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Why Be In Ketosis – Part XII (Thyroid)

There is a pattern that I’ve noticed on every live-stream that I’ve appeared on talking about ketosis that someone always asks the question: “What about the thyroid?”  That’s literally how it’s asked. . . someone I am unfamiliar with keys in the question, “What about the thyroid?”

The blunt sarcastic response in my head is usually, “Well, what about it?”

Buried within the vague periscope or twitter question above is the real question that is on the minds of thousands of people,  “Does ketosis effect the thyroid . . . ?”

There’s loads of information about the thyroid on the internet.  Much of it is garbage.   Seriously.  Ask Google about “thyroid,” and you’ll see thousands of articles, posts and comments on WebMD, Women’s Health, and Wikipedia all across the “interwebby.”  Everyone, and I mean everyone, seems to have a “thyroid opinion.”  Much of the “wikopinion” out there is here-say, conjecture and anecdotal. It doesn’t really give people any foundational understanding of what their thyroid is doing, or more importantly for that matter – what their thyroid isn’t doing.

Of late, the Paleo and Vegetarian thought leaders seem to decry nutritional ketosis because they claim that this dietary approach suppresses thyroid function. This wiki-theory (yes, it is just a theory) was extrapolated from a single study where the T4 level dropped in the first few weeks after ketosis was entered.  But just because T4 drops, doesn’t mean the diet suppresses the thyroid.  Using T4 as a screening test alone for assessment of thyroid function is 1987 thinking (1987 brought us the Kia Concord and the Subaru Justy just so you get the mental picture).  T4 fluctuates with a number of binding proteins and following this number alone is really bad medicine.  Taking thyroid advise from the Paleo people is like asking your Fed Ex driver about the correct lift on your 4×4 truck.  Really?

Excessive insulin, the hormone produced when you eat sugar, starch and some proteins, actually stimulates thyroid peroxidase antibodies and can cause exacerbation of thyroiditis (causing over-production or under-production of thyroid hormone).  Because 85% of the people I see in my office over-produce insulin (this is referred to as insulin-resistance), in response to starches, there is a significant flux in thyroid function due to  this pre-diabetes state (insulin over-production) on high carbohydrate based diets.

Leptin, the hormone produced by fats cells when they are “full,” actually stimulates the conversion of T4 to T3.  At least 40% of my obese, insulin-resistant patients are also leptin-resistant, meaning they over-produce leptin as well.  This has a suppression effect on T4 (by converting it to T3) and is the usual cause of the T4 levels being lower when initially staring a ketogenic diet.  It is also the reason that some people feel anxious or “activated” when changing to nutritional ketosis.  Leptin-resistance is driven by a high level of fructose in the diet and the presence of high triglycerides, inhibiting the leptin signal from crossing the blood-brain barrier.  As a person follows a ketogenic diet and lifestyle, leptin returns to normal over 3-6 months and T4 levels normalize.  The Paleo and Vegetarian nay-sayers never mention that . . . do they?  What they won’t tell you is that calorie restriction, which is a must for weight loss, on the DASH, Mediterranean, Paleo or Vegetarian diet causes suppression of testosterone, leucine, and thyroid function, causing worsening T4 suppression over time.  Hmmm . . .  put that in your low-fat green vegetarian taco, and smoke it.

Wait . . . I don’t advocate smoking so, ignore that.

The point is, a ketogenic lifestyle stabilizes thyroid function and improves auto-immune thyroiditis. I’ve seen it happen clinically for over 12 years.  It, also, dramatically helps stabilize the other 30 hormones involved with the diseases of civilization including obesity, insulin resistance and diabetes.

Watch my live-stream recording below to find out more about the thyroid.


Why Be In Ketosis – Part X: PPAR-alpha

Benefit #10 in my 25 part series on “Why Be In Ketosis?”

This evening we briefly discuss PPAR-α, a powerful hormone that is stimulated by the ketogenic state.  It has a number of known benefits.  A number of great questions also popped up that we answered.  Listen and watch as we discuss them here:

Stay tuned for more great content on Facebook Live, Periscope and Instagram.

Is Your Oatmeal is Killing You?

“Doc, if I don’t get my testosterone up, I’m just going to die!”

I’ve been hearing that statement from men more and more often lately.   And, the answer isn’t what you’d think.

If you’ve watched late night TV recently, you’ve probably seen the many advertisements for testosterone supplements for low testosterone in men or what is now being called “Low T” Syndrome.   It seems like this is the new advertising trend so much that patient’s use the term “Low T” as part of their conversations.

Watch the four minute short below about how your testosterone and sense of fatigue is being driven by your oatmeal or breakfast cereal . . .

