Does Your Thyroid Need Dietary Carbohydrates?

Blog - April 12 thyroid.png

Thyroid hormones have an important role in regulating metabolic rate. When some people adopt a low-carbohydrate lifestyle, their thyroid hormone levels may change. Several factors may contribute to the thyroid response.

Firstly,eating fewer calories than you expend, causing weight loss, prompts the body to reduce thyroid function to slow its metabolism. That’s because the body interprets any form of energy restriction from any cause as a sign of famine, leading it to reduce metabolism by 5-15% to conserve energy stores.

Secondly,even when energy is not restricted, a ketogenic diet seems to result in improved thyroid hormone sensitivity (i.e., it takes less hormone to produce the same effect), and puts less of a burden on thyroid hormone (T4) production in the thyroid gland and its conversion to T3 in the liver.

It has been repeatedly demonstrated that a well-formulated ketogenic diet (WFKD) improves insulin sensitivity, often dramatically so in people with insulin resistance or type 2 diabetes. There is also strong evidence that the brain’s sensitivity to the satiety hormone leptin is improved during nutritional ketosis as well. Thus an improved thyroid hormone response during a low-carb, high-fat eating diet would be quite consistent with these other documented improvements in hormone sensitivity.

How many published studies from well designed, prospective human trials have shown that impaired thyroid function (i.e., hypothyroidism) occurs on a ketogenic diet? The answer to this question is quick and simple – NONE!

It is common to find recommendations on the internet for daily carb intakes at or above 100 grams per day to maintain “normal thyroid function.” But here’s the key question: are these higher thyroid hormone levels really normal, or is this a relatively hyperthyroid state (compared to nutritional ketosis) driven by excess dietary carbohydrates?What if the lower T3 levels associated with a WFKD are indicative of optimum T3 sensitivity and thus the true physiologic norm for humans?

The other proposed “cure” for this “problem” is to intermittently eat lots of carbs. What sense does it make to be jerking the body back to deal with the disposal of high carbohydrate loads? Given that blood beta-hydroxybutyrate levels characteristic of nutritional ketosis reduce oxidative stress and inflammation, why would you want to shut down this beneficial effect even part of the time?

If carbohydrate-restricted diets were having a negative effect on thyroid function, it would be predicted that a disproportionate number of people would develop clinically obvious cases of thyroid failure (hypothyroidism) while following a ketogenic diet.Let’s look and see how many new cases of low-carb-induced hypothyroidism were reported in a number of large randomized studies published in the last decade.  Please see the CHARTBlog - April  chart.png

While these studies were not purposefully designed to look for thyroid dysfunction, overt hypothyroidism is hard to miss. These studies were all run by (or involved monitoring by) top-notch physicians, so a new case of hypothyroidism would definitely have been reported as a “serious adverse event” associated with the LCHF diet. And yet, out of 350 closely monitored patients, there were none!

Studies:Along with his early mentors and collaborators, Dr. Phinney was involved in three studies of ketogenic diets in which they measured one or more parameters of thyroid hormone response. The first study involved six subjects on a very low-calorie ketogenic diet (VLCKD) for six weeks, the second evaluated nine men given a weight-maintenance ketogenic diet for 4 weeks, and the third studied 12 adults given a VLCKD with or without exercise training for 4-5 weeks.

In addition, in 2005 Yancy et al. published a study (Nutr & Metab) of 28 diabetics given a LCHF diet for four months, during which their mean TSH values did not change significantly (1.6 to 1.4 uU/L).

So let’s query these data from three perspectives:

1) failure of the thyroid to make enough T4,

2) failure of the liver to turn enough T4 into T3, and

3) markedly improved T3 sensitivity.

Starting with the latest data from Yancy et al. first, if either the thyroid gland or the liver were failing to maintain adequate thyroid hormone effect, TSH should increase. It does not, but this was only measured in one study. Second, if the liver is failing to make enough T3, then TSH and T4 values should rise. In both our 1980 and 1988 reports, T4 went down slightly. And third, in all three studies blood T3 levels went down sharply (from a mean of 151 to 92) but clinical signs and symptoms were not indicative of overt hypothyroidism.

Case in point: Dr. Volek ran some thyroid tests on 14 overweight/obese men whose other results were reported in a 2004 study. Eight of these men consumed a reduced energy ketogenic diet for six weeks and then switched to a low-fat diet for another six weeks. Six other men consumed the low-fat diet first and then switched to a ketogenic diet. Average free T3 concentrations in the 14 individuals were significantly lower after the ketogenic plan than the low-fat diet (3.5 vs 4.2 pmol/L). Regardless of diet order, free T3 concentrations were lower during the ketogenic diet in 13 out of 14 men (see figure). However, despite the lower free T3 levels, the measured resting metabolic rates of these subjects were not different between diets.

