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Late-Night Sugar Cravings, Thyroid Testing, and Gut Pathogens


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We have another Q&A episode at long last, where we get through more questions we’ve received.  We do read all of your questions, so keep sending them, and we aspire to get to them all someday.

In this episode, we cover:

3:30 How to deal with late-night sugar cravings
12:52 What Chris (and Steve) ate for breakfast
14:15 Troubleshooting Thyroid labs
27:40 Testing for gut pathogens

Full Text Transcript:

Steve Wright:  Hey, everyone.  Welcome to another episode of the Revolution Health Radio Show.  This show is brought to you by ChrisKresser.com.  I’m your host, Steve Wright from SCDLifestyle.com.  With me is integrative medical practitioner and healthy skeptic Chris Kresser.  So, Chris, you’re in the middle of your book launch.  How’s it going?

Chris Kresser:  Well, it’s going pretty well.  As you know, Steve, it’s actually not coming out until New Year’s Eve, but I do feel like I’m in the middle of it because I’m planning the book tour and we’re getting ready for a really cool bundle campaign where we’re going to sell multiple copies of the book with lots of free goodies attached to it both for individuals and for gyms and clinics, and that’s going to start on Black Friday, I think, the day after Thanksgiving, if we can get it all together by then.  And yeah, it’s just a lot of fun choosing the venues and places on the tour where I’m going to go and enlisting the support of the hundreds of volunteers that we have around the country, which is just amazing.  It’s a lot of work, but it’s a lot of fun, and the book is completely finished.  We handed in the final-final manuscript, and it’s off to the printer, and in fact, the final copies of the book will be available… I’ll probably get the first copy in a week or two, and we’ve sent out review copies, which are based on a slightly older version of the manuscript, to a lot of bloggers and influencers, and I’m already starting to get some great feedback on the book, so that’s pretty exciting.

Steve Wright:  Yeah, congratulations, man.  This is exciting.

Chris Kresser:  Hey, have you gotten your copy yet?

Steve Wright:  I have not gotten my copy.  I hear it’s in transit, though.

Chris Kresser:  Cool.

Steve Wright:  So, I think it’ll arrive here soon.

Chris Kresser:  Good.  It’s been a labor of love, so I hope you enjoy it.

Steve Wright:  Yeah, I’ve heard some other advanced copy getters are pretty excited about it, so I’m going to plan to hopefully get it before Thanksgiving and devour it during the little break there.

Chris Kresser:  Nice.  Well, it’s raining cats and dogs here in Northern California.  We’ve had almost no rain this fall, and it seems like we’re just trying to catch up for that today.  I’m kinda liking it.  Sometimes it just feels nice to be warm and dry and cozy on a really rainy day, especially when there hasn’t been a lot of rain lately.  So, it’s a good time to be recording a podcast.

Steve Wright:  Beautiful.  Gotta stay in touch with nature.  Good deal.

Chris Kresser:  Exactly.

Steve Wright:  Awesome.  Well, before we get into this week’s Q&A session, Chris, I want to let everybody who’s listening to this know that obviously as you’re the sponsor of this podcast, you’ve put out something called Beyond Paleo.  Now, what Beyond Paleo is, is it’s Chris’ free 13-part email series on burning fat, boosting energy, and preventing and reversing disease without drugs.  Probably a lot of these tips are going to be in Chris’ book, and you want some of this stuff ahead of time, you should go to ChrisKresser.com, look for the big red box, and go ahead and put your name and email in that box, and he’s going to start sending you these free emails right away.

Chris Kresser:  All right, so we have a Q&A episode at long last again.  We’ll try to get through some questions we’ve received.  We do read all of your questions, so keep sending them, and we aspire to get to them all someday.

How to Deal with Late-Night Sugar Cravings

Steve Wright:  One day.  But yeah, we definitely thank everyone for sending their questions, and we’re doing our best her.  So, let’s not waste any more time.  This first question, Chris, comes from Ben.  Now, Ben wants to know how he can deal with his late-night sugar cravings.  He finds that the paleo diet is often derailed by late-night snacking even though he knows it’s not good for him.  He feels like he needs something that he can substitute for treats to meet this need but that’s also healthy and fits within the paleo diet.  Do you have any recommendations for Ben?

Chris Kresser:  I do, quite a few actually.  Late-night sugar cravings are often related to blood sugar dysregulation, which in turn can be connected to adrenal fatigue syndrome, and by that I mean this whole constellation of signs and symptoms that is often referred to as adrenal fatigue.  That can be low cortisol or high cortisol or a problem with the cortisol rhythm, in other words, cortisol is low when it should be high or high when it should be low, or the melatonin is out of whack, the whole circadian rhythm is out of whack.  Those are typically the main causes of these late-night sugar cravings.  Another one can be inability to burn carbohydrates or fat properly for fuel, problems with the citric acid cycle, ATP and energy production, and that is often related to micronutrient deficiencies, so deficiencies of various B vitamins and cofactors of the enzymes that are required to make the citric acid cycle and energy production work well.  And for someone on a paleo diet, assuming they’re eating a diversity of foods and nutrient-dense foods, nutrient deficiency would most likely be caused by poor stomach acid because the paleo diet is definitely not deficient in nutrients, like I said, if you’re eating a balanced diet, so it may be that you’re not processing the nutrients that you’re eating well if nutrient deficiency is the cause of your particular problem.

