Chris Kresser Gives Me Deep Insight and Confirms My Hashimoto’s Amelioration Approach

I titled it that way because in an email I got from Chris this morning, he wrote/confirmed much of what I was seeing in comments over my last post about my clinical diagnosis of my subclinical Hashimoto’s Thyroiditis, on top of my own Googling. I shot him an email yesterday. Recently, we’ve been loosely sharing info (not collaborating) in terms of gut biome stuff, resistant starch, and people being more sane about carbohydrate intake…more skeptical of Keto “Clarity.”

Not meaning to take up lots of time. First, the good news. A lipid panel after some months on moderate carb instead of LC. I’m pretty tickled by it. Looks pretty gold standard to me and the graphs pretty dramatic. I’ll bet that with a more relaxed carb intake, mindful eating and less fat gluttony, others are no longer going to have need of finding out why their C is so high, and have to buy a copy of Cholesterol Clarity. :)

OK, I got the thyroid tests you recommended. Thank you very much. Pretty clear Hashi’s, right? I have a history of elevated TSH. Back in 2008/9, it was 16. Now just under 10.

Chris’ take:

Yes, that’s Hashimoto’s. Unfortunately treating it is a little more complex than I can get into in an email, but here are a few considerations:

1) Remove any immune triggers. You’re on the right track with what you suggested, but you might also consider autoimmune paleo for a 30-day period to see if it has any impact on your thyroid numbers and symptoms (if you have any).

2) The goal with Hashi’s or any autoimmune disease is promoting t-reg cell function. Butyrate, as I’m sure you know, is a major t-reg cell promoter/differentiator. So keep it up with the prebiotics/RS. But you also want to focus on optimizing glutathione and 25D levels, since they play an important role in t-reg fx as well.

3) Watch your intake of goitrogens. I doubt you’re having a raw kale smoothie everyday, but that would be a bad idea. Eating a moderate amount of raw or steamed cruciferous veggies is fine; just don’t overdo it.

4) Make sure you’re getting enough zinc, selenium, and iodine. That said, too much iodine can trigger or flare Hashi’s in a small minority of cases so I’d limit to about 1 mg/d. Sea vegetables like kelp, wakame, hijiki, arame, etc. are generally the best option, along with fish head soup.

5) If you’re symptomatic, you might want to consider low-dose naltrexone. Check out my interview with Amy Myers which was part of her autoimmune summit; we went into a lot of detail on LDN.

6) Keep this in mind: right now you have what’s called “subclinical hypothyroidism” (high TSH and normal thyroid hormones). There’s a debate about whether that should even be treated at all. Not all people with subclinical hypothyroidism progress to clinical hypothyroidism, and studies generally don’t show much measurable benefit from treating, especially when there aren’t symptoms to begin with. Something to consider.

Other key things to do are to figure out if there’s anything more fundamental that is triggering immune dysfunction, i.e. SIBO, leaky gut, parasite, heavy metal toxicity, etc. But for that stuff you may need to work with someone.

So, does this look like a lot of sound advice to me, to you—kinda like in the vein of your doctor being a partner, not an authority that just prescribes you pharm from the schedule? And do note: I’ve met Chris in person and he’s very familiar with my medical history. We live in the same state. And it’s perfectly fine to put his guidelines to me, out to you for chewing. His advice to me is not advice to you.

…But did you take very particular note of #6, my lovable HYPOCHONDRIACS?

“Keep this in mind: right now you have what’s called “subclinical hypothyroidism” (high TSH and normal thyroid hormones). There’s a debate about whether that should even be treated at all. Not all people with subclinical hypothyroidism progress to clinical hypothyroidism, and studies generally don’t show much measurable benefit from treating, especially when there aren’t symptoms to begin with. Something to consider.”

This goes to something I’ve told myself for decades, in any situation where some action seems called for:

One Option is to Do Nothing!

This is in stark contrast to the typical human knee-jerk, whenever a problem presents: DO SOMETHING!