And finally, although it was a relatively short 11-day study, Bisschop et al. fed six men weight-maintaining diets containing 85%, 44%, and 2% of energy as carbohydrates. Although TSH and REE did not decline, serum T3 values plummeted, these results again show a disconnect between circulating T3 and REE in the context of a ketogenic diet.

The only viable interpretation of these data is that ketogenic diets markedly increase tissue sensitivity to T3, and thus serum T3 levels decline while the physiological response to T3 remains normal. In this scenario, both the thyroid and the liver have to do far less “work” to maintain a normal thyroid physiologic response. Taking this one step further, why would anyone want to force their thyroid or liver to greater levels of thyroid hormone production by eating lots more carbohydrates? Forcing the pancreas to make more insulin by eating more carbs clearly doesn’t do a lot of good for type 2 diabetics, and we think the same logic applies here for thyroid function.

It’s understandable why some people may be concerned or misled by the changes in thyroid hormones that occur when one adopts a low-carb high-fat lifestyle. Don’t be pressured into eating more carbs than you really need on the mistaken assumption that they are required to maintain normal function of your thyroid gland.

SOURCE: Does Your Thyroid Need Dietary Carbohydrates?by Stephen Phinney, MD, PhD on May 3, 2017

https://blog.virtahealth.com/does-your-thyroid-need-dietary-carbohydrates/

To learn more about Hypothyroidism please read:

  1. Metabolic Syndrome X and Hypothyroidismhttps://2healthyhabits.wordpress.com/2018/03/09/metabolic-syndrome-x-and-hypothyroidism/
  1. The Ketogenic Diet for Healthhttp://www.ketotic.org/2014/12/the-effect-of-ketogenic-diets-on.html

Conclusion: There is no evidence that we are aware of indicating that ketogenic diets cause hypothyroid, or negatively impact thyroid function. The fact that T₃is lower in ketogenic dieters is probably part of the mechanism that protects lean mass when fat is being lost. Moreover, low T₃may possibly even be an indicator of a life extending effect, an effect we have suggested elsewhere when examining the cortisol profile of ketogenic dieters.

I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

416-428-5285

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

Nutritional Ketosis, Treating Type 2 Diabetes

Nutritional ketosis is a natural metabolic state in which your body adapts to burning fat rather than carbohydrates. It is clinically proven to directly reduce blood sugar (HbA1c), improve insulin sensitivity (HOMA-IR) and reduce inflammation (as measured by white blood cell count and CRP).

Screen Shot 2018-11-23 at 3.24.07 PM

Dr. Phinney answers viewer’s questions:

Q: I am interested in reversing type 2 diabetes – is a ketogenic diet recommended?? Thx! —Susie T.

Dr. Phinney’s Answer: Insulin resistance is the hallmark of type 2 diabetes and manifests as carbohydrate intolerance. Like other food intolerances, the most logical and effective approach to managing carbohydrate intolerance is to restrict sugars and starches to within the individual’s metabolic tolerance. A well-formulated ketogenic diet can not only prevent and slow down progression of type 2 diabetes, it can actually resolve all the signs and symptoms in many patients, in effect reversing the disease as long as the carbohydrate restriction is maintained.

For complete answers to this and the other questions please copy and paste this link into your address bar

https://blog.virtahealth.com/ketogenic-nutrition-type-2-diabetes-dr-steve-phinney/

Q: Appreciated your article on the concerns about prolonged fasting. Could you comment on the utility and safety of shorter durations of fasting (i.e. 16 hrs of fasting/8 hrs of eating or 20 hrs of fasting/4 hrs of eating over a period of 1 day)? —Anonymous

Q: Can you achieve this on a vegetarian diet too? A lot of people I know from India, including my wife, are vegetarian and prediabetic or T2D. I am a T1 and now on keto diet, but I am not able to convince the vegetarians to eat meat. —Anonymous

Q: Does the amount of fat I eat in a ketogenic diet interfere with my ability to burn body fat? —Marcos C.

Q: Why are blood ketone values lower in the morning than in the afternoon/evening? —Nikola S.

Q: When I started my cholesterol was fine. Now my glucose has dropped 40%, but my cholesterol is 241. Should I be worried? —Kerry J.

 Q: Since families often (and should!) eat together, is there any concern about children who are eating high fat diets at breakfast and dinner with their ketogenic parents, but higher carb foods at lunch/snacks at school? —Tera N.

 Q: What are your inflammation biomarkers? —Tekla B.

 Q: Can long-term keto diet contribute to hypothyroidism? —Sonia Z.

