Why Paleo May Not Be Working For You (It’s Not What You Think)

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My notes are starred and underlined. I’ve written, “Yes, yes, yes, finally!” 

No, I am not having a Meg Ryan moment. I am hearing a doctor say two very important things. Things I have suspected for a while now.

They came out in the latest Thyroid Session I’ve been listening to. 

This one was with Dr. Sara Gottfried, a doctor operating not far from me, in Berkeley, California, who focuses on hormonal issues in men and women, but particularly women. She is the author of The Hormone Cure

Most requested session

Her session, How to Lose Weight When Your Thyroid is Off was the one most voted for write-up by Paleo/NonPaleo readers. Read on to find out what those two moments of vindication were, the main points of the information she shared, and how she addresses thyroid recovery.

The presentation is available for a limited time for free. However, if you’d like lifetime access to it, to all the other Thyroid Sessions, transcripts, and lots of other goodies, you can do so by getting an all-access pass to the Thyroid Sessions.)

sara-gottfriedHere are 26 important, salient points from Dr. Gottfried’s presentation.

1. Having thyroid issues occurs in women 20x more than in men. 

2. Thyroid determines the metabolism rate at which you burn calories. Every single cell in the body has a receptor for thyroid. If you have thyroid issues, you have problems which show up in many ways.

3. When the thyroid slows, it makes priority decisions: a kind of triage. It will decide to take the focus off losing weight and growing hair in favor of performing other, more critical functions. 

4. A sure sign of thyroid problems is sparse or missing outer thirds of the eyebrows. Other classic signs are poor quality and number of eyelashes, dry skin, dry, straw-like hair, thin, brittle fingernails, an additional 5-20 pounds.

5. 30% of women at age 30 have thyroid problems, 50% of women at age 50 have thyroid problems.

6. Many women suffer from “thyropause”, when women in mid-life start to get thyroid issues in significant numbers. The main three markers are weight gain, feeling tired, and mood issues. 

7. Other symptoms are cold hands and feet, constipation, decreased sweating, headaches, poor muscle tone, tingling hands and feet, low sex drive, slow speech, brain fog.

8. Thyroid problems also show up in children. These show themselves in short stature, thicker trunks, large abdomens, shorter limbs, hyperlaxity (ultra-flexible joints), small hands, scoliosis, flat feet, thick skin, incomplete sexual characteristics, such as thin pubic hair, recurrent infections, sometimes learning disabilities, overweight, heavy birthweight, delayed growth, delayed puberty.

sarahgottfried

9. 90-95% of thyroid issues are due to autoimmune thyroiditis. Graves disease is another cause, and secondary causes are diet and nutrition, stress and super low carb diets.

10. If you suspect a problem, the following tests should be run: TSH, T4, T3, rT3, TPO and antithyroglobulin antibodies. To go further you can also have a physical exam and ultrasound of your thyroid. 

11. rT3 results show how well your body is converting T4 into useable T3. If you are producing too much rT3, you are not producing enough T3 and will have problems. This imbalance occurs when you have a crisis or your body perceives there is a crisis and as a result, your metabolism will slow down, and rT3 will block thyroid receptors making it difficult for thyroid hormone to get into the cells and do their work.

12. Dr. Gottfried has a 3-step system for healing the thyroid, restoring metabolism, and kickstarting weight loss once more: 

  • lifestyle changes
  • proven botanical therapies
  • bio-identical hormones

13.  Women are more complicated than men. They have more neurotransmitters and hormones, and tend to have higher levels of stress than men. They have more estrogen, less testosterone, the liver is more complicated. Women are subjected to more endocrine disruptors probably due to the cosmetics and other products we put on our skin. A low carbohydrate diet doesn’t serves women as well as it serves men. 

bmi14. Terry Wahls has told her that her research has shown that for women with a BMI of 23 or less, paleo doesn’t deliver weight loss. 

15. Most health studies have been done on men, and it is automatically assumed that the results apply to women too. Gender differences mean this isn’t so. (I have been saying this for ages!)

16. The most important lifestyle change is changing to a low inflammatory diet, a paleo diet. Stay away from high-glycemic foods as insulin resistance will do further damage to the thyroid.

