It’s common for people with hypothyroidism and Hashimoto’s Thyroiditis to have low levels of triiodothyronine, also known as T3.  Sometimes the T3 levels will be within the lab reference range, but less than optimal.  On the other hand, sometimes they will be outside of the lab reference range.  Either way, the goal is to try to bring the T3 to an optimal level, and in this blog post I’ll discuss seven ways to increase low T3 levels.

Before I discuss the seven ways to increase low T3 levels, you might wonder why I’m not talking about T4 in this post.  In 2016 I did release a blog post entitled “7 Causes of Low T4 Levels”, and while some of the same factors will cause low T3 levels, there are different causes as well.  In addition, I usually recommend to test for the free T3 levels, and from an optimal perspective you want to see these levels between 3.0 and 3.5 pg/ml, although some sources will suggest a tighter range (i.e. between 3.2 and 3.5 pg/ml).

It’s also important to mention that not all medical doctors will test the T3 levels.  Many will only test the TSH and T4, while some will test the TSH alone.  The reason for this is because in most cases the T3 isn’t going to change their recommendations, as most medical doctors will 1) base their recommendations off of the TSH, and 2) prescribe synthetic thyroid hormone to just about all of their patients with a hypothyroid condition. If this describes your doctor then you might want to consider switching to a different doctor, or another option is to try to order free T3 on your own.

With that being said, let’s go ahead and look at the seven ways to increase low T3 levels.  Please keep in mind that I’m not listing these in the order I recommend.

1. Take synthetic T4.  Although I’m starting with synthetic T4 because this is the most common recommendation by medical doctors to address both low T4 and low T3 levels, this isn’t my first preference.  And the reason for this is because while taking thyroid hormone replacement is necessary at times, this doesn’t do anything to address the underlying cause of the problem.  In addition, Synthroid is the most common brand of synthetic thyroid hormone medication recommended, and it has a lot of fillers, along with artificial ingredients.  As a result, if someone absolutely needs to take synthetic T4, they should look into a more hypoallergenic form, such as Tirosint.

Some reading this might wonder how taking synthetic T4 will increase low or depressed T3 levels.  Well, T4 converts into T3, and so if someone has healthy levels of T4, then they should be able to convert the T4 into T3.  However, if someone has a problem converting T4 to T3 then taking synthetic T4 won’t be effective in raising T3 levels.

2. Synthetic T3.  If someone has low or depressed T3 levels, then it might make more sense to take synthetic T3 rather than synthetic T4.  Synthetic T3 is also known as liothyronine, with Cytomel being a common brand.  A recommended starting dosage is 25 mcg per day, although some will start with lower doses (i.e. 5 mcg).  While some medical doctors will recommend synthetic T3 if someone has low T3 levels, since T3 is the active form of thyroid hormone, many are cautious about doing this out of fear that the person will develop hyperthyroid symptoms.

Earlier I mentioned that it might make more sense for someone who has low or depressed T3 levels to take synthetic T3 instead of synthetic T4, although it depends on the situation.  For example, if someone has depressed levels of both T4 and T3, then it wouldn’t make sense to only have the person take synthetic T3.  In fact, as I mentioned previously, if the person is able to convert T4 to T3 then in this scenario they might be fine just taking synthetic T4, although in some cases taking both synthetic T4 and T3 might be warranted.  On the other hand, if someone has normal levels of T4 and low or depressed levels of T3, then this might be a good indication that synthetic T3 is needed.

However, just as is the case with taking synthetic T4, synthetic T3 doesn’t do anything to address the cause of the problem.  And so while taking synthetic T3 might be necessary in some cases, the obvious goal should be to fix the conversion problem and/or address the autoimmune component (for those who have Hashimoto’s), which I’ll discuss later in this post.

3. Natural thyroid hormone.  If someone needs to take thyroid hormone replacement, desiccated thyroid hormone should be considered.  Brand names include Armour, Nature-Throid, and WP Thyroid.  These all include T3 and T4, along with other thyroid cofactors (T1, T2, and calcitonin).  This type of thyroid hormone replacement can especially be helpful if someone has low or depressed levels of both T4 and T3.  Although over the years I have had many patients take Armour and do fine, I prefer Nature-Throid and WP Thyroid because they are hypoallergenic.  And while many people do fine taking synthetic thyroid hormone, some people don’t do well on this, yet thrive when taking desiccated thyroid hormone.  On the other hand, a small percentage of people don’t do well on natural thyroid hormone, and actually do better when taking synthetic thyroid hormone replacement.