Here are a few practical ideas, suggestions that you can try right away without even doing any more diagnostic work to find out what the source of the problem is:  One is to eat a high-protein breakfast, and by ‘high-protein’ I mean over 40 or 50 grams.  You can’t do that by eating eggs unless you’re eating a whole lot of them!  So, it really has to include animal protein.  Fish tend to be the highest protein per weight, so a filet of salmon, for example, or tuna or something like that, can get you up to 40 or 50 grams pretty easily if it’s a substantial size, you know, 6 to 8 ounces or something like that.  You could, of course, have eggs and then add some animal protein with that, like smoked salmon or steak, a classic steak and eggs breakfast, or bacon, of course.  Starting with a really high protein intake early in the morning has a stabilizing effect on blood sugar throughout the day, and it’s a recommendation I often make for people with adrenal fatigue issues, people with hypoglycemia, and also people with hyperglycemia who are overweight and trying to lose weight.  For all of those populations it can be really helpful.

Likewise, you might want to try just boosting your protein intake in general for the same reason because it does tend to have a stabilizing effect on blood sugar.  So, if you’re eating something like maybe 12% to 15% of calories from protein, which is about the average in the US – 15% actually is the average – you might try boosting that up to 20% for a period of time or even 25%, although I think most people, unless you’re training really hard, doing a lot of strength training or muscle building or other kind of intensive training, I think 25% is probably too much for the long term, but over a short period of time, it may help to decrease these sugar cravings.

Another reason that some people have sugar cravings is they’re not eating enough carbohydrate, and so they end up having really strong sugar cravings in the evening that they tend to satisfy with less healthy carbs, like sweets, candy, sugar, etc.  And one thing you can do is just eat more fruit and safe starch, and by that I mean starchy tubers or plants like sweet potatoes, white potatoes, plantains, yuca, taro root, lotus root, white rice if you tolerate it, things like that, and eat more of that throughout the day so that you don’t have these really intense carb cravings at night that you’re more likely to go off the rails with.

If none of that works, you may want to take a look at your adrenals.  Work with a functional medicine practitioner who can order an adrenal stress index from a lab like BioHealth and see what’s happening with your cortisol and DHEA.  As I said, that’s often a cause of these kinds of problems, and you could try taking some adaptogenic herbs, which help regulate cortisol production, depending on whether your cortisol is high or low.  Things like Seriphos for high cortisol or licorice root extract for low cortisol can be helpful.  Eleutherococcus, which is Siberian ginseng, rhodiola, cordyceps, maca – these are all adaptogens, which means they can raise cortisol when its low and lower it when it’s high, and so they’re good choices in either high or low cortisol states.  There are also some nutrients that can be beneficial to support brain health to regulate the output of cortisol from the adrenals.

In the interim or if you can’t find a practitioner, there are some things you can do on your own.  One is try a couple of supplements from Designs for Health called Metabolic Synergy from Designs for Health and GlucoSupreme Herbal.  There are a lot of nutrients in there that support healthy blood sugar regulation. I noticed that a lot of people have issues that can’t completely be resolved by dietary changes for a number of reasons, and one these was blood sugar dysregulation that leads to cravings, and that can really derail people from sticking with a new healthy, nutrient-dense diet.  So, Metabolic Synergy and GlucoSupreme Herbal.  You can also use coconut oil to curb cravings.  You can just eat it straight out of the jar if you’re feeling like you’re having a big craving coming on.  You can just take a spoonful of coconut oil, and that’s very rapidly absorbable energy, and that can sometimes take the edge off of a craving.  Hopefully one or more of those suggestions will help.

Steve Wright:  Yeah, I think you shared a ton of info there, Chris, and I would like to add maybe just a little bit to that, like, when you’re stuck in that sugar-craving sort of mindset where you’re almost consumed by your thoughts.  I’ve struggled with this a lot up until this year, and so I actually came up with a protocol that helps get me through these times.  Do all of Chris’ other recommendations, and if you find yourself in a position where you’re being consumed by these thoughts and these cravings, you can start with what Chris said.  Have some coconut oil, at least 2 tablespoons, and then wait a few minutes.  If that doesn’t help, I’ve found that 10 grams of glutamine could sometimes starve off the cravings.  If you’re having some sort of potential issue up in the brain with fuel up there, the glutamine can help.  And then the other thing is that you always have to take into account where the cravings are coming from.  Now, if it’s late night, this might not be the case, but for those people who are suffering with cravings throughout the day, sometimes you’re really just desiring a change in your emotional state.  You’re under some stress or you’re put in a position where you’re looking for a change in your physiology, and so if you can come up with a way to actually do that – so you try the fat, then you try the glutamine, and then try this where you either do some sort of physical thing where you actually change your body state, so like doing pushups to failure or wall squats or something like that.  You can journal, like, just write out all your crazy thoughts until your hand hurts, and actually you can borrow a page from parenting.  Obviously you can’t do this at work, but if you’re at home, literally just verbalizing and screaming into a pillow what’s going through your brain can really help you get that energy out of your body and sort of reset where you want to be so you can stick to your goals.