[easyazon_image add_to_cart=”default” align=”left” asin=”031632289X” cloaking=”default” height=”160″ localization=”default” locale=”US” nofollow=”default” new_window=”default” src=”” tag=”fretheani-20″ width=”103″] [easyazon_link asin=”031632289X” locale=”US” new_window=”default” nofollow=”default” tag=”fretheani-20″ add_to_cart=”default” cloaking=”default” localization=”default” popups=”default”]So here’s Chris’ NTY Bestselling book[/easyazon_link]. Perhaps you said before, “”I have lots of paleo books already.” Me too. Being on all the publisher’s lists, I recently went to a used bookstore in Campbell and got $300 for two hand carts stacked to the top. My bookshelf is pretty sparse now.

But given the contrast I see here, this one will stay there along with just a few others, and a few amazing cookbooks in hardcover.

Also, take note that Chris’ book will be coming out in paperback soon, with a new title, The paleo Cure. Fortunately, it’s already subsumed that the cure is personal, not one for all. You might want to snag a hardcopy, before they’re all gone. Or, just get the kindle. :)

Thanks, Chris. …I still recall when you approached me way back about a GERD series you were doing. I’m so glad you did, and I could not be happier for your marvelous success. You’re one of the very good guys for sure.

Since Covid killed my Cabo San Lucas vacation-rental business in 2021, this is my day job. I can't do it without you. Memberships are $10 monthly, $20 quarterly, or $65 annually. Two premium coffees per month. Every membership helps finance this work I do, and if you like what I do, please chip in. No grandiose pitches.


  1. rob on December 10, 2014 at 13:05

    Re hypochondriacs, I look at the symptoms here

    And my immediate reaction was “OH CRAP!”

    One benefit of having a health insurance policy with an insanely high deductible is it turns “OH CRAP!” into “Oh well, I’ve lived with worse.”

    Very much appreciate posting Chris’ take on it, cause I ain’t going to no doctor.

    • Richard Nikoley on December 10, 2014 at 13:21

      My own doc said that for TSH under 10, there is significant debate over whether treatment is warranted.

      I’m sure there’s plenty of anecdotal in that. Same for T2D. How many people have lived good lives, died in their 80s, in thousands of years, who never knew they were type 2 diabetic.

      It is, after all, a medical diagnosis, not a human one, so to speak.

    • gabkad on December 10, 2014 at 15:14

      It’s the fT3 and fT4 that are important. TSH is produced by the pituitary so you know your pituitary is going great guns. Your thyroid is struggling because it need a big ass whooping to produce a normal amount of thyroid hormone. The poor thing is getting beaten.

      I wonder if even if the fT4 and fT3 are okay, but cholesterol is rising, is this part of the inflammatory process of Hashi? Higher LDLs are indicative of inflammation after all. I don’t give a flying f… about LDL generally, but rising levels are indicators.

      Historically patients were given pig thyroid to lower their cholesterol level. Now we have statins………….major bullshit. Not getting to the root cause of the problem. Just whacking the shit out of the liver.

    • damndirtyape - on December 10, 2014 at 16:08

      Surprised to hear that considering the endos I deal with say anything more than 3-4 is too high.

      I had a totally fucked up crazy bezerk thyroid that was giving me anxiety attacks and horrendous “sleep jolts” yet my TSH was around 5. I was positive for Hashimoto’s by the way.

      Ended up getting an ultrasound, had nodules, had a suspicious biopsy, and eventual thyroidtectomy. My surgeon said my thyroid was so scarred he used a surgical chisel to remove it.

      Turns out the nodules were clear, but they found small papillary tumors in each lobe so I’m actually lucky my thyroid went crazy and tipped me off with symptoms long before the cancer spread. This was 2 years ago . FYI I’m a 46 year old male.

    • Chris Kresser on December 10, 2014 at 17:26

      To be clear, from a diagnostic perspective the optimal range for TSH is 0.5–2.5. But that doesn’t *necessarily* mean that people with TSH >2.5 should be treated with replacement hormone. It does mean that the clinician should investigate potential underlying causes that may be adversely affecting thyroid function, and address those causes. If that does not bring the TSH down, then the decision about whether to treat should be based on whether the patient is symptomatic, what their goals are, etc.