4. Thyroid glandular supplements.  For those who are unable to get a prescription for Armour, Nature-Throid, WP Thyroid, or a different brand of natural thyroid hormone, there are thyroid glandular supplements that contain desiccated thyroid hormone, and don’t require a prescription.  Some of these thyroid glandular only include T3, while others have both T4 and T3.  It’s common for these thyroid glandular supplements to also include nutrients and/or herbs that support thyroid gland function.  Common nutrients included include selenium, tyrosine, and zinc, and ashwagandha is an adaptogenic herb that is added to some thyroid glandular supplements.

5. Compounded thyroid hormone medication.  Compounded T4/T3 is made by a compounding pharmacist, and is another option to consider.  One advantage of compounded T4/T3 is that the doses can be customized.  Another advantage is that the product can be formulated to be hypoallergenic.  Some compounding pharmacists can also put together a custom formulation using desiccated thyroid.  However, getting T4/T3 through a compounding pharmacy can be considerably more expensive.

6. Correct the conversion problem.  So far I have focused on different types of thyroid hormone replacement.  But even if you need to take thyroid hormone, it makes sense to address the cause of the problem.  I mentioned earlier that ideally T4 should convert into T3, but many people have problems converting T4 to T3.   If someone’s thyroid panel reveals normal T4 levels and low or depressed T3 levels, then this is a pretty good indication of a conversion problem.  However, it’s also possible for BOTH T4 and T3 to be low and to have a conversion problem.  When this is the case it can be more challenging to determine if the person has a problem converting T4 to T3, although reverse T3 may be elevated in this situation.

There are numerous factors that can interfere with the conversion process, but three of the more common reasons why people have a problem converting T4 to T3 include 1) liver problems, 2) gut dysbiosis, and 3) elevated cortisol levels.  As a result, these are the primary areas I focus on, and while most of the time doing so will correct the conversion problem, in some cases this can be challenging.  For more information I would read my blog post entitled “6 Factors Which Can Affect The Conversion of T4 to T3”.

Should Someone Take Thyroid Hormone Replacement While Fixing The Conversion Problem?

As for whether someone who has a conversion problem should take thyroid hormone, this depends on the person.  While the cause of the problem needs to be addressed, we also need to remember that T3 is the active form of thyroid hormone.  As a result, if someone has very low or depressed thyroid hormone levels then we don’t want these to be low for too long.  The reason for this is because thyroid hormone affects every cell and tissue in the body.

In addition, while sometimes the T3 levels will increase relatively quickly while addressing the cause of the problem, this isn’t always the case.  Sometimes it can take many months to correct the conversion problem.  There can be a few reasons for this.  One reason is because it can take time to address the liver, gut, or adrenal imbalance which are responsible for the conversion problem.  Another reason is because sometimes we greatly improve the health of these areas, only to find another factor is responsible for the poor conversion of T4 to T3.

7. Detect and remove the autoimmune trigger.  Most people with hypothyroidism have Hashimoto’s Thyroiditis, which is the reason behind their low or depressed T4 levels, and low or depressed T3 levels are common as well.  So when someone has low T3 (and T4) levels as a result of Hashimoto’s, the goal is to do everything necessary to detect and then remove the autoimmune trigger.  This is easier said than done, and over the years I’ve written many articles and blog posts on some of the different triggers, and I also talk about this during my free webinars.  In my upcoming book on Hashimoto’s I’ll go into even more greater detail about triggers, including an entire section dedicated to how to detect all of the different triggers, and another section that focuses on removing your triggers.

While some people with Hashimoto’s don’t need to take thyroid hormone replacement, others need to take it while addressing the cause of the problem.  And there are those who need to take it on a permanent basis.  It depends on how much damage to the thyroid gland has taken place.

Can There Be Other Factors Responsible For Low T3 Levels?

Although having Hashimoto’s and/or a conversion problem are the most common reasons why someone has low T3 levels, there can be other factors.  I’m not going to get into great detail about these here, and ideally you want to work with a natural healthcare professional to address this.  But here are some other potential causes of low T3 levels:

Dysregulation of the hypothalamic-pituitary-thyroid (HPT) axis.  Although T3 is produced during the conversion process, some T3 is also produced in the thyroid gland.  TSH is a pituitary hormone, and it is responsible for signaling to the thyroid gland to release T4 and T3.  The hypothalamus communicates with the pituitary gland.  As a result, if there are problems with the communication between the hypothalamus and pituitary gland, this in turn can affect the communication between the pituitary gland and thyroid gland, which can result in low T4 and/or T3 levels.