Chris Kresser:  There you have it, folks, a whole different approach.  I’m sure one of those things is going to help, and hopefully together they’ll take care of the problem for you.

What Chris (And Steve) Ate for Breakfast

Steve Wright:  Yep.  Cool.  Well, let’s roll on.  Wait!  Chris, we forgot.  What did you have for breakfast today?

Chris Kresser:  Let’s see.  I had some chorizo from The Fifth Quarter.  Actually, no, the chorizo was from Freestone Ranch, which is where we get our half a hog.  I had some sautéed kale in ghee, and then I had a purple sweet potato with some butter and a little bit of sauerkraut.

Steve Wright:  Nice.  Well, Chris, you’ll be excited to know that at least two people wrote in and they wanted to know what Steve had for breakfast.

Chris Kresser:  Aha, great!  Let’s hear it!

Steve Wright:  I’ve been working some crazy hours right now.  Tuesdays and Wednesdays are when I see clients and then I’m trying to work on some other projects for SCD Lifestyle, and so I don’t have a whole lot of time to cook, so I’ve actually been doing the Bulletproof Coffee in the morning, and I’ve found that just for my digestion I can’t put a ton of butter and MCT in it, so that usually gets me from about 6 a.m. until about 10:30.  Then, for instance, today I knew that I wanted to save my leftover chicken and greens and everything for lunch so I didn’t have to cook at lunch, so I actually ate an EPIC bar and I had some blackberries at, like, 10:30.

Chris Kresser:  Right.  All right!  Cool, so let’s go on to the next one.

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Troubleshooting Thyroid Labs

Steve Wright:  Yeah, so this next question comes from Daniella, Chris.  She wants to know about her thyroid.  First of all, her TSH is normal, but she says it’s in the lower normal range.  Her T4 is normal, but it’s in the higher range, and her T3 is normal in the lower range.  She says she knows that something is wrong with her.  She gains weight with a glass of water, and she thinks it has something to do with her T3.  What can she do about this?

Chris Kresser:  This is a huge question, of course.  And let me take a step back and just talk a little bit about what is normal with thyroid labs, and this applies really to all reference ranges.  It might surprise some people to learn that the way that reference ranges have been developed in many cases is not that scientific.  With TSH, or thyroid-stimulating hormone, what they have done is taken a whole big group of people, tested their thyroid-stimulating hormone, and then created a bell curve of the results and then determined that if you’re in a certain range within that bell curve, you have normal thyroid function.  But the problem with doing that is in these studies where they determined the range, they didn’t exclude people from the bell curve analysis who have known thyroid conditions, hypothyroid conditions, or people who have unknown or undiagnosed thyroid conditions, and that’s a much larger group of people.  I can tell you I see a lot of patients whom I diagnose with hypothyroidism who weren’t aware that they had it in the first place.  The typical lab range for TSH using those somewhat warped guidelines is 0.5 to 4.5.  So, if you go into your doctor and you get your TSH tested and it comes back at 4.2, the doctor is going to say:  Look, you’re in the reference range.  Your thyroid is fine.  There’s no problem.  But there have been studies that have been done over the past decade where they took a big group of people and tested their TSH but they excluded people with known or diagnosed hypothyroidism, and then they also excluded people with hypothyroidism that was diagnosed using other methods aside from TSH, and when they did the bell curve analysis in that group, they found that a TSH in a normal healthy person without thyroid disease is more like 0.4 or 0.5 to 2 or 2.5, depending on the study that you look at, so that’s a much narrower range.  It’s almost identical on the bottom end of the range, but at the top of the range, which is what is indicative of hypothyroidism, is much lower obviously, 4.5 to 2.5 or even 2.  I guess that’s the first thing I would say is that a really normal TSH is within that range of 0.5 to 2 or maybe a little above 2.  And you also have to understand that TSH fluctuates a lot.  I read one study, I think, that said you’d have to do a hundred tests of TSH to get a true average.

Steve Wright:  Wow!

Chris Kresser:  Yeah.

Steve Wright:  That makes TSH a beautiful marker to test once a year!

Chris Kresser:  Right, exactly!  If you test it once a year, you’re never going to know what your actual average TSH is.  That doesn’t mean it’s not useful or valuable to test TSH.  It does mean that you should be aware that there is considerable variation, and if you see one number that’s off, you probably want to test at least once or twice more to see that it’s a pattern and not just an isolated occurrence because TSH can be affected by a lot of different things – food related, supplements, lifestyle, sleep.  It’s also different at different times of the day.  It’s not a completely diurnal hormone like cortisol, but the range of TSH is different, and what you’d expect it to be in the morning is slightly different than you’d expect it to be in the afternoon, and some studies have taken that into account and others haven’t.