17. Don’t go too low in carbs. If you are in ketosis, or if you are eating 10-15g of carbs a day, that is too low. The thyroid will dysfunction and you will stop losing weight. Use “slow carbs” such as sweet potatoes and the carbohydrates in other vegetables.

18. Avoid goitrogenic foods. These are thought to slow down the thyroid and even grow the size of the thyroid. Goitrogenic foods include kale, broccoli, brussel sprouts. The goitrogens can be deactivated by light cooking but using them in a green juice is a disaster. Also avoid soy. It has been shown that a single serving of soy will slow down the thyroid by 7%.

19. Medium chain fatty acids (like coconut oil) is also a great addition to the diet. In the video at the end of the presentation, when Dr. Gottfried makes a soup, she uses Bulletproof MCT oil which she also recommends in smoothies.

20. Cortisol levels that are too high or too low will affect the conversion of T4 to T3 (the active form). 91% of her patients have high cortisol (stress hormone). It will also slow down production of all hormones. Dr. Gottfried uses “Inner Balance“, a free app that helps regulate stress. She’s also a big fan of yoga (shoulder stands are good for the thyroid) and meditation. If you can’t meditate, she suggests a magnesium bath – 10-15 minutes in a bath, as hot as you can stand it, with some epsom salts.

21. Don’t do extended cardio. It will raise cortisol. Burst training is quicker and more effective. Burst training is like tabata – very intensive bursts of exercise for a very short period of time followed by rest, repeated several times. After a warm up, go hard for 1 minute, then rest for 1-2 minutes and do this 7-10 times. Works for weights plus short bursts of cardio. 15-20 minutes of weight training, twice a week has been shown to make a difference to women.

22. Rhodiola and ashwagandha botanical remedies help with high cortisol. Herbal remedies are not well-proven. Cardamom helps with depression, gut issues, and mouth ulcers.

23. Most people have too much or too little iodine. If you have autoimmune thyroiditis, you need to be careful with iodine as your “sweet spot” is not as broad as those without the disease. Dr. Gottfried recommends food sources for iodine, such as sea vegetables (dulse, kelp), rather than supplementation.

24. The third step in Dr. Gottfried’s protocol is to use bioidentical hormones in the lowest dose and for the shortest time. This low time/dosage is to avoid the problem of hormone resistance where the dosage is continually increased for it to be effective. She likes the natural thyroid medications ArmourĀ® and Nature-Throid.

25. TSH test results should be 0.3 and 1.5. Results for free T3 and free T4 should be in the top half of your labs normal range, while rT3 results should be in the bottom half of the normal range for your lab. Autoimmune antibodies should be within normal range.

26. The presentation ended with a cooking demonstration for Thai Coconut Soup. 

I found the comment about women struggling to lose weight with paleo and a BMI of 23 or less to mirror my own experience. Outside of pregnancy, I have never had a BMI higher than that (it is what I’m at now) and have only ever been able to lose weight with a very low carb/low fat diet along with a significant amount of starving. I think it is valuable to hear that paleo may not be the weight-loss answer for those wanting to get to a low body weight (and maybe that shouldn’t be the goal), especially once hormones start to fall. 

The other point about gender differences is huge. Paternalism is rife in general, and in paleo. It is important to hear from a medically qualified source that women are different and not to take on blanket advice, tested on men, for ourselves without critical evaluation.

Dr. Gottfried’s presentation is free May 6th and 7th, or you can purchase an all-access pass to all the Thyroid Sessions and watch them at your leisure. Click here to do that.

sara-gottfriedSara Gottfried, M.D., is a practicing integrative physician and author of the New York Times bestselling book, The Hormone Cure (Scribner, 2013). Dr. Sara teaches women and men how to balance their hormones naturally, regardless of age.


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Written by 

Alison Golden writes on the topic of paleo over at Paleo/NonPaleo. She aims to share ideas, inspire and motivate readers by teaching them how to live paleo in a non-paleo world. She is also the author of the bestselling book, The Modern, No-Nonsense Guide to Paleo, a unique tool that gives the reader hundreds of strategies to navigate the learning process to successful paleo living.

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