Direct inhibition of the thyroid gland.  Although most cases of hypothyroidism are a result of Hashimoto’s, some factors can directly inhibit thyroid hormone production.  For example, certain environmental toxins such as mercury can inhibit thyroid hormone production, although sometimes environmental chemicals can cause an immune system response.  Either way, in this situation the goal should be to reduce your toxic load.

Some people are concerned about goitrogenic foods inhibiting thyroid hormone production.  Although I would be cautious about eating soy, eating cruciferous vegetables usually won’t cause any problems.  I spoke more about this in a blog post entitled “5 Things To Know About Goitrogenic Foods”.

Problems with T3 binding to the carrier proteins.  Both T3 and T4 are carried through the bloodstream bound to certain proteins.  Thyroxine-binding globulin (TBG) is one of these, although it has a higher affinity for T4 than for T3.  Both T4 and T3 bind to serum albumin, although these hormones have a higher affinity for TBG.  So for example, if the TBG level is low due to a person taking corticosteroids, this will result in lower levels of thyroid hormone in the blood.

In summary, many people with hypothyroidism and Hashimoto’s have low or depressed levels of T3.  Unfortunately many medical doctors don’t test the T3 levels, as they will only test for the TSH, and perhaps T4.  Ideally you want to increase T3 levels by addressing the cause of the problem, which is usually either damage to the thyroid gland caused by the immune system, or a problem converting T4 to T3.  However, thyroid hormone replacement can also increase the T3 levels, and some of the different options include synthetic T4, synthetic T3, desiccated thyroid hormone, thyroid glandular supplements, and compounded T4/T3.

It’s common for people with thyroid and autoimmune thyroid conditions to have thyroid nodules.  It’s also common for people to be concerned about them, and to wonder whether their nodules are malignant, if there is a way to shrink nodules, etc.  While I have written a few articles in the past on this topic, I figured I’d put together an updated post that discusses five things anyone with thyroid nodules should know.

1. Many people have thyroid nodules.  As I mentioned in the opening paragraph, it is very common for people to have thyroid nodules.  One journal article mentioned that while 4 to 7% of the population have palpable thyroid nodules, ultrasonography reveals that up to 67% of the population has them (1).  Another study mentioned that up to 35% of the population have thyroid nodules show up on an ultrasound (2).  Even if we go with the lower number, 35% is quite high, as this means that roughly one third of the population has thyroid nodules.  The incidence of thyroid nodules increases as we age, and the prevalence is higher in women (2), although they are more likely to be malignant in men, especially those over 70 years of age (3).

2. Most thyroid nodules are benign.  Only around 5% of thyroid nodules that are detected through palpation are malignant (1).  But most thyroid nodules are not detected through palpation.  And for those thyroid nodules evaluated by a biopsy, the prevalence of malignancy ranges from 4% to 6.5% (4).  So while at least one third of people reading this will test positive for thyroid nodules, only a very small percent of these nodules will be malignant.

With that being said, the incidence of thyroid cancer has increased substantially in the United States over the last four decades (5), as the American Cancer Society estimated that 62,450 people in the United States were diagnosed with thyroid cancer in 2015 (6).  Most people with thyroid cancer are diagnosed with papillary thyroid cancer.  According to the American Cancer Society, both stage one and stage two papillary thyroid cancer have a 5-year relative survival rate of nearly 100%, and in stage three it’s 93% (7).  In stage four, the 5-year relative survival rate drops down to 51%.

Follicular thyroid cancer also has a near 100% 5-year relative survival rate in stage one and two, with a 71% 5-year relative survival rate in stage three, and a 50% 5-year relative survival rate in stage four (7).  Medullary thyroid cancer has a pretty good 5-year relative survival rate in stages one through three, but only a 28% survival rate in stage four.  Anaplastic thyroid cancer has a 5-year relative survival rate of only 7%, but fortunately only 1-2% of all thyroid cancers are anaplastic.