    • gabkad on December 10, 2014 at 19:20


    • Steven on December 11, 2014 at 00:42


      My family has bought exactly 2 “Paleo” books.

      Richards here and yours.

      Everyone else is just noise. People doing the look at me dance. Yes they may have some valuable stuff to toss in the ring but by and far you offer the most pragmatic sensible approach.

      Thank you.

  2. Mycroft+Jones on December 10, 2014 at 13:39

    Any ideas on where to get T2 that doesn’t have T4 mixed into it?

    • gabkad on December 10, 2014 at 15:16

      You ARE kidding, right? You can get T3. Patients who rely on T3 only have to play a bigtime balancing game.

    • Mycroft+Jones on December 10, 2014 at 17:09

      I said T2 without T4 mixed into it. Not T3. T2 isn’t habituating; T3 is.

      It is explained in here:

    • gabkad on December 10, 2014 at 19:24

      As far as I know T2 is not manufactured separately.

    • John on December 11, 2014 at 10:19

      It does look like it’s an additive to a fair amount of diet pills, but lots of them seem to have other products. The only diet pill that looks like it only had T2 was “T2 Xtreme” by San. Not sure of the dosages or if they are using the right forms of T2 or what (you can find it on Amazon). Also looks like you can buy it direct from the manufacturer in gram amounts, if you know someone who is a good compounding pharmacist.

  3. Bret on December 10, 2014 at 19:13

    …kinda like in the vein of your doctor being a partner, not an authority that just prescribes you pharm from the schedule?

    Which reminds me, stories have been cropping up of bloggers being targeted by state prosecutors for “giving medical advice” over the internet.

    I was going to elaborate, but I can’t. I’ll get too pissed off. Maybe I’ll still be able to make out a few words in the constitution after all these douchebags are finished wiping their asses with it.

  4. John on December 11, 2014 at 08:44

    Looks like some pretty good advice from Chris. One question… have you looked into getting more gelatin and glycine from either food, supplements, or both? After all, gelatin rich bone broth is a key component of the GAPS diet, which focuses on healing the gut (something that is right in line with your interest in RS and probiotics). Glycine also tends to be deficient in modern diets, even most paleo diets, and seems to be the thing holding back production of glutathione (as Chris Masterjohn points out here- . Gelatin and glycine are both anti-inflammatory, and isn’t inflammation a big problem with Hashimoto’s as well?

  5. Jerry on December 11, 2014 at 16:50

    A gluten-free diet worked for me. Thyroid antibodies dropped to undetectable.

    • Richard Nikoley on December 11, 2014 at 17:27

      Good to know, Jerry. Excellent data point. Oh, well, here I go confounding the shit out of everything, again. :)

    • Jerry on December 12, 2014 at 09:25

      For what it’s worth, I tried gluten-free after reading a book about thyroid function (I can’t recall the title right now, but I’ll look for it). Basically, it explained that the gluten molecule has side-chains that closely resemble surface proteins on pancreatic beta cells, thyroid cells, and brain cells (in the cerebellum). When gluten gets through your gut undigested, it provokes an autoimmune response. First, you attack your pancreas and get symptoms of diabetes. This lasts for years, and it’s very mild at first. Next, you attack your thyroid and get Hasimoto-like symptoms. After years of this, then you attack your cerebellum, and start to lose coordination. He claims to have treated many patients by eliminating gluten. I tried it, and so far I have had very good results for 4 years.

      I’ll post the title once I find that book…it’s around here somewhere…

    • Richard Nikoley on December 12, 2014 at 10:00

      Yep, all makes sense.

      The one thing I would add is that I doubt it’s the gluten CAUSING this, per se. Rather, I think it’s gluten being able to exploit a compromised gut (other stuff too, but we’re such a grain based society). Or, it may be a push-pull-push kinda deal, or, to put another way, a small positive feedback mechanism whereby gluten exploits, the exploitation causes further compromise, allowing more exploitation, etc.

