Low Temperatures, Despite Thyroid Supplementation (Cynomel / Cynoplus)?? What Gives??

[BigShoes]

Hello all,

My temps are still low despite taking a pretty hefty daily dose of cynomel and cynoplus. I commenced use in c. March 2023 (3 months ago) on a pretty low dose (10mcg T3, 20mcg T4 - 1/6 of a cynomel and cynoplus), and gradually, gradually increased the dose over time. I was advised by the D-Rod (at least, to my understanding) to gradually increase the dose 'til I saw a relief in symptoms - staying on the same dose for at least 2-3 weeks before increasing as needed, or possibly even a touch longer, to ensure that I did not tip into hyper-.

I have just recently increased the dose to what is now a pretty hefty sum (c. 30mcg T3 and 90mcg T4) - almost complete thyroid replacement - but am observing low temps.

TIMELINE

I basically went: 1/6 of both a cynomel and a cynoplus tab, to 1/4, to 1/3, to 1/2, and now pushing cynoplus (the t3/t4 combo) even higher to 3/4.

When I first moved up to c. 1/4 to 1/3 of each, I noticed a pretty good increase in temperatures within a week or so. Some indications from March:

Things were looking good temperature-wise. However, I did not notice any meaningful improvements in any of my hypo- symptoms at all... being: dry brittle hair, hair falling out, puffy face / puffy eyes and water retention, low energy / lethargy / tired all the time, poor digestion, poor sexual function, cold hands / feet / nose and other circulation issues (leg veins don't look healthy - not varicose yet, but don't look to be flowing well), other estrogenic symptoms (gyno c. the size of grapes, hips, spider veins beginning in places), terrible vitiligo, and many more.

I spoke to the D-Rod way back in March to say basically that "my temps seem to have increased quite nicely, but none of my symptoms are improving... what gives?" To which I was given the advice (to my understanding): "dose to treat symptoms, not just temps" i.e. if I still have hypo- symptoms (on the comparatively low dose of 1 grain that I was on) then I may still need to increase the dose (i.e. system still did not have adequate thyroid hormone).

So this is exactly what I did. Gradually, gradually increased the dose making sure not to tip into hyper-... only now I am at almost complete thyroid replacement, with very little improvement to any hypo- symptoms.

I started taking temps again in the past couple of weeks and am back in the low 97s, which is exactly where I was prior to thyroid replacement. This morning's reading:

and this was after a few tries - even got a 96.9.

Any advice on why this could be? I think this needs to be cracked before I will ever start to feel better.

Current Areas of Investigation:
Gut Health
- Possibly not absorbing the thyroid I am ingesting for some reason... Possibly low grade gut infection / endotoxin... antibiotics?? I have 2 weeks worth of doxycycline (in the UK, I had to tell the pharmacy I had chlamydia to get them - thanks for the tip @Herbie ! hahaha) , but am unsure whether to take them for two reasons: (1) they could upset the balance of the gut and allow the more resistant bacteria to take hold, leading to worse problems. (2) they can actually worsen mitochondrial function, and hence, metabolism (not sure how short vs. long term this impact would be).

Not sure what else it could be...

I have searched the forum and found a few threads with similar issues - but it seems to be a highly individual thing and difficult to find a "protocol" of things to check for.

----------------------------------------------------------------------------------------------------------------------------------------------------------------

Other Guides:

PROFILE

32M, 180lbs (82kg), 6 ft 1 (186cm), c. 12-15% body fat

FOOD

I eat pretty similarly every day. Approx:
- 1/2 lb / 250g of meat (usually beef) (c. 500kcal)
- 500ml goat milk (c. 300kcal)
- 2 eggs (c. 150kcal)
- 1 oz / 30g cheese (I can't digest any more than that - constipation) (c. 125kcal)
- 25g beef gelatin
- c. 300g well-cooked potatoes and white rice with my evening meal (c. 300kcal)
- OJ, Cola, honey, gummies / other sugar delivery mechanism ad libitum - I'd say at least 1.5L of juice / cola and whatever, plus minimum 100g sweet sugars (c. 1000kcal BARE minimum - more like 1500kcal)
- A bunch of extra table sugar in. milk etc. (c. 50-100g of table sugar) (200-400kcal)
- Random pickings / grazing at other things - prawns, sausages, vanilla ice cream, fruit (grapes) whatever takes my fancy
- Calves liver once per 1-2 weeks (I can't find good liverwurst to have a small amount daily), occasional oysters

I would say c. 3000kcal is a good estimate, but I don't really measure (the above is an estimate) and never think about portion control anymore. I don't force-feed, but I don't restrict. When I'm hungry, I eat.

MOVEMENT

Fairly sedentary throughout the day. Lots of WFH. At least one gentle walk outside daily though. I also do one single set of one weight lifting exercise every day (Monday Chinups, Tuesday Shoulder Press, Wednesday Lunge etc. etc.) - muscles are being worked, but very low volume and 1 week to recover.