The reason why I’m talking about these statistics is to show you that while there without question is a risk of untreated thyroid cancer, the progression is much slower when compared to other cancers, and overall the 5-year relative survival rate is pretty good.  By comparison, the 5-year relative survival rate for the four most common malignancies in developed countries is 73-89% for breast cancer, 50-99% for prostate cancer, 43-63% for colorectal cancer, and only 12-18% for lung cancer (8).

If you’re wondering when a biopsy is necessary, please read an article I wrote in the past entitled “Is It Necessary To Get A Biopsy For Thyroid Nodules?”

3. A radioactive iodine uptake test won’t confirm or rule out malignant nodules.  For those are diagnosed with hyperthyroidism, a radioactive iodine uptake test is commonly recommended.  One reason is to confirm or rule out Graves’ Disease, as most people with this condition will have a high uptake of radioactive iodine, although I’ll add that testing positive for thyroid stimulating immunoglobulins is not only a better way of diagnosing Graves’ Disease, but is less invasive.

Besides trying to confirm a diagnosis of Graves’ Disease, another reason why endocrinologists will recommend this test is to detect thyroid nodules, as well as to differentiate between benign and malignant nodules.  And the way it tries to accomplish this is by looking at “hot” and “cold” nodules.  About 80 to 85% of thyroid nodules show up as being cold on the uptake test, and about 10% of these nodules are malignant (9).  Hot nodules account for only 5% of nodules, although the likelihood of these being malignant is less than 1%.  So essentially you’re hoping to see a hot nodule, but are far more likely to see a cold nodule, and 90% of these will be benign.

I’m not suggesting that the radioactive iodine uptake test has no value, but in my opinion it makes more sense to first get a thyroid ultrasound.  First of all, this is less invasive than the radioactive iodine uptake test.  Second, it can provide an accurate measurement of the size of the nodule, which isn’t the case with the uptake test.  And third, other characteristics of the nodule on an ultrasound can give an indication if it is potentially malignant, and thus warrants a biopsy.  It’s also worth mentioning that for those who don’t have health insurance, a thyroid ultrasound usually costs a lot less than a radioactive iodine uptake test.

The truth is that neither an uptake test or a thyroid ultrasound are perfect methods for confirming or ruling out malignant nodules.  But since the uptake test is more invasive and costs more, it makes sense to start with the thyroid ultrasound.

4. Problems with estrogen metabolism is a common cause of thyroid nodules.  According to the research, estrogen is a potent growth factor both for benign and malignant thyroid cells (10) (11).  Estrogen is also a factor with uterine fibroids, and one study involving 1144 participants looked at the relationship between thyroid nodules and uterine fibroids (12).  The authors concluded that uterine fibroids in women were definitely associated with the presence of thyroid nodules, and that estrogen might play a pivotal role in the occurrence of both of these.

As a result, if you have one or more thyroid nodules, doing things to support estrogen metabolism is a good idea.  One of the best ways to accomplish this is by eating plenty of cruciferous vegetables, as these help to support estrogen metabolism due to the compounds Indole-3-Carbinol and 3,3′-diindolylmethane (DIM) (13) (14).  Another option is to take DIM in supplement form.

For those women who are taking estrogen, I came across one study involving 33 women who received estrogen therapy for one year, and it did not seem to increase the growth of thyroid nodules (15).  While I can’t say that I’m a big fan of estrogen therapy, I realize that some women can benefit from taking estrogen (preferably bioidentical estrogen).

5. There are no specific herbs or supplements to shrink thyroid nodules.  Although supporting estrogen metabolism can help to shrink thyroid nodules, the truth is that this isn’t always effective.  Shrinking thyroid nodules can be challenging, but here are a few other factors to consider:

An iodine deficiency can cause thyroid nodules.  A few studies show a relationship between iodine deficiency and thyroid nodules (16) (17) (18).  Of course iodine is very controversial in the world of thyroid health, which I have discussed in past articles and blog posts.  Although many people with thyroid and autoimmune thyroid conditions don’t do well with iodine, at the same time we can’t ignore an iodine deficiency.  This doesn’t mean that everyone with thyroid nodules should supplement with iodine, but it probably would be wise for those with thyroid nodules to do a urinary iodine spot test, and if they are iodine deficient they should work with a healthcare practitioner who can help them correct this deficiency over time.

The main reason some people don’t do well with iodine, even when they have an iodine deficiency, is because they are also deficient in antioxidants.  While some doctors will recommend for their patients to take antioxidants while administering iodine supplementation simultaneously, I have found that a safer approach is to first increase the person’s antioxidant status over the course of a few months before having them supplement with iodine.  And when the person starts supplementing with iodine they should start with smaller doses.