      So, I think it’s entirely plausible that if one elimintates gluten, lets the gut heal, feeds it nicely, that future forays into moderate gluten consumption may present no problem.

      I think most of us ought to be able to handle gluten. Again, dose makes the poison. Probably nothing but rice or perhaps potatoes and beans, should be a staple food.

  6. JasonC on December 15, 2014 at 13:54

    My wife’s Hashi’s is even more “subclinical”. TSH and other thyroid hormones are in the functional ranges, and she has no symptoms. But her TPO-Ab are in the low 200s.

    HOWEVER, she *does* have a leaky gut, evident in the Zonulin and Lipopolysaccharide measurements by Cyrex. So we’re now trying to fix that.

  7. JasonC on December 15, 2014 at 14:01

    P.S. A low-gluten diet (i.e. avoid foods with any added flour or wheat), but not “100% gluten free” diet (i.e. avoid food prepared with utensils that previously grazed bread), did not improve her TPO-Ab number. The Cyrex sensitivity test did not show dairy as a problem so she eats kefir and yogurt (and tapioca starch).

    A subsequent ALCAT food sensitivity test lit up like a christmas tree – things like sulfites, yellow #5, ginger, pepper, cauliflower, broccoli, iceberg lettuce, spinach… (weird huh). So now she’s avoiding those too.

    We’re now considering some kind of “gut healing” protocol, i.e. 4-day bone broth fast, then anti-pathogen botanicals, then probiotics, prebiotics, and fermented foods.

  8. Maura on December 18, 2014 at 17:14


    My sister and I both have Hashi’s and use thyroid medication. We started the RS protocol and at about the 3 week period we both started having palpitations needing to lower our thyroid med dosage. Has anyone else mentioned this effect to you? The other results of the RS usage have been good.

    • Richard Nikoley on December 18, 2014 at 17:27

      Hey Maura:

      Well, the funny thing with me (probably a lot of people) is that once something gets on my radar I see it all the time. Yep, and in fact just this morning while book writing/editing.

      “Hello, just thought I’d post a little update for those that are wondering if the gluten-free diet helps with auto-immune thyroid disease.

      “There have been some doubters posting here and I understand. My first post on this article was asking Chris to explain the gluten-thyroid connection more clearly, because none of the articles he referred to really did. There was a vague connection, but no studies showing clear scientific proof that going on a gluten-free diet healed auto-immune throid diease.

      “I decided to try it out anyways (after reading this article and Wheat Belly and a few other online articles and reading the stories of a few people that felt better after going gluten-free).

      “Almost three years ago, I quit gluten cold turkey. I have hashimoto’s and my dose at the time was 120 mg of Erfa once a day (dessicated thyroid, similar to Armour, but Canadian version). My current dosage is 15 mg, every other day and I expect to be completely off drugs soon. It takes time, but about every 2-3 months I need to lower my dosage. I am amazed and delighted every time I lower my dosage. I have made a few other smaller changes in my diet (I always ate very heathy before so it was not a case of suddenly eating more heathy), but the gluten-free diet is the single most important change I made.

      “Obviously, it is not only my dosage, but my thyroid antibodies as well that have dropped enormously, Every blood test I take is better than the last and I am almost within the normal range now. I feel much, much better and I attribute it all to getting off gluten.

      “I would have never tried the gluten-free diet had it not been for people like Chris Kresser. No proper study has been done, pretty much all we have is anecdotal evidence of people like me. I wasn’t going to wait for the scientific community to prove it to me. Especially since there is no harm besides inconvenience in trying it out. I am certainly glad I did.

      “Best of luck to anyone who is just starting it out, it is a tough diet to follow, but it’s soooooo worth it!”

    • Richard Nikoley on December 18, 2014 at 17:29

      To clarify, I meant people having to lower dosage once they begin doing various sensible things to address the underlying cause of a gut problem.

      This may be the first time I’ve heard about potato starch underlying the need to lower. But, intuitively, my untreated condition is better now than 7 years ago so it’s conceivable that that would have translated to a need to lower meds if I were on them.

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