet for last couple of months; still trying to get on the PH Diet supplements; Have reasons to suspect bacterial infection(s) as a contributor.

    As always, any thoughts would be appreciated.

  22. Hi Sammy,

    Mario and I had a discussion about C, carnitine, and hypothyroidism a while back. Here: http://perfecthealthdiet.com/?p=636&cpage=1#comment-2280.

    I’d be inclined to supplement vitamin C, maybe 3 g/day, rather than carnitine. C is needed to make carnitine, but I think I’d rather let my body make carnitine. Based on the papers Mario and I linked to, it seems that supplemental carnitine has the potential to block T3 entry to the nucleus and thus exacerbate hypothyroidism.

    I’d recommend getting on the PHD supplements first before doing the more complex ones. For hypothyroidism, C, iodine, selenium, magnesium (and, as this post shows, copper) are basic.

    I don’t object to the supplements your doctor recommends, but I think it’s usually best to do the basics first, and try more esoteric things later.

    Best, Paul

  23. Hi Paul,

    Thanks for your work. I have read quite a bit recently about the effect of diet on hypothyroidism. I have Hashimoto’s, and according to several sources, including this one, http://thehealthyskeptic.org/iodine-for-hypothyroidism-like-gasoline-on-a-fire, iodine is not appropriate to take for Hashimoto’s.

    In July, I became gluten-free and somewhat Paleo, and my need for medication (I’d taken 100mcg Levoxyl and 2.5 mcg Cytomel daily for years) decreased almost overnight. I now am down to 88mcg Levoxyl—-and I can tell my body is not finished adjusting itself.

    I also began taking 2000IU of D3 over the summer.

    I look forward to continued information from your blog!

  24. Hi Shirley,

    Iodine in Hashimoto’s is a very controversial topic.

    It’s tricky because almost everyone has an immediate negative reaction to iodine if they increase the dose too quickly, which is very easy because the thyroid is extremely sensitive to alterations in iodine level, especially if starting from a deficiency condition. And it takes a long time, about a month, to adjust to even a minor change (a doubling) in iodine intake.

    Then there is the fact that iodine supports the extracellular immune response, so as Chris points out in that post (and we point out in our book), it can aggravate an autoimmune attack.

    On the other hand a lot of people with Hashimoto’s experience benefits from sustained higher iodine intake. Our commenter Mario is an example. There are various possible mechanisms by which this can occur. Enhanced immune function can cure infections which are precipitating the hypothyroidism. Higher iodine levels will tend to reduce TPO levels, which might relieve the autoimmune attack. So it’s not entirely obvious which way the iodine effect should go.

    My recommendation would be to eliminate all grains except white rice, and the major legumes like soy, take selenium and other non-iodine supplements immediately, and wait 3-6 months for wheat-derived antibodies to clear. Then very slowly ramp up iodine, starting with less than 1 mg/day, waiting a month, and going no faster than doubling once per month. While doing this, monitor thyroid hormone levels and antibody levels, and carefully monitor how you feel. Reduce iodine if any negative symptoms appear.

    You might want to search for “hypothyroidism” and read the comments on our various posts.

    Best, Paul

  25. Sammy, my MD is firm about how to take a thyroid test.

    I was told, upon waking, take your thyroid related supplements (iodine, selenium, and thyroid medication). Take the test non-fasting! For example, in the afternoon after lunch. Take the test the same way each time, to reduce variables. Keep careful notes.

    Taking the test fasting, or skipping your normal thyroid dose, or not taking your selenium will tend to make the scores look worse, that is, more hypothyroid.

    We need updated thyroid scores on you, TSH, FT3 and FT4, taken ON your meds, so you know what this dose is doing for you. You said your TSH was 0.4 last week, but did you take the test ON your meds and NOT fasting?

    Also, you want to know if your FT3 is still at the bottom of the range or not.

    If you skipped your meds the day of the test, a TSH of 0.4 might indicate slight over medication which will dial your thyroid down.

  26. Hi Paul,

    Thanks for the great response. I didn’t realize taking iodine was controversial. I will follow your suggestions and see what happens. While my energy is still really good, without the T3 I still occasionally get brain fog, so I’ll have to see if I can eliminate that tendency with my diet/supplements.

    Three questions: Should I take the supplements separately, or can I take the multivitamin I have (from Costco) that has 150mcg iodine, 55mcg selenium, 1.7mg riboflavin, .9mg copper—among other things.

    What might negative reactions to too much iodine be?

    Also, while my diet does not include gluten, every now and then (once per month?) I’ll have a small bite of something that has flour. Will this interfere with my process of eliminating antibodies in a significant way? How extreme do I have to be?