So, as you can see, there are a lot of issues here related to testing TSH, and we haven’t even gotten into testing T4 and T3 and free T4 and free T3 and thyroid antibodies and all of the issues there, which are a legion.  It sounds like the questioner had a TSH in the low end of the normal range, so I’m assuming that it’s below 2.5 based on that and that then wouldn’t signal hypothyroidism as an issue.  She mentioned T4 and T3 being normal.  T3, the range is usually 71 to 180, but I like to see people above 90 or 100 for optimal function, and also it’s important to test the free fraction hormones, free T3 and free T4, to get a better sense of how much thyroid hormone is available to the tissue.  Hormones are fat soluble and the blood is mostly water, so in order for them to be transported around the bloodstream they have to be attached to a protein carrier.  So, when a gland, like the thyroid gland, produces hormone, it’s produced in what’s called total form, and ‘total’ means it’s still bound to the protein carrier that takes it around the bloodstream.  But in order for the thyroid hormone to enter the cell, which is where it’s used, it needs to be cleaved from that protein carrier, and when it is cleaved, it becomes what’s called free fraction hormone.

So, you have the total T4 and total T3, and then when those are cleaved and become free fraction, you have free T4 and free T3, and those are arguably more important because they are what are available to the cells and tissues to perform the functions that thyroid hormone is supposed to perform.  That doesn’t mean that they’re better or that it’s not helpful to test for total T4 and total T3 because the total T4, in particular, tells you how much thyroid hormone is being produced by the gland, and that’s important information to have.  And you can have normal total T4 and T3 and abnormal free T4 and free T3, and that gives you different information.  That tells you that the problem is not so much that the thyroid gland isn’t producing enough hormone; the problem is the conversion of the total hormones to the free hormones.  Likewise, you can have normal T4 and free T4 and low T3 and free T3, and in that case, again, the problem is not usually with the thyroid gland because over 90% of what’s produced by the thyroid gland is T4.  The problem is the conversion of T4 to T3, and that is usually impaired by things outside of the thyroid gland.  Inflammation and stress can impair that conversion, and then poor gut health can impair it because 20% of T4 is converted into T3 in the gut.

And then finally, thyroid antibodies should be tested multiple times if you suspect that Hashimoto’s or autoimmune thyroid disease might be present, and you should always suspect that if you have hypothyroidism because it’s one of the most common, if not the most common, cause of hypothyroidism in the US.  So, there’s a lot to thyroid testing.  I have a special report on thyroid on my website with probably over 20 articles, ChrisKresser.com/Thyroid.  Check that out if you haven’t read it yet.

It is also possible here that you don’t have a thyroid issue.  If your TSH is normal and your T4, T3, free T4, free T3, and thyroid antibodies are all normal, then it may be that the weight gain is not related to thyroid, and it isn’t always related to thyroid problems.  I have many patients who are overweight who have totally normal functioning thyroids, and I’ve also had patients who have subclinical thyroid issues and we correct that to the point where their numbers are in range and they have no more hypothyroid symptoms and it doesn’t lead to any additional weight loss.  In fact, if you look at the scientific literature, you’ll see that, in general, correcting subclinical thyroid issues often does not lead to weight loss.  Other potential causes of difficulty losing weight, assuming your diet is dialed in and your physical activity is dialed in, would be sleep problems, like sleep apnea, non-restorative sleep.  There are numerous studies now that have drawn a connection between poor quality or not enough sleep and weight gain.  A single night of poor sleep has been shown to decrease insulin sensitivity, so you can imagine that over time, many, many nights of not enough sleep could have a pretty significant effect.  And you want to check the adrenals and cortisol production because cortisol dysregulation has also been shown, along the same lines, to affect appetite and weight regulation.  You want to check gut health because, as we’ve discussed many times, including on the last show, the microbiome, the microflora in the gut have different effects on metabolism and weight regulation, and changes in the gut microbiota can lead to changes in weight regulation.

Weight loss seems like it would be so simple, right?  But I can tell you that it’s one of the more difficult things to address if all of the basics have already been dialed in.  I mean, if somebody comes to me and they’re on a Standard American Diet and they’re not exercising, getting them to lose weight is like shooting fish in a barrel.  I mean, it’s the easiest thing in the world.  But if someone comes to me and they are following the paleo diet and they have been for a while and they are exercising regularly and they’re doing everything that we talk about on this podcast and I write about on the website to take care of themselves and they’ve maybe lost most of the weight but there’s that last 10 pounds, that can be really tricky clinically to deal with and to figure out for the clinician and also for the patient.

Some of the tests that can be helpful in identifying issues would be the Adrenal Stress Index from BioHealth, that’s my preferred lab; or tests for gut health, like a comprehensive stool analysis from a lab like Doctor’s Data or Metametrix, which is now part of Genova, or BioHealth.  The urine organic acids profile Organix Dysbiosis from Metametrix for testing for SIBO and dysbiosis is a great profile.  Hormones for women always should be considered.  Estrogen and progesterone changes and low progesterone or estrogen dominance can lead to weight gain definitely, and that’s a common thing that I see in my practice, so doing a full monthly saliva hormone profile would be a good idea.

