Healthy Hormones

Low Dose Naltrexone for Hashimoto’s and Weight Loss

Research has shown the benefit of using low dose naltrexone for Hashimoto’s thyroiditis and other autoimmune conditions.

​If you have ​an autoimmune condition such as Hashimoto’s thyroiditis, reducing the inflammation in your body is crucial to help you feel better and lower your antibody levels.

​If you don’t lower the inflammation, it will be next to impossible to lose weight or feel as good as you can.

Lose dose naltrexone has been shown to substantially lower inflammation.  It also helps to raise endorphin levels which makes you feel better overall.

There is ​also a lot of anecdotal evidence that LDN can help ​some people lose weight.

​In this article, I will discuss LDN and what some of the research is showing about it.  I will explain how ​it can be used to potentially lower antibody levels, help with chronic pain, and ​maybe even help ​people with ​Hashimoto’s to lose weight.

Let’s get started…


​What is LDN?

​LDN is short for low dose naltrexone.

Naltrexone was developed in the 1980s to treat patients with opioid withdrawal.  It is a sister drug to the well-know Narcan (naloxone).

​It is an opioid antagonist, which means it blocks opioid receptors in the brain.

When taken in doses of 50-100mg, it completely saturates the opioid receptors which prevents the person from experiencing the “high” that they normally would get from taking opioid (narcotic) medications.

It is therefore used by people in drug or alcohol rehab to help them stay off of their drug of abuse.

Dr. Bernard Bihari performed research ​in which he discovered that naltrexone in low doses helped reduce symptoms and inflammatory markers in patients with autoimmunity, cancer, and HIV.

How does LDN work?

Endorphins are our “feel good” chemicals.  They are associated with feelings of pleasure, sexuality/sensually, euphoria and pain relief. Essentially, endorphins make us feel good and give us a sense of well-being. 

Endorphins are what cause the “runners high” when ​we exercise.

Low levels of endorphins are associated with the opposite effects: physical and emotional pain (including chronic pain found in disorders such as fibromyalgia), and addiction.

Low doses of naltrexone (from here on I will refer to it as LDN) appears to increase the level of endorphins in the brain by only partially blocking the opioid receptors when the endorphin levels are at their highest (3-4am).

This signals to the body that the levels are low, so it temporarily increases endorphin production.

Endorphins appear to modulate the immune system.  Therefore, raising the endorphin levels (like LDN does), impacts the immune system in a positive way.  

LDN has also been shown to decrease inflammation in chronic pain conditions, which is why the people that have the most success using LDN typically have chronic pain as one of their main symptoms.

​Low Dose Naltrexone for Autoimmune Conditions

​People with autoimmune conditions typically have lower levels of endorphins than people without autoimmunity.

So it makes sense that if LDN raises endorphin levels, it would help someone with an autoimmune condition feel better.

​Also, autoimmune conditions are associated with an increased level of inflammation.  So the anti-inflammatory effects of LDN would obviously also help ​lower the overall inflammation in the body.

​In addition to the benefits listed above some studies have shown that the use of LDN can help to improve the immune system and reduce auto antibodies in some autoimmune conditions.

​The m​ajority of research regarding LDN that I found ​​dealt with how it can impact multiple sclerosis (MS), Crohn’s disease, and fibromyalgia.  However, it has also been used to in many other conditions.

​​Now let’s see what impact LDN has on thyroid disease (particularly Hashimoto’s).

​Low Dose Naltrexone for Hashimoto’s

To learn more about Hashimoto’s thyroiditis, read my article here.

I discuss natural treatments for Hashimoto’s in this article.

​LDN appears to improve Hashimoto’s (and all hypothyroidism for that matter) by:

​Much of the evidence of LDN impacting Hashimoto’s is anecdotal, meaning doctors and patients give their personal experiences using it.  To this point, the number of research studies are small and sporadic.

However, a quick Google search will take you to websites such as that will show you much of the research and patient testimonials about LDN.

I myself have had several patients that reported feeling much better when taking LDN.  Some even showed a reduction in their antibody levels.

​Does LDN Help with Weight Loss?

​The answer is yes in some studies, no in others.

​LDN should never be prescribed for the sole purpose of weight loss, but some patients have had some significant weight loss while taking it.

​It appears that LDN helps with weight loss by affecting the following:

  • Reduces Insulin Resistance – Insulin resistance is a common cause of weight gain, so it makes sense that reducing it will result in weight loss.
  • Increases Growth Hormone – Growth hormone increases lean muscle mass and increases fat burning, both of which help with weight loss.
  • ​​Modulates Appetite – LDN may help to normalize the appetite in people with a damaged metabolism which helps to match their appetite with the amount of energy they burn.
  • Decreases Inflammation – High levels of inflammation cause several hormonal changes including insulin resistance, leptin resistance, poor T4 to T3 conversion, high estrogen and low testosterone.  All of these lead to weight gain.
  • Improves Sleep – Lack of sleep has been shown to increase inflammation and weight gain.  Studies show that LDN ​improves sleep in patients with sleep apnea and chronic pain syndromes

​Naltrexone can be found in a currently marketed drug for weight loss – Contrave.  However, the doses in this pharmaceutical drug are higher than the ones I recommend in this article.

​How to Take LDN

LDN is a prescription medication, so it must be prescribed by a medical professional – doctor, nurse practitioner, or physician assistant.

The vast majority of doctors have little to no experience writing it.  You may have to do your own research to find a doctor that is knowledgeable about LDN and willing to prescribe it for you.

Naltrexone is not available in most retail pharmacies in the low doses we are discussing in this article.  You will have to purchase it from a compounding pharmacy.

Insurance will not cover it.  Fortunately, it is usually less than $50 per month, so it is still affordable.

​How to Dose LDN –

​I have had the most success with LDN by starting on a low dose then stepping up the dose every 2 weeks until we get to the target dose.

My typical prescription looks like this:

Take 1.5mg daily at bedtime for 2 weeks, then 3.0mg daily at bedtime for 2 weeks, then 4.5mg at bedtime thereafter.

​Side Effects of LDN –

​LDN has virtually no side effects, which makes it a great medication to try in people with autoimmune conditions, especially those with chronic pain.

Rarely, patients may complain of vivid dreams or muscle spasms when taking the 4.5mg dose.  If that happens, reducing to 3mg usually resolves the problem.  

The patient can try to go back up to 4.5mg a few weeks later if the 3mg is not adequate to resolve their symptoms.

Remember, LDN partially blocks opioid receptors.  So if you are taking a opioid (narcotic) medication regularly, it could block the effects of your pain medication.

​Therefore, if you are on regular narcotic pain medications, ​you should ​​NOT take LDN at least until you reduce or stop your pain medications.  At the very least, you will want to take your pain medications at a different time to try to prevent the interaction.

​If you take your pain medication at the same time (or close to it) as you take LDN, it could block the effect of ​the ​narcotic medication on the opioid receptors which would in effect reverse its action.

This could result in a​ sudden increase in your pain level.  While it is not life-threatening, you could experience a lot of pain until the LDN wore off and you were able to take more pain medication.

If you are interested in trying LDN, it is critical that you give your doctor a complete list of all of your current medications.  This will help him or her to know if you can safely try LDN.

​If you have Hashimoto’s and you decide to try LDN,. it is important that you watch your thyroid levels closely.  LDN may decrease your thyroid antibody levels which could cause your thyroid hormone level to increase and cause symptoms of hyperthyroidism.

That would be a great thing ultimately, but it could be potentially dangerous at first.  You may therefore need to lower your thyroid medication dose.  


​Low dose naltrexone is a seldom used, yet potentially helpful medication in people with Hashimoto’s and other autoimmune conditions.

Studies show that it can lower inflammation in autoimmune conditions.  It also raises endorphin levels in the brain which makes the person feel better.

​It is especially helpful in people who suffer from chronic pain, although it should not be taken at the same time as an opioid pain medication because it can block the effect of the pain medicine.

​If you are interested in trying it, you will need to find a medical provider with experience in prescribing it.  It will need to be purchased from a compounding pharmacy and insurance will not cover it.

Now it’s your turn…

Have you ever tried LDN?

If so, what was your experience with it?

Leave your comments below.

The Best Natural Treatments for PCOS

​If you have PCOS (polycystic ovarian syndrome), you know how hard it is to treat.

​You were probably told to “lose weight.”  Easier said than done.  You were probably also told to cut back on your sweets and carbs.

You may have even been prescribed metformin, which is a medication for diabetes.  Or perhaps a birth control pill or an antidepressant.

​Like most health problems, if you truly want to have success at reducing or eliminating your PCOS symptoms, you must get to the root causes instead of just treating symptoms.

​In this article I will discuss PCOS, what causes it, common symptoms associated with it, how to diagnose it, and several natural treatments that can help you manage it.

Here we go…


​What is PCOS?

​PCOS (polycystic ovarian syndrome) is a combination of several hormonal imbalances in women​.  The symptoms that you have depend on which hormones are out of balance and to what degree.

Most PCOS patients have the following hormonal imbalances:

Not all women will have all of these hormone imbalances, but most PCOS patients will have 1 or more of them.

​The primary culprit of all of these hormone imbalances is insulin.  

Insulin resistance develops which starts a chain reaction that results in all of these hormonal issues – high testosterone, high estrogen, low progesterone, and ​leptin resistance.  The symptoms of PCOS then follow.

These imbalances commonly result in the development of metabolic syndrome, which is a group of risk factors that increase your risk for heart disease, diabetes and stroke.

These hormonal imbalances prevent the normal ovulation cycle.  ​As a result, multiple immature follicles or cysts develop in ​the ovaries which can be seen on ultrasound, which is where the name polycystic ovarian syndrome ​originated.

​Common PCOS Signs and Symptoms

​​If you have PCOS, the symptoms you have will depend on ​WHICH hormones are out of balance and how ​MUCH they are out of balance.

​Some of the more common PCOS symptoms include:

  • Excessive Hair growth – Caused by excess testosterone and insulin resistance
  • Weight Gain (even when eating well and reducing calorie intake) – Caused by a combination of leptin resistance, insulin resistance, and hypothyroidism
  • Menstrual Irregularities – Caused by an imbalance in estrogen and progesterone
  • searchMultiple Ovarian Cysts – Caused by an imbalance in estrogen and progesterone
  • searchHair Loss – Caused by hypothyroidism, nutrient deficiencies, and androgen/testosterone excess
  • searchDepression and Mood Changes – Caused by hypothyroidism and sex hormone imbalances
  • searchFibrocystic Breast Disease, endometriosis, PMS – Caused by excess estrogen and/or low progesterone
  • searchInfertility – Caused by hypothyroidism and low progesterone

​How to Diagnose PCOS

PCOS is diagnosed if you have at least 2 of the 3 conditions:

1.  Absence of ovulation, which leads to irregular menstrual periods or no periods at all.

2.  High levels of androgens, or signs of high androgens, such as excessive body or facial hair.

3.  Cysts on one or both ovaries.

​If you are having some of the symptoms that we have discussed, it is reasonable to assume you either have PCOS or are in the process of developing it.

​Natural Treatments for PCOS

The conventional approach to treating PCOS is to mask the symptoms.

This may make you feel better in the short term, but it does not result in long term improvement.

My conventional training taught me to treat PCOS patients with oral birth control pills, metformin, and anti-depressant medications.

While none of those treatments are bad in and of themselves, most of them don’t get to the root cause of the issues.

Birth control pills ​artificially regulate the estrogen and progesterone levels, but ​they don’t address the ​cause of the imbalance that is preventing you from having a period in the first place.

Anti-depressants may help you sleep better and will help control your mood swings, but it doesn’t address the hormonal imbalances that ​are the cause of the moodiness.

Metformin has some practical use ​for treating insulin resistance.

If you decide to t​ake these medications for a short time to control your symptoms while you make the other changes I discuss, that is reasonable.  

However, PLEASE don’t let these symptomatic treatments be the ONLY thing you do for your PCOS.

​The sooner you can begin reversing the hormonal imbalances in your body, the sooner you can begin feeling better and avoid the future complications brought on by the imbalances.

If you remember anything from this article, please remember this:

All women that are diagnosed with PCOS should be treated for insulin resistance.

To read more about insulin resistance, please read my article here.

Every treatment that I discuss below focuses on reducing the insulin resistance in your body.

You will need to aggressively do ALL of the things discussed.  Doing only 1 or 2 of them will most likely not be enough to give you the improvement you are seeking.

​1.  Change Your Diet

​Changing your diet will not by itself completely reverse the symptoms of your PCOS, but nothing else will ​work if you don’t address your diet.

​So what dietary things can you do to treat your PCOS?

Let’s start with some basic guidelines that are helpful for almost any health condition:

  • Eat whole organic-based foods
  • Avoid ALL processed foods
  • Eliminate sugar from your diet
  • Avoid most gluten and dairy-containing foods (some people can eat more than others)
  • Not ALL carbs are bad (but most people eat way too many)
  • There are times you should eat and times that you SHOULDN’T

​These guidelines can be applied to whatever diet you choose.

All of these diets should be looked at as a starting point only.

Every person is different and may require slight modifications for their particular situation.

For example, someone with severe adrenal fatigue many need a higher ratio of healthy carbs than the diet suggests.

With that in mind, the following diets are approved for patients with PCOS:

​I would strongly suggest hiring a nutritionist or health coach to help with your diet.

It can be very difficult and confusing to monitor your macromolecule ratios and make appropriate adjustments depending on your particular situation and symptoms.

​Your diet will require some adjustments along the way that would best be monitored by a professional.

​2.  Exercise the Right Way

​Exercise is critical to help reverse the hormonal imbalances of PCOS.

However, not all exercise is created equal.

Doing the right ​KIND of exercise and the right ​AMOUNT of it is vital.

Some forms of exercise such as walking on a treadmill for an hour may have very little impact on weight loss and hormone changes that are needed in PCOS.

​There are 2 ​things regarding exercise that you should focus on when trying to reverse your PCOS:

1.  Shorter and more intense exercises

2.  Building up more lean muscle mass

​I have mentioned high intensity internal training (HIIT) in several of my articles.  It is an outstanding treatment for PCOS.


Because it helps reduce insulin resistance.

​As a reminder, insulin resistance is the primary root cause of PCOS.  If you want to reverse your PCOS, you must address the insulin resistance.

Increasing your lean muscle mass is also very helpful for PCOS because it increases your resting metabolic rate.

When exercising, it’s important to match your level of exercise with your level of energy.

Over-exercising can be as harmful as not exercising because of its impact on cortisol levels.

3.  Manage Your Stress

​Stress may be the most overlooked cause of health issues that we have, yet it is one of the most important to address.

​I’m not just talking about the severe forms of stress – divorce, loss of a loved one, severe sickness or injury, etc.

The daily stresses also take a toll on your body – traffic jams, family conflict, job issues, kid issues, and others.

These stresses affect our cortisol levels which can cause bad things to happen in our body.

Stress has been found to be associated with the following:

Weight gain

​- Hormonal imbalances

Autoimmune diseases

Premature death

Most people think stress is just “a way of life” and there isn’t much they can do about it.

That just isn’t true.  We can do a lot to reduce the negative effects stress can have on our lives.

Here are some things that you can do to help you better manage your stress:

  • ​Listen to music that activates delta waves prior to sleep
  • Get 8 hours of quality sleep EACH night
  • Eliminate toxic relationships from your life
  • 20-30 minutes of yoga or meditation every day
  • 1-3 days of quality exercise each week
  • 30 minutes per day of activities that you enjoy and relax you
  • Mentally change how you manage stress and how you internalize it
  • Consider hiring a life coach or health coach

Pick at least 1 or 2 of the things above and start doing them each and every day.

You won’t get healthy until you address your stress and improve how you manage it.

That is true for any health issue, not just PCOS.

​4.  Decrease Inflammation

​Inflammation in the body is the root issue of almost all diseases.

That is true for PCOS as well. ​

Inflammation leads to insulin resistance, leptin resistance and weight gain.

It also worsens hypothyroidism by increasing the production of reverse T3.

​As I have already discussed, PCOS is caused by inflammatory conditions such as insulin resistance and leptin resistance.

To make matters worse, PCOS leads to increased inflammation which will itself worsen the hormonal imbalances, thus creating a vicious cycle.

So what can you do about it?

Check your inflammatory markers (CRP and ESR).  If they are elevated, begin looking for possible sources of the inflammation.

If you can find the source, you can work on eliminating it which will help to balance your hormones.