    Thanks again for your thoughtful response. While my endocrinologist is fantastic, his knowledge base doesn’t include the intricacies of diet or supplementation, so I’m left to my own research…

  27. Hi Shirley,

    I would definitely take T3 as long as that is helping. It’s benign, so it’s not one you need to try to rush yourself off of.

    You should definitely take a multivitamin, and yours sounds like a normal one which is what we recommend (not a super-high dose multi). Then take our other 8 supplements daily along with it.

    Negative reactions – when increasing iodine I commonly experienced hyperthyroid symptoms. You may also experience an enlarged thyroid. TSH may go up temporarily. Some people get hypothyroid symptoms. Bromine toxicity symptoms, as iodine drives bromine out of tissue, are common. This may include skin effects / acne. Drink a lot of water and eat extra salt while supplementing iodine to help excrete bromine and other halides.

    As far as wheat goes, some people are very sensitive. Even consuming a little may keep antibodies around. I would recommend total elimination. That said, odds are once a month will not be a problem. (Of course, Russian roulette is not a problem five times out of six …)

    Best, Paul

  28. Paul, if a multi contains the recommended amount of the vites/minerals you suggest supplementing additionally in the book (like, 200 mcg selenium, etc), do we need to take extra amounts of these, or is the multi enough?

    (I’m looking into the Rainbow Light multis–here is one I’ve been thinking of: http://www.rainbowlight.com/Categories.aspx?Category=c785776c-81b3-4325-8083-ccc7606ea87e Would love to know what you think! I would still be supplementing vit D, K2, C, iodine via kelp and magnesium. Would my supplemental selenium, copper and chromium needs most likely be covered with this? It contains 200 mcg selenium, 2 mg copper, 200 mcg chromium…)

    Also, do you have favorite brands of multis and other supplements that you recommend?

    Thanks in advance!!

    Lauren 🙂

  29. Hi Lauren,

    The book recommendations are from all sources, so if your multi has 200 mcg selenium DO NOT take additional selenium.

    Yes, that multi would cover selenium, chromium, and copper, although you might eat some beef liver once in a while to get a little extra copper. It is a little high in folic acid and E to our tastes, but an excellent mix overall.

    Our supplement recommendations page has some suggestions, but we don’t feel strongly about brands, so buy whichever brands you prefer.

    Best, Paul

  30. Ooh–thanks so much! I didn’t even see the supps page you have (oops!)

    Thank you for being such a helpful resource. Every question I’ve asked has had a prompt and helpful reply! I really enjoy learning from your work! 🙂

  31. Hi Paul, I have an update.

    I redid blood tests and my FT3 went from 2.2 to 2.4, so not a big rise considering that 2 years ago (before being low carb) was 2.9.

    The only thing I have changed during this 3 months is that I took 3g of carnitine, 30g CoQ10 and 500mg of vitamin C. I reduced my copper intake because 3 months ago it was in the high range.
    I’m still limiting my carbs to 40-50g from plant foods but tomorrow I will start eating 100g a day from “safe starches”.

    I found this article that explains a lot of things:

    “”… T3 is a key regulator of metabolic rate, and that calorie restriction causes a decline in T3. Studies also show that diets that continuously restrict carbohydrate (like the Atkins diet, for instance) cause a reduction in T3, and that administering carbohydrate can restore T3 levels after they have declined.”

    I hope 100g would be enough for me.

  32. Hi Kratos,

    Thanks for the update!

    I think 100 g/day ought to be sufficient.

    Best, Paul

  33. Hi, I really hope they will fix it!

    I read you post about carnitine:

    If I have understood correctly supplementing carnitine will give energy to my muscles (due to more fats being transported into the mithocondria) but will inhibit nuclear uptake of T3 in other tissue (for example causing hair loss etc).
    Is it correct?

    Maybe I can try increasing my vitamin C intake to 1g/day, I read somewhere that taking more than 350mg in a single dose will made the exess excreted in urine. Is it true?
    Do you think is better do take it with meals?
    Now I take 250mg at breakfast and 250mg at dinner.

    Thanks a lot.

  34. Hi Kratos,

    Yes … I think carnitine levels should be controlled by the body and you should supply enough vitamin C so that it can easily make the amount of carnitine it considers optimal.

    Vitamin C will get taken up by cells, if they need it it won’t be excreted. So there’s little harm in taking higher doses. It can take months to repair scurvy at only 1 g/day, but if you’re healthy 500 mg is an adequate maintenance dose.