Thyroxine may help to suppress thyroid nodules.  It is thought that levothyroxine-induced suppression of TSH secretion can shrink thyroid nodules, as it prevents the growth-promoting effect of TSH on thyroid cells (19).  Of course this would only be an option for those people with hypothyroidism and Hashimoto’s Thyroiditis, as you wouldn’t want a person with hyperthyroidism to take thyroid hormone.  I’ll also add that this treatment isn’t always effective, as a study involving 40 patients with confirmed benign nodules showed that suppressive therapy with levothyroxine didn’t decrease the size of benign nodules (20).

Ethanol ablation.  Percutaneous ethanol ablation for cystic thyroid nodules was introduced in 1989.  Yes, injecting ethanol into thyroid nodules can actually shrink thyroid nodules (21) (22).  This wouldn’t be my first option if I had thyroid nodules, but I would probably consider this procedure before surgery.  Ethanol ablation has been reported to have a success rate of 82-85% reduction after an average of two sessions in the management of thyroid cysts (23) (24).  However, it doesn’t seem to be as effective in shrinking solid thyroid nodules.

Laser thermal ablation.  This is a relatively new treatment option, and it can be effective with minimal complications (25).  In addition, while ethanol ablation seems to be more effective for shrinking cystic nodules, laser ablation can help with solid nodules.  It also seems to be less costly than other procedures.

I came across a journal article on laser therapy (26) which discussed a study involving 1531 patients who underwent laser ablation for 1534 nodules.  According to the study, 83% of the nodules were treated with a single session of laser ablation, and the average reduction in nodule volume at 12 months was 72% (26).  There were 17 complications, with 8 of them being major, although all of them recovered completely after they were treated with steroids.  So there are some risks, but of course this is also the case with the surgical removal of the thyroid gland, which is what many doctors recommend when someone has nodules.  A more recent meta-analysis from 2017 showed that percutaneous laser ablation was safe and useful in shrinking benign thyroid nodules, improving thyroid function, and relieving symptoms related to pressure (27).

While laser ablation for thyroid nodules seems promising, I’m not sure where someone would go to get this procedure done.  Not surprisingly, it doesn’t seem like there are many of practitioners who offer this type of treatment.  In addition, we need to keep in mind that this treatment doesn’t do anything to address the cause of the problem.  On the other hand, if someone takes a natural treatment approach but the thyroid nodules don’t shrink, then they might want to consider this procedure.

So hopefully you learned a few new things you didn’t already know about thyroid nodules.  Although many people have thyroid nodules, the good news is that most of these are benign.  Problems with estrogen metabolism and an iodine deficiency are common causes of thyroid nodules, and while addressing these imbalances is essential, there are other treatment options to consider.  Thyroid surgery is an option, but should be the last resort.  Other options include thyroxine therapy, ethanol ablation, and laser ablation.

The autoimmune Paleo (AIP) diet is recommended to people with all different types of autoimmune conditions, including Graves’ Disease and Hashimoto’s Thyroiditis.  And while some people thrive when following this diet, others find this to be a very challenging diet to follow.  There are a number of concerns people have when following the AIP diet, and in this blog post I am going to discuss four of the main ones.

Concern #1: The duration of the diet.  Upon having the AIP diet recommended to them, many people become concerned as to how long they will need to follow this diet for.    This isn’t meant to be a long-term diet, although how long someone needs to follow the AIP diet depends on the person. For example, the AIP diet also serves as an elimination diet, and many healthcare professionals will recommend for their patients with an autoimmune thyroid condition to follow this diet strictly for 30 days.  This is the approach I take in my practice.

After 30 days some people choose to slowly reintroduce some foods, while others continue to follow the AIP diet for a few additional months.  If after 30 days someone is thriving while following the diet then it makes sense for them to continue following it for at least a few additional months.  If someone feels worse after 30 days of following an AIP diet then it might be best for them to reintroduce foods.

It’s worth mentioning that some people aren’t necessarily thriving after 30 days, but they are feeling somewhat better, yet they find following the AIP diet to be a major struggle.  In this situation it probably is best to have the person continue with the diet, and re-evaluate after two to four weeks.  While some people will experience physical symptoms, there is a mental aspect as well.