Some common sources of hidden inflammation in the body include:

1.  Undiagnosed low grade food sensitivities

2.  SIBO or other intestinal overgrowth issues

3.  Chronic infections -EBV, CMV, H. pylori and others

4.  Standard American Diet – high in processed foods

5.  Autoimmune Conditions – Hashimoto’s and others

6.  Hormonal Imbalances – these alone can be bad enough to raise the inflammatory markers

​5.  Use the Right Supplements

​Supplements should be a cornerstone in the treatment of PCOS.

Be very careful and selective with which supplements you consider using.

Make sure you get them from a reputable source.  Not all supplements are created equal.

Supplement manufacturers are not under as strict of regulation as pharmaceutical companies.  That’s why it’s critical that you buy only from good companies that self-regulate themselves.

​Make sure you focus on the following areas when choosing your supplements:

  • Reducing and reversing insulin levels
  • Reducing inflammation
  • Reducing leptin levels
  • Reducing androgen and testosterone levels
  • Improving the metabolism of estrogen

​I will quickly go through each of these and give you my recommended brands for each supplement.

Supplements that Help Lower Insulin Levels:

  • Alpha Lipoic AcidALA helps reduce insulin resistance and lower blood sugar levels.  Use up to 1800mg per day in a sustained release form for best results.  Use up to 6 months.
  • Berberine Berberine can lower the A1c as much as metformin.  It also helps with weight loss in patients with insulin resistance.  Use up to 2000mg per day for up to 3 months for best results.
  • GlucomannanThis is a viscous fiber that reduces carbohydrate absorption and helps you fill up faster with results in weight loss.  Use 4 tablets 15 minutes before a meal for best results.
  • Krill oil + Astaxanthin Fish oil can reduce insulin resistance by lowering inflammation and leading to weight loss.  It can also increase lean muscle mass.  You will need 2-4 grams per day to get this benefit.

​Supplements that Help Lower Estrogen and Estrogen Metabolites:

  • DIMhelps reduce the conversion of testosterone into estrogen, plus it helps the body metabolize estrogen through the least estrogenic pathway.  Use up to 300mg per day for up to 3 months.
  • Calcium D Glucarate – increases liver metabolism of estrogen and androgens.  It can also increase the elimination of endocrine disruptors.  Use up to 3000mg per day.  

Supplements to help lower testosterone:

  • Zinc + Saw Palmetto – Zinc and saw palmetto help reduce the conversion of testosterone into its active metabolite DHT.  This can help reduce acne, hair loss and mood swings.  Use 60mg of zinc and 600mg of saw palmetto together daily for best results.

​6.  ​Monitor All of Your Hormones

​Remember, PCOS is usually caused from several hormones becoming imbalanced in the body.

Don’t get stuck on just thinking about the sex hormones (estrogen and progesterone), since they seem to cause the majority of symptoms.

Consider monitoring these hormones as well:

  • Leptin ResistanceCheck your fasting leptin level.  If you are overweight and your leptin level is above 12, you have leptin resistance.
  • Insulin Resistance a fasting total insulin level > 5 is indicative of insulin resistance.  This should be your primary focus when treating your PCOS.  Lowering your insulin will help to normalize all of the other hormone levels.  
  • High Testosterone – check the free and total testosterone levels.  Most PCOS patients have high free testosterone and often normal or slightly high total testosterone levels.
  • Cortisol check your am cortisol level.  Normal ranges are 14-16.  Any level above or below this indicate adrenal issues and could be affecting your energy levels.
  • Hypothyroidism  Hypothyroidism and PCOS are closely linked.  Make sure you get a complete thyroid panel (TSH, free T4, free T3, reverse T3, TPO antibodies, thyroglobulin antibodies) plus a sex hormone binding globulin level. 
  • Low Progesterone – PCOS patients commonly have very low progesterone levels which should be addressed.  

​7.  ​Consider Prescription Medications

​I am all for doing as much as we can naturally to keep our bodies running smoothly.

However, there is a time and a place when prescription medication may be necessary.

Think of PCOS as a spectrum.  On one end the hormonal imbalances are relatively mild.  Making the lifestyle changes and using the supplements I have discussed may be enough to reverse the condition and improve symptoms.

On the other end of the spectrum, the hormonal disruptions are severe.  

Lifestyle intervention​s and natural treatments may improve symptoms to some degree, but they may not be enough to fully reverse the condition.

In those cases, it may be necessary to consider medications to treat the insulin resistance, leptin resistance, and sex hormone imbalances.

You will need the guidance of a knowledgeable doctor to walk you through these treatment options.


​Polycystic Ovarian Syndrome (PCOS) is a syndrome ​caused by several hormonal imbalances in the body.

These include elevated androgens, insulin resistance, low progesterone, and leptin resistance.

Rather than just treating the symptoms, it is important to identify the root causes and address each specifically.

All PCOS patients should be treated for insulin resistance.

Like most conditions, diet, exercise, stress reduction and proper supplementation are foundational to treatment.  Medications are sometimes needed as well.

​Now it’s your turn…

Have you been diagnosed with PCOS?

What treatments have you tried?

What has helped?  What hasn’t?

Leave your comments below.

Selenium Deficiency and the Thyroid

​Selenium is crucial for normal thyroid function.

In fact, if you have undiagnosed selenium deficiency, it could be making your thyroid function worse.

If you have chronic digestive issues, there is a good chance that you have inadequate selenium levels.

​Selenium is especially important if you have an autoimmune thyroid disease such as Hashimoto’s or Grave’s Disease.

In this article, I will discuss selenium deficiency and the thyroid, how to know if you are selenium deficient, give you some great food sources of selenium, and discuss how and when ​you should consider using a supplement.

Let’s get started…


Why is Selenium Important for Normal Thyroid Function?

​Bear with me as I quickly describe the science behind selenium and its important role in the body.

Selenium is required for the proper function of some proteins in our body called selenoproteins.

​These proteins perform many important functions in the body including:

     – Conversion of T4 to T3

     – Production of antioxidants

     – Energy productions and metabolism

​Let’s discuss some of these functions in a little more detail:

​1.  Increases T4 to T3 Conversion

Selenium is required for the ​optimal conversion of T4 into T3 in the peripheral tissues.

​​Selenium is ​needed for the ​proper function of the deiodinase enzymes​ which perform the conversion process.

As a quick reminder, the thyroid gland produces primarly T4, which is a thyroglobulin molecule with 4 iodine molecules attached to it.  This is the transport form of thyroid and is mostly inactive.

In order for the body to be able to use the thyroid hormone, an iodine molecule must be cleaved off of the T4 by the deiodinase enzyme, which converts it into T3​.  T3 is the active thyroid hormone.

2.  Decreases Autoimmunity

​Selenium has been shown in studies that it reduces autoimmune inflammation in patients with Hashimoto’s Thyroiditis.  It​ has been shown to reduce the TPO antibody levels.

​3.  Strengthens Your Immune System

​Having a deficiency of selenium does not in itself cause illness.

It appears instead that being deficient in selenium just makes us more susceptible to illnesses due to its role in normal immune function. 

In other words, having an optimal selenium level helps to ensure that our immune system is working at its maximal level.

​This is because ​selenium plays a huge role in increasing antioxidant levels in the body.

In fact, selenium supplementation has been shown to improve immune function in patients that were deficient.

​4.  ​Reduces Thyroid Damage from Iodine

​Iodine is a controversial issue in regards to thyroid health.

There is plenty of evidence that shows that low iodine is a huge cause of thyroid disease worldwide.

However, there is also evidence that excessive iodine can also damage the thyroid gland and may even increase the incidence of autoimmune thyroid disease such as Hashimoto’s.

One study showed that taking iodine in the presence of LOW levels of selenium may actually increase your risk for thyroid tissue damage.​

Conversely, if you supplement with selenium in the presence of low iodine levels, it can also worsen hypothyroidism.

It appears that iodine is dangerous to the thyroid ONLY when selenium levels are low or high.

Optimizing the selenium level allows the thyroid to tolerate a wide range of iodine levels.

The selenium appears to protect the thyroid from iodine at least in some part because it increases ​regulatory T cell levels.

​What if you have Hashimoto’s?  

I believe the evidence shows that it is okay to take iodine if you have ​Hashimoto’s as long as you are also supplementing with selenium.

​How Do You Know if You Have Selenium Deficiency?

​Selenium deficiency doesn’t necessarily cause any obvious symptoms, but there are some signs to look for that can indicate that you may be low. 

Let’s discuss some of the big ones below:

1.  You have a history of ​digestive problems

​Selenium deficiency is common in patients that have chronic digestive issues such as Crohn’s disease, Celiac disease, etc.

This is felt to be due to malabsorption caused by the inflammation that is occurring in the gut.

Selenium deficiency is commonly associated with vitamin B12 deficiency because ​they both are affected by poor gut absorption.

​So if you have B12 deficiency or any type of chronic gut inflammation, there is a strong chance that you are deficient in selenium.

​2.  You have a low free T3 level

​As I discussed earlier, selenium is important for the conversion of T4 to T3.

​When that conversion process is reduced, the free T4 levels will begin to rise and the free T3 levels will begin to fall.

To make matters worse, if you go see your doctor and he or she ​only checks your TSH and T4 and not your free T3 level, it will look like your thyroid levels are “normal” or even “high.”

Meanwhile, your hypothyroid symptoms continue to worsen because you are low in active thyroid hormone.

​Not a good situation at all.

That’s why it is critical that you find a doctor that will check a complete thyroid panel and will listen to you and your symptoms, and not solely depend on lab results to manage your thyroid problem.

​3.  ​You have hair loss or brittle nails

​Let me start with an obvious statement:  Not all hair loss is caused by selenium deficiency (you’ve seen my photo and my selenium level is good!).

However, selenium deficiency has been shown to cause changes in hair​.

It also can cause your nails to get brittle and crack easily.

Replacing low selenium levels has been shown to improve hair growth and nail growth.

If you suffer from unexplained hair loss or brittle nails, you should consider getting a further workup.

At a minimum, you should look at these micronutrients as possible culprits:  iron, zinc, selenium, and biotin.

You should also get a complete thyroid panel.

​4.  Your RBC Selenium level is low

​There is a lab test to measure the selenium level in the body, specifically in the red blood cells.

It is called an RBC Selenium Level.

I do not routinely check ​this on patients.  If I suspect a selenium deficiency, I start treatment.

However, if a patient continues to have signs or symptoms of selenium deficiency, it can be checked to make sure they are absorbing the selenium ​from their food or supplements.

​How to Treat Selenium Deficiency

​So if you think you have a selenium deficiency, what should you do about it?

Selenium is a micronutrient, meaning only small amounts are needed.

It can be replaced in your body either through increasing your consumption of foods that are high in selenium and/or by taking a selenium supplement.

​Food Sources of Selenium

​Without a doubt, it is always safest to use ​food to increase nutrient levels in our body.

Most Americans eat so poorly that simply improving their diet can do wonders for helping them to regain their health.

​The food with the highest amount of selenium is brazil nuts.

​Eating 2 brazil nuts per day will increase your selenium level as much as 100mcg of selenomethionine.

​Other foods with good selenium content include:

  • checkmushrooms
  • checkfish – cod, halibut, tuna, salmon
  • checkshrimp
  • checkchicken
  • checkeggs
  • checkturkey

​It’s always best to start with natural food sources such as these.

However, that is not always possible.  

For instance, I ​am personally allergic to brazil nuts and I don’t have a big fondness for fish (unfortunately). Therefore, I use a supplement periodically to ​keep my selenium level optimized.

Selenium Supplements

​When using supplements, it is always critical to use a good quality supplement from a respected company that uses​ quality control standards when making their products.

My preferred brand for supplementing selenium is below:

How to Supplement with Selenium

Why I Like It

May reduce antibodies in patients with Hashimoto’s

Also acts as an  anti-inflammatory

May help reduce anxiety symptoms

Helps boost T4 to T3 conversion (helpful in those with high reverse T3)

Who Should Use It

    • Patients with hair loss or hair thinning
    • Patients with a known thyroid disorder and hair loss
    • Patients with other nutrient deficiencies like zinc or iodine
    • Patients who frequently take acid blockers for acid reflux
    • Patients with other GI related issues (IBS, gas/bloating, IBD)
    • Patients also taking zinc

How to Use

    • Take 200-400 mcg per day (do not exceed 400 mcg daily)

My Recommended Brand and Product

Get Selenium Here

​I prefer selenomethionine because of it’s high bioavailability.

I typically recommend supplementing for only a few months (3-6) which should restore the levels in the body to the optimal range.

​Like most things, you can overdo selenium supplementation as well.

Excess selenium can cause a variety of symptoms, including GI upset, white blotchy nails, hair loss, fatigue, irritability, and mild nerve damage.

One study even showed a possible increased risk of prostate cancer in patients with excessive selenium.

Once you have repleted the tissues and changed your diet, continued supplementation should be unnecessary.

The only exceptions would be if you have poor absorption from chronic digestive tract conditions such as inflammatory bowel disease, IBS, Celiac diease, etc.


​Selenium is a vital micronutrient for normal thyroid function, immune system function, energy production, and metabolism.

Selenium deficiency is common but can be difficult to diagnose.

It is always best to treat selenium deficiency by eating food rich in selenium.

​If that isn’t possible or if you have absorption issues due to chronic GI issues, adding a good quality selenium supplement may be necessary.

You should not take a selenium supplement indefinitely.  Usually taking it for a few months is sufficient unless you have a chronic GI problem.

If you have a selenium deficiency, it is also important to look for other micronutrient deficiencies such as iron, zinc and iodine.

Now it’s your turn…

​Do you think you have a selenium deficiency?

What have you used to treat it.  Has it helped?

Leave your comments below.​

How to Treat Insulin Resistance

​Have you been diagnosed with insulin resistance, pre-diabetes, or even diabetes?

​Even if you haven’t been diagnosed with insulin resistance, there is a good chance that you have it and don’t even know it.

Insulin resistance is primarily a dietary disease – what you have been eating has played a major role in causing you to have this condition.

The good news is that by changing what you eat and how you live, you can ​make major strides in reversing this condition.

​In this article I’m going to discuss a comprehensive approach on how to treat insulin resistance.  

This will include a proper diet, activity level, supplements, medications, and much more…

​What Is Insulin Resistance?

​In order to understand insulin resistance, it’s important to understand what insulin is and what is does NORMALLY in the body.

​Insulin is a hormone that is secreted by the pancreas.

When we eat a meal that contains glucose (sugar), the pancreas is signaled to secrete insulin​ into the bloodstream.

The insulin will attach to the sugar and move it into the cells where the sugar can be used as fuel for energy.

It also moves the sugar into fat and liver cells where it is stored to be used for fuel at a later time.

That is how things should work.

​With insulin resistance, things get messed up.

​When we eat too much sugar (which is most people in the US), the cells get bombarded with so much sugar that it can be toxic to the cells.

To protect the cells from this toxic load of sugar, the cells downregulate the insulin receptors.

In other words, they reduce the number of channels that the insulin ​can use to enter the cells, kind of like locking several of the doors that ​go into your house.

The results?  Insulin is not as effective, so the pancreas releases even more of it and the blood sugar level gradually increases.

The process gradually worsens over time.  Your insulin and blood sugar levels continue to rise until someone checks your blood sugar and diagnoses you with pre-diabetes or diabetes.

Has this happened to you or someone you know?

The shocking part is this process is occurring right now in about 50% of the people in the United States.

​This is an epidemic that must be addressed.

By the way, when discussing diabetes in this article, I am referring to Type II diabetes.

Type I diabetes is an autoimmune condition where the body’s immune system attacks and kills the cells in the pancreas that produce insulin.  Those folks therefore don’t make enough insulin and must take insulin shots for the rest of their lives.

​Insulin also does a lot of other really bad things​ as well.

It is one of the most inflammatory substances in our body.

​Insulin causes cancer.

​Insulin causes us to gain weight by increasing the size of our fat cells.

Insulin increases our risk for heart disease​ and Alzheimer’s Dementia​ as well.

​Are you beginning to see why it is so important to keep your insulin level as low as possible?

​How Do You Know If You Have Insulin Resistance?

​There are a few symptoms that can indicate that you may have insulin resistance.  

They include:

  • checkBelly fat
  • checkFrequent cravings for sugary foods
  • checkIrritability when going long periods without eating
  • checkDizziness and lightheadedness between meals
  • checkInability to lose weight

​There are also a few lab tests that are very helpful in diagnosing insulin resistance.

