The Thyroid-Gut Connection | Chris Kresser
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The Thyroid-Gut Connection

by Chris Kresser

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This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.

Hippocrates said: “All disease begins in the gut.” 2,500 years later we’re just beginning to understand how right he was. And, as I’ll explain in this article, hypothyroidism is no exception. Poor gut health can suppress thyroid function and trigger Hashimoto’s disease, and low thyroid function can lead to an inflamed and leaky gut – as illustrated in the following diagram:


The gut-thyroid-immune connection

Have you ever considered the fact that the contents of the gut are outside the body? The gut is a hollow tube that passes from the mouth to the anus. Anything that goes in the mouth and isn’t digested will pass right out the other end. This is, in fact, one of the most important functions of the gut: to prevent foreign substances from entering the body.

Another important function of the gut is to host 70% of the immune tissue in the body. This portion of the immune system is collectively referred to as GALT, or gut-associated lymphoid tissue. The GALT comprises several types of lymphoid tissues that store immune cells, such as T & B lymphocytes, that carry out attacks and produce antibodies against antigens, molecules recognized by the immune system as potential threats.

Problems occur when either of these protective functions of the gut are compromised. When the intestinal barrier becomes permeable (i.e. “leaky gut syndrome”), large protein molecules escape into the bloodstream. Since these proteins don’t belong outside of the gut, the body mounts an immune response and attacks them. Studies show that these attacks play a role in the development of autoimmune diseases like Hashimoto’s.

We also know that thyroid hormones strongly influence the tight junctions in the stomach and small intestine. These tight junctions are closely associated areas of two cells whose membranes join together to form the impermeable barrier of the gut. T3 and T4 have been shown to protect gut mucosal lining from stress induced ulcer formation. In another study, endoscopic examination of gastric ulcers found low T3, low T4 and abnormal levels of reverse T3.

Likewise, thyrotropin releasing hormone (TRH) and thyroid stimulating hormone (TSH) both influence the development of the GALT. T4 prevents over-expression of intestinal intraepithelial lymphocytes (IEL), which in turn causes inflammation in the gut.

The gut-bacteria-thyroid connection

One little known role of the gut bacteria is to assist in converting inactive T4 into the active form of thyroid hormone, T3. About 20 percent of T4 is converted to T3 in the GI tract, in the forms of T3 sulfate (T3S) and triidothyroacetic acid (T3AC). The conversion of T3S and T3AC into active T3 requires an enzyme called intestinal sulfatase.

Where does intestinal sulfatase come from? You guessed it: healthy gut bacteria. Intestinal dysbiosis, an imbalance between pathogenic and beneficial bacteria in the gut, significantly reduces the conversion of T3S and T3AC to T3. This is one reason why people with poor gut function may have thyroid symptoms but normal lab results.

Inflammation in the gut also reduces T3 by raising cortisol. Cortisol decreases active T3 levels while increasing levels of inactive T3. 1

Studies have also shown that cell walls of intestinal bacteria, called lipopolysaccharides (LPS), negatively effect thyroid metabolism in several ways. LPS:

  • reduce thyroid hormone levels;
  • dull thyroid hormone receptor sites;
  • increase amounts of inactive T3;
  • decrease TSH; and
  • promote autoimmune thyroid disease (AITD).

Other gut-thyroid connections

Hypochlorhydria, or low stomach acid, increases intestinal permeability, inflammation and infection (for more on this, see my series on acid reflux & GERD). Studies have shown a strong association between atrophic body gastritis, a condition related to hypochlorhydria, and autoimmune thyroid disease.

Constipation can impair hormone clearance and cause elevations in estrogen, which in turn raises thyroid-binding globulin (TBG) levels and decreases the amount of free thyroid hormones available to the body. On the other hand, low thyroid function slows transit time, causing constipation and increasing inflammation, infections and malabsorption.

Finally, a sluggish gall bladder interferes with proper liver detoxification and prevents hormones from being cleared from the body, and hypothyroidism impairs GB function by reducing bile flow.

Healing the gut-thyroid axis

All of these connections make it clear that you can’t have a healthy gut without a healthy thyroid, and you can’t have a healthy thyroid without a healthy gut. To restore proper function of the gut-thyroid axis, both must be addressed simultaneously.

Healing the gut is a huge topic that can’t be covered adequately in a few short sentences. But I will say this: the first step is always to figure out what’s causing the gut dysfunction. As we’ve reviewed in this article, low thyroid is one possible cause, but often hypochlorhydria, infections, dysbiosis, food intolerances (especially gluten), stress and other factors play an even more significant role. The second step is to address these factors and remove any potential triggers. The third step is to restore the integrity of the gut barrier. My preferred approach for this last step is the GAPS diet.

The influence of thyroid hormones on the gut is one of many reasons why I recommend that people with persistently high TSH and low T4 and T3 take replacement hormones. Low thyroid hormones make it difficult to heal the gut, and an inflamed and leaky gut contributes to just about every disease there is, including hypothyroidism. Fixing the gut is often the first – and most important – step I take with my patients.

  1. Stockigt, JR and Baverman LE. Update on the Sick Euthyroid Syndrome. Diseases of the Thyroid. Humana Press, Totowa, NJ, 1997, pp.49-68


Join the conversation

  1. I am having a flare of diverticulitis and on flagyl and cipro. I had my thyroid removed and take both T4 and T3 because I don’t convert right. Question is while on the antibiotics my eyes are swelling which happen before I got my thyroid numbers stable. Could the medication or change in my diet (liquid for 3 days) or medication mess with my thyroid numbers?

  2. Have there been any studies in the effects of thyroid absorbtion in a person who has had their large intestine removed (due to colitis that was unresponsive to treatment) ? Is there a connection between the two? After the surgery my son has developed severe hypothyroid symptoms but normal TSH, T3 levels.

            • Some foods and such are listed on a spectrum with some being more acidic or alkaline. The best overall general diet is in the middle. It then can sometimes be helpful to know where on the spectrum such things are. The body, relatively healthy ones, work to maintain a balance.

          • You replied to me so your comment is located right under mine and slightly off to the side. That is why I thought you were trying to answer my question. If you make a general reply then it will be aligned with all the other original ones. It’s about a type of grouping.

  3. Good read. But here is the problem I have. I have no thyroid due to cancer and they keep my TSH Levels extremely low so I don’t have a reoccurrence. I have begged every Endo and GI to look at a correlation and they don’t. So how would I proceed to treat for constant IBS-D & GERD?

    • I had my thyroid removed due to cancer in December. I am on 25mg cytomel 2x daily currently. I have been on this for almost 4 weeks and lately have been having stomach pains and constipation every now and then. Is this you as well? I have not gone to the doctor about this issue yet.

      • Do you not take T4? If not how do you feel on T3 alone? I had my thyroid removed 2.5 yrs ago due to Hashimotos and Graves. I don’t convert T4to T3 and have a slightly elevated Reverse T3 so I was thinking abt taking T3 only in order to flush out some of the RT3. Curious to know how how dosing is done on if taking T3 alone.

        • There is actually a formula T3:T4, read the book by Dr. Tennant, called Healing is Voltage and another really important book by Dr. Mark Starr “Hypothyroidism” the Epidemic. We all need this information. Really!