For example, if someone started following the AIP diet with the mindset that they would need to be strict for three months, mentally this would be more challenging than planning on being strict with the diet for 30 days, and then taking it on a month-to-month basis after the 30 days had passed.  Of course everyone is different, as some people don’t find following an AIP diet to be a struggle at all (at least that’s what some patients tell me!), while others are thinking about reintroducing foods after one or two weeks.

Concern #2: Will following this diet cause nutrient deficiencies?  Some people are concerned that following an AIP diet for a prolonged period of time will lead to nutrient deficiencies.  As a reminder, this isn’t meant to be a long-term diet, but this isn’t out of concern that people will become deficient in certain nutrients.  Even though it’s a restrictive diet, the allowed foods are nutrient dense. And while some of the excluded foods are also nutrient dense, such as eggs, nuts, and seeds, you can still get all of the nutrients you need from the AIP diet.

While meat is nutrient dense, especially when it is from a good quality source, vegetables are also an excellent source of nutrients. One problem is that most people don’t eat enough vegetables per day, and another problem is that many people who eat plenty of vegetables don’t eat enough variety.  I realize that for people who don’t enjoy eating vegetables this can be challenging, but as I’ve mentioned in past articles and blog posts, you can “sneak” in some vegetables by adding them to a daily smoothie.

In addition, how you prepare your vegetables can make a huge difference with regards to taste. For example, I don’t enjoy eating plain steamed broccoli.  On the other hand, if I add garlic and olive oil to the broccoli then I find that it tastes much better.  You might prefer to add something else, and while I can’t say that I’m very creative in the kitchen, that’s what cookbooks are for.

Should you be concerned about nutrient deficiencies if you are a vegan or vegetarian?  After all, if you don’t eat meat or fish then you will rely on getting all of your nutrients from fruits and vegetables.  I spoke about this in an article entitled “Vegetarians, Vegans, and the Autoimmune Paleo Diet”.

Concern #3: The stress associated with following this diet.  Most people are dealing with chronic stress prior to making any dietary changes, but the AIP diet is perceived as a stressor by many people.  Probably the biggest concern by most people that follow the AIP diet is simply the challenge of following a restrictive diet due to the number of excluded foods.  Another concern by some people, especially many with hyperthyroidism and Graves’ Disease, is losing weight while following this diet.   I have worked with many people over the years who have lost a lot of weight due to their hyperthyroid condition, and most are concerned that following a strict AIP diet will result in even more weight loss.  I spoke about this in greater detail in a past blog post entitled “How To Maintain A Healthy Weight While Following An Autoimmune Paleo Diet”.

Of course many people have the opposite problem, as they would love to lose weight, but are having a difficult time doing so, even when following a strict AIP diet.  Although the primary goal of the AIP diet isn’t to lose weight, this can still be a stressor for many people.

Either way, the increased stress levels associated with following an AIP diet shouldn’t be overlooked.  And the reason for this is because some of the benefits of following an AIP diet can be counteracted by the person’s increased perception of stress.  Knowing that there is the possibility of reintroducing foods after 30 days can greatly help to decrease one’s stress levels, but for some people, 30 days can seem like an eternity when they can’t eat most of the foods they have regularly eaten for decades.

This is why some people need to take baby steps.  For example, it might be best for some people to first work on adding more servings of vegetables so that they won’t be as hungry when they start eliminating foods.  If someone is accustomed to eating only one or two servings of vegetables per day they can make it a goal to eat an additional daily serving of vegetables each week, so that by the time four weeks have passed they will be eating four additional servings of vegetables on a daily basis.  Some people will then be able to jump into the AIP diet at this point, while others might feel the need to exclude one or two foods each week.

The time of the year can also play a role in how stressed out someone is when following the diet.  For some people, following the AIP during the holiday season is very stressful due to the temptation of family dinners, holiday parties, etc.  Going on a vacation can also be an obstacle, as I’ve had patients who were planning to go on a vacation a few months after starting the AIP diet, and their goal was to follow the AIP diet strictly for 30 days and then to start reintroducing foods, regardless of how they felt after the 30 days.  The point here is that rushing the reintroduction process can also result in added stress on the person.  You want to try to set yourself up for success, and realize that no matter what time of the year you start this diet there will always be challenges.