​Ask your doctor to order these tests:

1.  Fasting ​insulin level – should be < 5

2.  Hemoglobin A1c – should be < 5.3

3.  Fasting blood sugar – should be < 85

4.  Possibly a 2 hour post-meal glucose level – should be < 120

If any of these labs are higher than these optimal levels, you have evidence of insulin resistance and you need to incorporate the treatment recommendations that I will discuss below.

It is critical to your long term health!

​How To Treat Insulin Resistance

​Now that we have identified that you have insulin resistance, let’s discuss treatment options.

One of the biggest issues with treating ​diabetes is that the current treatment recommendations of ​many conventional medicine organizations ​focus purely on lowering blood sugar and do little to address insulin resistance.

​A large part of their recommendations, especially in regards to diet, ​are obsolete.  New research has shown that a lot of what we thought was true isn’t anymore.

​For example, the American Diabetes Association still recommends multiple portions of carbs from grains and other sources daily, then using insulin to keep the blood sugar levels low.

This is recommended despite that fact that studies show that simply​ lowering blood sugar levels has no benefit in reducing mortality.  In fact, adverse events are actually INCREASED due to increased episodes of low blood sugar (hypoglycemia).

That is unfortunate because by the time the blood sugar is high enough to get the attention of most doctors, the insulin resistance has probably been around for quite awhile and has been causing problems.

Diabetes is really just advanced insulin resistance.

In my own practice, I had a patient that presented to my office complaining of uncontrolled diabetes with glucose levels running in the high 200s.

​I put him on a whole food, low carb diet.  However, he really didn’t ​want to change his diet, so he requested that I send him to a certified nutritionist at a local hospital.

​The nutritionist actually told him that he wasn’t eating ENOUGH carbs and increased his carb intake substantially!

A month later, he called back to my office complaining that his blood sugar had gone up into the 400s!

That is why it is important that you do your homework and learn as much as you can about insulin resistance and how to reduce it.

You are in charge of you!

Insulin Resistance and Weight Loss

​You will never lose weight unless you get your insulin resistance under control.

That is because when your insulin levels are high, your body is unable to burn your fat cells as a fuel source.

The burning of fat cells in the body is controlled by an enzyme known as hormone sensitive lipase.

​This enzyme is inhibited by insulin.  

Therefore, you MUST reduce your insulin level if you ever want to get the weight off.

Insulin resistance is also closely associated with leptin resistance which I discuss in this article.

If your leptin levels are elevated, it will be almost impossible to drop any significant weight.


​Changing your diet may be the single more important thing that you can do when treating insulin resistance.

You will not have success if you don’t change what you eat.

​However,​ keep in mind that diet alone may not be enough to lower your insulin levels.

​It is going to require a comprehensive approach involving everything we discuss in this article.

​- Foods to Eat

​When deciding on what food to eat, ask yourself this simple question – Did God make this food or did man make it?

In other words, eat only whole, natural foods and avoid processed food.

Most vegetables are good.  Try to stay away from starchy ones such as potatoes except on occasion.

When eating fruit, stick primarily with the berries and cherries.  Also kiwi, lemon and limes.

​Protein – chicken, turkey, fish (not tilapia), eggs, deli meats

Fat – coconut, avocado, olive oil, nuts and seeds (not peanuts), chia, flax

​- Foods to Avoid

​​If you have insulin resistance, you need to avoid any foods that will be rapidly absorbed and are high in sugar.

These include:

  • flagSugar – Any source of sugar should be avoided.  That includes high fructose corn syrup, honey, cane sugar, and brown sugar.
  • flagRefined Carbohydrates – This includes breads, pastas, tortillas, chips, bagels, pizza crust, etc.
  • flagBeer and Alcohol – These are loaded with carbs and sugar and will increase your insulin levels.

​There ​is a general rule that you should keep in mind:  Eat when you are hungry and stop eating when you are full.  Quit focusing on calorie counts and listen to your body.

One caveat to this rule.  If you also have leptin resistance, it could affect your perception of hunger and you won’t be able to trust what your body is saying to you.

​- Macros

Macros is short for macromolecules.

There are 3 macromolecules we talk about when discussing diet – carbohydrates, proteins and fats.

​The conventional approach to treating insulin resistance is to just go “low carb.”

However, carbs aren’t the only macromolecule that can increase insulin levels.

​​Proteins also increase insulin production, so it is important that your diet be low in both carbs AND proteins.

That means you should eat a diet high in good quality fats.

Your ratios of these macros should be in these ranges:

  • check50-70% fat
  • check20% protein
  • check10-20% carbohydrates

​You may need to adjust these ratios depending on what kind of a lifestyle you live.

If you have more muscle mass you may need more protein.

If you are extremely active, you may need more carbs.

Just make sure that most of your food comes from high quality fats.

​If all of this seems overwhelming, you could consider one of these diets that have lots of online support, recipes and other information:

Whole 30 Diet

Ketogenic Diet

Paleo Diet

​All of these diets have been shown to help with weight loss and reduce insulin levels.

​- Intermittent or Prolonged Fasting

​The one thing that is probably overlooked more than anything else when treating insulin resistance, obesity, and other conditions is fasting.

Going without food is probably the most effective strategy for lowering insulin and blood sugar levels.

​And yes, when done correctly, it is safe and very effective in repairing your metabolism.

Fasting should be done in conjunction with diet, supplements, and even medication to work the best.

It is extremely important for you to know that fasting should ​NOT be done without physician supervision, especially if you are diabetic and are on a diabetes medication or insulin.

Fasting is so effective, it will drop your blood sugar which could potentially cause serious hypoglycemia.

Also, if prolonged fasting is used excessively, it can cause prolonged calorie restriction which can damage your metabolism and make insulin resistance worse.

In other words, fasting can be very effective when used correctly, but can be harmful when done incorrectly.

​How does fasting work?

The longer you go without eating the lower your insulin levels fall.

Once your body uses up the majority of stored glucose in the liver for energy, it switches over to using the triglycerides that are stored in your fat cells.

You then start burning fat for fuel and your body becomes more sensitized to insulin.

There is one other important caveat that you should know:

Your adrenals and thyroid should be working optimally before trying intermittent fasting.

If you try fasting and you develop symptoms of dizziness, lightheadedness, tremors, increased thirst or urination, that may be a sign that your adrenals or thyroid are not working optimally.

​Get them working well then you can try fasting again.

​If you are ready to try fasting, start with this simple program:

– Start with a 14 hour fast

– Eat an early dinner

​- Eat an early lunch around 11am the next day

– Repeat this twice weekly

Click here to read more from my article on intermittent fasting.


​​Exercise is very important in treating insulin resistance.

Now if you aren’t exercising at all, doing anything is better than what you are doing now!

​Simply taking a 15 minute walk will do wonders for your body and metabolism.

However, the best exercise for insulin resistance is High Intensity Interval Training (HIIT).  Studies show that it helps sensitize the body to insulin.

It sounds complicated but it’s not.

HIIT focuses on doing small bursts of all-out, maximum effort for 30 seconds followed by 60-90 seconds of moderate exercise.

This is repeated 5-10 times in a single session at least once per week.

This can be done while walking, on a treadmill, regular or stationary bike, rowing machine, etc.

Doing HIIT training for 10 minutes is more effective than just walking on a treadmill for 30.

Stress Management

​Cortisol plays a big role in insulin resistance.

If you are under ​stress, your body will increase cortisol production.  The cortisol decreases your body’s sensitivity to insulin which makes insulin resistance worse.

This is true for chronic stress but also acute stress.

That is why it is essential for you to develop some healthy stress reduction habits if you want to decrease your insulin resistance.

These can include yoga, prayer time, good sleep, and fun hobbies.

It may also mean changing jobs or avoiding toxic relationships.

​Just think of the word “balance.”  We need balance in every facet of our lives.  Without it, we will start breaking down physically, emotionally, and mentally.


​There are a few supplements that have been shown to improve insulin resistance.

​Only taking these supplements will not get rid of your insulin resistance.

However, they are another tool in your toolshed that when used with the diet and lifestyle changes we have discussed can be very helpful.

The best supplements for reducing insulin resistance include (click on each for my recommended brand):


​Unfortunately, many people with insulin resistance may need to consider medication, especially when it is advanced.

The diet, lifestyle changes, and supplements may simply not be enough to lower their insulin levels.

With that in mind, you have to be VERY careful about which medications you should use.

Remember, as a general rule, conventional medicine is more focused on lowering blood sugar levels than reducing insulin levels.

In fact, many prescription medications lower blood sugar by INCREASING insulin levels!

When insulin resistance is the cause of the elevated blood sugar, why would we use a medication that worsens the insulin resistance?

​It makes no sense.

The good news is there are several medications that actually lower BOTH the blood sugar and insulin levels.

As an added bonus, they typically cause some weight loss as well.

Compare that to other medications including insulin that result in significant weight GAIN.

I’m not going to go into great detail about the “good” medications for insulin resistance, but I will list them below.  

If you and your doctor determine that your insulin resistance is bad enough to merit using a medication, you should consider using one of these:

  • checkMetformin
  • checkAcarbose
  • checkSGLT-2 Inhibitors
  • checkGLP-1 Agonists​ – These are especially helpful if you are also dealing with leptin resistance.​​​

Each of these medications have their own set of precautions and contraindications, so make sure that you and your doctor discuss them thoroughly and monitor for any potential side effects or problems.


​Insulin resistance is an extremely common and dangerous condition, affecting up to 50% of the US population.

Untreated, it can lead to pre-diabetes and ultimately Type II diabetes.

It will be almost impossible for you to lose weight until you reduce your insulin resistance.

Diet is a crucial part of managing insulin resistance.

Lifestyle interventions such as exercise and stress management are also critical.

Supplementation can help and prescription medication will often be needed, at least for awhile.

Incorporating ​ALL of these modalities will be necessary for you to have success in reducing your insulin resistance.

Now it’s your turn…

​Do you have insulin resistance?

What helped you to lose weight and reduce your insulin levels?

What advice do you have for others in your situation?

Leave your comments below.

The 6 Step SIBO Natural Treatment Guide

​Do you struggle with stomach issues like ​gas, bloating, abdominal cramps, diarrhea and/or constipation, or nausea? 

Does it seem like you have a lot of sensitivities to food that you haven’t always had?

​Do you ​struggle with ​chronic skin rashes, fatigue, asthma, and other symptoms for which you have never gotten relief?

​If so, there is a good possibility that you are suffering from small intestinal bacterial overgrowth, also called SIBO.

​In this article I will discuss SIBO – what it is, what causes it, and how to diagnose it.

​I will also ​give you a 6 Step SIBO Natural Treatment Guide that will help ​you resolve the problems and improve your quality of life.

​Here we go…


​What ​Is the Purpose of the Small Intestine?

​So what exactly ​does the small intestine do?  ​A lot actually.

This 20 foot long tube helps us digest our food and absorb vital nutrients.

It also helps fight off infections and regulates our immune system.

The muscles in the walls of the small intestine contract in an organized fashion which ​pushes the contents further down​.  That action helps to clear bacteria before they have a chance to multiply excessively.  This is called peristalsis.​​​

What Is SIBO?

​​​​There is bacteria ​in our entire GI tract, from our mouth to our anus.

​The amount of bacteria, however, varies in different parts of the GI tract.

Normally, the amount of bacteria in the small intestine is very low (less than 10,000 bacteria per mL of fluid).  Compare that to the large intestine (colon) where there is normally over 1 billion bacteria per mL of fluid!

​Also, the bacteria that live in the small intestine are different kinds than the ones found in the colon.

We have several natural mechanisms that prevent ​excessive bacteria from growing in the small intestine.  These include:

  • checkIleocecal Valve – the valve between the small intestine and colon that prevents the backflow of bacteria from the colon.
  • check​Stomach Acid – kills the bacteria in the stomach and small intestine.
  • checkDigestive Enzymes – these also have an antimicrobial effect.
  • checkGALT – the immune system of the small intestine that will attach and remove foreign materials including bacteria.
  • check​Gut Motility (peristalsis) – keeps the contents of the intestine moving through before the bacteria in it have a chance to multiply excessively.

​If ​one or more of these protective mechanisms fail, bacteria ​can begin growing in the small intestine. This is called small intestinal bowel overgrowth, or SIBO.

SIBO is usually not caused by the overgrowth of a single bacteria.  Rather, it is usually many different bacteria that begin growing that are normally present in the colon.

There can also be opportunistic organisms like yeast that can take over that normally are held in check by our healthy bacteria and protective mechanisms.

​This increase in bacteria or yeast damages the mucosa of the small intestine which affects its normal function.

The result is ​digestion is impaired and nutrients are not absorbed as well, such as vitamin B12, iron, vitamin D and vitamin A.  

The mucosal damage can also cause gaps to occur ​between the cells of the protective lining of the small intestine which allows proteins and bacteria to pass into our bloodstream that would not normally be allowed.  This is called “leaky gut” or intestinal permeability.

The foreign proteins trigger our immune system to react which can cause food allergies or sensitivities, generalized inflammation, and autoimmunity.

​SIBO Risk Factors

​​​​Several things increase our risk of getting SIBO.  They include:

SIBO Symptoms

SIBO symptoms seem to mirror those seen with irritable bowel syndrome (IBS).  In fact, there is a strong association with IBS and SIBO.

Researchers even recommend that SIBO should be ruled out before giving any person a diagnosis of IBS.

SIBO ​and ​Thyroid

​Since such a huge p​art of this blog focuses on thyroid disorders, I ​believe it is import ​to discuss the​ connection between SIBO and thyroid disorders.

​​​Hypothyroidism is an extremely common cause of SIBO that is frequently missed by doctors.

One study found a high risk of SIBO in patients taking levothyroxine, most likely because of decreased gut motility and lack of stomach acid commonly found in hypothyroidism.

If you have hypothyroidism, please study this article closely to see if you have any symptoms that could indicate the presence of SIBO.

On the other hand, if you have been diagnoed with SIBO, it is important that you get a complete thyroid panel drawn from a doctor that is comfortable managing hypothyroidism and Hashimoto’s Thyroiditis.

To learn more about hypothyroidism​, read my articles here​ and here.  To learn about Hashimoto’s, read my articles here and ​​here.

​How to Diagnose SIBO

​​​​The most common tests for diagnosing SIBO measure how much hydrogen, glucose, or lactulose the bacteria in your small intestine are producing.

These tests are far from perfect and can result in a high percentage of false-negative results.

For this reason, I don’t test every patient that I think has SIBO.  If they have many of the common symptoms, in my opinion it is okay to start treating them for suspected SIBO.

If their symptoms aren’t as clear cut, then testing them before beginning treatment may be a good idea.​

Testing them after treatment to make sure the SIBO has been eradicated is often a more practical plan.

The 6 Step SIBO Natural Treatment Guide

​Before we start with the different treatment options, it’s important to remember the primary ​rule of functional medicine – find the root cause of the problem and correct it.

​​​If you just clear the bacterial overgrowth in the small intestine but you don’t address what caused it in the first place, it is likely that the bacteria will eventually return and you will be right back where you started.

For example, if your SIBO is linked to the fact that you eat a ton of sugar and processed carbs, you must address your diet while you are clearing the bacterial overgrowth.

If you have uncontrolled hypothyroidism, you must get your thyroid in balance in order to prevent the SIBO from returning.

There are several steps to successfully eradicating SIBO.  ​​The basic concept is to:

     1.  Reduce or eradicat​e the ​invading bacteria in your small intestine 

     2.  Re-populate the small intestine with beneficial bacteria

     3.  Heal the intestinal lining

     4.  Take the right supplements

     5.  Eat the right foods.

1.  Diet –

​Diet is the critical first step in healing SIBO.

​The bacteria that have overgrown in your small intestine prefer certain foods that they need to grow and multiply.

​The fermentation of these foods is what leads to the symptoms that SIBO causes.

​That’s why your goal should be to remove these foods so that you can “starve” those bacteria. ​

​Several diets have been shown to treat SIBO.  Each has its positives and negatives.  The ones that seem to work the best with SIBO include:

To ensure the best chance at success, I would suggest picking one of the diets and sticking to it and the treatment protocol very strictly for at least 2-3 months.

If you aren’t seeing symptomatic improvement, then you can switch to one of the other diets.

If the reintroduction of ​foods causes a flare in your SIBO symptoms – bloating, gas, diarrhea, etc. – you may need to continue on the treatment protocol for longer or you may ​even have an undiagnosed food sensitivity.

– Fermented Foods

Once the bacterial overgrowth has been reduced through the diet, fasting, and herbal antibiotic treatment, the next step should be the reintroduction of fermented foods.