    Yes, taking it with meals is a bit better as the acid is less likely to irritate anything.

    Best, Paul

  35. Thanks for clarifying!

    Looking at blood results I noticed some things:

    1) I have always had low cholesterol (135[140-220]) and hypercalcemia (10.7[8.4-10.2]).
    After cutting all carbs my cholesterol went up to 213! (HDL 88, LDL 125).

    Now I report my lab-tests over time:

    12/06/10 (added 500mg vitamin C)
    cholesterol 160 (HDL 79 so my LDL fraction went down)
    calcium 10.1 [8.4-10.2]
    ionized calcium 4,25 [4,25-5.25]

    04/09/10 (stopped vitamin C)
    cholesterol 201 (LDL 121)
    calcium 11.0 [8.4-10.2]
    ionized calcium 4,5 [4,25-5.25]

    09/12/10 (readded 500mg vitamin C and ate a lot more satured fats)
    cholesterol 184 (but LDL 87)
    calcium 10.1 [8.4-10.2]

    So it seems vitamin C brings my LDL cholesterol and calcium down!!
    It’s strange that ionized calcium (the bioavailable fraction) is low but my total calcium is high, my
    albumin seems fine.
    In the last 6 months I haven’t changed my carb or calcium intake (from yoghurt and cheese).
    I’m wondering if I will benefict from higher doses of vitamin C.

    2) I think I have some problem with copper:

    12/06/10 (never supplemented copper)
    copper 36 [80-140]

    04/09/12 (supplemented 1mg copper at day)
    copper 118 [80-140]
    ceruloplasmin 39 [25-50]

    09/12/10 (stopped supplementing copper)
    copper 91 [80-140]
    ceruloplasmin 19.4 [25-50]

    Do you think my low ceruloplasmin and normal copper are due to copper toxicity?

  36. Hi Kratos,

    It looks like you really need vitamin C! Be sure to take care of your other antioxidants – esp. selenium, zinc, copper. You may wish to supplement NAC also.

    I think low ceruloplasmin is most likely due to a copper deficiency. Your copper was low on June 12 before you supplemented copper, normal in September while you were supplementing 1 mg, then low again in December after you stopped.

    It looks like all the antioxidants are deficient. You should stay on our supplement regimen.

    Best, Paul

  37. Yes also my zinc was at the bottom of range!

    Probably I have a lot of oxidants in my blood, also my serum ferritin is pretty high:

    “Iron is required for normal cell growth and proliferation. However, excess iron is potentially harmful, as it can catalyse the formation of toxic reactive oxygen species (ROS) via Fenton chemistry. For this reason, cells have evolved highly regulated mechanisms for controlling intracellular iron levels. Chief among these is the sequestration of iron in ferritin.”

    You are right: going too low carb for long time is very dangerous (at least for me).

    I started the PHD diet today!! Soon I’ll take the reccomanded supplements.
    For vitamin C I’m going to buy it in form of sodium ascorbate, is it egually effective?
    I know it is easier on the gut.

    I’ll let you know soon!

  38. Hi Kratos,

    Great! Welcome to the club!

    Sodium ascorbate is fine, any form of C is fine by us.

    Best, Paul

  39. Hello Paul,

    Can I do it too, please? I mean, show the results of my blood tests and ask your opinion?

    September 2009 my doctor only tested TSH: 2,49 mIU/l

    June 2010, after half a year of diligent low carbing (max. 30 g per day):
    TSH: 1,32 mIU/l
    FT3: 2,51 pg/ml
    FT4: 1,3 ng/dl
    TPO Antibodies: 14 IU/ml
    Thyreoglobuline Antibodies: <10 IU/ml
    TSH receptor antibodies: <0,3 IU/l
    I had a new doctor at that time and she said that FT3 was low, but the rest seemed alright.

    Then came summer and I had two weeks of vacation, and also took a "food vacation", eating carbs, sugar, wheat…
    After coming back home, I went very low carb. There were days that I didn't even allow myself 5 grams of carbs per day.
    In September, three months later, these were the results:
    TSH: 2,49 mIU/l
    FT3: 2,7 pg/ml
    FT4: 1,36 ng/dl
    TPO Antibodies: <10 IU/ml
    Thyreoglobuline Antibodies: <10 IU/ml
    TSH receptor antibodies: 1,2 IU/l
    The doctor said that the nasty one here are the TSH receptor antibodies which increase my TSH production.
    After that I gradually started adding more and more carbs to my diet.