Concern #4: Having decreased bowel movements.  Constipation is a concern with the AIP diet, and the reason for this is because a lot of people rely on the excluded foods for their main sources of fiber.  This includes grains, legumes, nuts and seeds.  I spoke about this in a blog post entitled “What Thyroid Sufferers Need To Know About Fiber, Resistant Starch, and Short Chain Fatty Acids (SCFA).”

In this blog post I discussed how those who follow an AIP diet will need to get their fiber from fruits and vegetables.  But the problem is that most people don’t eat enough vegetables.  In addition, some people who do eat plenty of vegetables don’t eat a sufficient number of fiber-rich vegetables.  The truth is that most people don’t know which fruits and vegetables are highest in fiber, and in the blog post I mentioned some of these, including apples, artichokes, avocados, broccoli, Brussels sprouts, dried figs, pears, plantains, and sweet potatoes.

So while there can be different factors that can cause chronic constipation, if you became constipated shortly after starting the AIP diet then you want to make sure that 1) you are eating plenty of vegetables per day, along with some fruit, and 2) most of the fruit and vegetables you eat are higher in fiber.  So for example, while it’s fine to eat some lettuce and spinach in the form of salads and smoothies, these are lower in fiber when compared to other vegetables.  As a result, if leafy greens are your primary source of vegetables then you very well might become constipated.  I personally enjoy eating salads, and I also add leafy green vegetables to my smoothies each day, but I also try to eat other vegetables that are rich in fiber.

In summary, for those who are thinking about following an AIP diet, or are currently following it, hopefully this blog post will help you to overcome some of your concerns.  If there are other concerns you have that I haven’t mentioned in this post about the AIP diet, please feel free to let me know in the comments below.

Many reading this know that I wrote a book on hyperthyroidism and Graves’ Disease in 2011, with a revised edition in 2013.  Over the years I have been asked by many people if I plan on coming out with a book that focuses on hypothyroidism and Hashimoto’s.  My goal was to have a book out on this topic in 2015, but I guess the saying “better late than never” applies here, as in early 2018 I finally plan on releasing my first book on Hashimoto’s Thyroiditis.

As for why it has taken me so long to write this book, the truth is that when I set a goal to have the book released in 2015, my goal was simply to have a book on Hashimoto’s Thyroiditis.  My practice focuses on both Graves’ Disease and Hashimoto’s, and since I already had a book on Graves’ Disease it made sense to release one on Hashimoto’s.  However, along the way I decided that I didn’t just want to write another book on Hashimoto’s, but I wanted to make it the very best book on this condition.

So with each passing year I found myself doing more and more research, and adding more and more content.  But while it’s great to have a lot of content, of course I also needed to make the book interesting and easy to understand, which is no easy task.  But finally the book is in the hands of an editor, which is why I decided to put together this blog post.

How Will This Book Be Different From Others?

There is no shortage of books on Hashimoto’s that focus on helping people get into remission, and so I’m sure you might be wondering how this book will differ from others out there?  While I’m sure there will be some overlap between my book and others, here are a few key differences:

1. I’m confident that my book will provide the most comprehensive information on the different triggers of Hashimoto’s Thyroiditis.  I know this is a bold statement, as there are a few books on Hashimoto’s that discuss many of the different causes, but if you’re interested in learning about all of the different triggers then this is the book for you.

2. I just mentioned how it will be the most comprehensive book with regards to discussing the different triggers, and I’m equally confident that it will be the most comprehensive book when it comes to helping you DETECT your specific triggers.  While it’s great to know all of the different triggers, the real key is to try to find your specific triggers, and there is an entire section dedicated to helping you with this.  You heard me right, as I didn’t just dedicate a single chapter to this, but an entire section that will show you how to find your triggers.  And while I do talk about testing, I’ll add that those who are on a budget don’t have to spend a lot of money on tests, which I also talk about in the book.

3. Overall this probably will be one of the longest books on Hashimoto’s, if not THE longest.  The reason for this is because I didn’t want to hold anything back when writing this book.  And while I realize that a longer book doesn’t always mean a better book, I’m confident that those with Hashimoto’s will find most of the information to be of value.  I don’t have an exact page count yet, and it might be a tad shorter after the editor gets through it, but most of the information will remain intact.

If the prospect of reading a very long book turns you off, I should let you know that this book is organized so that you can easily read the content you want, and skip over the content you have no interest in.  Of course you can simply visit the table of contents and choose to only read those chapters that are of interest to you.  But even within each chapter you can skip around and focus on the material that you find to be the most interesting.