Fermented foods contain healthy bacteria that are essential for normal gut health.  They are the ultimate natural probiotic.

​Fermented foods can help to repopulate the GI tract with healthy strains of bacteria.

Common types of fermented foods include:

​Fermented foods can be a bit of an “acquired taste.”  However, I think the benefits ​they offer make it worth the effort ​for you to learn how to enjoy them.

Remember, fermented foods should be added LATER in your treatment.  If your SIBO is active, the healthy bacteria in the food can increase the fermentation in your small intestine which can worsen your symptoms.

2.  Probiotics –

​Probiotics are an essential component in the treatment of SIBO.

​At first, it may not make sense to treat a condition ​caused by an overgrowth of bacteria with a bacterial supplement.

​It is important to realize that the herbal or prescription antibiotics kill both the good and bad bacteria.  For example, in this study, a low carb diet caused a reduction in bifidobactera, one of the good guys.

That is why it’s critical to rep​lenish the good guys in the GI tract so you can return to normal gut function.

With that in mind, there are some things you should consider when using probiotics:

  • asteriskNot all probiotics work for every person
  • asterisk​Some probiotics contain prebiotics which can make SIBO worse
  • asterisk​Some patients do better when probiotics are added AFTER the SIBO has been treated with antibiotics
  • asteriskAs a general rule, soil-based probiotics are better tolerated in SIBO than lactobacilli and bifidobacteria based probiotics
  • asteriskIt is usually best to change up the probiotics periodically instead of using the same product all of the time
  • asterisk​Probiotics are not a substitute for fermented foods and will not work as well

As a general rule, I would suggest using soil-based probiotics during the treatment phase of SIBO.  

In the repopulation phase, I add lactobacilli and bifidobacteria based probiotics if the patient can tolerate them.  This is also when ​fermented foods should be added.

– Soil-based Probiotics

Soil-based probiotics are usually much better tolerated in SIBO patients than lactobacilli or bifidobacteria based probiotics.

That is why they should be used early during the treatment of SIBO, even ​when antibiotics are being used.

The soil-based probiotics that I recommend include:

– Lactobacilli and Bifidobacteria Probiotics

The probiotics may actually WORSEN symptoms in the early stages of treatment, but they are generally well tolerated once the bacterial load has been reduced.

I generally recommend adding these probiotics later in the treatment and AFTER treating with soil-based probiotics.

My favorite brands include:

– Beneficial Yeast

Some patients are extremely sensitive to probiotics and have a hard time tolerating any of them.

In those situations, treating them with saccharomyces boulardii can be helpful.

This beneficial yeast competes with the bad bacteria and can help inhibit their growth in the small intestine.

My recommended brand can be found here.

​3.  Herbal Antibiotics and Supplements

​Herbal antibiotics are essential for treating SIBO.

​At times it may be necessary to use prescription antibiotics, but it is preferable to start here.

​On this treatment you should usually start seeing a reduction in SIBO symptoms within 2 weeks.  If you aren’t seeing benefit by 2-4 weeks you need to reassess your treatment plan and ​consider going a different direction.

Phase 1 – Reduce Bacterial Burden

​There are several herbs that have been shown to have antibacterial and antifungal properties:

  • checkBerberine 500mg daily – studies
  • checkOregano Oil 600mg daily – studies​​​​
  • checkCaprylic Acid 400mg daily – studies​​​​
  • checkUndecylenic Acid 125-250mg daily – studies
  • check​Thyme Oil 100-200mg daily – studies
  • checkGrapefruit Seed Extract 100-200mg daily – studies

​These herbs are grouped into the following products that are available online:

​- Candibactin AR

​- Candibactin BR

​- AC Formula II

​The recommended dosages and treatment lengths are:

  • Candibactin AR/Candibactin BR x 30 days (maximum dose recommended on bottles, titrate up as tolerated.
  • Candibactin AR/BR + AC Formula II + Diflucan x 30 days
  • Candibactin AR/BR x 30 days + Prescript assist + AC Formula II x 30 days at maximum dosages or until symptoms decrease (you should notice a decrease within 2 weeks)
  • ​For constipation predominant SIBO or IBS – consider adding Antratil – study here​​​

Repeated doses may be necessary for complete eradication.

Phase 2 – Rebuilding and Reducing Inflammation

​After 1-2 rounds (or more) of Phase 1, you can move into Phase 2 which will rebuild the normal gut flora and heal the mucosal damage in the small intestine.​​​

– Rebuild the Intestinal Mucosa

Glutamine helps close​ the tight junctions in the intestinal mucosa which heals leaky gut.

My favorite brand is available here.  Take 1 scoop in water 2-3 x daily.

– Support the Immune System

Several supplements help to support the immune system.  These include:

     Zinc – get my preferred brand here.

     Selenium – get my preferred brand here.

     Vitamin D – get my preferred brand ​​here.

     IgG from Bovine Colostrum – get my preferred brand here.

– Promote liver detoxification

These supplements boost liver function which helps rid the body of toxins.

     Curcumin/tumeric – get my preferred brand here.

     Ginger – get my preferred brand here.

     Milk Thistle – get my preferred brand here.

     This is a great combo supplement with all of them.

– Exercise

Exercise itself can have a positive effect on the gut ​bacteria.

It is therefore important for you to exercise consistently throughout your SIBO treatment.

​4.  Prokinetics

​Prokinetics are very helpful in the treatment of SIBO by helping to propel the bowel contents through the GI tract.

​This is important because the methane gas produced by the intestinal bacteria actually slows down gut transit.

​Keeping things moving through the GI tract prevents constipation​.  That is important because each bowel movement helps dump (no pun intended) excessive bacteria from our body via the stool.

​It is important to have at least 1 large bowel movement each day.  Anything less is going to cause problems.

​Many people have NEVER had regular BMs, so that seems like an impossible goal.  It needs to happen, however.

​It will be hard to get your SIBO under control if you are constipated.

​If you are chronically constipated, you should have a workup for hypothyroidism which ​is a common cause of it.

Some natural prokinetics include:

​Triphala – this herb has the advantage of helping gut motility but it also helps balance the intestinal bacterial flora which makes it a perfect supplement for SIBO.

– In cases of severe constipation, it is helpful to use Triphala in combination with magnesium.

– In later stages of SIBO treatment, it’s better to use this supplement which has other nutrients that help to heal the gut.

At times, it may be necessary to use magnesium citrate (200-2000mg per day) in order to increase your bowel movement frequency.  Vitamin C crystals (ascorbic acid) can also be added to the magnesium citrate if needed.

There are several prescription prokinetics that can be used (erythromycin, Reglan, Propulsid), but they have significant side effects and should only be used when Triphala has failed.

​5.  Intermittent Fasting

and terms

​There are 2 main ways to kill the unwanted bacteria in the small intestine that you get with SIBO:

​- “Starve” them out by selectively avoiding the foods that they feed on, like I discussed earlier under diet.

​- Don’t eat anything at all for periods of time to really starve them out, otherwise known as intermittent fasting.

​Intermittent fasting can be an extremely effective technique for multiple conditions, including SIBO.

​Intermittent fasting not only decreases the bacterial load by reducing the amount of food we eat, it also has other benefits:

Start by going without food for 14-16 hours for 2-3 days per week.  

That means eating dinner one evening, then not eating again until lunch the next day.

Make sure you eat the same amount of calories the next day with lunch and dinner that you would have if you had eaten breakfast so you don’t damage your metabolism by eating too few of calories.

In other words, make sure your lunch and dinner have at least 1200 calories total.

This technique can go a long way toward improving your symptoms of SIBO.

​6.  Antibiotics

​I know that this article is about ​natural treatments for SIBO, but it’s important to mention that many SIBO patients may need prescription antibiotics to help eradicate the bacteria in their small intestines.

​I recommend almost always starting with the herbal therapies, but if symptoms persist despite 2 or more treatment rounds, it may be time to consider a prescription antibiotic. This could be needed in up to 15% of people.

​Also, some people just have difficulty tolerating the herbal therapies.

​If you do end up needing a prescription antibiotic therapy for your SIBO, make sure you also request a prescription antifungal medication.

​The herbal therapies treat fungal infections, but the prescription antibiotics don’t.

​My preferred SIBO antibiotic regimen is:

Rifaxim 1200mg + Neomycin 1000mg x 10-14 days plus Diflucan 100mg x 30 days

​If patients use this regimen in conjunction with all other therapies I have mentioned in this article, re-treat is usually not necessary.


​SIBO is a serious condition that is often misdiagnosed as IBS.

​IBS should not be diagnosed until SIBO has been ruled out.

​Untreated, SIBO can lead to chronic inflammation, gut issues, and the development of autoimmune conditions.

​If you have classic symptoms, it is reasonable to consider treatment even without a diagnostic test.

​You can consider testing later to determine if the SIBO has been eradicated.  If your symptoms are not classic, testing may be warranted before starting treatment.

​The complete eradication of SIBO can be difficult, but if all steps in this treatment guide are followed, long term success is possible.

​This SIBO Natural Treatment Guide includes diet, herbal antibiotics, probiotics, prokinetics, intermittent fasting, and possibly prescription antibiotics.

​It is also critically important to identify the root cause of your SIBO and correct it, or else long term success may be difficult.

​Now it’s your turn…

​Have you been diagnosed with SIBO?

​What treatments have you tried?

​Were the treatments successful?

​Did you learn anything from this article that will help you?

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The Hashimotos Symptoms Checklist

Hashimoto’s thyroiditis is the most common autoimmune disorder.

​If you have been diagnosed with hypothyroidism, there is a high likelihood that you have Hashimoto’s and don’t even know it.

It’s important to be tested for Hashimoto’s if you have symptoms of low or high thyroid or both!

If you have an autoimmune disorder, you should also be tested for Hashimotos.

In this article, I will discuss the common symptoms associated with Hashimoto’s thyroiditis – in the early stages, middle stages and late stages – and how to make the diagnosis by showing you what tests you will need to request from your doctor.

I discuss the best natural treatments for Hashimotos in this article.

Here we go…


​What is Hashimoto’s Thyroiditis?

​Hashimoto’s Thyroiditis (from now on I will refer to it as Hashimoto’s) is an autoimmune disorder. In other words, something causes your immune system to go rogue and start attacking your thyroid gland.

​It was first described by a Japanese physician, Dr. Hakaru Hashimoto, in 1912.

It is common in Japan because of their heavy fish consumption. Fish contain a lot of iodine, which when found in high amounts is a common cause of autoimmune thyroid disease.

​It is the most common autoimmune disorder in the US and its incidence is increasing rapidly.

​In fact, in my office I typically diagnose one to three new patients every week with Hashimoto’s!

​The next obvious question is – why?

​Most physicians think that it is almost purely due to our genes. However, that is only part of the story.

​In a study of identical twins with an autoimmune disorder, only 50% of their twins also had an autoimmune disorder.

​While that shows a strong link to genetics, there is obviously something else at play as well or that percentage would be higher.

There appear to be several factors that contribute to the development of Hashimotos:​

    • Genetics – family history of thyroid disease, variations in cellular thyroid components
    • Toxins – Iodine, fluoride, perchlorate, mercury, cadmium, etc.
    • Nutrient Deficiencies – Vitamin D, B vitamins, zinc, selenium, iodine
    • Infections – EBV, coxsackie virus, human parvovirus B19, herpes virus, H. pylori

​All of these factors may create a situation where the immune system attacks a part of your body (in this case, your thyroid) instead of just the foreign invaders that they are designed to attack.

How Common is Hashimotos?

Up to 10% of the US population has Hashimoto’s, and it occurs more often the older we get.

It is much more common in women. In fact, 7 women are diagnosed for every 1 man that is diagnosed. Some experts estimate that it may be present in up to 20% of women!

It is more commonly seen around the times of puberty, pregnancy and menopause, which seems to show that hormone fluctuations may play a role in the development of Hashimotos.

If appears to be more common in Caucasians and Japanese individuals.

So what are the common symptoms of Hashimotos?​

Hashimoto’s Symptoms Checklist

Hashimoto’s is by far the most common cause of hypothyroidism, or low thyroid. In fact, some researchers believe up to 90% of hypothyroidism is due to Hashimoto’s!

Hashimoto’s causes hypothyroidism because the antibodies produced by our confused immune system cause inflammation in the thyroid cells. That inflammation will damage the cells and eventually destroy them.

2 factors cause the variation in symptoms in Hashimoto’s:

    • Fluctuations in thyroid hormone levels
    • The level of inflammation from the autoimmune condition

The level of inflammation can wax and wane, which can cause the severity of symptoms to vary as well.

Think of an arthritic knee.  At times the inflammation is not too bad so the symptoms are mild.  At other times, the inflammation is increased which also worsens the symptoms.​

At times, the inflammation can cause an increased release of thyroid hormone which can result in symptoms of hyperthyroidism.

That is because as the thyroid cells are being destroyed, stored hormones can be released into the blood stream, causing a toxic load of thyroid hormone.

Enough thyroid cells will eventually be destroyed that the thyroid will no longer be able to produce adequate thyroid hormone to keep up with the demands of the body. Hypothyroidism then develops.

By the time that most Hashimoto’s patients are diagnosed, they have probably had the condition for years.

However, the thyroid was not damaged early in the disease to the point of causing enough symptoms to make the patient seek medical help. Or they may have blamed the symptoms on something else.

Early Symptoms of Hashimoto’s

Early symptoms of Hashimoto’s are typically mild symptoms.  These include:

    • Mild fatigue
    • 5-10 pounds of weight gain
    • Depressed mood
    • Difficulty focusing
    • Dry skin, dry and brittle hair, nonspecific rashes
    • Mild constipation
    • Mild fluid retention (especially in the face and lower extremities)
    • Voice changes or the sensation of throat swelling
    • Reduced ability to sweat
    • Mild joint pain and muscle aches
    • Mild to moderate changes in the menstrual cycle

If you have any of these symptoms, it is important that you get your thyroid antibody levels checked.

At this point, if the inflammation is reversed, it is possible to avoid permanent damage to the thyroid gland.

Hyperthyroid Symptoms

Over the next several years, people with Hashimoto’s can fluctuate between hyperthyroidism and hypothyroidism.

This is because the thyroid antibodies will attach to the thyroid gland and cause increased inflammation.

This inflammation may trigger the thyroid to release a surge of thyroid hormone which will cause symptoms of hyperthyroidism.​  These symptoms can be even worse if the person is already on thyroid medication.

Symptoms that indicate an increased level of thyroid hormone include:

    • Hot flashes or episodes of heat intolerance
    • Jitteriness
    • Symptoms of anxiety
    • Fatigue or big swings in energy level
    • Insomnia
    • Facial flushing
    • Heart palpitations or racing pulse
    • Weight loss or weight gain

Not all Hashimoto’s patients will have these episodes of hyperthyroidism.

Some folks just have a progressive decline in thyroid function and have classic symptoms of hypothyroidism.

Symptoms of Advanced Hashimoto’s

Eventually, if the Hashimoto’s isn’t found and addressed, all thyroid stores will be depleted and hypothyroid symptoms will occur.

The typical symptoms of a patient with advanced Hashimoto’s include:

    • Extreme fatigue/exhaustion
    • Moderate weight gain (usually 20-30 pounds)
    • Hair loss or hair thinning
    • Mood changes, typically depression
    • Menstrual irregularities
    • Chronic and debilitating muscle or joint pain
    • Chronic constipation, other GI issues such as gas/bloating, SIBO, acid reflux, low stomach acid

I discuss a more extensive list of symptoms of hypothyroidism in my article found here.

Even in the advanced stages, patients can still have “flares” during which their symptoms are much worse.

These symptoms can include worsening fatigue, jitteriness, sudden weight gain, brain fog, and GI symptoms.

If this happens, it is important to see your doctor for further evaluation and labwork.

Your healthcare provider may also notice an enlarged thyroid gland on exam (called a goiter). The majority of goiters are caused by Hashimoto’s.

In fact, people with Hashimoto’s are 3 times more likely to develop thyroid cancer than people without Hashimoto’s.

If your thyroid is enlarged, you need to see a doctor to get a definitive diagnosis. Enlargement can also be caused by other conditions, including thyroid cancer.

How to Diagnose Hashimotos

​Hashimotos can be diagnosed in 3 ways:

    • Positive thyroid antibodies
    • Positive thyroid ultrasound
    • Positive thyroid biopsy (fine needle aspiration)

The vast majority of patients are diagnosed with Hashimoto’s by finding elevated levels of thyroid antibodies on blood testing.