SLEEP

My sleep is not great tbh. I often get to bed too late (old habits die hard), and can take some time to get to sleep. However, I always sleep through the night and always wake up without an alarm. Never wake up feeling rested though.

SUPPS

Thyroid, Fat solubles: D3 (3000IU), K2 (2mg), experimenting with small amounts of vitamin E (100IU max)

 

[Jennifer]

Things were looking good temperature-wise. However, I did not notice any meaningful improvements in any of my hypo- symptoms at all... being: dry brittle hair, hair falling out, puffy face / puffy eyes and water retention, low energy / lethargy / tired all the time, poor digestion, poor sexual function, cold hands / feet / nose and other circulation issues (leg veins don't look healthy - not varicose yet, but don't look to be flowing well), other estrogenic symptoms (gyno c. the size of grapes, hips, spider veins beginning in places), terrible vitiligo, and many more.

Have you been under more stress than usual? If so, could you finally be taking enough thyroid to have lowered adrenaline that was falsely elevating your temp? Do you know what your pulse was prior to and after upping your dose? Given your hypo symptoms and cold extremities, I’m wondering if your lower temp may be revealing a low basal metabolic rate. Some email exchanges with Ray that might resonate:

Thyroid Supplementation Doesn't Help / Causes Issues​

T3, by lowering stress, sometimes reveals a low basal metabolic rate, that was hidden by high stress hormones. The body produces about 4 mcg of T3 per hour, so taking more than that can interfere with regulatory processes. It's helpful to use the resting pulse rate, and the 24 hour temperature curve, along with other signs, such as mood, appearance of veins on the hands, etc. The peak temperature should be in the afternoon.

The temperature rise during the day is the most important thing, since nocturnal stress hormones can give a misleading impression in the morning. Resting pulse rate is another good indicator. Milk and cheese are the best calcium sources.

If you are eating enough protein, about 100 grams, and salt and thyroid, then I would consider the steroids--something might be interfering with your production of pregnenolone and DHEA. Things that could do that would be very low cholesterol, or a deficiency of vitamin A (retinol), or possibly other deficiencies.

If your cholesterol is above 200, and the thyroid supplements didn't warm you up, it's possible that something is interfering with your steroid synthesis, which might be a deficiency of something like vitamin A, or interference from something like iron or carotene. Have you tried a supplement of pregnenolone or DHEA? Were any other hormones, such as prolactin, measured? If you are taking the aspirin regularly, you should make sure to get vitamin K, from kale, liver, or a supplement. Anemia, like cold feet, is a common sign of low thyroid function.

I occasionally see that happen [T3 WILL CAUSE LOW TEMP/PULSE]; sometimes people have had their pulse rate decrease 40 or 50 beats per minute. The temperature of your fingers, toes, and nose helps to interpret the balance between stress and thyroid; your fingers should be less cold as your metabolic rate comes up. In extreme hypothyroidism, the hands and feet can be very cold while the oral temperature looks o.k.; then as the metabolic rate increases, the difference between fingers and mouth decreases.

Ray Peat Email Exchanges - Ray Peat Forum Wiki

raypeatforum.com

 

[BigShoes]

Hi @Jennifer ,

Thank you very much for your message, I really appreciate it.

I've been pretty stressed for years really. Still, I do my best to manage it, and reduce it as best as I can, and look on the bright side of things :) I still have a cheerful "disposish" most of the time.

Tbh though, by far the biggest stressor to me is my health (and has been for ages). "The healthy person has a thousand wishes, the sick person has only one". I could bear all of my other problems 100 times over (and be 100 times more helpful at helping others with theirs) if I was feeling well. I find being sick very distressing.

I actually did have an exceptionally stressful week recently (emergency surgery - general anaesthetic - no scars to the torso though, recovery has been okay). But I don't believe this has driven the lower temps - I had intermittently taken my temps a few days in the last 3 weeks or so (prior to the emergency surgery) and was noticing similar low 97s every single time.

Apologies, it's hard to give an exact log, because I haven't been taking them every day, but:
(1) Feb 2023 and before: prior to thyroid supps - generally low 97s upon waking, occasionally rising to high 97s through the day, never above 98.0.
(2) March 2023: upon taking thyroid in the first month or so, I slowly began to measure temps in the mid 98s (as in the photos above).
(3) April / May 2023: I stopped measuring my temps for a while and went by "how I felt" (through April and a good chunk of May). Then decided to begin measuring again because other symptoms weren't improving at all. And every time I've measured, they've been in the low 97s again.