 Q: Why some people’s LDL goes sky high on keto diet? —Sonia Z.

Dr. Phinney: The changes we see in total and LDL cholesterol levels are much less predictable than the changes in triglycerides and HDL cholesterol. For the full answer click the link below.

Q: There is a lot of concern about protein intake and gluconeogenesis kicking people out of ketosis. As stated in your book, moderate protein is .6-1 gram/pound of lean body mass. As long as you stay within that protein range is GNG something to be concerned about? —James F.

 Q: Does Diazoxide helps in the ketone production? Thanks a lot for sharing your knowledge. Your influence is bigger than you think. —Salomon J.

 Q: Does athlete fat oxidation rate vary continuously with carb intake? Or is keto the only way to get it above 0.5g/min?—Norman T.

 Q: My daughter has high uric acid on KD, we don’t know if she did before KD, have you seen this before?—Justine L.

 Dr. Phinney: Yes, blood levels of uric acid usually double in the first week of a ketogenic diet or with fasting. This is because there is a competition between ketones and uric acid for excretion by the kidneys early in adaptation. As the adaptation process proceeds over a few months, the uric acid level comes down to normal levels even as nutritional ketosis continues, Thus this is a process of clearance (i.e., excretion), not over-production from dietary protein, and this temporary elevation in uric acid is usually harmless unless one is prone to gout. That said, the precursors of uric acid are pretty high in organ meats like liver and kidney, so if these are part of one’s diet, they should be eaten in moderation. You can learn more about keto-adaptation here.

Q: Thoughts on patients suffering from depression and/or hypothyroidism and keto diets? Also, interested in your thoughts on “The Fast Metabolism Diet” by Haylie Pomroy, which encourages a 5x/day eating plan, which includes a couple days of a keto-like diet after some carb and protein-heavy days each week over the course of a month. Thank you for what you do, sir. Appreciate your work. —Tyler S. 

Q: Love your and Dr. Volek’s low carb performance book – amongst the ‘good’ fats you talk about high-oleic safflower being acceptable (better PUFA ratio). Are high-oleic SUNflower oils OK and can you cook with them? —Chris B.

 Q: Could blood ketones, along with blood sugars, be used to fine-tune insulin dosing? Too little insulin with someone with type 1 and we get DKA. With too little insulin ketones disappear. Could we use ketone levels are consistently below 0.3mmol/L as a signal that we have too much basal insulin? —Marty K.

 Q: Does Virta know the benefit of whey protein for diabetes? Not sure in the context specifically of DM, but it is a very high quality protein source – BCAA, immunoglobulins —Salomon J.

 Q: Why NOT eat certain oils, such as safflower and sunflower oil? Do these oils impact ketosis or is it for other reasons? —India K.

Q: Can you please explain hair loss on Keto? —Jessy G.

Q: Thanks for all you do!! There are groups that advocate the potassium to sodium ratio at 4 grams to 1 gram per day. Does that fit into your view of those two. Also, is 400 milligrams of Magnesium appropriate? Thank you! My ketone level ranges from .3 to 1.2. —Mark K.

 Q: Are you looking at Cardiac Calcium Score? —Lincoln C.

 Q: Hi Dr. Phinney. I have chronic pain and take a lot of medications. Also have controlled type 2 diabetes. Do you think taking 4400mg of gabapentin a day could be why I am not losing weight that easily. I am eating under 30 grams of carbs a day and I don’t eat a lot of fat. I eat just twice a day, and only around 950-975 calories. Thank You! —Teresa R.

 Q: While someone pursuing a therapeutic ketogenic diet for the management of cancer, epilepsy, Alzheimer’s or dementia may want to reduce protein to achieve elevated ketone levels, do you think someone trying to manage diabetes or lose weight needs to consciously worry about “too much protein” or can they just follow their appetite when it comes to protein intake? —Marty K.

 Q: If you are trying to reduce saturated fat but maintain ketosis, what fat sources do you recommend? —Gail K.

For answers to the questions above please copy and paste this link into your address bar

https://blog.virtahealth.com/ketogenic-nutrition-type-2-diabetes-dr-steve-phinney/

For more information please refer to the book that Dr. Phinney and Dr. Volek co-authored the New York Times Best Selling “The New Atkins for a New You” published in March 2010. Available at https://www.amazon.ca/New-Atkins-You-Ultimate-Shedding/dp/1439190275/ref=sr_1_1?ie=UTF8&qid=1539113181&sr=8-1&keywords=The+New+Atkins+for+a+New+You

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

If you are interested in following my postings, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

As always, I am interested in your thoughts on these topics.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

lpolstra@bell.net

Facebook https://www.facebook.com/2healthyhabits/