I will occasionally discover an enlarged thyroid on physical exam, but that is usually only a handful of times per year.

Get a Complete Thyroid Panel​

Hashimoto’s will not be diagnosed without a complete thyroid panel.

A TSH, which is typically the only thyroid test ordered by most conventional doctors, will not diagnose autoimmune thyroid disease. The TSH typically will not become permanently elevated until the Hashimoto’s has become advanced.

A Complete Thyroid Panel Includes:

  • TSH
  • free T4
  • free T3
  • reverse T3
  • TPO antibodies
  • Thyroglobulin antibodies

​90% of Hashimoto’s patients have elevated TPO antibodies. 80% have elevated thyroglobulin antibodies.

If either the TPO or thyroglobulin antibodies are >35 ng/ml, the diagnosis of Hashimoto’s can be made.

A small percentage of Hashimoto’s patients will have normal antibody levels, but their ultrasound will be abnormal or their thyroid biopsy will show evidence of the disease.

It is also recommended that all patients with elevated thyroid antibodies should have a thyroid ultrasound. If it is normal, the ultrasound should be checked every 2 years. If it shows evidence that the thyroid is growing, a repeat ultrasound should be performed every 6 months.

Evaluate Inflammation

It is also a good idea to monitor the level of inflammation in your body if you have Hashimoto’s.

Inflammation itself can worsen thyroid function by reducing T4 to T3 conversion.​

It can also worsen insulin resistance and adrenal dysfunction.

All of these issues can lead to worsening fatigue, weight gain, and other symptoms that can worsen the hypothyroid symptoms that are already present.​

Inflammation can be evaluated by checking the following lab tests:

    • Erythrocyte Sedimentation Rate (ESR)
    • C-Reactive Protein (CRP)
    • Ferritin

If these levels are elevated, it is a sign that inflammation is increased in the body and your thyroid gland may be under assault and being damaged.

Look For Other Autoimmune Conditions​

One study showed that up to 5% of patients with Hashimoto’s have celiac disease. Another study showed up to 50% of celiac patients have Hashimoto’s.

Therefore, it is recommended that all patients who are diagnosed with Hashimoto’s should be tested for celiac disease.

Statistically, if a patient has an autoimmune disorder such as Hashimoto’s, they have a higher risk of having a second autoimmune disorder. These include Type I diabetes, multiple sclerosis, rheumatoid arthritis, lupus, celiac disease, Addison’s disease, and others.

Consider Hashimoto’s If You Have a Mood Disorder​

Many Hashimoto’s patients may be misdiagnosed with mood conditions such as depression, anxiety, and bipolar disorder.

One study also showed that people with these conditions have a higher prevalence of anti-thyroid antibodies.

Because of this, any person with anxiety, depression, or other mood disorders should have a complete thyroid panel checked.

Instead of taking anti-depressants or anti-anxiety medications, they may need their thyroid issue treated!

So I Have Hashimotos.  What is My Prognosis?

Most conventional doctors are taught that Hashimoto’s is an irreversible, inevitable disease that will eventually kill the thyroid.

They are taught that patients should just have periodic thyroid levels checked and thyroid medication should be prescribed once the levels are abnormal and the patient becomes hypothyroid.

They don’t believe anything else can be done.

Of note, one study showed that up to 20% of patients with Hashimoto’s can have spontaneous recovery of their thyroid function.

Just like in other autoimmune diseases, I believe (and the literature supports this belief), that the course of Hashimoto’s can be slowed or even reversed with proper lifestyle interventions.

I will discuss many of those interventions in my treatment article found here.

Hypothyroidism does not have to be inevitable in Hashimoto’s!


Hashimoto’s thyroiditis is the most common autoimmune disorder.

90% of all hypothyroidism may be due to Hashimotos.​

Early in Hashimoto’s, the symptoms may be mild and not recodgnized as being due to a thyroid issue.

In some patients, their symptoms may vacillate between hypothyroid and hyperthyroid because of fluctuations in inflammation levels. ​

If Hashmoto’s has been present for years, ​it will eventually destroy the thyroid gland which will cause typical symptoms of hypothyroidism.  Thyroid medication will be required.

Hashimotos is typically diagnosed by having a TPO antibody and/or thyroglobulin antibody level >35, or with a positive thyroid ultrasound or biopsy.

Inflammatory markers should also be tested.

All patients that are diagnosed with Hashimotos should have a thyroid ultrasound and be tested for celiac disease.

With appropriate lifestyle interventions, the progression of Hashimoto’s can be slowed or even reversed.

Now it’s your turn…

Have you been diagnosed with Hashimotos?

What symptoms did it cause in you?

Leave your comments below.

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Treatment of Reverse T3 Dominance

Reverse T3 dominance could be the reason why you still have hypothyroid symptoms even though you are taking thyroid medication.

Or why you struggle to lose weight even when your thyroid labs are “normal.”

Never heard of reverse T3 dominance?  Most people haven’t, including most doctors.

High levels of reverse T3 could be slowing down your metabolism, reducing thyroid function at the cellular level, and causing multiple symptoms of hypothyroidism.

The purpose of this article is to inform you about reverse T3 – its purpose in the body, what causes it to get elevated, how to test for it, and how to reduce it back to optimal levels.

Let’s get started…


What is Reverse T3?

The thyroid gland primarily produces T4.  That is thyroglobulin with 4 iodine molecules attached to it.

T4 is the inactive transport form of thyroid hormone.  In order to be used by the body, an enzyme called a deiodinase must cleave off an iodine molecule to convert it to T3.

T3 is the active hormone that can then interact with cells of our body and turn on certain cellular functions.

However, T4 can also be converted into reverse T3.

Reverse T3 will also bind to the cellular thyroid receptors.  However, it doesn’t trigger any cellular reactions.

So basically reverse T3 serves as a “brake” to our thyroid system.

Why Do We Have Reverse T3 in the First Place?

The production of reverse T3 is normally not a bad thing.  It gives our body another way of regulating our energy production and output.

Reverse T3 production will increase during times of extreme stress.

That makes sense if you think about it closely.

For example, if you have an acute infection such as pneumonia, a kidney infection, or you’ve had something like a car accident and have suffered multiple injuries, your body needs to turn down the metabolism to conserve energy so it can be used to fight the infection or injuries.

This system works very well for such acute situations.

There is actually a medical term for this condition – Euthyroid sick syndrome.

However, with the onslaught of chronic conditions and resulting inflammation in our society, it has also become extremely common ​outside of the acute setting of a hospital.

People that are under extreme stress develop this condition which results in a high reverse T3 level, low free T3 level, and a normal TSH and T4 level.

Does this sound familiar?  Do your labs look like that?

In 20+ years of private practice, I have never seen this diagnosis given to a patient that wasn’t in the hospital.

But if you look at studies like this one, ​something as common as a calorie-restricted diet can raise reverse T3 levels and lower free T3 levels and cause other symptoms that “resemble euthyroid sick syndrome.”

So what is going on?​  What causes the reverse T3 levels to increase (reverse T3 dominance)?

Let’s talk about it more…

What Causes Reverse T3 Levels to Increase?

From what we have discussed so far, unless you are acutely ill or have suffered a major injury of some sort, you want your reverse T3 level to be as low as possible.​

​Does an elevated reverse T3 cause any symptoms?

The answer is yes! 

The symptoms will be the same as you would think of with someone with an extremely slow metabolism (which is what reverse T3 dominance causes):

  • Constant weight gain without changing your eating habits
  • Severe fatigue
  • Symptoms of hypothyroidism
  • Depression or anxiety
  • Joint pain

If you have any of these symptoms, it’s important to get your reverse T3 level checked and follow the treatment instructions that I will discuss below.

But first…

What are some of the most common causes of reverse T3 dominance?

    • Chronic physical or emotional stress – This can include job stresses, financial problems, family issues, death of a loved one, and divorce.  It also includes trauma including PTSD or permanent injuries from car wrecks, etc.
    • Chronic illness or infections –  This can include infections such as mono or SIBO, or chronic illness such as cancer, diabetes, heart disease, or even obesity.
    • High or low cortisol (Adrenal fatigue) – Either end of the cortisol spectrum will affect reverse T3 levels.  Read more here.
    • Low ferritin – Suboptimal levels of iron and ferritin have been shown to increase reverse T3 levels.
    • Acute illness or injury – Patients with an acute issue that requires ICU treatment have been shown to have low T3, high reverse T3, and normal TSH levels.
    • Severe calorie restriction – especially HCG diets or very low calorie diets.  These diets have been shown to increase reverse T3, slow metabolism, and make it almost impossible to have permanent weight loss.
    • Chronic inflammationAny inflammation will result in reduced T4 to T3 conversion and an increase in reverse T3 production.  Inflammatory conditions include autoimmune disease, leptin resistance, insulin resistance, intestinal dysbiosis, and cancer.
    • Chronic untreated gut infections or imbalancesUp to 20% of all conversion of T4 to T3 occurs in our gastrointestinal tract.  Any gut imbalance therefore has a huge impact on thyroid function.  Examples of this includes SIBO, GERD, yeast overgrowth, inadequate gut bacteria, overuse of antibiotics, and inflammatory bowel disease.
    • Certain medications – Medications that can increase reverse T3 levels include beta blockers, diabetes medications, anti-seizure medications, depression medications and narcotics.

​If you have one or even more of the above issues, it is important for you to be tested for reverse T3 dominance.

How to Test for Reverse T3 Dominance

Testing for reverse T3 dominance is readily available but may be hard to get ordered.

You will need to see a doctor that has a full understanding of the thyroid and doesn’t just depend on the TSH to determine thyroid health and function.​

It is critical that you get a complete thyroid panel.  I discuss this more in this article.

This will include the TSH, free T4,free T3, reverse T3, TPO antibodies and thyroglobulin antibodies.​

As you can see from this graph, when reverse T3 dominance occurs, the TSH level will remain normal the vast majority of time.  So will the free T4 level, which is the other lab test that most conventional doctors will order.

The lab tests that will show an abnormality the quickest will be the reverse T3 level and the free T3 level.  You can see that as the reverse T3 levels rise, the free T3 levels fall.

Even though your TSH may be normal, your thyroid is not working well at all!​

That is why the reverse T3 and free T3 are absolutely the most important thyroid tests to get when assessing for reverse T3 dominance.​

You will also want to check the ratio of reverse T3 to free T3 to get an idea of what is happening in your cells.

Normally you want your free T3 to be as high as possible and your reverse T3 to be as low as possible.

I consider a reverse T3 > 15 to be abnormal.

It is possible to have a normal free T3 level but still have a very high reverse T3.  That is why the ratio is important.

​To get the ratio, divide your free T3 by your reverse T3.  The ratio should be >0.20.

Any number less than 0.20 indicates that you have too much reverse T3 and you need to take steps to lower it.

How to Lower Reverse T3 Levels

Okay, so you’ve gotten the necessary lab tests, and your reverse T3 level is > 15 and/or your free T3: reverse T3 ratio is < 0.20.

What can you do to decrease your reverse T3 dominance?

The single most important thing is to identify the root cause.​  This is always the primary goal of functional medicine.

If your diabetes is out of control and you don’t change your diet and lifestyle, your reverse T3 will not decrease.

If you are in a toxic job or a toxic relationship, you will never get your cortisol levels in the optimal range which will prevent your reverse T3 level from dropping.

I could give several other hypothetical situations, but I think you get my point.

Focus primarily on the issues that you know you have FIRST.  Then consider some of the other treatment options I will discuss below.

1. T3 Medication

The quickest way to reduce reverse T3 levels is by using pure T3 hormone.

This includes short acting T3 such as Cytomel or liothyronine, but also sustained release T3 from compounding pharmacies.

This is so effective because you are able to skip the conversion step required with medications that contain T4 such as Synthroid and levothyroxine.

Your body can’t make reverse T3 unless it has T4.  If you remove the T4, the reverse T3 levels will obviously drop.​

Make sense?

When you give T3 only medication, it will result in the free T3 level rising, T4 level dropping, reverse T3 level dropping, and the TSH level dropping.​

When on this therapy, it is very important to monitor your reverse T3 levels closely, usually every 1-2 months.

Typically the reverse T3 level will drop below 10 within 2 months (assuming you are on enough T3).​

This is by far the fastest way of reducing your reverse T3 dominance, but if you don’t identify and correct the root cause, it will just go back up.​

By the way, natural dessicated thyroid (NDT) medications such as Armour Thyroid, Nature-throid, and others may not be adequate to lower reverse T3 levels.​

They are still about 80% T4, which may still provide too much T4 that can be converted to reverse T3.

If you are on an NDT medication, you may need to reduce the dose for a couple of months and add T3 to lower the reverse T3 levels.​

Again, it will be imperative to identify the root cause of your reverse T3 dominance, or else the reverse T3 levels will go back up once you return to your typical NDT dose.​

2. Increase T4 to T3 Conversion

Every patient with a thyroid issue is going to need one or more supplements.​


When you have low thyroid you produce less stomach acid which results in less nutrient absorption.

I discuss many nutrient deficiencies and supplements here, but for this article I will only mention those that help with conversion of T4 to T3.​

​The primary nutrients that have been shown to increase this conversion are zinc and selenium.  Increasing conversion of T4 to T3 means less conversion to reverse T3 which will lower its level.

My preferred supplements are below:

How to Supplement with Selenium

Why I Like It

May reduce antibodies in patients with Hashimoto’s

Also acts as an  anti-inflammatory

May help reduce anxiety symptoms

Helps boost T4 to T3 conversion (helpful in those with high reverse T3)

Who Should Use It

    • Patients with hair loss or hair thinning
    • Patients with a known thyroid disorder and hair loss
    • Patients with other nutrient deficiencies like zinc or iodine
    • Patients who frequently take acid blockers for acid reflux
    • Patients with other GI related issues (IBS, gas/bloating, IBD)
    • Patients also taking zinc

How to Use

    • Take 200-400 mcg per day (do not exceed 400 mcg daily)

My Recommended Brand and Product

Get Selenium Here

How to Supplement with Zinc

Why I Like It

Many people are deficient in zinc

May help with T4 to T3 conversion

May increase cellular sensitivity to thyroid hormone

Has anti-inflammatory effects

How to Tell if You Need It

    • If you have Hashimoto’s and hair loss
    • If alkaline phosphatase is < 70

How to Use

    • Take 30-60 mg daily (do not take more than 60 mg)

My Recommended Brand and Product

Get Zinc Here

3. Manage Leptin Resistance and Insulin Resistance

​Most hormones in the body work together.

When there is a change in one hormone, it will affect other hormones as well.

In fact, hypothyroidism has been linked with leptin resistance as well as insulin resistance.

Hypothyroidism leads to a state where it is easy to develop leptin resistance and insulin resistance.

Conversely, leptin and insulin resistance slow metabolism and increase inflammation which increase reverse T3 production, which makes losing weight almost impossible.

Very high reverse T3 levels are almost always found with elevated insulin and leptin levels.

That’s why you need to request a fasting insulin and leptin level if your reverse T3 is > 15.

You will not be able to get your reverse T3 level down and keep it down if you don’t also address the leptin and insulin resistance.

You can read more about how to do that in my article here.

4. Decrease Inflammation

​Inflammation is a vague concept.

We all know that excessive or prolonged inflammation is bad, but what do we do about it?

It is hard to measure and even harder to treat.

However, it’s important to identify and address because inflammation directly increases conversion of T4 to reverse T3.

The lab tests that we use to measure inflammation in the body are nonspecific, meaning they do not tell us what is causing the inflammation.

If they are elevated, it can still indicate to us that inflammation is high in the body and we need to identify the source of it.

The primary tests that indicate inflammation are:

    • C-reactive Protein (CRP) – Should be as low as possible (<1.0)
    • Erythrocyte Sedimentation Rate (ESR) – Best if this is < 10.

​If you have high levels of inflammation AND high levels of reverse T3, you can safely assume that inflammation if causing or at least worsening your reverse T3 dominance.

The next step is to identify the source of the inflammation.

In hypothyroid patients, the source of inflammation is usually from one of 3 issues:

    • Food Sensitivities -typically gluten and dairy but there may be others.  They promote inflammation, primarily in the gut.
    • Gut imbalances – such as SIBO or yeast overgrowth.  Both also increase inflammation.
    • Hormone imbalances – especially insulin resistance and leptin resistance.

If your CRP or ESR levels are elevated, you should look closely at these 3 common sources and address them.

If you don’t know the source of your inflammation, you can still consider some supplements that help reduce inflammation by improving the detoxification of the body, primarily in the liver:

Just blindly treating inflammation is far from ideal but can be helpful if you can’t identify the source of your inflammation.