I’ll talk more about the organization of the book shortly, but just as an example, the first section of the book will focus on how and why people develop Hashimoto’s, and I do think it’s important to have a good understanding of your condition when trying to restore your health.  But if for any reason you don’t want to read this then of course you can skip this entire section.

As another example, in section two (the triggers section) there will be a chapter dedicated to toxic mold, which doesn’t apply to everyone.  And so if you don’t want to read this specific chapter you can simply skip it.  Or perhaps you just want to learn about the treatment options for toxic mold, which is in section four.

So while I realize that some people will choose to read the entire book, others will pick and choose to only read the information that is of interest to them.

4. This book will be very well organized.  I just mentioned this, and while this might not seem like a big deal to you, I’ve read a lot of books on Hashimoto’s, along with other health-related books, and most of them aren’t well organized.  And there are a few reasons why a well-organized book is important.  First of all, when treating your Hashimoto’s condition naturally, you will do things in a certain order.  This usually includes first understanding your condition, then learning about the different triggers, and then you ideally will want to do things to detect the underlying cause of your condition, and finally you’ll want to take a natural treatment approach.

As a result, this book is divided into five sections, with the first section talking about how and why people develop Hashimoto’s, the second section discussing all of the different triggers, the third section showing you how to detect your triggers, the fourth section focusing on removing your triggers and correcting other imbalances, and the fifth section answering your burning questions, including how to maintain a state of wellness after getting into remission, how to overcome fatigue and brain fog, how to lose weight, etc.

Another reason why a well-organized book is important is because a good book should be used as a reference, and when referring back to the book, you want the information you’re looking for to be easy to find.  While this is the purpose of an index, which this book will also include, I think that the layout of the book alone will make it an amazing reference guide.  I should also mention that at the end of each chapter there will be a “chapter highlights” section, and some might choose to first read the chapter highlights to find out the specific topics they want to focus on.

5. There will be specific recommendations.  This of course isn’t the only book on Hashimoto’s that gives specific recommendations, and you probably know that there isn’t a one-size-fit-all treatment plan.  While this book includes some great information on diet, along with suggested doses of supplements and herbs, the book isn’t meant to replace the guidance of an experienced natural healthcare practitioner.  With that being said, I realize that some people will attempt to self-treat their condition, and while this isn’t something I recommend, anyone who is thinking about self-treating their condition should definitely read this book first.

I’ll also add that while the book gives supplement recommendations, it doesn’t promote supplements.  In other words, while I do recommend nutritional supplements and herbs to my patients, the goal of this book isn’t to sell supplements.  In fact, I also give plenty of food recommendations as well.  I even give some recommendations for those who are vegans and vegetarians.

6. There will be no recipes.  I’m sure that some people might not be happy about the lack of recipes, and while it seems that most health-related books include recipes these days, the truth is this isn’t a recipe book.  And so if you are mainly interested in recipes this book isn’t for you.  The good news is that there are plenty of other recipe books.

7. Most of the information is supported by research.  There are references to hundreds of research studies included, and so this book isn’t solely based on my clinical experience with Hashimoto’s.

When Will The Book Be Released?

I’m pretty certain that the book will be released sometime in the first quarter of 2018.  In all likelihood it won’t be released in January, and if I had to guess I’d have to say that it will be out by late February or early March.

What Format Will The Book Be In?

The book will definitely be in both printed and Kindle format.  I personally love to listen to books on Audible, and so I might create an audio version in the future, although I’m not 100% certain at this point.

As I get closer to releasing my book I will give more updates, and of course once I have finalized a release date I’ll be sending an email to let you know.

Although I think it’s a good idea to express gratitude on a daily basis, since today is Thanksgiving I figured I’d share ten things I’m thankful for:

1. My wonderful wife

2. My two beautiful daughters

3. The rest of my family

4. My excellent staff (Kate and Carson)

5. My terrific patients

6. My loyal email and Facebook subscribers

7. Continuing to maintain a state of wellness

8. Being in a profession that I absolutely love

9. Putting the finishing touches on my upcoming book on Hashimoto’s Thyroiditis!

10. Not traveling for Thanksgiving (we travel just about every year, and so it’s nice to take a break)

I’m sure there are a few other things I could have listed that I’m grateful for, but these are the ones that immediately come to mind.

Please feel free to share some of the things you’re most grateful for in the comments section below.

Have a Happy Thanksgiving!!!