    This is the result two weeks ago, after Christmas and New Year, where I allowed myself everything "bad" and after one week of taking it easy again, mainly cutting out industrial seed oils, wheat and sugar:
    TSH: 0,8 mIU/l
    FT3: no result :-/
    FT4: 1,29 ng/dl
    TPO Antibodies: 15 IU/ml
    Thyreoglobuline Antibodies: 25 IU/ml
    TSH receptor antibodies: <0,3 IU/l
    You will see that the TSH antibodies are now behaving again.
    It's a bit stupid that the lab didn't test the FT3, although I asked them to do that. I will have to wait 8 weeks now for a new blood test to see if FT3 production is okay.

    I have reduced my Levothyroxine from 100 to 75 between November and January and have now reduced further to 50. I hope that after the new blood test results in March, I will be allowed to reduce the Levothyroxine to 25 or even nothing at all.

    I am rather confident that I have repaired the damage of my self-sabotage.
    At the beginning of the year – logically – I gained a bit of weight. But at the moment I have lost a tiny bit again and it seems to stabilise.
    I am now trying to be patient, diligently keeping away from industrial seed oil, sugar and wheat (although I do indulge from time to time), and hope that I will gradually start to lose weight automatically.
    I do still supplement, but things seem to be going well. Except for zinc, selenium and iodine which do very badly and refuse to budge at all.
    I have increased my iodine now (carefully), switched from yeast bound selenium to yeast-free selenomethionine and I switched from zinc picolinate to zinc monomethionine with a tiny bit of added copper (which I now take in the evening in stead of in the morning). I agree with you that a lot of what we need to do to get to good health, is experiment ourselves and see what works for each of us.

    I know this is a lot of text. I am sorry. I am renowned for making short stories long *g*.

    Kind Regards,

  40. Hi Tarragon,

    You’re doing very well! Congratulations!

    It sounds like you’re doing everything right, so I don’t have any advice to give other than, “keep on.” Hopefully you’ll continue to heal. Work up the iodine very slowly, and don’t overdo the zinc. If you’re getting ~3 mg copper it should be safe to get up to 50 mg zinc, but remember food probably has 15, multi may have 15, so high-dose zinc supplements can be risky.

    Best, Paul

  41. Hi,
    I just bought a copy of your book and am enjoying the new nutrition info. I’m hoping to see improved health! But I do have a question regarding Vitamin D. I wondered if you were aware of the research from a controversial project called the “Marshall Protocol.” Frankly, their hypotheses regarding chronic disease and pathogens seem similar to those in your book; however, their conclusions on Vitamin D intake are quite different. If you go to Amy Proal’s web site: http://www.bacteriality.com there are links to peer-reviewed papers on Vitamin D. Any thoughts?


  42. Hi Lynn,

    Yes, I’m familiar with the Marshall folks.

    I think they’re right about some things, like some pathogens being able to interfere with vitamin D biology.

    I think it’s extremely unlikely that Benicar is a better ligand for the vitamin D receptor than natural vitamin D. The evidence for this claim is virtually non-existent: a computer model for protein interactions by Marshall that no one else believes in or can reproduce. So I think their protocol of creating a vitamin D deficiency and giving patients Benicar is very likely to do harm.

    Nothing I’ve heard from former chronic disease patients who tried the Marshall Protocol is inconsistent with that assessment. Successes seem to be transient; the norm seems to be failure and rapid disease progression within 2 years.

    I prefer antibiotic protocols like the one at http://cpnhelp.org combined with, of course, our diet and nutritional program. That’s how I cured my chronic illness.

    I do think it’s good that they’re helping highlight pathogens as the causes of chronic illness and focusing attention on the ways pathogens suppress immunity. But I think their protocol is a mistake.

    Best, Paul

  43. Hi Paul,

    I have an update after being on PHD for about 4 months (with an average of 120g carbs/day).
    I had blood tests last week and here the results:

    Glucose 113 {70-105}
    HbA1c 5.0 {4.6-6.0 (non diabetic)}
    CRP 10 mg/L {<50}

    Zinc 70.0 {68-107}
    Ceruloplasmin 21.2 {25-50}

    TSH 5.8 (0.3-4.0)
    FT3 3.5 (2.1-4.9)

    They seems very alarming to me, glucose was rising every 3 months in the last 2 years (from when I began low carbing), in the last 4 months I added more carbs but it increased again. My HbA1c is fine but I don't think is healthy to have that high fasting glucose.

    My CRP is very high, it is in the range but in the long term is bad:

    I took 2mg copper and 30mg zinc every other day for the last 2 months but serum zinc lowered! I never supplemented zinc before. My ceruloplasmin even with supplementation is low.
    I supplemented also with 1g vitamin C and magnesium.