5. Lifestyle Changes

​Without getting overly technical, doing 4 basic things can make a huge impact on your health, including your reverse T3 levels:

    • 8 hours of quality sleep per night
    • Reducing and managing your stress
    • Eat a balanced diet of whole, real foods
    • Daily low intensity exercise and episodes of high intensity exercise 1-3 times per week

Just doing these 4 things alone will do more to bring you back to a state of health than anything else we have discussed.

On the other hand, if you do everything else that I recommend in this article but neglect these 4 things, you will not be successful and your reverse T3 dominance will continue.​

I realize these things are easier said than done, but they have to be a primary focus for you to have success.​

​By the way, reverse T3 is an important component of our thyroid hormone system.

Decreasing reverse T3 levels are not harmful in the short term and can in fact be helpful.

However, persistently low levels of reverse T3 increases the risk for hyperthyroidism if left suppressed for a long time.

That’s why the goal will be to “flush” out the elevated reverse T3 levels for only a short period of time and then allow the body to balance out the levels of T3 and reverse T3.


Reverse T3 dominance is a common problem for many hypothyroid patients. 

It may be the primary reason why some patients have persistent hypothyroid symptoms despite being on thyroid medication and why so many thyroid patients have difficulty losing weight and keeping it off.

In order to diagnose reverse T3 dominance, you need to have your free T3 and reverse T3 levels checked.

A reverse T3 level > 15 is considered abnormal, and a T3:reverse T3 ratio of < 0.20 indicates that you have too much reverse T3.

Treatment includes taking T3 medication for a short period of time, taking supplements to improve T4 to T3 conversion, and making appropriate lifestyle interventions to reduce stress, inflammation, and leptin/insulin resistance.

Doing all of these things can help get your body back and balance and reduce your hypothyroid symptoms and weight loss resistance.

Now it’s your turn:

Do you have reverse T3 dominance?

What treatments have you tried?

What has worked for you?

Leave your comments below.

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The 6 Step Leptin Resistance Treatment Guide

Are you tired of gaining weight despite eating very little and exercising?

Have you dieted off and on your entire life but just can’t keep your weight off?

Do you eat like a bird compared to friends and family yet you can’t lose weight like you once could?

Are you eating less than you ever have but are still gaining weight?

Do you feel like something is wrong with your metabolism yet your labs always come back “normal?”

If you answered yes to any of these questions, you are likely dealing with leptin resistance.

In this article I will discuss leptin resistance, how to diagnose it, and give you a 6 step treatment guide that you can use to help reverse leptin resistance.

Here we go…


What is Leptin Resistance?


It is highly likely that you have never heard of this hormone, much less know what it does in the body.

Don’t feel bad.  Most doctors have little to no knowledge of leptin either.

I myself was unaware of leptin until just a couple of years ago.

Leptin is called the “satiety hormone.”  It is produced primarily by fat cells.

Its primary function is to signal the hypothalamus in the brain that we have plenty of fat stores and we don’t need to store anymore.

This causes our appetite to reduce and our metabolism to increase so we can burn the stored fat.

There is another hormone called ghrelin which basically does the exact opposite of leptin.  It makes us hungry and slows our metabolism.

The 2 hormones together normally strike a healthy middle ground to keep us in energy ​balance.

Leptin Resistance

So what is leptin resistance? 

For reasons we don’t completely understand, the brain begins to ignore the elevated leptin levels and continues to signal to our body that we are hungry and need to store more fat.

When you brain ignores the leptin signal, it goes into starvation mode.

Think of someone stranded on a desert island without food.  What would their body do to compensate?

Their metabolism would slow down to conserve energy, and their appetite would increase to stimulate them to find food.

The same thing happens in leptin resistance even though the patient has an excess of fat stores.

This leads to more weight gain and higher leptin levels which just worsens the cycle.

Connection with Insulin Resistance

A similar thing happens with insulin resistance.

With insulin resistance, the body ignores the elevated insulin levels and it therefore requires more and more insulin to move the sugar from the blood stream into the cells to be used for energy.

The insulin causes an increase of inflammation in the body which worsens the insulin resistance.

High levels of insulin cause you to store calories that you eat in the form of belly fat.​

At some point the blood sugar levels begin rising and type II diabetes develops.

Leptin resistance and insulin resistance typically run hand-in-hand.  It is rare to find one without the other.

Both conditions cause the metabolism of the body to slow which results in weight gain and obesity.

Read more about treating insulin resistance in my article found here.

Connection with Hypothyroidism

In leptin resistance, as your leptin level increases and your metabolism slows, your reverse T3 levels will increase.

This is a normal compensatory response by the body.

Thyroid hormone is responsible for the majority of the metabolism in the body.

As your leptin levels rise in leptin resistance, your overall basal metabolic rate slows.

This decrease in metabolic rate signals the body to convert T4 to more reverse T3 and convert less to active T3.​

Here are the results from a recent patient of mine that demonstrate this:

Reverse T3 serves as a brake for your metabolism.​  As your leptin levels rise your reverse T3 levels will also rise.

Reverse T3 actually competes on your cells for binding with the free and active T3 hormone.

This results in a further lowering of your metabolism and causing damage to it.

​A prolonged elevation of reverse T3 is called thyroid resistance.

Signs and Symptoms of Leptin Resistance

The typical patient with leptin resistance has problems losing weight unless they are on an extremely strict diet.

The damage to their metabolism means they have to eat an extremely calorie-restricted diet just to maintain their weight.

Even just occasional cheating will cause them to put on pounds.

Patients with leptin resistance tend to experience at least 2 of the following symptoms:​

    • Inability to lose weight despite eating a calorie-restricted diet and exercising regularly
    • Constant weight gain accompanied by a ravenous appetite
    • Constant food cravings, even after eating a large meal
    • Constant fatigue, low energy, or feeling “sluggish”
    • Cold body temperature (less than 98.0 degrees F)
    • Low resting heart rate (defined as 50-60 first thing in the morning assuming that the patient is overweight and not aerobically conditioned)
    • Worsening symptoms of hypothyroidism (hypothyroidism frequently accompanies leptin resistance)

​Having 2 or more of these symptoms doesn’t guarantee that a person has leptin resistance, but it means there is a high chance that they do.

Diagnosing Leptin Resistance

The only way to definitely diagnose leptin resistance is by doing labwork.

You will have to ask your doctor specifically to order these tests.  Remember, there is a strong possibility that he or she will not know what leptin is or know how to interpret the results.

The gold standard for diagnosing leptin resistance is by checking the fasting serum leptin level.

Your serum leptin level should be less than 10-12.

If you are at least 20 pounds overweight and your fasting serum leptin level is > 12, the diagnosis of leptin resistance can be made.

Please note that most labs will list a reference range that is based off of your BMI.

Don’t let this fool you into thinking your leptin level is normal just because it falls within the reference range.

Of course leptin levels will go up as your BMI increases.  That is the point of this article!

That just confirms that the majority of obese people have leptin resistance.

I would also recommend ordering the following tests in addition to the serum leptin level:

    • Uric Acid
    • Complete Thyroid Panel (specifically a reverse T3)
    • Fasting Total Insulin Level
    • Hemoglobin A1c

Uric acid is an indicator of how well your body is metabolizing fructose.  This is important because fructose combined with a high fat diet can worsen leptin resistance.

If you uric acid level is > 5, that indicates that you are consuming too much fructose or your liver is having a hard time metabolizing it.

​A reverse T3 level > 15 indicates thyroid resistance that also needs to be addressed.

A fasting total insulin level and hemoglobin A1c will indicate the presence of insulin resistance.

A fasting total insulin level > 5 is indicative of a problem.  So is a hemoglobin A1c level > 5.3.​

Like I said earlier, it is very rare to find leptin resistance without insulin resistance.

Leptin Resistance Treatment Guide

So, now you have the lab tests you need.  Based on those results and the symptoms you are having, the diagnosis of leptin resistance can be made.

So what can you do about it?

This is a difficult condition to reverse, but it can be done if you are fully dedicated.

The vast majority of treatments will be up to you.  How committed you are to reversing this will determine your level of success.​

Trying just one or two steps in this guide will only give you limited success.

To ensure the best chance at success, you will need to incorporate as many steps as possible.​

Finding a​ doctor that understands leptin resistance and how to manage it will also be important if the first few steps are not enough to reverse the condition.

1.  Improve Your Diet​

Changing your diet is critical to reversing leptin resistance.​

– Get rid of all processed foods and eat only whole, natural foods.

The Standard American Diet is full of processed foods that increase inflammation in the body.

Inflammation causes the leptin levels to increase and only worsens the condition.​

Dietary changes alone will probably not drop your leptin levels to normal, but you will never be successful with reversing leptin resistance if you don’t change your diet.​

By the way, there is something very important that you need to keep in mind.  Too much protein can actually increase your leptin.​

Protein increases leptin by interacting with mTOR.​

Many of the currently popular low carb diets are also high protein, which can actually increase leptin levels!​

Carbohydrates cause an increase in insulin levels which signals the body to store fat and gain weight.

Eating protein increases mTOR levels which can also signal the body to store fat and slow metabolism.

Fat does not send such a signal to the body.​

It is therefore important to get 60% of your total calorie intake from good, healthy fats.

20% of your calories should come from high quality complex carb sources.

The remaining 20% of your calories should come from high quality, organic proteins.

Eating this way will allow all 3 levels to decrease – your leptin, insulin, and mTOR.

– No more calorie restricted diets!​

​It has erroneously been pounded into our brains that in order to lose weight, we need to reduce our calories.

Yes, we need to stop over-eating, but many times people take it too far.

​If you don’t eat enough calories, you body will go into starvation mode and lower your metabolism to conserve energy.

​If you do this long enough, you metabolism can get damaged permanently.

The best thing to do is listen to your body – if you’re hungry, eat.  When you’re full, stop eating.  However, be careful with this rule if your leptin level is high.

Quit paying attention to calories except to make sure you percentages of macros – carbs, proteins, and fats – are in the recommended levels.

– Try Intermittent Fasting

Another popular but wrong concept is eating several small meals throughout the day to keep your metabolism burning.  I have been guilty in the past of telling my patients this very thing.

In effect, eating multiple small meals increases the time our body spends processing calories.  This causes the insulin levels to surge which can ultimately lead to insulin resistance.

If you eat larger but less frequent meals, your body will spend more time without insulin which will sensitize it to the insulin and allow it to work more efficiently.​

This is called intermittent fasting – you eat the same amount of calories per day, but you eat it in fewer meals.

An example would be skipping breakfast 2 or 3 days per week. 

Remember, it’s important to still get your total calories in for that day.  That means lunch and dinner need to be larger than they would be if you ate breakfast.​

There are other types of intermittent fasting that are more effective, but I would recommend starting with this first.

2.  Start HIIT Exercise Training

Exercise is important to reduce leptin resistance, but doing the right type and amount of exercise is critical.

Going for a casual walk or bike ride are great for family time, but not so much for weight loss or leptin resistance.

Conversely, over-exercising can be just as harmful.  This is because if causes cortisol levels to rise, which affect insulin levels, which will make losing weight and lowering leptin difficult.

The best exercise for leptin resistance is High Intensity Interval Training (HIIT).

HIIT training has been shown to lower leptin levels – but it could take months.

HIIT training is simple to do and doesn’t require extra equipment.

Instead of just walking, try walking as fast as you can for about 30 seconds then drop back to a slow pace to allow your heart rate to come back down.  Once it does (usually about a minute later) repeat the process.​  Do this at least 5 times.

The same thing can be done on a bicycle, rowing machine, treadmill, elliptical, etc.​

The heart rate variability is what increases metabolism and helps lower the leptin level.​

If you are not currently exercising, make sure you take it slow so as not to cause a cortisol increase.

Start with 1 session per week for 10-30 minutes then increase your frequency and intensity as tolerated.  Let your level of fatigue be your guide to show you when it is time to increase.

3.  Improve Your Sleep

If you aren’t sleeping well, it will be much harder to lose weight.

Lack of sleep has been found to increase leptin levels and leptin resistance.

Getting good sleep will help to accelerate weight loss, while poor sleep will slow it down.

Sometime just breaking bad habits can make a huge difference.

For example, avoid caffeine or other stimulants in the evenings.

Set a consistent sleep schedule – go to bed at the same time every night and get up at the same time every morning.

Cut off all electronic stimulation (TV, phone, computer) at least 2 hours before bedtime.

Make sure you have a comfortable, supportive bed and a good, supportive pillow.

If that still isn’t enough, there are some great supplements that ​can help.

How to Supplement to Improve Your Sleep

Why I Like It

May help improve energy levels

May help to decrease levels of inflammation

May help reduce brain fog and mental slowness

Requires lifestyle change for best results

How to Tell if You Need It

    • You should be getting 8 hours of quality sleep every night.
    • If you find yourself waking up exhausted then you should consider checking for sleep apnea or a trial of the following supplements to improve sleep

How to Use

    • Take each supplement as indicated on the bottle or as recommended below
    • In addition to these supplements make sure you practice adequate sleep hygiene, that means: black out curtains for your bedroom, noise cancelling ear plugs, having a consistent sleep schedule, and avoiding all electronics 3 hours prior to your scheduled bed time

My Recommended Brand and Product

For minor sleep issues start with supplements containing 5-HTP which may promote proper melatonin production and induce sleep naturally (take 100mg 30 minutes before your scheduled bed time):

Get 5-HTP Here

For more difficult cases consider the addition of melatonin + 5-HTP, start with 1-3mg of melatonin and don’t be afraid to use melatonin if you need it.

Get 5-HTP and Melatonin Here

For more the most difficult cases consider using serotonin and GABA potentiators. These supplements help enhance GABA and serotonin neurotransmitters in the brain and help induce deep sleep.

Get GABA/Serotonin Potentiators Here

4.  Treat Insulin Resistance

As I discussed earlier, insulin resistance and leptin resistance are usually both present at the same time.

If you follow all of the steps in these leptin resistant treatment guidelines​, your insulin level will drop as your leptin level drops.

Several hormonal abnormalities have already hit by the time leptin resistance develops.

Since insulin resistance is present in about 50% of the population, chances are you may have it whether you know it or not.​

If your fasting insulin level is >5 and your hemoglobin A1c is > 5.3, you are already showing evidence of insulin resistance and are on the road to developing Type II diabetes if you don’t make the changes we have discussed.

You may want to consider using these supplements to help lower your blood sugar and insulin levels.

5.  Treat Thyroid Issues

– Is Your Thyroid Medication Correct?

As discussed earlier, elevated leptin causes an increase in conversion of T4 to reverse T3, which means less is converted to active T3.

Giving T4 thyroid medication to a patient with elevated reverse T3 only adds fuel to that fire.​

​That’s why the addition of T3 medication such as Cytomel or sustained release T3 can be very beneficial.  It allows you to completely bypass the whole conversion process.

This forces the active T3 levels higher and lowers the reverse T3 levels.

Reducing your T4 dose can also help by removing the substrate that is converted to reverse T3.  This includes T4 only medication like Synthroid but also NDT medication such as Armour Thyroid or Nature-throid.

– Improve your T4 to T3 Conversion

Many hypothyroid patients are deficient in nutrients that are essential for normal thyroid function.

By boosting these nutrient levels in the body, it can help with the conversion of T4 to active T3.

Supplementing for the 2 most common nutrients needed for T4 to T3 conversion can often be very helpful.​  Click on each to see my preferred brands.

    • Zinc – Zinc is a powerful anti-inflammatory and helps with the conversion of T4 to T3.  Use in doses of 30-60mg daily (60mg is best in leptin resistance).
    • Selenium – Selenium helps reduce inflammation, balance the immune system, and helps with T4 to T3 conversion.  Doses range from 200-400 mcg daily.

6.  Consider a GLP-1 Agonist

​Steps 1 through 5 of this Leptin Resistance Treatment Guide are critical to reduce leptin resistance.

However, they may not be enough to completely reduce the leptin levels back into the normal range.

It may require a certain medication for a short time.

GLP-1 agonists have been shown to dramatically reduce leptin levels and lead to significant weight loss.​

This class of medications includes Victoza, Byetta, Bydureon, Adlyxin, Tanzeum, and Trulicity.

These meds treat many of the issues that occur with leptin resistance:​

  1. They reduce leptin levels.
  2. They cause significant weight loss even in the absence of diabetes.
  3. They reduce the rise in leptin levels that often occurs after rapid weight loss which can help patients keep off the weight long term.​
  4. They reduce insulin resistance and blood sugar.