So, those are hopefully some ideas.  If you’ve tried a lot of things already and you’re not making much progress and you suspect you may have a thyroid issue but you’re not sure, it may be a good idea, if you can, to find someone who’s really experienced in more advanced thyroid testing and hormone testing.

Steve Wright:  Awesome, Chris.  So, just to recap, if your TSH is under 2.5 but your total T4, your free T4, your total T3, your free T3 are in the lower half of the lab ranges, at this point you’re not talking hypothyroidism; you’re talking typically something else.

Chris Kresser:  Yeah, generally if the TSH is in range… Well, let me put it a different way, Steve.  If the TSH is normal, which means in my book below 2.5 and above 0.5, maybe even below 2, depending on the situation, and the free T4 and total T4 are normal, but the free T3 or total T3 is low, then what you have in that situation is a conversion problem.  There isn’t an issue with the thyroid gland and the hormone that’s being produced because that would be T4, but there’s a problem with converting T4 to T3, and that happens outside of the thyroid gland for the most part.

Testing for Gut Pathogens

Steve Wright:  OK.  Awesome.  Well, let’s roll on to our next question here.  This next question comes from Liz, Chris.  She says:  “I’ve been diagnosed with intermediate colitis, as it doesn’t exactly match ulcerative colitis or Crohn’s.  I’ve also been diagnosed with primary sclerosing cholangitis, bile duct scarring and inflammation.  I guess it’s an exacerbation of the colitis.  I’m convinced that I, like yourself, picked up a parasite or something while traveling in Central American, as that is where my diarrhea started 10 years ago.  What is the gold standard for parasite testing, as all the tests I’ve had so far have come back negative?  Is the Metametrix testing accurate, and do I have that option in Australia?  I feel that slippery elm would help calm down the colitis, but my doctors keep saying that they feel the slippery elm would be very bad for my liver.  I can’t find any research to support this claim, however.  What do you think?”

Chris Kresser:  The first thing to know is that PSC, primary sclerosing cholangitis, is thought to be an autoimmune condition.  I’m not sure if you’re aware of that or not, but that’s really helpful to know because it does change the way that you would approach dealing with it.  Now, that doesn’t been that focusing on potential gut pathogens isn’t important because as we’ve discussed on the show before, gut issues are often involved in immune dysregulation and autoimmune disease, and in fact, some researchers, like Alessio Fasano who we had on the show, believe that leaky gut or intestinal permeability is a precondition to developing autoimmunity in the first place.  And there are many instances where people first have some kind of infection, and then that evolves into an autoimmune condition.  Lyme disease is one potential example there.  Viral infections can trigger autoimmune disease.  Mycobacterial infections can triggers autoimmune disease.  So, a post-infectious autoimmune reaction is probably what’s happening here.  If there was an initial infection when you were traveling overseas, then whether or not you got rid of that infection, it could have triggered the PSC.

In terms of gut testing, the Metametrix test is the only one that’s really available overseas.  I use either BioHealth or Doctor’s Data or Metametrix, which is now Genova, and because it’s DNA PCR testing, they have typically been able to do the testing overseas because the viability of the sample isn’t as big of a question when you’re doing the DNA PCR analysis… Well, the viability of the sample is still a question, but it’s not as time sensitive.  But they’ve recently changed their testing methodology where they are doing some culture in addition to the DNA PCR methodology, so I’m not sure yet how that works internationally, especially somewhere as far away as Australia.  I think there is an Australian Metametrix distributor that you can work through that could probably give you the answer to that question.  I’m not treating patients internationally anymore, so I haven’t had as much experience sending those kits to places like Australia in the last few months.  You also might want to look at – if you can get the Metametrix testing – the Organix Dysbiosis profile, which is going to tell you about SIBO and dysbiosis and fungal infections.  And if you can’t find anything on any of those tests, it still doesn’t mean, unfortunately, that you can rule out a parasite unequivocally because as helpful as these tests can be, they’re not perfectly accurate.  Although, I would say if you’ve had four to five tests from good labs, six tests – which it sounds like you may have – and they’re all negative, then the issue might not be a parasite.  It just may be the effects the parasite had on you originally, which can be quite significant, and also the immune dysregulation that it caused or the dysbiosis changes in your gut microbiota that that infection caused originally.

In many cases when I’m treating people with gut pathogens, it’s only the first step to get rid of the pathogen.  A lot of people have the idea that once we get rid of the pathogen they’re going to feel great and just be able to move on right then and there, and the reality is usually a little bit different.  Usually getting rid of the pathogen makes a significant difference, but then we have to do a lot of repair work because of what the pathogen did to the gut and sometimes what the treatment can do to the gut if the treatment involves antibiotics or multiple antibiotics, which can sometimes be necessary with really difficult-to-treat gut pathogens, like Blastocystis hominis, for example.