  4. I was wondering if anyone has ever has had gerd with hypothyroidism. I am 30 years old and was diagnosed with mild hypothyroidism and never given and meds for it. I lived a life of chronic headaches,brain fog,insomnia body aches extreme neck pain on both sides of my back. My dr told me I had fibromyalgia and put me on gabapentin which did nothing for me. About 7 months ago of this year I had a chronic cough that lasted about 2 months until my dr gave me an inhaler. Followed by the asthma I began to have upper stomach pains and chronic acid reflex. I was put on tecta acid blocker pills. The pills did nothing and I found the only thing I could do was change the way I eat. No citrus,no milk,tomatoes,chocolate and fatty greasy foods,caffeine or alcohol
    . I have had this pain for about 6 months now and anytime i eat any of the mentioned above I suffer fro, awful acid reflex burning pain. I have read that thyroid disorders are linked to gerd. I have an appointment in January with my gastro specialist and he will take a look at my stomach and see what is going on. Two months after the chronic cough I began to have very bad throat pain. I felt a lump stuck in my throat followed by radiating sharp pain that went up and down my throat into my ear. I went to and Ent(ear nose throat specialist) and he said the thyroid looked fine and diagnosed me with globus hystericus which is caused by anxiety. I insisted my dr check my thyroid levels and of coarse they were low and she finally put me on Synthroid for the first time. I noticed a difference within a month of being on it. I was able to finally remember things the joint muscle pain and headaches were gone and my mood became more positive. This is my third month on Synthroid my t4 I sill low so they will be monitoring it from now on which is good. unfortunatley I still Have the pain and tightness Im my throat with the chronic acid reflex. I have made changes to my diet and I am hoping for the best. If anyone has experienced the throat pain /lump feeling with hypothyroidism and has any advice please let me know if there is anything i can do for it. Also if anyone has ever been diagnosed with hypothyroidism and gerd any information and advice would be appreciated. Thank you

    • Hi Trisha,
      Yes you and I share the same symptoms I am 36 with gerd and “with mild hypothyroidism and never given and meds for it. I lived a life of chronic headaches,brain fog,insomnia body aches extreme neck pain on both sides of my back.” I just thought I’d quote you since we match up perfectly. My headaches are migraine though which may be your case as well.

      I have learned some things that have helped me as I have attempted to self treat and stay off meds. For the Gerd I have completely eliminated oily foods and liquid dairy, which is hard to break down and added a cap full of apple cider vinegar a day to heighten acidity in my stomach and prevent reflux. This has worked so well for me that I can take a cap and then have a small bowl of ice cream now and be ok. But that is now that I have the condition under control. I wouldn’t recommend it starting out. My father is hypo and also gerd as well. Everything has been about diet.

      I have also eliminated the brain fog (my longest bout was 6months before I figured this out:( )after I identified It was caused by lipids. Eliminating many things from my diet, especially almonds, caffeine, alcohol, artificial sweeteners, ect. Secondly, I realized that the hypo and malnutrition were causing the secondary symptoms as well. I was at 900 cal and have since increased to 1200 and take supplements now.

      Slow release iron, and for fatigue potassium iodine, taking 1000mcg is safe and it took away, (no kidding took away) the fatigue. I take it in the sprouts kelp tablet form. Also, 500mcg of magnesium which can help regulate blood sugar and break down insulin resistance that causes the weight issues. I always take probiotic and omega 3 too the two things that get to the source long term, gut health and brain health, and don’t take just any multi vit because many can cause worse brain fog.

      I and my father have both too had the lump in our throats and burning as well as Meniers type stuff with our ears. All I can say about that is it does go away as you take care, I almost think that too is related to iodine but I am not sure exactly how. Perhaps nodules? I don’t know. It seems those are secondary symptoms that have only showed up with me when my condition is really out of control. Just get to the root and the tree dies.

      Everything here I have researched and read about. For the both the constricted throat and hypo lump I have found stress is the worst thing. Though it’s controversial dr. Lam’s writings about adrenal fatigue really resounded with me as well.

      Usually doctors really are not versed in this. Especially the connections between adrenal, thyroid, serotonin levels, the immune and brain. There are so many treatments that overlap some of which I have mentioned. Treating with diet has been great for me.

      I have never posted on a site before but I do want to help you if I can. I hope some of this does. If only to let you know I was really, really bad for many years until I figured this stuff out and I have been basically clear of cronic gerd for 6years and the other symptoms for just under a year. Try not to stress. You can get through this.

      God bless! Anne

      • I am 69 & have nearly all these symptoms & been told my thyroid is low normal. I now have the thyroid nodule & diverticula in my throat. Yes, that’s right so this has gone on a long time, untreated – mostly cause I can’t get docotr’s attention on this possibility. I am healthy (though apparently not so much). I exercise, eat healthy & yet I have diverticulitis. This ain’t right. I’m making an appointment & tell her what I’ve read about you’ll. So thank you & I’ll get back with you all. PS I had a lump on my neck & this masseuse rubbed the heck out of my neck & that lump moved to my chest. After an ex ray, which hardened the fluid, a sonagram & a lecture from the radiologist to not eat rich food. (I eat small 3×5 cheesecake weekly & cut out the small order of clam chowder). Yeah, I’m insulted & frustrated with the cheap controlling mechanisms of nurses who dictate what tests doctors can do. Pray for better healthcare. I’m glad I found your remarks. Thanks, Paula

        • Guys, I did make it to my nurse practitioner & she offered to prescribe synthroid even though my numbers ar marginal, but I declined for two reasons: too easy to get medicine & 2nd no explanation how I ended up with diverticulitis, thyroid lump in esophagus (I think result of hard massage on my neck). I am not litigious, but I think these stomach issues are result of halving generic for ambiane (I no longer take) & then halving pravastatin. I don’t have germ, but experienced it recently after talking halved pills. So I stopped & now take a whole pill. My health is worth more than money. Odd pharm. & doctors allowed it without knowing the potential dangers. I’m choosing to continue to watch my diet & exercise, no caffeine & whatever else I learn. I just hope this isn’t a losing battle. P

      • I have just read Anne’s story and it has given me renewed hope. I have suffered with intermittent gerd for a number of years now. I have had all the usual tests… endoscopy, ultrasounds, colonoscopy, celiac test and no one has been able to say what causes it. I am having symptoms again now and it is terrible.
        Burning/sore stomach, with a feeling of soreness all the way up to my throat. I have low thyroid function, t4 of 10.6
        but gp says in the normal range (which starts at 9) so not on meds.I feel so awful that I get tearful and feel like I’m never going to get the problem sorted as I don’t know the cause. Due thyroid bloods this Friday, so will see if level still low. Your post Anne about a connection between thyroid and acid reflux has made me wonder whether a higher t4 would improve my symptoms. Anyway, I just wanted to say thank you for your post (most posts are years old) but I noticed yours was recent so thought I would add my own experiences on this occasion.
        It’s always good to hear other people’s experiences as it reminds me that I’m not alone!

      • I am suffering from the exact same symptoms that you have for close to 3 months now and had my thyroid checked today and it was low. I would love to chat with you. I’m desperate for some answers. Thank you. Anne I would love to chat with you as well. Please contact me. Gretchen

      • just realized that my ringing in my ears has gone away. I started using himalayan pink salt exclusively 2 years ago, it has iodine and other trace minerals in it. bet that is what took it away.

    • I am suffering from the exact same symptoms that you have for close to 3 months now and had my thyroid checked today and it was low. I would love to chat with you. I’m desperate for some answers. Thank you, Gretchen

    • I know the exact pain in your throat and jaw. It is actually your esophagus spasming. Forget the MDs. Go to a holistic doctor. I took all the same pills and found out they just cause more problems.

  5. Hi all, 31yo M, 5’9 135lb. I was just diagnosed with hypothyroid by my ND. Low T3 (.6!), high LDL, low alkaline phosphatase, low HCT. What my ND told me is basically border-line anemic (but my iron levels are great) and need to take Cytomel. This is after a 10year battle trying to figure out my IBS, with IBS-A and constipation. The thing is I’ve been losing weight, have enormous stools (lots of undigested food), but otherwise feel fine. Stool tests also reveal complete lack of ANY good bacteria. So I’m wondering if Cytomel to fix thyroid is enough, or if I need to supplement with selenium, iodine, etc. Unlike typical hypothyroidism, I don’t have weight gain (in fact weight loss) but have mild coldness and mild brain fog/tired. This all started with trying to regulate digestion so I wasn’t spending 1.5hr in bathroom daily, and now it’s progressed to thyroid! Thoughts?

    • The hypothyroid actually leads to elivated LDL… it’s likely because the body is trying to hold on to cholesterol in an effort to produce the needed thyroid hormones

  6. I have have and autoimmune thyroid disease. I take 150 mcg. of Synthroid a T4 drug and 5 mcg. cytomel. Recently I stopped taking my cytomel a T3 drug and my stomach is no longer functioning. Why
    Thanks Mara

  7. Hi I am a Hypothyroid patient. I have too many problems like digestion, insomnia, feeling fatigue and so on.

    One of the doctors advised me to take lioynin tablets for some T4 and T3 conversion.

    Is there any body on this forum who has any idea about these tablets? Some doctors say not to take them and this particular doctor recommends me the same.