The medication may only be needed for a few months but will need to be monitored closely.

The trick will be finding a doctor that understands leptin resistance and how it relates to insulin and thyroid resistance and who is willing to prescribe it in this scenario.


Leptin is a largely unknown, but an extremely important hormone.

Leptin resistance is a common cause of obesity and a big reason why many people can’t lose weight and keep it off.

In order to improve leptin resistance, it typically takes a multi-faceted approach which includes diet, exercise, improving sleep, reducing insulin resistance, optimizing thyroid function, and even medication.

Only doing 1 or 2 of the steps in the Leptin Resistance Treatment Guide will most likely not be enough.

It is critical for you to find a doctor that is knowledgeable about leptin resistance who can walk through the treatment with you.

Now it’s your turn…

Do you think you may have leptin resistance?

Have you been diagnosed with leptin resistance?

What has helped you in your treatment?

Leave your comments below.

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The Best Hashimoto’s Thyroiditis Natural Treatments

What are some Hashimoto’s thyroiditis natural treatments?

What can you do to get rid of many of the symptoms of Hashimoto’s or even possibly make it go away altogether?

In this article, I will walk you through the most effective natural treatments for Hashimoto’s.

This will include common nutrient deficiencies that are present in Hashimoto’s and the supplements you should consider using.

I will also discuss the most common food sensitivities and dietary recommendations for Hashimoto’s.

Finally, I will touch on infections and toxins that may trigger or worsen Hashimoto’s.

Let’s get started…


ConsiderNutrient Deficiencies

Many nutrients are essential for normal thyroid and immune system function. A deficiency of them sets a person up for the development of conditions such as Hashimoto’s and other autoimmune diseases.

In our affluent society where there is generally no lack of food availability, how could anyone be deficient in nutrition? That doesn’t seem possible.

Several things play a role (taken from Hashimoto’s Thyroiditis Root Cause by Izabella Wentz):

  • Modern farming techniques Non-organic farming typically involved using fertilizers and pesticides. Also, a typical field is used year after year to plant the same crop, which will deplete the soil of nutrients.
  • Standard American DietThe typical diet eaten by most Americans contains highly processed, nutrient-deficient food.
  • MedicationsMillions of people take medications on a daily basis that affect the absorption of nutrients in the gut and alter the beneficial bacteria in our digestive system that are essential for normal digestion of food. These include acid blockers (omeprazole, ranitidine, etc.), antibiotics, and even oral birth control pills.
  • Food SensitivitiesMany people are sensitive to certain foods and may not even know it. The most common are dairy and gluten. These sensitivities cause an increase in inflammation of the digestive tract which can affect it’s ability to absorb nutrients.
  • Hidden InfectionsPatients may have infections they don’t even know they have. These include H. pylori, intestinal parasites, etc. All can increase inflammation and alter the normal gut flora which can impair nutrient absorption.
  • Restrictive DietsDiets that are not nutritionally balanced can do more harm than good.
  • HypothyroidismYes, being hypothyroid can itself cause nutrient deficiency by slowing the emptying of the stomach, reducing the amount of acid in the stomach, and even causing an imbalance of gut bacteria.

Common Nutrient Deficiencies in Hashimoto’s


Studies have shown that low levels of selenium can serve as a trigger for the development of Hashimoto’s.

You can become deficient because of gut issues (inflammation, altered gut flora) or even from gluten-free diets.

Symptoms of selenium deficiency include anxiety and hair loss.

Taking selenium will reduce thyroid antibody levels and anxiety symptoms.

Studies have shown that selenium supplementation is helpful even if the selenium levels are normal.

How to Supplement with Selenium

Why I Like It

May reduce antibodies in patients with Hashimoto’s

Also acts as an  anti-inflammatory

May help reduce anxiety symptoms

Helps boost T4 to T3 conversion (helpful in those with high reverse T3)

Who Should Use It

    • Patients with hair loss or hair thinning
    • Patients with a known thyroid disorder and hair loss
    • Patients with other nutrient deficiencies like zinc or iodine
    • Patients who frequently take acid blockers for acid reflux
    • Patients with other GI related issues (IBS, gas/bloating, IBD)
    • Patients also taking zinc

How to Use

    • Take 200-400 mcg per day (do not exceed 400 mcg daily)

My Recommended Brand and Product

Get Selenium Here


Ferritin is the iron storage protein. It is essential for transporting thyroid hormone into the cells.

Lack of ferritin causes hair loss, fatigue, cold intolerance, and shortness of breath.

Ferritin levels should be checked in all Hashimoto’s patients, especially those that are experiencing hair loss.

The optimal ferritin level for thyroid function is 90-110 ng/ml.

Iron levels can best be restored by eating foods high in iron such as meats, especially organ meats. Vitamin C also helps with iron absorption.

Sometimes, supplementation may be necessary at least for awhile.​

How to Supplement with Iron

Why I Like It

May boost energy levels

Up to 50% of Hypothyroid patients are deficient in iron

Helps promote thyroid conversion & function

Generally works within 1-2 months

How to Tell if You Need It

Check your iron studies and only supplement if your levels are sub optimal or low:

  • Ferritin – Optimal Levels = 40-50
  • Serum Iron – Middle of the reference range
  • TIBC (Total Iron Binding Capacity) – Middle of the reference range
  • Percent Saturation – 35-38%

How to Use

  • Liquid Iron:  start with 10 ml each day, do not exceed 20 ml per day (if you take more than 1 dose per day make sure to split it apart from one another and take at least 4 hours away from your thyroid medication)
  • Iron Capsules:  start with 1 capsule of iron and increase up to 3 per day as tolerated and based on your serum iron/ferritin levels (take at least 4 hours away from your thyroid medication)

My Recommended Brand and Product

Use liquid iron if you have intestinal issues such as gas, bloating, diarrhea, constipation or if you have previously failed capsule forms of iron:

Get liquid iron here

Use this capsule form if you don’t tolerate the liquid iron version above (some patients have various symptoms on liquid iron such as teeth pain or simply can’t tolerate the taste or texture of the liquid):

Get iron capsules here

B Vitamins

B vitamins are commonly deficient in Hashimoto’s patients, especially B12.

This is due primarily to low stomach acid which is common in Hashimoto’s.

Signs and symptoms of deficiency include fatigue, grooves in your tongue, and an elevated homocysteine level (which should be less than 6 umol/L.

All Hashimoto’s patients should have their B12 level checked.  If it is <1000, they should consider supplementing.​

By the way, over 60% of the population has a gene mutation in the enzyme MTHFR, which can impair the body’s ability to metabolize B vitamins. This can cause the homocysteine level to become elevated, which is a risk factor heart disease and other conditions.

It is important for these patients to take a methylated form of B vitamins, especially folic acid. If you don’t know if you have the gene mutation, either get tested or take a methylated B vitamin. My recommended brand can be found here.

You should also consider supplementing with B12 shots.

Many Hashimoto’s patients have GI issues that can impair the absorption of nutrients.

Completely bypassing the GI tract by giving it in shot form is the best way to ensure that the B12 is absorbed as much as possible.​

How to Supplement with B12 Shots

Why I Like It

May boost energy and reduce fatigue

May help increase metabolism and fat loss

Help improve mood and increase concentration

Generally works within 1-2 weeks

How to Tell if You Need It

Patients with the following symptoms should consider using B12 shots:

    • Obesity or weight gain
    • Fatigue or low energy levels
    • Lack of sleep or insomnia
    • Depression or anxiety
    • Hair loss or lack of hair growth
    • Serum B12 levels < 1000
    • Homocysteine levels > 9
    • MCV (mean corpuscular volume) > 92
    • High levels of inflammation

How to Use

    • Take 5,000 mcg of Methylcobalamin every 7 days for at least 10 weeks
    • You will need 10 weeks worth of injections to saturate tissues and increase cellular B12 levels

My Recommended Brand and Product

Make sure you get methylcobalamin shots in a high enough dosage for best results.


Zinc is essential for normal thyroid function. Most patients with thyroid disease are deficient.

Zinc is not stored in the body, so a consistent daily intake is required to maintain levels.

Zinc deficiency can be detected by a low alkaline phosphatase level, which is a routine lab tests run by most labs. It’s optimal range should be 70-90 U/L.

How to Supplement with Zinc

Why I Like It

Many people are deficient in zinc

May help with T4 to T3 conversion

May increase cellular sensitivity to thyroid hormone

Has anti-inflammatory effects

How to Tell if You Need It

    • If you have Hashimoto’s and hair loss
    • If alkaline phosphatase is < 70

How to Use

    • Take 30-60 mg daily (do not take more than 60 mg)

My Recommended Brand and Product

Get Zinc Here

Vitamin D

Vitamin D is essential for normal thyroid function.

Studies show that over 40% of the population is deficient. However, that study defined deficiency as a 25-hydroxy vitamin D level of less than 20 ng/ml. Other studies show that a level of 60-80 ng/ml is needed for optimal thyroid function. When using those levels as “normal,” over 90% of the population is deficient.

Low levels of vitamin D have been shown to increase the risk for development of Hashimoto’s.

All Hashimoto’s patients should have their 25-hydroxy vitamin D level checked yearly.

Most patients need at least 5000u per day of vitamin D3 with K2 such as this one.

How to Supplement with Vitamin D3

Why I Like It

Most people are deficient in Vitamin D

May help with T4 to T3 conversion

Deficiency increases risk for Hashimoto’s

Has over 200 functions in the body

How to Tell if You Need It

    • 25-hydroxyvitamin D level < 50

How to Use

    • If < 40 take 10,000u daily for 90 days, then drop to 5000u daily.
    • If > 40, take 5000u daily
    • Check level yearly

My Recommended Brand and Product

Get Vitamin D3 Here


Iodine can be listed under both toxins and essential nutrients for normal thyroid function.

That’s because a deficiency of iodine is the world’s leading cause of hypothyroidism.

However, excessive amounts of iodine can increase the risk of the development of Hashimoto’s.

This means iodine has a small therapeutic window – Too little is bad, but too much is also bad.

Hashimoto’s was rarely seen in the United States until the nationwide salt iodinization program began in 1924.

​Some people fear that using iodine in patients with Hashimoto’s may make the condition worse, and it can – but usually only in patients with other thyroid issues and those on medications that are known to interfere with thyroid function (lithium, amiodarone, etc.).

In the majority of cases, and if used correctly, iodine can be safe to use in patients with both hypothyroidism and Hashimoto’s.

Taking the iodine with selenium can help prevent any negative effects – such as an increase in thyroid antibodies that has been shown to occur in some studies.

Supplementing with both selenium and iodine has been ​shown to reduce TSH and result in an increase in peripheral thyroid hormones and may protect against an increase in thyroid antibodies in patients.

Patients with thyroid issues like Hashimoto’s usually tolerate iodine, but it must be accompanied with normal and optimal selenium and iron levels.

If you decide to take iodine, make sure your thyroid antibodies are checked regularly by an experienced provider.

How to Supplement with Iodine

Why I Like It

May improve thyroid function

May help detox some substances

If deficient with improve other systemic problems

Generally works very quickly in deficient patients

Who Should Use It

Supplementing with iodine can be difficult.

If possible I recommend testing your urinary excretion of iodine prior to supplementation.  If you decide not to test yourself then start out at very low doses (~200-300mcg per day) and slowly increase the dose based on your symptoms.

How to Use

    • Take 200-300 mcg per day and slowly titrate dose based off of symptoms – discontinue if you experience any negative side effects and seek professional help
    • It is safest to take it with selenium 200-400 mcg daily

My Recommended Brand and Product

For low doses start with 200-300 mcg of kelp caps and titrate your dose as tolerated:

Get Iodine Here (low dose)

For higher doses I recommend liquid iodine with a combinations of both iodine and iodide:

Get Iodine Here (high dose)

Look For Food Sensitivities

So, what foods should you eat? What foods should you avoid?


Everyone by now how has heard about this mysterious gluten molecule that seems more dangerous than a nuclear weapon. Why is it so bad?

Multiple studies such as this one have shown a strong link between Hashimoto’s and gluten intolerance.

There is a higher incidence of Celiac Disease in Hashimoto’s patients. However, even people that test negative for gluten antibodies can still react to it.

Some researchers estimate that up to 1/3 of the population has some degree of gluten sensitivity.

It is believed that gluten looks similar to parts of the thyroid gland. This causes the immune system to make antibodies against the thyroid because of molecular mimicry like I discuss​ under Consider Infections below.

Gluten also worsens intestinal permiability (leaky gut).

Gluten is a component of wheat, so it is present in pasta, breads, crackers, etc. Gluten is also frequently used as a filler in other foods and is commonly found in things such as shampoo, makeup, etc. It is even present in some medications!

The most simple and cost-effective way of determining if you are gluten sensitive is using an elimination diet. In other words, remove it completely from your diet for about 3 weeks. After the 3 weeks are over, re-introduce it into your diet. If you have any kind of reaction – nausea, diarrhea, dizziness, fatigue, etc. – you are most likely gluten sensitive.

To top it off, the immune response to gluten can last for up to 6 months after eating it!

That is why it is critical to follow a gluten-free diet 100%. Anything less may not reduce the thyroid inflammation adequately to prevent the Hashimoto’s from killing it.

There is enough data for me to feel confident in recommending a gluten-free diet in all Hashimoto’s patients.

Actually, I believe there is ample evidence to suggest that everyone should be gluten-free.

This has fortunately gained enough traction in society that becoming gluten-free is much easier than it was just a few years ago.

A quick internet search will uncover multiple websites with recipes and other information to help you in this journey. Many grocery stores also have sections featuring gluten-free products.

If you want to read more about gluten, I highly recommend the book Wheat Belly by Dr. William Davis.

By the way, removing gluten from my diet was the single most effective therapy that brought me back to a life of health.

Other Food Sensitivies

About 90% of food sensitivities occur from the following foods:

  • Wheat
  • Milk
  • Soy
  • Eggs
  • Peanuts
  • Tree nuts
  • Shellfish
  • Fish

Tomatoes, potatoes, peppers, corn, citrus, beef and pork can also cause problems in some people.

Your doctor can order a basic food allergy panel which will check most of these common food allergies. If you test positive, you know that you need to remove that food from your diet.

Remember, however, that you may still be sensitive to that food even if you don’t have antibodies to it.

There are also tests available to check for IgG antibody levels to various foods.

As I discussed under gluten, the most simple way for you to find out if you have any food sensitivities is to use the elimination diet.

You can either remove one food at a time for 3 weeks, then reintroduce it and see if you react. This process could take 6 months or more to get through all of the foods. Or, you can bite the bullet and remove all of the top 8 culprits together for 3 weeks, then reintroduce each one separately every few days. If you react, keep that food out of your diet. If you don’t react, you can continue to eat it then reintroduce the next one on the list.

Get On An Anti-inflammatory Diet

The goal for Hashimoto’s is to reduce the level of inflammation in the body, especially the thyroid.

One of the best ways of accomplishing that goal is to remove inflammatory foods.

The Most Inflammatory Foods

  1. Gluten
  2. Sugar
  3. Dairy
  4. Vegetable oils
  5. Artificial sweeteners and preservatives
  6. Saturated fats

Removing these things from your diet will have a HUGE impact on your health, including your thyroid health.

There are several popular diets that are excellent at removing these things and giving you instruction on what you can eat.

The best diets for Hashimoto’s are:

Any of these diets will have you eating clean, whole foods and reducing your systemic inflammation quickly.

It can take several months for the inflammation to reduce substantially, so don’t give up!​

Remember, even though you start one of these diets, you may still need to do an elimination diet to help you determine what food sensitivities you have.

Get Your Gut Healthy

1.  Betaine HCL with Pepsin

​Advertisements from pharmaceutical companies make it seem like almost everyone has too much stomach acid.

In reality, it’s exactly the opposite.

Most patients have low levels of stomach acid.  That includes almost all Hashimoto’s patients.

When stomach acid is low we can’t absorb nutrients as well.

The lack of acidity also makes it easier for bacteria and other organisms to survive their passage through the stomach and set up residence somewhere in the body, causing an infection to develop.

Adding betaine hcl with pepsin can help increase the stomach acid to optimal levels and relieve many of the reflux and other GI symptoms you may be having.​

​Betaine HCl and Pepsin should be taken after a protein-rich meal, starting with one capsule per meal, at the end of the meal. The dose should be increased by one more capsule at each meal until symptoms of too much acid are felt (burping, burning, warming in the stomach region, etc.). At that point, you will know that your dose is one capsule less than what resulted in symptoms.