So, I would definitely do all that gut testing, and then I would also turn my attention to immune regulation.  I would focus on… Well, let me step back.  There are some things you can do to calm down inflammation in the gut, and one of those could be the GAPS intro protocol or the Specific Carbohydrate Diet, which Jordan and Steve had a lot of great info on their site about.  You could consider doing a low-FODMAP diet, which would reduce the fermentable carbohydrates that would be an issue if you have SIBO.  You could consider butyrate, which is a short-chain fatty acid that’s anti-inflammatory and it’s been used in a lot of clinical trials to reduce inflammation in colitis.  The dose there would be maybe 4 grams per day during the flare period.  You could try something like Theracurmin, which is a water-soluble form of curcumin that’s anti-inflammatory and well absorbed.

And then while you’re getting the gut inflammation under control, I would, as I said, turn my attention more to immune regulation, and that would be things like liposomal glutathione, which can increase glutathione levels.  Glutathione promotes T-regulatory cell function, which has a balancing effect on the immune system.  Something like Prescript-Assist, which is a soil-based probiotic, can really help.  It’s really more of an immune supplement, in a way, than something that actually increases the amount of beneficial bacteria in the gut.  It has an immune-modulating effect on the gut.

Resistant starch and/or prebiotics are kind of an interesting thing.  I talked about this with Jeff on the last podcast we did about the microbiota.  The prebiotics can often be problematic for people with gut issues.  They can cause gas and bloating and things like that, and of course, the low-FODMAP diet is designed around minimizing intake of those foods, but on the other hand, as we discussed with Jeff, eating fermentable fibers and foods that have prebiotic effect or even taking prebiotic supplements is the most effective way of increasing the numbers of bifidobacteria in the gut, and that in turn over time can have a really beneficial impact on the gut.  So, even though this seems to make no sense at all on paper, in some cases I will use prebiotic supplements with patients even if they’re on a low-FODMAP diet, because keep in mind ‘low-FODMAP’ doesn’t mean ‘no FODMAP.’  It means minimizing your intake of them.  So, I think that in those cases, starting with a really low intake of prebiotics and then increasing slowly over time can really help build up the beneficial gut flora, which can in turn have an immune-modulating effect and, of course, reduce inflammation in the gut because the short-chain fatty acids that are anti-inflammatory are produced by bacteria that are fermenting those prebiotic fibers.

And then the last thing would be something like low-dose naltrexone, which I’ve talked about a bunch of times on the show, so you can search the archives for that, but it has a pretty profound effect on T-regulatory cell production and central nervous system inflammation.  Some of the best studies that we have on it are on people with Crohn’s disease, so there’s a direct connection there for you, and probably if you dig up some of those studies – or maybe we can link to one in the show notes – and you take that into your doctor, if they’re open minded and progressive, they might be willing to prescribe that.  It might help with the PSC even though there are no studies on LDN and PSC, per se, all of the autoimmune diseases have a similar mechanism, and almost all of them involve dysfunction of the T-regulatory cells, and so a medication that improves the function of the T-regs would work even if there aren’t any studies on it.  And I’ve seen that happen.  I’ve seen that a lot with LDN working for conditions that there aren’t necessarily any direct studies on in the literature.

Steve Wright:  Yeah, I’ve heard from a lot of clients, as well, that LDN can be very beneficial in a lot of these complex illnesses.

Great, Chris.  Well, I know that you have to get back to your book tour duties, and you have a lot of upcoming events to plan, so we do want to thank you for the amount of time that you had to spend with us today answering questions for all the RHR listeners.  For everyone who did listen to the podcast today, please keep sending us your questions at ChrisKresser.com.  And also, if you could and you’ve liked the show, head over to iTunes and leave us a review.  That really helps get more popularity of the show, introduce us to new fans and help more people.  Thanks and have a great day.

Hey, loyal Revolution Health Radio fans, this is just a PSA announcement that Chris and I had a lot of technical difficulties with this audio and so the podcast ended up being shorter than what we wanted.  We answered fewer questions than what we wanted, but Chris is very busy with his book tour right now, and I hope that you can stick with us through this compressed schedule that he has as well as these technical difficulties that we experienced today.

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Join the conversation

  1. Hey Chris and everybody else!

    It finally seems that I’ve found a place where high-quality, well-researched, well-practiced medicine is the norm.

    Background: male, 40 years old, engineer, superintend of airport comms. Working day shifts and also night shifts (twice a week). Slightly overweight, started eating paleo 3 weeks ago (but I’m also eating berries and other fruit at breakfast – no protein, by the way). Lost a bit of weight.

    Medical history: an episode of severe reactive arthritis when I was 18 that lasted for approximately 8 months; free of inflammatory symptoms ever since (HLA b27 positive). Quit smoking 3 years ago. Exercise 3-4 times a week, 1-2 hours per session (mainly running). Perplexing episode of panic disorder 1 year ago. No anxiety now, but that was a real scare.

    Ever since I was a little child I have this late-night cravings. Not just sugar cravings but also cheese, or bread, or any other food item, cravings! It gets worse when I take melatonin to counteract the effects of jet lag or night shifts. The cravings are ruining my efforts to reach an ‘adequate’ BMI. Concerning my eating habits I’m very disciplined during the day: not fond of fast food, refined carbs, sweets and processed food in general. My parents hail from the Mediterranean (European side) and we followed at home a rather ‘traditional’ Mediterranean diet (lots of veggies, olive oil, tomato, garlic, onions, some cheese, poultry and also lots of oily fish – sardines and mackerel in particular). Any suggestions regarding those annoying and difficult to manage cravings?