  8. If my thyroid level’s just tested normal, should I still take my thyroid medicine?My endocronologist said I do not need to, yet I have Rosacea and Ulcerative Colitis and read thyroid medicine helps these immune and gut issues. Please advise.

    • No matter if your thyroid levels read normal, there could be other underlying issues with your thyroid. It is a lifetime thing. It can be controlled but not cured. Keep taking your meds and maybe look for another Dr! That’s what i had to do very recently. Don’t stop taking them, ever!

    • I am curious if anyone is getting feedback from Chris…if there is a hidden response or something.
      I have Hashimotos and ulcerative colitis. I just got off a round of prednazone from a UC flare-up and am flaring up again, so back to prednazone and a new drug. I was just diagnosed with Hashimotos in January. I cannot help but wonder if its being untreated….(and finally doctor relented and is giving me 25 mcg Synthroid – he is convinced to wait another solid 3 months before considering raising it and also adding in the cytomel) is causing the flareup.

      But I don’t know…cause I have been positive I’ve had thyroid issues most of my adult life…so many symptoms…just no doctor willing to do the proper testing until recently.

      • By the way – is a good article – thank you. And, for my ulcerative colitis I am doing the GAPS diet again. It hasn’t had a chance to work yet…but in past I went for stretch several years with no flare – longest ever….so it has to be helpful for autoimmune illness.

      • This sounds odd but I just posted a mouse study to my facebook page about how vinegar might be helpful for UC.

  9. Hi Chris, i’m glad i stumbled across this post. It’s very informative. A little over a year ago I was diagnoised with Hashmoto’s and had a really tough time for a year. I had a Thyroidectomy in Nov. 2014 and have been hyperthyroid ever since. They are slowly lowering my synthroid and my T4 is down to 15 but my Antibodies have went even more high (TPO) they’re over 900. I’m on 88 mcg. of synthroid and am now having gallbladder trouble and getting ready to have it taken out. It has numerous stones in it. Could the Hashmotos and going without a thyroid have helped to contribute to the gallbladder problems and do you know why my Antibodies are running so hig? Could it be the gallbladder causing it as well. Thanks for your informative post.

      • My endocrinologist said that it is different. When you have no thyroid, and you get into the hyperthyroid phase, that means that the medications have to be dropped in dosage. That is what has been happening to me. I have had a thyroidectomy back in 2016. I am now having acid reflux problems etc., but also have had weight loss surgery too.

    • Was just looking at an online Pubmed article (book?) titled, “Autoimmunity to the Thyroid Gland” -NCBI bookshelf. It does discuss the proposed Yersinia connection and other factors none of which include gluten.

  10. It doesn’t make sense that Chris recommends the GAPS diet on this page for thyroid support, yet in a recent interview stated that many of his hormone troubled patients, who were on paleo diets (very similar to the GAPS diet) without success, heal their thyroid and other hormone problems by adding a decent quantity of safe starches back into their diet – abandoning the GAPS diet. So Chris, which is it?

    GAPS diet doesn’t allow starches. So the GAPS diet isn’t Chris’s latest recomendation, instead a very different diet is.

    GAPS and other severe paleo diets that do not allow starches cause problems in the long run, it’s becoming clear. Now if bloggers would edit their websites with their more recent opinions, PLEASE.

    • Look into the autoimmune protocol (AIP) diet. It does work and you can introduce foods back in once you know what foods are affecting your digestion.

  11. I stumbled on this article. I was diagnosed with Hashimoto’s. I since went off gluten, dairy, and soy and eat very little if any processed food (I do eat organic tortilla chips). I also began taking vsl3 probiotic supplement (2 capsules per day). I saw a big improvement but still had an enlarged thyroid. Recently I upped the amount of vsl3 to 4 capsules per day and noticed my thyroid shrinking which is what lead me to start researching the gut/thyroid connection. I am convinced now of the need to strictly address my gut health and am excited to realize I may be able to fully reverse this autoimmune thyroid disease! Thank you for your post

    • Would be great to be able to be in touch with someone by email who has such problems and has been doing something towards putting them right. I think I hve underactive thyroid and acid reflux, most of my symptoms fit with it. Have tried probiotics for a while but dont seem to be working and seem to be worse if anything. You can write to me at r y c h h m o at a o l dot c o m.

      • I have had thyroid issues since I was 21, had a goiter and removed half my thyroid by surgery. Was not on medication until I was 40 and gad to fight to go on synthroid with my dr. Did see a slight improvement but the only thing that really helped was diet. I started taking 3 capsules of cinnamon to help with inflammation and drinking at Keats 2 liters of lemon water to help with stomach acid. I also do not eat any bread or wheat. All of this has changed my life. Just a small tip if anyone wants to try something natural. Oh and no I repeat no caffeine. That was the hardest !

    • Really! I am interested to know how things have gone since then? I have multi-nodular goiter but my new Endo dropped my cytomel and greatly lowered my Levo down to 25 mcg from 75 mcg.
      I have dropped almost all dairy and dropped all grains which might account for this change in my meds or not.. Hypothyroid Mom claims cure but may be just long term remission on her site.

      • Goiter…needs iodine…Lugols is the liquid form..Iodorol…is tablet form…Google Dr David Brownstein..extensive research on Iodine and Thyroid…he has written books…has website…is both an M.D. and ND…you can get Lugols from jcrowsmarketplace…dot…com

  12. I tried GAPS, as I thought it sounded wonderful and I was convinced it would help me. It didn’t seem quite right for me and I am now on the SCD (Specific Carbohydrate Diet). I felt so good the first week or so. Now in my third week, am feeling tired, even when getting 7 or more hours of sleep. I am wondering if I need more carbs. than I am getting. When I took Dr. Mercola’s metabolic typing test, I was a ‘mixed type’, needing carbs., fats and proteins. Does anyone have any feedback?

    • I had my son on SCD for a couple of years. He experienced very low stamina and was not growing. When I put him on another diet, his energy level increased significantly and he started to grow. Now he has wonderful levels of energy. He is still gluten-free, but he clearly benefits immensely from consuming rice, quinoa and other grains, all of which he couldn’t eat on the SCD diet.

    • I do…and I am no expert in any way…just an experienced GAPS dieter. I am doing it now but am still having UC flares. I am wondering if its my recently diagnosed Hashimotos causing this flare…anyway…I did GAPS (very similar SCD) for years in past and it was quite successful – longest I’d ever been, in not having flare ups. I was stupid and got off of it. It worked for me….and put my ulcerative colitis in remission. A colonoscopy showed my colon the healthiest it had been in 25 years.

      I’m not pitching the GAPS diet…I realize there are other diets out there that work for different people. I just happen to believe in it – with one caveat perhaps testing to see if eggs and fermented dairy really OK with your body before introducing them.

      After tons of research I strongly believe all of these autoimmune diseases have one thing in common….its cause by a leaky gut. I think the gut must be sealed up before any healing can begin.

  13. Hi Chris,

    I find the following statements conflicting:

    “you can’t have a healthy gut without a healthy thyroid, and you can’t have a healthy thyroid without a healthy gut. To restore proper function of the gut-thyroid axis, both must be addressed simultaneously”

    “Fixing the gut is often the first – and most important – step I take with my patients.”

    You said, it’s important to restore both the gut and thyroid functionality simultaneously. But then at the end, you concluded that fixing the gut is the first thing to do. I want to know two things:

    1. GAPS is the best universal protocol for a compromised gut because it addresses and fixes the gut starting at the deepest root level known to mankind. Do we have a similar protocol for fixing a compromised thyroid?

    2. If thyroid and gut are screwing up each other in a round robin fashion, do we need to look for a parallel fixing strategy or a serial fixing strategy? My guess is we should go for a parallel strategy. Either way, could you please explain which strategy to chose and what does the strategy comprise of?

    • He did say that he would start the patient on thyroid hormones first so allowing the patient to concentrate on healing the gut. I would say that once the gut was healed.., then… The patient could go off the hormones.