​If you get burning after taking it, drinking a mixture of one teaspoon of baking soda in a glass of water will reduce these temporary symptoms.

Don’t take betaine hcl is you have a history of ulcers or if you are taking an NSAID or steroid medication.​

My favorite brand of Betaine hcl with Pepsin is this one.​

​2.  Probiotics

Most hypothyroid and Hashimoto’s patients have some degree of intestinal dysbiosis (usually due to decreased kinetic movement of the bowels from lack of thyroid hormone).

​As a result many Hypothyroid patients are prone to develop a condition known as Small Intestinal Bowel Overgrowth (or SIBO).

Patients with SIBO tend to get gas and bloating with lactobacilli-based probiotics but can usually tolerate soil-based probiotics well.​

That’s why it’s usually best for most Hashimoto’s patients to use a good soil-based probiotic such as this one.​


Various infections have been implicated in the development of autoimmune diseases, including Hashimoto’s.

There are 2 main theories of how these infections trigger the immune system to attack the thyroid gland.

  1. Molecular Mimicry – In this theory, bacterial cells or other microbes look very similar to cells within our body (such as thyroid cells). Our immune system produces antibodies to kill the microbes, but since they look like our own cells, the end result is the antibodies produced attack the cells in our body instead of just the microbes.
  2. Bystander Effect – Another theory suggests that the microbes (especially viruses) take up residence in the cells of our body. In the process of killing the microbes, our immune system also damages the cells in our body where the viruses are residing.

The most common organisms associated with Hashimoto’s are Mycoplasma, Candida, and Epstein-Barr virus.

Other organisms implicated include Helicobacter pylori, Lyme disease, Yersinia, Coxsackie virus, and Hepatitis C. Intestinal parasites may also be present.

Low stomach acid, nutrient deficiencies, altered gut bacteria, and an impaired immune system all contribute to Hashimoto’s patients having an increased risk of having any of these infections.

If you aren’t improving despite following a strict diet and restoring any nutrient deficiencies that are present, that is the time to start looking for hidden infections or toxins.

Avoid Toxins

Unfortunately, our world is full of chemicals and other substances that can be harmful to us, including our thyroid gland.

An example of these are the endocrine disruptor chemicals (EDC). They are everywhere and are impossible to completely avoid.

Some types of them are even stored in the fat calls of our body. This is bad because if we start burning fat as an energy source (which happens in the diets listed above), many of these stored chemicals are released. They can worsen thyroid function and stop weight loss.

An example of an EDC that is controversial is fluoride. It has been added to many water supplies since the 1940s because it reduces the incidence of tooth decay. However, fluoride can be toxic to thyroid cells and can cause inflammation and even thyroid cell death.

There are a few common sense things that we all can do to at least reduce the amount of exposure to endocrine disruptor chemicals:

  • Drink filtered water
  • Drink from glass or metal containers (avoid plastic bottles)
  • Install a shower head filter such as this one.
  • Use a non-fluoride toothpaste.
  • Avoid using herbicides on your lawn or plants (Google “Homemade Weed Killer” for safe alternatives).

You can also help your body get rid of toxins by doing one simple thing – Sweat!

Sweating is one of our body’s best detox mechanisms.

Regular time in a sauna and high intensity interval training (HIIT) are 2 excellent ways of activating our sweat function.


There are several natural treatments that you can do to improve your Hashimoto’s symptoms.

Considering potential nutrient deficiences and taking targeted, high-quality supplements is critical.

It is also very important to identify any food sensitivities that you may have by utilizing the elimination diet.

Increasing your stomach acid and taking a good probiotic can help to increase nutrient absorption and improve your immune system.​

Infections and toxins can also be playing a role in your autoimmune condition.

Now it’s your turn.

Are you appropriately supplementing for any deficient nutrients?

Do you have any food sensitivities?

Have you identified any infections or toxins that may be worsening your Hashimoto’s?

Leave your comments below!

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The Best Natural Treatments for Adrenal Fatigue

Are you constantly tired no matter how much you sleep?

Do you get overwhelmed by stressful situations that you could handle in the past?

Is it hard to get out of bed in the morning even after a long sleep?

Do you depend on caffeine or sugary drinks just to get through the day?

If you answered yes to any or all of these questions, there is a strong chance that you are dealing with adrenal issues, particularly adrenal fatigue.

In this article I will discuss the symptoms of adrenal fatigue and how to diagnose it.

I will then walk you through the best natural treatments for adrenal fatigue and lifestyle changes that will help you regain your energy and your life.

Here we go…


What is Adrenal Fatigue?

So what is adrenal fatigue? 

When the body is under stress, the adrenal glands will release hormones such as cortisol, DHEA, and epinephrine.

These hormones regulate heart rate, the immune system, energy storage, and more.

Cortisol is our “stress hormone.”  When its levels are elevated, that signals the mitochondria in our cells to increase energy production to help us get through whatever stress is occurring.

When the body is functioning correctly, the cortisol will only be elevated for a short period of time then drop back to the normal pre-stress levels.

However, under high stress situations such as chronic illness, relationship issues, death in the family, a job you hate, and others, the cortisol level remains high for an extended period of time.

Eventually, the adrenal glands will be unable to keep up with the cortisol demands and the levels will drop.

Energy production in the cells decreases, which causes symptoms of fatigue.

These people often resort to consuming large amounts of caffeine, sugar, or other stimulants just to get through the day.​

This is what we call adrenal fatigue.​

If something causes ​the adrenals to essentially stop all cortisol production (such as autoimmune disease or other damage), it can be life-threatening.  This is called adrenal insufficiency or Addison’s Disease.

These patients require oral steroid replacement in order to live.​

On the other hand, Cushing’s Disease is a syndrome that causes an incredibly high amount of cortisol in the body which leads to many serious and potentially life threatening conditions.

As a general rule, conventional medicine does not recognize any adrenal issues until it reaches one of these extreme levels.

If your cortisol levels are in the normal reference range of the labwork, you will be told you are “normal” and sent on your way.

Like other hormones in the body, small changes to concentrations of these hormones can lead to big symptoms that are felt throughout the body.

People with suboptimal levels of cortisol can have significant symptoms that affect their quality of life, so it deserves our attention.

There are 4 basic stages of Adrenal Function/Dysfunction:​

    • “Surviving” – In this scenario, the normal cortisol slope is absent because of increased cortisol production. (This is actually MY cortisol curve during a very stressful time of my life)
    • “Thriving” – Cortisol production is normal.
    • “Wired and Tired” – The cortisol levels are high during the day then drop during the evenings.  That makes you feel anxious in the morning then exhausted by evening.
    • “Crashed Stage” – The adrenal gland is no longer able to keep up with the cortisol demands so the levels drop very low.  Extreme fatigue is the predominant symptom.

Cortisol has been shown to increase insulin resistance.  It also worsens leptin resistance.

Elevated cortisol also promotes hypothyroidism.

All of this leads to weight gain and lack of energy.

Adrenal Fatigue Symptoms

Symptoms that suggest you have adrenal problems and that you may need to get your cortisol level evaluated include:​

These symptoms indicate a problem with energy production and adrenal issues.

Remember, cortisol is a “stress hormone” and is typically secreted in to response to a perceived stress.

These stressors can include:

    • Frustration or emotions related to your job, work or social life
    • Over-exercising
    • Anything that is physically stressful on the body (exercise, manual labor, etc)
    • Lack of sleep (especially if prolonged over months or years)
    • Pressure of school work/work load
    • Poor diet or food choices (especially diets lacking in fruits and vegetables)
    • Constant use of stimulants such as caffeine
    • Complete lack of exercise or sedentary lifestyle
    • Chronic medical conditions (high blood pressure, insulin resistance, chronic pain, etc)
    • Recent illness
    • Anything else that causes your annoyance, frustration or stress

Please note that many of these symptoms are non-specific and can also indicate that something else is going on in the body.

That is why it is important to get a thorough evaluation by a qualified medical professional.

How to Diagnose Adrenal Fatigue

So how do you diagnose adrenal fatigue, especially if your labs fall in the “normal range?”

There are several ways to test for cortisol available.  Some are better than others.

I’m going to discuss the ones that I think are best.

It is easiest to start with a serum cortisol level.

This test can be very frustrating because is has a very large “normal” reference range.

However, it’s cheap and usually easy to get. 

Levels that fall in the middle of the reference range will not be particularly helpful, but it can show us a lot if it falls in the low normal or high normal of the range.​

So what is low normal or high normal?

    • Low normal cortisol range – 8am serum cortisol levels ranging from 4 to 10
    • Normal cortisol range – 8am serum cortisol levels ranging from 11-18
    • High normal cortisol range – 8am serum cortisol levels greater than 20

​It is important to check your serum cortisol level at 8am because that is when it is at its ”peak” level.

This represents the highest level your cortisol will be throughout the day.  If it’s already low normal at 8am, it will only get worse from there.

In order to get a full evaluation of your cortisol levels it may be necessary to evaluate the “rhythm” of your cortisol throughout the day. ​

By checking your cortisol several times per day you can accurately see how your body is responding to various situations.

This allows for more detailed information which can then be used for treatment.

The most accurate form of testing is through urinary measurements taken several times throughout the day (compared to a 24 hour urine test).

This is even more accurate than salivary levels.

My favorite is the DUTCH test.​

With the DUTCH test, you check your urinary cortisol levels 4 times throughout the day.  This gives a much better representation of how your cortisol level is trending.

Although this test is the best, it is expensive and more difficult to perform.

So should every patient that we suspect has adrenal fatigue have their urinary cortisol level tested?  No.

I would recommend starting with an 8am serum cortisol level.  Depending on what it shows, then moving to a DUTCH test may be necessary.

It is also worth doing a trial of treatment if your levels are “normal” but you are still symptomatic with several of the symptoms I discussed earlier.​

Natural Treatments for Adrenal Fatigue

So based on your symptoms and perhaps a low normal serum cortisol test or even an abnormal DUTCH test, you have been diagnosed with adrenal fatigue.

What can you do about it?

Actually, there are a lot of things that you can do.

Many of them are common sense.  Others are more targeted treatments that will depend on which stage of adrenal dysfunction you are in.

For now, let’s divide into 2 main groups – those that have low cortisol levels and those that have elevated cortisol levels.


Treatment for Low Cortisol (“Wired and Tired” and “Crashed”)

Click on each supplement to see my recommended brand.

    • Adrenal glandulars:  These work best for patients with very low cortisol levels.  They also tend to provide an immediate boost to energy levels.  Using glandulars in combination with other supplements listed below may be necessary.  Should be used for 6+ months.
    • Adrenal Adaptogens:  Adaptogens can actually help to lower cortisol levels when they are high and some can even raise cortisol levels when they are low.  There are many types of adaptogens but I find that blends of multiple adaptogens tends to work best.  These can be combined with glandulars as well for more benefit.  Should be used for at least 3 months.
    • CoQ10:  This coenzyme is involved in proper mitochondrial energy production and can help increase energy levels, which can be very helpful in adrenal-related issues.  Use 2 capsules (240mg) per day for several months.
    • Alpha Lipoic Acid:  ALA helps increase mitochondrial energy production, acts as a powerful antioxidant, reduces peripheral neuropathy, and lowers inflammation.  ALA can also help with weight loss due to its effects on insulin.  Start at 600mg daily and increase up to 1800mg daily as tolerated.
    • Vitamin B6:  Vitamin B6 is used in several pathways in the creation of adrenal hormones and many patients are deficient in it.  Taking higher doses of B6 during the acute phase of treatment may be necessary for a short period of time.
    • DHEA:  DHEA is the precursor to testosterone and other estrogen metabolites.  With low cortisol and low adrenal hormone production, supplementing with hormone precursors may be of benefit.  Start with a low dose every 2-3 days and increase to daily as tolerated.  Be careful because DHEA can turn into androgens or estrogens in high doses.
    • Pregnenolone:  Pregnenolone is another hormone precursor and can be helpful if used along with DHEA.  Watch out for acne as a side effect and like DHEA, start low and go slow.  The use of these hormones may be necessary for 3+ months.

​Treatment for High Cortisol (“Crashed” stage)

    • Phosphatidylserine:  Phosphatidylserine has been shown to reduce cortisol levels if taken in doses up to 600mg per day.  Use 4-6 capsules at night (each capsule is 100mg) and recheck cortisol levels in 2-3 months.
    • Ashwagandha:  Ashwagandha is an adaptogen that can actually help to lower cortisol levels when they are high and raise them when they are low.  It also can boost libido and may help with weight loss. It can also reduce anxiety symptoms caused by chronic stress.  Doses vary from 500-2000mg per day depending on tolerance and severity of symptoms.
    • Melatonin:  Melatonin has been show to reduce cortisol levels and may actually help improve your sleep at night.  Even if you are sleeping well, melatonin can still help reduce cortisol levels and should be considered.  It can also help with depression symptoms.  Doses vary from 1-3mg, but most people tolerate 3mg well.

Other Treatments

Using supplements alone will not be enough to adequately treat your adrenal fatigue and increase your energy level.

​It will be critical for you to make the necessary lifestyle changes as well.

Why?  Because your lifestyle is what got you here to begin with!

If you don’t learn how to reduce stress, get better sleep, and eat better, your adrenal fatigue symptoms will eventually return.

On the flip side, if you make the necessary changes in these areas, it will result in long term improvement for you.

Stress Management

Boy, this one is easy to say but hard to do!​

However, there is nothing you can do that will be more important to your success than learning how to better manage your stress.

​If there are stressors in your life that you can remove, then that should be a priority.

That may mean changing jobs, avoiding certain unhealthy people, or selling your kids (just kidding).

Unfortunately, there may be several stressors that can’t be removed, such as a sick family member, issues raising children, or others.

If that is the case, then you need to learn tactics that will help you manage stress and reduce its impact on your quality of life (and your cortisol!).

These stress reduction strategies can include:

    • Relaxation exercises such as yoga
    • Spend 20 minutes per day in prayer or meditation
    • Start doing something you enjoy (hobby, sports, etc)
    • Go outside!  Walking or hiking in nature can do wonders for our stress
    • Count your blessings and write them down.  It’s easy to get caught up in the negative cycle of only focusing on the things that are wrong in our lives.
    • Do something good for someone else without expecting anything in return, especially for someone less fortunate than you.
    • Donate your time or money to a worthy cause.
    • Make yourself smile everyday (even when you don’t feel like it)

Quality Sleep

I cannot stress enough how important it is to get a good night’s sleep every single night.

Your quality of sleep directly impacts your melatonin production when then impacts your cortisol level.

Lack of sleep also increases inflammation in the body and ​causes weight gain.

If you deal with sleep issues or insomnia, then this needs to be a priority for you.

You should be getting a minimum of 8 hours of sleep per night.

When you wake up, you should feel refreshed and energetic.

If this doesn’t describe you, then you need to make some changes.

These changes include:

    • Go to bed at the same time every night and get up at the same time every morning
    • No electronics (TV, phone or computer) for a least 2 hours before bedtime
    • Keep your bedroom cool and dark
    • Avoid stimulants (especially in the evenings)
    • Use supplements if necessary.  I discuss them in more detail in my article The Leptin Resistance Treatment Guide.


Diet is the most basic and one of the first things you should do to improve your energy and normalize your cortisol.

Something as simple as cutting out sugar and refined carbohydrates can do wonders for you.

Basically, you should focus on eating whole, natural foods and avoid processed food.

A simple question to ask yourself is, “Is this food natural or processed?”  Obviously, choose natural food.

In some cases, more stringent dietary instruction may be needed, but for now just realize that you HAVE to eat a healthy diet to increase your energy levels.

I would recommend starting with a good, whole food diet such as the ​Whole 30 diet or the Paleo Diet.


​There are definitely things that you can do to help you feel better and give you more energy if you have adrenal fatigue.

Start by checking your serum cortisol level along with other hormones such as insulin, leptin, and a complete thyroid panel.  You may want to consider urinary cortisol levels after the initial blood tests.

Once you have a clear picture about which stage of adrenal dysfunction you are in, supplements can be used to target your specific cortisol issues as well as other hormonal imbalances.

Appropriate lifestyle interventions will also be crucial for your success.  These include diet, stress management, and improving your sleep.

It is important to remember that correcting adrenal issues is not a quick fix – It may take 6 months or even longer.

​Be consistent and patient.  You can do it!

Now it’s your turn…

Do you have adrenal fatigue?

What supplements have you used?

Has your treatment been successful?

Leave your comments below.

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