  2. My son has recently been diagnosed with a blastocysts hominis infection, and I’ve been doing research trying to figure out what to do with the information. I read one of your blogs which says to treat with antibiotics. I was wondering does it have to be some special kind of antibiotics? My doctor recommended treating with AP Compound, which my son HATES drinking. Not sure how many symptoms he is having from the blastocysts hominis, so not sure what to do. Any help would be appreciated.

  3. Hello,
    I am 44 yrs old. I am extremely fatigue, blurred vision, hair loss, no endurance, never thirsty, gained 32 lbs in 7 weeks, distended abdomen( i look like i did when I was 9mths pregnant) with pain, muscle aches, mild depression, cannot stay awake, grouchy & irritable, memory/foggy/no concentration or focus, increased inflammation in sinuses, very dry eyes, and COMPLETE FRUSTRATION with my doctors.

    History of 4 sinus surgeries, ear cholesteotomas, TMJ, infertility, constipation, painful menstrual cycles, low blood pressure, gestational diabetes & hyperemesis during both pregnancies, chronic sinus & ear infections which led to diagnosis of Specific Polysaccharide Antibody Deficiency which led to monthly intravenous therapy of 30 grams IVIG, arthritis in cervical neck area, possibly Thoracic Outlet Syndrome, asthma.

    I stopped my IVIG treatments almost 20 months ago after when my son turned 19 months. Insurance issues. I was ok for about 6 months. Since then I have had strep 9 times, sinus infections, 13 rounds of antibiotics and steroids. Gained weight.. doctors gave me Concerta to fight the Fatigue/”possibly narcolepsy”… thyroid medications stated 7 yrs ago after my first child. Had to take infertility injections for second child 4 years ago.

    I am currently taking Synthroid 0.200 mg daily.
    TSH tested 14 times over last 3 years. Average is 3.6 to 4.95. But has spiked 3 times 15.7, 14.8 and recently 36.49. Currently it is 4.102

    T3 tested 4 times 1.9, 2.21, currently 2.3

    T4 tested 10 times. ranging from 0.98-1.75. Currently 1.19

    No problems with diabetes, heart, low blood pressure 98/62 today, recently CTscan slightly enlarged liver. No kidney issues.

    Very difficult to find doctors here in Louisiana, especially endocrinologist.

    LOOKING FOR HELP. My biggest issue besides not feeling well is that I feel like I am not the healthy mom I want to be. Being tired and fatigued means not being to spend time and energy with my kids. I WANT MORE. I want to be that giggly energetic mom again.

    Thanks in advance. I appreciate any advice

  4. Hello everyone

    I’m sorry to intrude and write a comment in this space but I guess it’s out of desperation.

    I need some advice / help

    3 weeks ago – I had symptoms of palpitations, tremors,hairloss, weight loss and excess heat intolerance – did normal tsh which was < 0.01. Thyroid antiglobulin of 635…. the physician sent me for an ultra sound.
    It picked up multiple adenoma and tumors to the thyroid/parathyroid…. then suggested I had graves disease.

    I then went to an endocrinologist who suggested no treatment and that i wait 3 weeks and repeat tests as it could be viral.

    I continued with symptoms…. especially the sore throat area and palpitations

    Yesterday I did bloods again…. and now my tsh is 12.3 which changed from hyperthyroidism to hypothyroidism….. but still leaving me with palpitations and insomnia.

    I am on no treatment, confused as to what to do.

    The doctor says I should leave it as it thyroiditis / thyroidtoxicosis

    I am a 38 year old female. I have a gastric ulcer for 8 years and I'm unsure how to deal with the thyroid.

    Can someone please advise me. It's now 1am in S A and I'm awake trying to find a solution to my illness.

    It has already cost me so much but I am still with no clue.

    Thank you for reading this and I hope to get some advise from this site.


  5. Hello Chris and everyone else,

    I live in the UK and have had thyroid problems (hypothyroid) for many years, though diagnosed in 2007. I have been taking Levothyroxine, which has increased from 25mcg initially to 125mcg now. Iin November last year, I have been through a nightmare as I have suffered a misscarriage. I am 35 years old and have planned this pregnancy for a while. However, only because of this incident, I have been diagnosed with Hashimoto thyroiditis, with antibodies up in the 600s.

    Since then, I have developed an obsession to find out what is wrong with my body. I was also vegan until then.

    I have discovered that I have Gut problems and was also anemic and I am now being treated by a lovely integrative doctor. In addition, I believe that I was severely deprived of nutrients (despite eating a lot organic fruit and vegetables for years). So I am taking plenty of vitamins at the moment and have also become Semi-Paleo (eating mainly vegetables, fish, chicken liver, no grains, no dairy).