  14. I’ve been suffering for years! Maybe you can point me in the right direction. I am 54. I have one quarter of one ovary and low estrogen. I’m through menopause. I’m taking generic thyroid medication for hypothyroidism prescribed by my PA. Since taking the thyroid meds, I’ve been suffering with “gut” pain on and off for several years. Have had two CT scans done at different times, nothing is found. Diagnosed with IBS/constipation and prescribed Amitiza to keep fluid in intestines and help constipation I was told. I am still suffering with bloating, belly tenderness, and stabbing gut pain on and off, comes and goes. The PA says my bloodwork “number” is good for thyroid. I also suffer from depression/anxiety and take 10 mg of Lexapro daily. No one seems to be able to help me. The “pain” is not in my head. Any advice would be appreciated.

    • Hey, I was in your same position. the problem here are your doctors. I never needed the lexapro although I took it along with the generic Tch treatment. problem is TCH levels tell you nothing. You should first read “” and then find a better doctor who will regulate all T levels. With hashimotos, I believe the T4 has a problem converting to T3 in your gut, so by taking more T4, you’re effectively doing nothing.

    • I have hypothyroidism and I can tell you from experience that every time my levels get out of wack, my stomach gives me fits. Acid reflux, constipation, pain in my left side, and especially bloating are the type of problems I have. You really need to see an endocrinologist. My PA was treating me and said my levels were normal every time we checked when, in fact, that wasn’t the case. I finally got in to see an endocrinologist and she informed me that my T3 was way too high and my T4 was way too low. Synthroid does not work for me. I was on a combination of Armour Thyroid and Synthroid (as prescribed by my PA). My endocrinologist said she would never prescribe those two medications together and took me off both. I’m now taking Tirosint and I’ve had no problems. My stomach issues have subsided and I feel “normal” again. From what I understand, Tirosint is just a purer form of Synthroid. Be careful taking generic meds because they are not the exact form of the medicine you are prescribed. I’ve lost 8 lbs. in 2 months and that, to me, says it all.

      • Aloha Sheryl, thanks for your comments, for the first time in a couple years it makes sense! I was placed on Armour Thyroid along with my Levothroxine and within 6 to 9 months I started having severe intestinal problems, unfortunately it wasn’t the only problem, I also had Angle Closure Glaucoma. But now I’m sure these 2 meds cannot be taken together, so Mahalo from the big Island.

    • Hello Pat,
      The Lexapro can really be causing a lot of your problems. It messes with your whole body hormone system(s) – all of them! You did not say if you started taking the Lexapro AFTER you started on the thyroid Rx, or BEFORE you started the thyroid Rx, or started BOTH about the same time. Lexapro, and drugs like it, cause a myriad of problems that the doctors don’t seem to know about, or don’t want to acknowledge. Don’t just Google “Lexapro side effects.” Instead, Google specific questions, such as “does Lexapro cause stomach pain” or “does Lexapro cause bloating,” etc. Weaning off the Lexapro (slowly) will help, while you work to repair your gut via diet.

      • I’m on meds for under active thyroid had bloods done or it as docisnt happy with my results I’ve got pain on right side of stomache when pain comes I’m sick it only happens at night time I get odd twinges in day but not every day the pain can ast u to 2 to 5 hours I’ve had ultra sound but when they did the scan they pressed the probe on my right side but I was in pain they told me they mite have to stop cause of me being in pain I worry constantly if its some thing more serious I hate hospitals I have panic attacks I’m scared help

  15. Hello All,
    To Chris
    I love all of your articles i’ve been reading through them. Quit vegetarianism,Quit gluten, plan on going paleo.
    I have a question i’ve been diagnosed with hashimotos or 7-8 months now. I’m treated on armour 30 mg my dr is slowly raising it because i have had heart issues in the past. Recently i’ve suspected adrenal fatigue as having a part in my misery. I have very slow heart rate low blood pressure, which seems to get better when i drink some salt water. I’ve started supplements on my own, ashwanganda and red panax. I’ve been on them for a week, and don’t notice too many side effects, but i’ve recently been reading that red panax can exacerbate an auto immune disease, is this true? My dr isn’t concerned about my periodic low blood pressure, shes a very nice person but she has very little experience with hashimotos. But there are times i feel my heart will stop and my son willbe without a mother, it’s frightening me and my family. I have an appointment in june with an endo which i’ve been waiting for since february, it just seems to be getting worse. Maybe you can give me some advice as to what i should be askingb my endo when i see her?
    Thank you for your time

    Wishing recovery good health and happiness to you all!

    • I’ve been suffering for years! Maybe you can point me in the right direction. I am 54. I have one quarter of one ovary and low estrogen. I’m through menopause. I’m taking generic thyroid medication for hypothyroidism prescribed by my PA. Since taking the thyroid meds, I’ve been suffering with “gut” pain on and off for several years. Have had two CT scans done at different times, nothing is found. Diagnosed with IBS/constipation and prescribed Amitiza to keep fluid in intestines and help constipation I was told. I am still suffering with bloating, belly tenderness, and stabbing gut pain on and off, comes and goes. The PA says my bloodwork “number” is good for thyroid. I also suffer from depression/anxiety and take 10 mg of Lexapro daily. No one seems to be able to help me. The “pain” is not in my head. Any advice would be appreciated.

      • Pat at your age your remaining partial ovary is not gonna make estrogen actually most women who have hysterectomies with intact ovaries find that they stop working altogether within a few months because the blood supply to the ovaries i is altreed during surgery. The Lexapro can cause gut problems as can ALL antidepressants. Get off it if you can in a gradual fashion and go see a hormone specialist for bio identicals.

  16. Since 2001 I have been experiencing Irritable Bowel Syndrome and before that in 1998 I was diagnosed with hypothyroidism, off the charts,and am a mother of 4 children, with 3 others sisters with similar problems. Two sisters were mothers and one sister never conceived. The two sisters who had children, both had thyroid problems as well as myself. My oldest sister has died, through many complications, my other sister has allergies as well as thyroid complications and leaky gut syndrome, and my older sister has fibromyalgia, and similar hypothyroid conditions, and I am IBS and hypothyroid on regular medication with issues of swelling of the knees and aches in the elbows and extreme weight gain. I just am at a loss that Dr.s haven~t been able to get us straightened out. I will look into the GAPS diet, because I want to help my sisters as well.

    • The problem with most of us is that we have candida over growth. Google candida and you may be shocked with all the diseases it can cause. If we get out gut healthy, most of these issues will go away. I have found a wonderful product from Plexus called Pro Bio 5 with 5 probiotics. They also have Bio Cleanse to help move the dead candida out of your system once the die off starts. These are all natural products. They have a full line of products to help with many issues you may have. If anyone is interested in finding out more, you can call me at: 731-607-0387. Or you can find me on facebook under Dorothy Balentine Kilburn. I will be glad to help anyone because, I know where you are coming from on these issues. These comments should have been below Darlene since her problems are a lot like mine.

  17. I ran across this late in the game, so I’m sure you must have an article to address this and if so, I’d appreciate a link. So given what you addressed, does it then make sense that some of us experience chronic diarrhea while in fact suffering from hypothyroidism? That is my situation. The diarrhea is a result of an autoimmune response to leaky gut, which in turn produces low thyroid function? Is that what you are saying?

  18. Love this post! I found it when, after starting on bone broth, I had to immediately (within days) reduce my T3 medication by almost half (T3 only – 62.5mcg to 37.5mcg). I thought I was having a Hashimoto’s induced hyper spell, but my pulse and temps have remained stable, even while reducing the T3. I can hardly believe this is possible! I thought I had healed my gut by cutting out all gluten, grains, dairy, and soy, as well as adding in fish and eggs (I had previously been vegan) and lots of ACV in my water daily, but over two years of this and I’ve been stable at “feeling okay.” Now a few weeks of bone broth and I’ve cut my meds, have more energy, and am slowly losing weight (just a couple of pounds so far, but the right direction). Am I kidding myself here? Could this be attributed to something else? Again, thank you for this and all of your other, very helpful and informed articles.

    • Rachel, I too am hypothyroid and trying everything I can to eat what is healthy for me to “heal” myself of hypothyroidism. I too have started bone broth after reading about all the good it does for people with our condition. I would love to know more about your bone broth experience and how and what else you are doing to get well. I’m thrilled to hear people are actually getting better. Is there a way I can contact you directly?