Is it that men have just stopped making testosterone?  Suddenly, everyone’s testosterone is low and men are complaining about fatigue, libido, and erectile dysfunction . . . or are they?

It’s actually the oatmeal . . . and the breakfast cereals.  Clinically, when a man cuts the cereals and oatmeal out of his diet, he actually increases testosterone by 50-150 points within 1-2 months.

If you practice medicine long enough, you’ll see a trend that seems to have arisen as our waistlines have expanded.  About half of the men in my office with insulin resistance, pre-diabetes or diabetes have low testosterone levels.  But this shouldn’t be a surprise.  Type II diabetes, metabolic syndrome and insulin resistance are all driven by an over production in insulin in response to a carbohydrate load in the meal. Patients with these conditions produce between two to ten times the normal insulin in response to a starchy meal. A number of studies both in animal and human models demonstrate that insulin has a direct correlation on testosterone suppression in the blood. This has been demonstrated in both men and women.  In fact, glucose intake has been shown to suppress testosterone and LH in healthy men by suppressing the gonadal hormone axis and more predominant testosterone suppression is seen in patient with insulin resistance or metabolic syndrome.

Image Credit: http://www.townsendletter.com/July2012/metsyndrome0712.html

In fact, to put it simply, insulin increases the conversion (aromitization) of testosterone to estrogen in men (it does the opposite in women by interacting with the hormone FSH).  Interestingly, leptin resistance has a similar effect.  I tend to see the worst lowering of testosterone in men with both insulin and leptin resistance.

What that basically means is that your breakfast cereal or oatmeal decreases your ability to maintain testosterone by up to 50% (1), lowers your ability to stabilize muscle (2), increases your risk for heart attack and stroke and makes you fat!

Death by oatmeal  . . . really?


How to you improve your testosterone?  Supplemental testosterone has been shown to help, but it comes with some risks, including prostate enlargement and stimulating growth of prostate cancer.  The most natural way to improve your testosterone is to change your diet.

A low carbohydrate or ketogenic diet turns down the insulin production and allows the testosterone to be available for use by the body. A ketogenic diet has the effect of reducing leptin resistance as well through weight loss.  A simple dietary change of this type is frequently seen in my office to increase testosterone by 100-150 points.


What is a ketogenic diet?  It is a diet that restricts carbohydrates to less than 30 grams per day, thereby causing the body to use ketones as the primary fuel source.  So, for breakfast tomorrow morning, hold the oatmeal (1/2 cup of Quaker Instant Oatmeal is 31 grams of carbohydrates) and have the bacon and eggs.  And, rather than have the cheesecake for desert this evening, have an extra slice of steak butter on your rib-eye and hold the potato.

Or, you might consider using a high fat shake with exogenous ketones.  This is my breakfast each morning:


Exogenous ketones mixed in sparkling water, 2 tablespoonfuls of coconut oil and my multi-vitamin and I’m usually full until after noon.

Either way, get rid of your breakfast cereals or oatmeal . . . it’s killing ya!


  1. Ballester J et al., J Androl. “Insulin-dependent diabetes affects testicular function by FSH- and LH-linked mechanisms.” Sept-Oct 2004; 25(5): 706-19.
  2. Manninen AH, Nutr Metab (Lond). “Very-low-carbohydrate diets and preservation of muscle mass.” Jan 31, 2006; 3:9.

KetoTalk From the Caribbean Sea


Dr. Nally recently spoke about Low-Carbohydrate/Ketogenic Diets on the 2016 Low Carb Cruise to the Eastern Caribbean.  While there, he and Jimmy Moore recorded another episode of KetoTalk with Jimmy and the Doc.

Listen in to KetoTalk Episode 20: A LIVE Q&A Session From The 2016 Low-Carb Cruise

Here’s what Jimmy and Dr. Nally talked about in Episode 20:
– We are in front of a LIVE audience of Ketonians
– How long will you experience hair loss when you go ketogenic?
– What role does resistant starch have on the keto diet?
– Is eating high-fat with high-carb harming my boyfriend?
– How does intermittent fasting help with keto?
– Whether to count total vs. net carbohydrates
– Whether you need to cycle carbs when building muscle
– What the best way to test your ketones is
– How to test blood ketones on a budget
– What the difference is between an NMR and basic lipid panel
– The dramatic changes in your cholesterol when going keto
– How long should you be on keto before running blood tests?
– Whether you should cut fat lower on keto to speed up weight loss
– Is having a lower body temperature a bad thing when eating keto?

You can listen at the iTunes page here, or download it for free to your favorite iTunes player.