    My TSH went from 3.2 to 5.8 and my FT3 went from 2.4 to 3.5. I don't know if I should be happy because my Ft3 normalized or not because my TSH became higher.
    My extreme cold intollerance became a lot better but I gain weight even with 1400kcal a day (I used to be very lean before even if I was eating a lot). My basal body temperature is still pretty low (97.1 F).
    I don't know if resistance training affects thyroid but I also started working out 2 times a week some months ago.

    Maybe low carb is not for me, please can you give me some advice for an healthy high carb diet?


  44. Hi Kratos,

    I’m not sure what to make of the high fasting glucose given that your HbA1c is so low. That doesn’t suggest a hyperglycemia problem, rather a cortisol issue which is high in the morning when you were tested.

    The TSH rise is alarming, but it’s good the T3 normalized. Same with the hypothyroid symptoms, mixed changes. I guess I would take it as mild progress that you’ve been able to affect the numbers, but the underlying issue is still there.

    Is your copper and zinc supplementation in addition to a multivitamin, or are you not taking a multi? You could try 2 mg every day for the copper.

    The weight gain is also consistent with a cortisol issue, as is the CRP level – high CRP indicates a chronic infection, and many chronic infections raise cortisol.

    I would try to get an adrenal panel, or at least cortisol, and consider what the infection could be. You might test an antibiotic and see if there’s an effect.

    It’s possible that higher carb intake could be helpful. If that’s your experience then I would give it a try. Higher carb intake can sometimes help against viral infections and almost always helps against fungal and protozoal infections but is likely to hurt with bacterial infections.

    You know my advice for healthy high-carb – safe starches. Eat a lot of rice!

    Best, Paul

  45. Hi Paul,

    Yes I forgot to tell you that I’m taking a multivitamin every other day.

    I take 1/2 tablet a day because it is high in B-vitamins:

    Now I noticed that 1/2 tablet contains only 17% of the RDA for iodine and I’m not taking iodized salt.
    Could iodine deficiency explain also high fasting glucose and high CRP?

    Do you know, if I supplement iodine at 100% RDA, how much time it takes to lower TSH?

  46. Hi Kratos,

    Iodine deficiency is definitely a concern and I think you should remedy that.

    Iodine deficiency won’t explain the high CRP and probably not the high fasting glucose either, but fixing the deficiency (if it exists) should be a step forward against both conditions.

    If the high TSH is due to iodine deficiency, then it should lower within a month. However, you might want to take a bit more than the RDA. If you do have an infection then the immune system will be consuming iodine.

  47. I found this about CRP and hypothyroidism:

    Thanks a lot Paul, I’ll let you know (I hope with good news)!

  48. Hi Paul, maybe my problems are due to infections.

    When TSH goes high, it’s actually because TRH (thyrotropin-releasing hormone) goes high.

    TRH is an immune system booster:

    “The human neuroendocrine thyrotropin-releasing hormone receptor promoter is activated by the haematopoietic transcription factor c-Myb.”


    “Our findings imply a novel functional link between the neuroendocrine and the immune systems at the level of promoter regulation.”

    It also makes sense that the body wants an increase in metabolic rate, to speed up the repairs from the bacterial infection, and it achieves this via cranking TSH, which in turn cranks thyroid hormone T3, which is one way to crank metabolic rate.

    I read in this (very interesting) book that during refeeding after a famine CRP usually goes high and the infection burden rise:

    “During the first
    2 weeks of refeeding, latent infections rapidly emerged (Fig. 3.5), particularly
    malaria, brucellosis, and tuberculosis, in association with bloody diarrhea and
    fever. During weight gains averaging 4.2 kg, symptomatic infections increased
    10-fold. Serum CRP was <10 mg/L in most (82%) before refeeding. Of those with
    initially low CRP, after refeeding, 32% had huge CRP elevations (49 ± 7 mg/L)."

    I remember my CRP became higher when I began gaining weight after being underweight (hoping that it isn't an obesity related inflammation), now my BMI is 23-24.

    So infections could explain the high TSH, high CRP and high cortisol.

    I increased my vitamin c intake to 2g/day to boost my immune system along with iodine.

  49. Hi Kratos,

    Very interesting papers. It makes sense that TRH upregulates thyroid hormone synthesis during infections because immune cells get a lot of their iodine from thyroid hormone.

    The refeeding phenomenon is very interesting. Shows the importance of designing a diet that neither feeds infections nor starves the immune system!

    Thanks much. I hope you can figure out how to treat your infection. It does sound like the logical explanation.

    Best, Paul

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