  19. Hi Chris,
    I’ve read a few articles and rather enjoy them. This one hits home. My girlfriend has hypothyroidism and is trying to lose weight. She has lost a significant amount but did it very unhealthly, barely eating and lots of running. I am an exercise physiologist by trade and we started working together. When we met I had to fight with her to eat more than 1200 calories. We’ve slowlly worked up to her normal resting metabolism (1700kcal via medgraphics indirect calorimetry). However, she is extremely bloated, added 8 lbs to the scale (while starting to train for an endurance race). Her blood tests recently came back all clear but her digestive tract is virtually not working. 5+ days without a movement, undigested food, feelings of constipation etc etc. Her mensi’s is off as well. I think the link is between her GI tract and Mensi’s. Any idea? She’s on synthroid and very active, 4 cardio workouts and 4 weight training sessions. I am at a loss.

    • I used to be just like that. There are other meds much better than Synthroid. She should go to, read there, and find a “good doc” and get checked out. I did after being on Synthroid for 10+ years, gaining weight yet working out like mad. I am now on Naturethroid for 2+ years and feel much better. Finding a “good doc” is the most important. I hope this helps.

  20. Two days ago i woke up feeling weak and out of it. Took my temperature. It was 93.8. I asked the doctor to take a blood test and my TSH came back at .7. Two months earlier it was 1.0. I’ve been under constant stress for the last three months, not sleeping much, and very agitated. More recently I’ve been very constipated, not peeing much, always hoarse, night sweats, foggy thinking. I suspect with all my agita I may have done a number on my pituitary causing it to stop sending TSH to my thyroid and giving me hypothyroid symptoms. If I am right, is there anything I can do to get my pituitary back to sending proper TSH to the thyroid?

  21. Hi Chris,

    I’m a 40 year old female with a previously active lifestyle. I had a slew of crazy health issues earlier this year– weight gain (25lb in 6 months), fatigue, body aches, GERD, depression, Brian fog, muscle cramps, heavy and horrible periods, PMS, etc. I was convinced that I had hypothyroidism, but all tests looked “normal” except for a lower FT3 and an RT3/FT3 ratio of 18 (pointing to cellular hypo?). I had torn a shoulder muscle the year before and was popping Advil and muscle relaxers all the time. I also had strep throat 6 times that year as well as a UTI and had taken antibiotics each time. I could not catch a break! I ended up going to a integrative MD after the heartburn and stomach pain was beyond what OTC antacids could handle. he ran a stool and blood allergy test. Turns out I had an H. Pylori infection and an unknown parasite– most likely all the Rx’s and Advil created the perfect breeding ground for that to happen. I was given more antibiotics to treat the infection (I wouldn’t if I knew there was an alternative) as well as progesterone cream for estrogen dominance. Things seemed to get better for a short time, but now I have 18 food allergies brought on from leaky gut and I’m still tired and depressed by my lack of energy. I can’t lose the weight no matter what I try– it won’t budge. I’ve cut wheat, whey/casein, eggs (I’m allergic to them all now) and just this last month I’ve cut alcohol completely. Still, no progress! Now I’m doing acupuncture and a series of cleanses. What else should I be trying??? I’m still not convinced that my thyroid is okay, but my dr has kind of thrown up his hands.

  22. Chris,

    Thanks for the great website.

    I was diagnosed with Ulcerative Colitis over 12 years ago. Recently I discovered that there may be a real connection to my adrenals. During an appointment with my endocrinologist, he found a large (benign) nodule on my thyroid. So, all the medicine (ASACOL) I’ve been taking for 12 years may not have been addressing the root cause of my condition. I have a good endocrinologist and will be focusing on my adrenals and thyroid once I am tapered off Prednisone.

    Do you have any resources that confirm the connections between UC, the adrenals and thyroid?

    Thanks again. Knowledge is hope.

    Scottsdale, AZ

  23. I followed the link to the GAPS diet, and agree with a great deal of the information contained therein. Probiotics, carrot juice, essential fats, etc….

    Can you contrast the diet itself with a vegetarian diet? I am a vegetarian with low thyroid and am on HRT (androgel).

    I avoid gluten, supplement with whey protein, and exercise vigorously 5 days a week. Even with this routine, I still struggle to lose weight.

    Thanks Chris, awesome information you bring!

    (I’m 49)

  24. Thanks so much for this! I just found your website. After suffering immensely for the past 15 years with Hashimoto’s, and probably to some extent since my early adolescence, I am finally on GAPS. My daughter, who just turned 15, is starting to suffer from the same symptoms I have had. Now I can help her to break the cycle of disease and live a better life than I have been able to. It is so important that you, and doctors like you, are doing more than just prescribing a pill, and trying to discover the cause of disease. So often I have wondered, “Why me?” Now I begin to have a glimmer of understanding. Thank you!!!

  25. I’ve been on GAPS for about a year now and only recently have found alot of people saying that they have gotten Thyroid issues from being on GAPS and I’ve done research that says that we need some carbs other then veggies! So is its really harmful to stay off grains and starches? As I feel better staying off them and was going to permanently.

  26. Hi There,

    I was wondering if you could recommend good MDs that have an alternative approach or GAPS background who are in the SF Bay area. I am having really bad gallbladder( GB) issues with no relief. Seen docs for the past two years about my GB and they all wanna yank it out. I am not overweight, 34 female and have been on Paleo but yes not diligently which is the problem. If you know of any please let me know… I am searching around myself and appreciate any ideas to start my real healing.

  27. Hi, I’ve been suffering from the following symptoms: chronic constipation, cold intolerance, and a very low immune system making me very susceptible to infections. My magnesium levels are in range but consistently over the past year my lymphocytes and immune system is in the lower borderline( 850-3900). MY TSH and T3 levels are also low, especially my TSH which is significantly low. Please advise me how I can treat this ? I always eat very healthy ( no gluten, no dairy,) and exercise and try to minimize stress.

  28. I started having problems about 7 years ago, right after my mother passed away and I started pre-menopause. I had such heavy bleeding that it caused anemia. My gyn at the time tried me on several heavy pills that caused my whole body to go out of whack. Long story short…I felt like I was having thyroid & hormonal issues. As for the thyroid, no one would put me on any thyroid meds (until now…too late in my book!) I developed 3 nodules. They continued to grow. I had just about every symptom of hypothyroidism..some sevearly. I developed MS. I went to a neurologist and described all of my symptoms and he sent me to an endochrinologist. This dr. finally put me on synthroid. It was like a miracle. All the things that I had been complaining about went away. For about 6 months that is! I got a sinus infection and had to go on antibiotics. For some reason the antibiotics also had potassium in them, for which I cannot take (IC), so I stopped them about 2 days shy of the dose. A few days later I began having terrible digestion issues. I have had slight IBS before in my life, but nothing like this. Severe bloating, gas, pelvic pain, distension, weight gain (23 lbs in 3 months), water retention. Burping even when drinking water. My endo switched me to Armour, but reduced my dose. My nodules were still growing, so he recommended I have my R side removed, which I did 2 months ago. They would not raise my armour and said my TSH is slightly high. I am still having terrible digestion problems, weight gain, etc. My other levels are all normal, except for my cholesterol is high. I am at my whits end!!!!! Now they say to take estrogen. I do have a history of thyroid disorder (mother). I read not to take estrogen, so now I don’t know what to do. I am now on gluten free diet, whole/clean foods, but only a slight change. I take probiotics and Keifer daily. I really don’t know where to go from here. No one will give me more armour to see if it helps.

    • Linda,

      I posted the above question to Chris (I’m a different Chris) .

      I’ve been through much of what you describe. And, I have a suggestion or two. First, I use both Armour/Synthroid. I’m truly useless without the T3 from Armour. The only way my body functions properly is if my TSH is driven down into the 0.0something range, Period! Higher and I have all the classic hypo symptoms.

      Second. I was having a horrible prob with bloated belly, constipation, and so on. Even with regular exercise and strict diet. It was inflammation. What worked was a water fast for 10 days. Then months of fat free, low cal Atkins to get myself (as fast as possible) to my ideal weight. Then lifting weights at the gym 4x/week.

      Is it a cure? Nope. Did it fix my symptoms? Yes! It might not be what you wanted to hear. But inflammation is a monster and left uncontrolled, it ruins your life. I had to take drastic action. And, am I glad I did!