    As doctors in the UK do not look into causes of misscariages (I was 6 weeks when it happened), I went abroad and had some investigations. Unfortunately, I have discovered though blood tests that I also have hyperhomocystenia (i think tthat is the name!) due to a the C667 gene mutation, which makes it more likely for my blood to clot.

    Anyway, sorry for the long message. I needed some advice in regards to my thyroid medication. My TSH is kept in the normal range (usually we aim for below 2 but the miscarriage messed that up a bit). Thought my T4 always comes in range, my T3 was 1.2 (1.27-3.07) and the FT3 was 3.4 (3.4-6.8). FT4 was 16.2 (10.6-22.7).

    My GP has acknowledged that my FT3 is below normal range but they refuse to prescribe any T4/T3 medication or natural thyroid, even if I have offered to pay for it myself. So they continue to prescribe Levothyroxine (T4) medication.

    Do you have any advice in regards to what migth be a useful thing to do please? I know I am taking a lot of your time; however, I do not seem to be able to get the help I think I need and I am too afraid to try for another baby any time soon.

    Thank you everyone for your help,
    Thanks Chris for all your information, I have loved all your articles, I am now trying to get my husband to move to a paleo diet 🙂 I also bought your book and I am looking forward to when it will arrive in the post.

    Thank you,

  6. Chris,

    Do you think that Jeff Leach’s statement that severe gas and 2-3 bowel movements a day indicates healthy bowel flora is accurate?

  7. I noticed the last few episodes of the RHR podcast aren’t showing up in iTunes. I use the podcast app from Apple on my iPhone and it’s a bummer the new episodes aren’t showing up. Something you are aware of?

  8. I have Grave’s Disease/autoimmune hyperthyroidism and it’s dismaying how little this gets talked about in regards to thyroid problems. When my TSH is around 1, I have mild hyperthyroid symptoms (BTW there is much overlap in the hyper/hypo symptoms depending on how your body responds to the excess of thyroid and how long your body has been dealing with it). If I have a TSH of .5 or anything under 1, I have significant hyperthyroid symptoms. So I question the validity of the lower end of the reference range too and think there are plenty of people with undiagnosed subclinical hyperthyroidism. I’ve known many women who complain of what I recognize as mild to moderate hyperthyroid symptoms but their thyroid labs come back in the “normal” range so are left to feel like they are anxious, jittery, crazy, wired-but-tired people.

  9. Hey Chris,
    I was wondering if you had explored methylnaltrexone? Some believe this may be good for GI issues because it does not cross the blood-brain barrier, which would be useful in preventing some of the long-term side-effects that some people experience with LDN. I am considering LDN for my GI issue, but I am afraid to do so if there is any significant possibility of side-effects.


  10. If you have a low TSH, low Free T3, and low Free T4, does this signal a pituitary problem?

  11. I have Type II diabetes with concomitant neuropathy, and am slightly obese. I am trying to turn all this around. I just read your article entitled, 9 STEPS TO PERFECT HEATLTH – #5 HEAL YOUR GUT.
    As for your “How to maintain and restore a healthy gut,” I have the following observations:
    “Remove all food toxins from your diet.” Ok. I can try to do this, but with the number of toxins in our environment, this is quite a task to attempt to do.
    “Eat plenty of fermentable fibers (starches like sweet potato, yam, yucca, etc.” Starches seem to exacerbate and sky-rocket my blood sugar levels. Sweet potatoes are high glycemic. Yams are slightly better. I’ve never tried yucca. What is the etc? Other recommendations would help here.

    The other two or three reconmendations I can attend to.

  12. As a listener from Australia who has just been diagnosed with Dientamoeba fragilis, I can recommend Bioscreen for your comprehensive stool test analysis. I am working with a FACNEM practitioner who believes it is the only test available in Australia right now that is worth doing. So maybe Liz might want to check that out. I too have indeterminate colitis, and the Bioscreen analysis showed D. Fragilis, as well as an overgrowth of Streptococcus (90% of all organisms), and less than 0.09% E. Coli and only small amounts of bacteroides spp. So it’s tinidazole for the parasite, and a very low carb diet to starve the strep. And if it weren’t for Chris, I wouldn’t have even thought to go down this path at all, so thanks!!

    • Hi Rebecca
      I’m from Australia as well and am interested in finding a good practitioner to work with on getting some general health tests done, including a comprehensive stool test. Unfortunately I haven’t had much success with my general doctor, all she recommends at my age (42) is to have some blood tests done, but I feel like my gut is not in a top condition at all (bloating, constipation, etc). Could you recommend a place on the web where I could search for such a practitioner, I live in Adelaide. Or, if you happen to live in Adelaide as well, maybe you can tell me the name of your practitioner. I’m not sure how these replies work, whether you get an email with my message, but I have included my email, if you would like to email me. Thanks Rebecca.

      • I’m on the Gold Coast. From my understanding if you find a practitioner that’s accredited with the Australasian College of Nutritional and Environmental Medicine (ACNEM), you are on the right track. Check out their website for accredited practitioners. Otherwise, reply again and I can ask my Dr if he knows anyone in Adelaide. Good luck!!