      I now know that I cannot eat anything man made (short of zero carb whey protein after a workout) And, I mean nothing. No man made salad dressing, no bread, crackers, pasta, no cooked veggies, no processed anything. Just smoked fish (in my electric smoker) chix, a touch of lean beef and turkey. Plus dried meats. The reason for this is clear. My body attacks carbs of any sort. Driving insulin levels up, storing it as fat and causing inflammation. There is a clear relationship between stored fat and inflammation. Get rid of it, period! There is a clear relationship between inflammation and all these symptoms. I’d much rather have fewer symptoms, wouldn’t you?

  29. I have Been dealing with thyroid issues all f my life. I am 26 and have within the last year figured out sometbing is really wrong with the way I feel. What should be my first step in fixing my thyroid issues. Should I get a blood panel test to see where my levels are and how it’s affecting my hormones or should I go straight to gaps diet? I am big on traditional gods and have started takin fermented cod liver oil, gelatin, coconu oil, grass fed butter and prescript assist probiotics. Also have been brewing kombucha for my gut health. I still feel my blood sugar levels dropping and I get really sick and weak. I feel so miserable like I am dying! I hate it and I’ve had enough!! Please let me know what I should do first.

    • Why haven’t you tried progesterone cream? Or ask your GP for an Rx for Prometrium. It will fix your low sugar s it did for me sounds like you are estrogen dominant. Skip the ferments they make things worse.

  30. Hi,

    It is important for me to thank you for this very interesting site. It gave me explanation to the mystery of my healt problems I am searching for so long! When I was around 16, I started to loose lots of hair and feel cold all the time. At 18, on one extremely ordinary morning, I started to feel extremely cold, anxious, depressed and I started to fall asleep almost anywhere. I always told the doctors that those symptoms were all related but as my thyroid gland exam seemed normal, they just insisted to give me medication for every symptoms (ritalin (for narcolepsy), Paxil, psychologist referral to find imaginary traumas, anti acid for the stomach -nexium…). Everything just went worst and I am 37 now and decided to make my own research and saw the Gapsme site (have lots of digestion problems since childhood) and then I saw your site. I have started a anti candida (have lots of symptoms for that as well!) diet. I red that thyroid problem can often be undetected with the classical test. Because of the normal result exam, doctors refuse to give me the thyroid classical medication and I am now followed by a nathuropath for the bad gut condition. I have always been convinced that there was something wrong with my thyroïd even though doctors are almost laughing at me and deny any relation in my symptoms. Is there natural substances that I can take to help my body produce the thyroid hormones? Is there any substances that does not need a doctors prescription that would help?

    Thanks again for your website, it is extremely useful- a revelation for me! Marie-Eve

  31. My daughter is GF but not dairy free. We do not worry about cross-contamination, so I can see where we could improve our concerns there. Anyway…she has AIT, but the hyperthyroid type. She is only 8 and so far no palpably enlarged thyroid nor eye involvement. Because she is young, we are not interested in “killing” her thyroid and putting her on thyroid meds the rest of her life. We have been doing biomedical treatments since 2010 so we have been on and off probiotics with no known “visual” benefits, but being that she is 8, I am not sure I would notice (she has never been one to complain of body pain)

    Well, my question is, is there a probiotic you would recommend for her, specific to AIT/hyperthyroid/Graves? I am not exactly looking to improve t4 to t3 conversion LOL unless there is a specific probie that will prevent reverse t3.

    Her other existing issues are: recovering from ASD, anxiety, sound sensitivity, positive thru DD labs for C. Diff and GPL labs indicating dysbiosis (treated on and off with high dose probies, like VSL#3 and Custom Probiotics)

    Thank you for any suggestions. 🙂

  32. Very fascinating! I developed hypothyroidism several years ago, when I made the mistake of going on birth control. I have gotten smarter since, came off it, changed my diet, reversed hypothyroidism, but always wondered what damage I might have done long-term to my gut flora. I recently spoke with a specialist who suggested doing a probiotic treatment (a month for every year of birth control use) to restore balance. As I am getting ready to do it ASAP. Meanwhile it made me wonder if thyroid issues and gut health have a lot in common–glad I found your article to confirm my hunch.

    • Hi Elena, it seems that we had similar reactions to birth control pills, would you be willing to email me about what you did to get to where you are now?

  33. So, what does a person who has no thyroid do? Mine was removed 7 yrs ago due to thyroid cancer. I take thyroid meds but still feel yuky and have constipation and digestive issues…all the time.

    • Stop the thyroid madness has a website and book

      Or Adrenal fatigue 21st century has a book

      If you have these two and your asking this question then couldn’t help you however if you don’t they are well worthy investments

  34. Hi Chris, very interesting and informative site, thanks! I hope you’ll take a minute to answer a couple of questions. I’m 49, male w/hashi’s (since age 33) , taking 75syn and 90 armour/daily. On a lower dose, my labs come out perfect but I feel awful and have all the problems you list, including major fatigue, near constant low blood sugar, significant intestinal blockage, rock hard bloated belly and major joint pain. On the higher dose listed above, I feel well enough and those problems fade nearly completely. I’m on a strict low carb diet (by necessity) and not diabetic. I also am an avid bicyclist and ride about 100 miles per week. My 2 questions are: First ( #1) when I work outside in the sun and modest heat, in short order I get very low blood sugar, below 70, regardless of type or quantity of food intake, candy does not help. Only time fixes it. Second ( #2) I now have tingling feet and hands, which I am now understanding can be a symptom of hashi’s. Is there anything I can do to improve these conditions?

  35. I have graves and had my thyroid removed two years ago. I’m trying to address my thyroid related food issues now, but am unsure how to maintain proper nutrition while respecting my food sensitivities (beef, eggs, lamb, tree nuts, dairy and gluten) while breastfeeding. My 9 week old son is very fussy and I’m wondering if I eliminate my food sensitivities would this help him? Also since I feel pretty limited on hat I can even eat how do I ensure my dietary changes don’t affect my milk supply? Lastly, since I no longer have a thyroid am I will considered a Graves’ disease patient or do I now have something else? Thanks!!

  36. Hi and thank you for these wonderful posts. I wish I would have known about them years ago. I had hashimotos and had the raidioactive iodine in 1996, had my gallbladder removed a couple of years after that… I have had severe joint problems, rosacea, exzema, depression and anxiety… and labs have shown B12 deficiency. I also have fibromyalgia with some bad brainfog. I round the GAPS diet and I have been shocked and amazed at how fast I am seeing improvements. I have only been doing this 2 and a half weeks but my skin is much more clear, my memory seems better. My energy level isnt really great yet but my depression is lessening a lot and while I dont have much energy, I am having enthusiasm and at least want to do things now. My question for you is this… I have read multiple things saying that I shouldnt have gone gluten free without a diagnosis first. How important it actually having a diagnosis? I am 50 and supposed to have a colonoscopy as part of a routine checkup and my doctor said that they can test for celiac disease with that. Have i had time to heal up enough and that test wouldnt be accurate? Should I add wheat back into my diet and then do the test. I really hate to do that especially when I read in your article that it can take up to 6 months for this to clear up. While I have only been doing the GAPS diet for a couple of weeks… over a period of months to a year… I have been moving to a diet that had a lot less carbs-which included a lot less wheat. I am fairly convinced that the gluten is what is the issue with me-especially after reading your article and I have so many of these issues but I suppose that there could be something else that I have changed that might account for my improvement. Bone broth or something. I know you cant give individual advice but can you make a general comment on how important or not important actually having the celiac disease diagnosis is… and if people in general should add wheat back into their diet to get a confirming diagnosis or if we should not worry about that and just continue on with what seems to be working.
    Thank you, Sabra

  37. please tell me where to find the complete list of footnote references for this article — only one footnote appears — very interesting article that applies to me totally & I would guess many others — thank you very much!

  38. Hi Chris,
    I am 33 years old, until last 6 months I was fit and healthy.. Suddenly I had a fatigue attack all blood tests revealed normal numbers. Doctors told me may be my low weight is reason and I put on almost 5 kilos in last 6 months or so. I weight around 55 kilograms for height of 5’5″.
    I was running well and had cut down on eating Junk food.
    Residing in India our staple food is Rice, Ragi, Wheat which we cook and have with a curry of vegetables, dal. I am a pure vegeterian no egg or meat in my diet.
    After 3 months I gained some confidence changed diet to add additional small meals to get things going. I felt better started running but with lesser intensity. Past 1month or so I again face similar symptoms of fatigue, sleepiness/tiredness/fatigue through days inspite of eating well and nutritious. So I read about this gut health associated cause related to these symptoms also leading to anxiety/depression. What is best way to come out of it, being in India does GAP diet workout for me since most of nutrition suggestions may be best for Western countries i.e. Eurpope and America? So do you include diet for other countries like India?

  39. I’ve been drinking George’s Aloe Vera water for years and recently was dignosed with Hashimoto’s (antibodies in the 1800’s). Wouldn’t Aloe have any healing affect on any immflamation in the gut?

  40. I just came across this post, which I realize was written a while ago, so no idea if you will see this post or not. But I thought I’d post just in case. Something you wrote captured my attention:

    “Hypochlorhydria, or low stomach acid, increases intestinal permeability, inflammation and infection (for more on this, see my series on acid reflux & GERD). Studies have shown a strong association between atrophic body gastritis, a condition related to hypochlorhydria, and autoimmune thyroid disease.”

    A little history about myself. In 2009, I lost 60 lbs with a low calorie diet. I gained about 15 pounds back last year and this year I have been trying to lose weight. But am having no success. I found if I even eat the amount of calories I should to maintain my weight, I still will end up gaining weight. This led me to wonder about my metabolism.

    My doctor mentioned my thyroid could be the problem and so she had the lab run tests. I have not heard back any results and it’s been about a week. I am assuming a letter will be in the mail saying everything is normal. But I’ve been reading about low thyroid since then and found I have at least a couple of the other symptoms – cold intolerance (I used to be hot all the time and now am always cold) and heavier menstrual cycles. I’ve also read how often tests can come back normal but there is still a problem.

    I also have been having issues with what I assume is either acid reflux/GERD. I spoke with my doctor about this but since it wasn’t happening frequently, she did not find the need for any medication. I was fine with this since I currently take medication for kidney stone prevention and migraine prevention. My husband has been dealing with acid reflux for about 2 years and takes both prescribed prilosec and zantac.

    I actually found your other articles on acid reflux, as well as this article on thyroid. I am interested in learning more about the possible connection of these two things. And any other helpful information/advice you’d be willing to share. Thank you so much!

    • Just wanted to add that I received the letter about my TSH level. It is listed as .73 (with normal range of .4 to 4.5).

  41. Chris, this question is about the GAPS diet, hypothyroidism and all the Cruciferous vegetables the GAPS diet has you eating. Arent these vegetables supposed to be avoided when you have hypothyrodism?

    • Steaming or boiling eliminates a substantial portion of the goitrogens in cruciferous veggies. You don’t need to avoid them, but may want to moderate intake.

  42. Hi,
    My symptoms are
    Pain in left side of abdomen,heavy head,constant fatigue,frequent constipation (with occasional blood in stool),rashes after having nonveg,pain in eye,muscle cramps and irritable behaviour

    Thyroid T3 2.87 T4 0.94 TSH 20.96 ANTI TPO 1300
    AEC 2.08

    Two years ago my stool test showed E Histolytica
    Endocrinologist has suggested thyroid medicine 75mg for life with vitiman supplements

    My questions
    1Could bacteria cause high TSH and allergic symptoms aswell?
    2If not do i have to get AEC and high TSH treated seperately?

  43. Hi from Norway! Lisa truity, I am glad Im not the only one who has experienced that gut health is everything when it comes to thyroid problems (and other health issues). What surprises me is that this approach is not a option when people are diagnosed with low thyroid (at least here). I was given medication (Levaxin) without any further check ups, for example minerals and vitamins, food intolerances or anything else. I live in Norway, and here it is still a “fact” that low thyroid is a life long diagnose and cannot be cured! After reading Dr Peter Osborne’s website (Houston) and his articles on gluten and the connection between leaky gut (which I have obviously had for MANY years), and thyroid problems, I am convinced that this was my problem in the first place, leading to hypothyroidism and fibromyalgi. I discovered I had an iodine deficiency too (had to struggle a bit to get that test done!), and that is also a very important test to do. I have had so many improvments to my health the last 10 months by just eating the right food for me. However, when I tell people (including doctors) that I have cured myself of hypothyrodism, they don’t believe me….. Fibromyalgia is also one of those diagnosis that is “impossible” to cure. Food is everything, and i truely believe that grains are bad for everyone. And the A1 milk we drink here is not a health food either. The “cleaner” my body becomes, the more I react if I without knowing it eat something with grains in it (for example Ester-C vitamins – they contain corn, although it says gluten free on the package). The definition of gluten is not updated in decades. There is gluten in ALL GRAINS, only different types, and I react to all of them, including rice.
    I haven’t heard about berberin – will check it out. You seem to have a lot of choice when it comes to different supplements in the USA. Unfortunately we are not allowed to order supplements from the US, only from other European countries within the EU, though with certain restrictions to how much. We have a very strict law when it comes to medication/supplements here, and the Norwegian equivalent to the FDA thinks that we don’t need supplements as long as we eat a “healty and varied” diet (based on grains and milk!!).

    • Would love to know more about the diet you say cured your Fibromyalgia and Hypothyroidism. I have both and my dr. Just gives me meds and basically says deal with it, there is nothing you can do about it.

  44. I too have been able to reduce/eliminate natural desicated thyroid by improving gut health, eradicating infections. I have had ibs colitis for decades. As a child I had the constipation kind which switched to diarrhea and inflammation. I did the scd/gaps low carb type diets for a few years and coyld avoid the diarrhea, but had gradually developed worsening hypot symptoms as an adult in spite of normal thyroid labs. I had to stay strict with diet or diarrhea would return. I also take zinc, manganese, selenium, chromium, molybdenum, and eat chicken liver pate for iron. This helped energy and libido and caused a slight improvement in thyroid function resulting in a need for less meds on some days. The thing that has really caused me to turn a corner however is berberine and berberine containing barberry root. I started using these alternating about a month ago and they have enabled me to eat normally. Starch and dissacharides no longer give me diarrhea, I have had to drastically cut back on thyroid meds and can envision that I will probably be completely off soon. My mood and energy have increased significantly. Even in the dark dreary winter here in kentucky, I am not feeling depressed. I got the idea to give berberine another try from zhao lipings work on gut infections as a cause for obesity. He mentioned berberine as showing very impressive results in their lab for decreasing bad microbes and increasing beneficial strains in their study subjects. I had some berberine previously but would get bad headaches after taking just one capsule for three days. It seemed like such a small amount I figured I must be having an allergic response. I decided to try again with 1/2 capsule a day and slowly work up. This worked. I guess it was actually die off that caused me to feel bad and berberine is so powerful just one capsule was too much.

  45. So, I have been on a thyroid medicine since 1992, I would love to change my diet and not take the medicine anymore, what do you suggest. I think you are right with it being gut related, burt I have no idea how to start dissecting the issue.

    • I have been on thyroid medicine for more than 15 years. After going Paleo in March last year I had to reduce quite quickly and stopped all medication after 2 months (I got overdose symptoms). When I started medication I had “normal” blood work but had a low FT3. The medication did not do much for me, and I believe that the gluten and casein intlerance I discovered last year is much to blame for all my “low thyroid symptoms” these years. I had constantly gut problems and my diet was low in protein and veggies and fruits and I always had digestive problems. I switched to a Paleo diet over night (no grains, no dairy, no fruits, no soy, no sugar). However, I suddenly experienced a lot of heart burn! It was so bad I thought I had a heart attack! It is possible to get off the medication, it just takes a lot of hard work and strong will. I had strong withdrawal symptoms for 3 months and at first I thought I was going to die (!); I had a hard time breathing, I was dizzy and even got ME symptoms for a few weeks (could not read, watch TV, etc). I guess my body was exhausted from being fed the wrong food for such a long time (decades). After 8 months into the new diet I found out I had a bacteria infection and yeast. I also had iodine deficiancy, as well as zink, magnesium and iron deficiancy. It takes time to heal, but if you change your diet it will affect your medication quite fast, maybe after a couple of weeks. So listen to what your body tells you, but at the same time be prepared there will be withdrawal symptoms. I have been without medication for 8 months now, and I no longer have all those symptoms I had when I was taking medication for low thyroid and my FT3 has never been better than now. My recommendation is that you take it very slowly, step by step. It is possible!

    • Connie, my suggestions would be that you get tested for food intolerances (IgG a good place to start) – preferably before you get off grains and dairy. If you change your diet to grains and dairy free, be sure you will get withdrawal symptomes… I had tem for 3 months. And please be aware that your medication will probably have to be reduced as you go along. I had to start reducing Levaxin after 2 weeks on the new diet. You can of course also take a week by week approach, and sort of adapt to a new diet over some time, and eliminate dairy first and grains afterward.
      A stool test is the best thing I have ever done for myself – as it turned out I had bad bacteria and yeast (I took one called CDSA 2.0, one of the best there is, I think). The Lab is Genova Diagnostics (Asheville, NC). You need good bacteria for your gut anyway, and these capsules can be bought wthout prescription. I use them every day. Try also digestive enzymes to your meals (lipase, amylase, protease) and see if that helps on digestion. They are also without prescription (at least here in Norway). I would also take omega 3, 2 table spoons olive a day oil and start cooking with coconut oil. All other oils should be banned. Coconut oil is good for the thyroid. I would also do a 24-hr urin test to make sure you have enough iodine. You also need to check your mineral and vitamins, especially vit D, magnesium, zink and selenium. If you have a leaky gut you probably have deficiencies in these minerals and vitamins (I did). Start with 1000 mg C every day (make sure they are without grain/soy based ingredients).
      Listen to your body, but reaslize that there is no quick fix to a gut/health that has been compromised for many years. I am still not “there”, after 10 months, and one problem I still have is eating fruit. My stomach starts WW3 everytime I try a banana or a handful of berries. If anyone out there has expereinced the same, I would appreciate hearing from you!
      Don’t care about friends and family caling you a nut case because you stop eating grains..or dairy! Good luck from Norway!

  46. Chris, with your recommendation of ginseng for supporting the cortisol rhythm, does it matter whether one is TH1 or TH2 dominatant. In reading Dr. K’s book that was the thing that was the most confusing. Without access to the tests or practictioners I wouldn’t want to treat the wrong one.

    Given that it is a rhytmic thing, should the ginseng be taken at certain times of day?

  47. Along with the GAPS diet for gut heaing we need to include colon cleanses either with thereputic enemas or colonic hydrotherapy sessions.
    Blessed Herbs has a complete herb cleansing kit.
    Also Kristina Amelong’s book, Ten Days to Optimal Health gives great advice on cleansing, detox, gut healing, colonics, etc.  She also has a website to purchase at home enema kits and detox supplements (cheaper then Blessed Herbs): She recommends bone broths and raw milk while cleansing, whereas Blessed Herbs recommends fresh pressed juices like apple juice (not possible for those with blood sugar problems).
    Their colon cleanse supplements are basically the same: bentonite clay, pysillum husk, apple pectin.
    If you have blood suagr problems, it may make cleansing more difficult.  I used True Balance supplement as suggested by Julia Ross in the Diet Cure to help and followed the raw milk and bone broth plan.  Amelong also recommends flax oil and coconut oil while cleansing.
    I find this approach to work and is so much easier to do than GAPS alone (the extra fiber is filling) with faster results.  I believe The GAPS diet also reccomends enemas and/or colonics, but only briefly and does not go into great detail about it.
    It is recommend that a person does 3-4 intense cleanses a year for one to two years if in poor health.

    • I’m not a fan of colon cleansing. Colonics can be harsh and depleting, and I don’t think they’re necessary – especially on a repeated basis. I can see a role for enemas over a short period, as Natasha suggests for people following GAPS, but I don’t recommend either colonics or enemas over an extended period. This is particularly true for people who are debilitated and have sensitive guts.

      • Colonics are invaluable. After fasting for 8 days, I had one done and there was morbid matter released every time. Days 9 and 10 were the same. I had another one on my last day, day 28, and got the same results. The same can be said for the day 29 and 30 when I had yet to consume anything solid. That was pure morbid matter stuck in my intestines. Not only did I feel refreshed, but hardly depleted. Even if that was the case, feeling depleted pales in comparison to the benefits of clearing out the decay from the colon.

        Dr. Walter Crinnion, ND, is world leading expert in the field of environmental medicine. His success rates implementing colonics in many of his patients has also been invaluable.

            • The summation of a parasite diagnosis by Bonnie may have to do with the metabolites produced by parasites either in the presence or absence of food. I have no sources but my boss has battled with parasites & has explained the effects of the metabolites on different parts of the body.

  48. It can be a genetic condition, but as I’ve written in my articles it can also be caused by inflammation, stress and high homocysteine levels.  See #5 in this article, and reason #2 in this article.

  49. Still a little confused over here. Do you consider thyroid hormone resistance to be an autoimmune condition? Can’t seem to find it in your previous articles.

  50. I’m not a big fan of the gland supplements.  A more sophisticated approach is to use adaptogenic botanicals like Panax ginseng, Siberian ginseng, Ashwagandha, etc. that elevate or reduce cortisol as necessary.  The most important thing is regulating the cortisol rhythm. You can have normal levels of cortisol, but if the rhythm is off, you’ll have symptoms.

    • Ashwagandha irritates the gut and many people with gut issues have side effects with it. Some of which include allergic reactions.

  51. Thanks, that clears up a lot and I’m looking forward to your next post! You say that the way to go is with a compound that regulates the cortisol rhythm, is adrenal gland tablets (in Sweden called Adrekomp and containing extract from natural adrenal glands from pigs along with vitamins A, C, B1, B5 and B6, minerals P, K, Zn and Betain HCl) such a compound?

  52. Another higly interesting post and yet I feel slightly more confused by every post I read, it’s a lot to take in and I guess the language barrier doesn’t help. I don’t know if I’ve got it all right and if I’ve missed something but I can’t understand that cortisol would decrease active T3. I’ve been recommended to support my adrenal glands by taking cortisone or a natural supplement with adrenal gland extract. I chose the latter and it’s helped me a lot, I feel much better. Now with what you’re saying about T3 it seems like it should’ve had the opposite effect? And what is your take on adrenal gland fatigue? The more I read (not only here) the more I think that my thyroid problems actually are adrenal glands problems. And finally, you haven’t really said anything about hypo2, I presume you’re familiar with Dr Mark Starrs theories. How do they fit in with your take on it all?

    • Charlotta,

      Many of your questions will be answered in my next article on adrenal stress and the thyroid, which I will publish either today or tomorrow. I’ve read about Type 2 hypothyroidism. I have been talking about it, but not under that name. Whenever I say “thyroid hormone resistance” or “thyroid receptor site downregulation”, that’s what I’m talking about. Cortisol depresses thyroid functions by several different mechanisms, which I’ll outline in the next article. Taking cortisone is not the way to support your adrenal glands. Taking compounds that regulate the cortisol rhythm is.

  53. Superb post Chris!
    What do you think about the possible effect of eating charred meat on serum AGEs, and on health in general, in people with a health GI tract.
    Here is the reason for my question. I had a few exchanges with a commenter under the post below. I looked into some refs the commenter provided.
    It seems that, in the absence of gut problems, ingested AGEs (e.g., Maillard) may not be a big deal. But I’m not sure.

    • Ned, you’ve looked into the AGE issue in much more depth than I have. The conclusion I reached after the little bit of research I did was similar to your own: that the potential damage caused by AGEs – even when someone has a leaky gut – pales in comparison to the harm caused by refined carbs and industrial seed oils. Based on the evidence I’ve seen, I don’t find cause to strictly avoid roasted or BBQ’d meat, but at the same time I wouldn’t eat it every day. For me this is a quality of life issue as well. I am interested in health, of course, but I’m also interested in living well. The pleasure that eating a particular food and the real physiological benefit that pleasure brings is always a part of the equation.

  54. While having no familiarity with thyroid issues, I’d still be interested to hear your (possibly relevant) take on the health of the “second brain,” something my tai chi teacher wrote about and which “Scientific American” and the NYT has covered. Many believe that traditional fermented foods are smart choices for promoting healthy intestinal flora, e.g. “the Activia Challenge.”


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