To your other points:
- Pulse - my pulse rate was always relatively high prior to thyroid (and still is), combined with the lower temps. Definitely was (/am) running on adrenalin and stress hormones (you can feel it... you just know). I used to measure my resting pulse anywhere from 85-100. Combine that with low temperatures = stressed individual. Definitely an interesting point about the thyroid finally reducing adrenal output. Although my pulse is still typically 90...
- Milk and cheese - If I could live off of sweetened milk, and cheese, I would. Sadly, I really struggle to digest it... I think it's the casein proteins (that's my theory - I have experimented with lactose powder and am fine with it, and am pretty okay with butter - so I don't think it is the sugars or the fats). I have recently switched to goat milk and have noticed some *slight* improvements, but not much.
- Protein - usually getting 100g-120g of animal protein - I try not to go higher, because it seems to correlate with my hair falling out faster (more hair fall on the comb)
- I salt liberally with cooked meals, but may be lower than the recommendation here.
- Cholesterol - My cholesterol total was slightly elevated before commencing thyroid (205 total) - and I have a relatively high amount of saturated fat and sugar in the diet. So I am *assuming* this is still okay (haven't done blood work since Jan/Feb
- Iron - I was actually recommended by someone here to get an iron panel to check for overload - I still haven't done this yet, NHS will not do it, and I haven't found a place to do it privately just yet. I will look into this again...
- Vit A - possibly, although I do eat liver and dairy.
- Aspirin - I have played around with this on occasion, but don't really like it / don't seem to get much out of it in the short term.
- Prolactin and Estrogen - both were elevated (16ng/dl and 33pg/ml - minimum 2x optimal for a man) - I don't know how I can bring these down - tried so many things.

 

[mostlylurking]

Hello all,

My temps are still low despite taking a pretty hefty daily dose of cynomel and cynoplus. I commenced use in c. March 2023 (3 months ago) on a pretty low dose (10mcg T3, 20mcg T4 - 1/6 of a cynomel and cynoplus), and gradually, gradually increased the dose over time. I was advised by the D-Rod (at least, to my understanding) to gradually increase the dose 'til I saw a relief in symptoms - staying on the same dose for at least 2-3 weeks before increasing as needed, or possibly even a touch longer, to ensure that I did not tip into hyper-.

I have just recently increased the dose to what is now a pretty hefty sum (c. 30mcg T3 and 90mcg T4) - almost complete thyroid replacement - but am observing low temps.

TIMELINE

I basically went: 1/6 of both a cynomel and a cynoplus tab, to 1/4, to 1/3, to 1/2, and now pushing cynoplus (the t3/t4 combo) even higher to 3/4.

When I first moved up to c. 1/4 to 1/3 of each, I noticed a pretty good increase in temperatures within a week or so. Some indications from March:

View attachment 51982View attachment 51983View attachment 51985View attachment 51986

Things were looking good temperature-wise. However, I did not notice any meaningful improvements in any of my hypo- symptoms at all... being: dry brittle hair, hair falling out, puffy face / puffy eyes and water retention, low energy / lethargy / tired all the time, poor digestion, poor sexual function, cold hands / feet / nose and other circulation issues (leg veins don't look healthy - not varicose yet, but don't look to be flowing well), other estrogenic symptoms (gyno c. the size of grapes, hips, spider veins beginning in places), terrible vitiligo, and many more.

I spoke to the D-Rod way back in March to say basically that "my temps seem to have increased quite nicely, but none of my symptoms are improving... what gives?" To which I was given the advice (to my understanding): "dose to treat symptoms, not just temps" i.e. if I still have hypo- symptoms (on the comparatively low dose of 1 grain that I was on) then I may still need to increase the dose (i.e. system still did not have adequate thyroid hormone).

So this is exactly what I did. Gradually, gradually increased the dose making sure not to tip into hyper-... only now I am at almost complete thyroid replacement, with very little improvement to any hypo- symptoms.

I started taking temps again in the past couple of weeks and am back in the low 97s, which is exactly where I was prior to thyroid replacement. This morning's reading:

View attachment 51987 and this was after a few tries - even got a 96.9.

Any advice on why this could be? I think this needs to be cracked before I will ever start to feel better.

Current Areas of Investigation:
Gut Health
- Possibly not absorbing the thyroid I am ingesting for some reason... Possibly low grade gut infection / endotoxin... antibiotics?? I have 2 weeks worth of doxycycline (in the UK, I had to tell the pharmacy I had chlamydia to get them - thanks for the tip @Herbie ! hahaha) , but am unsure whether to take them for two reasons: (1) they could upset the balance of the gut and allow the more resistant bacteria to take hold, leading to worse problems. (2) they can actually worsen mitochondrial function, and hence, metabolism (not sure how short vs. long term this impact would be).

Not sure what else it could be...

I have searched the forum and found a few threads with similar issues - but it seems to be a highly individual thing and difficult to find a "protocol" of things to check for.

----------------------------------------------------------------------------------------------------------------------------------------------------------------

Other Guides:

PROFILE

32M, 180lbs (82kg), 6 ft 1 (186cm), c. 12-15% body fat

FOOD

I eat pretty similarly every day. Approx:
- 1/2 lb / 250g of meat (usually beef) (c. 500kcal)
- 500ml goat milk (c. 300kcal)
- 2 eggs (c. 150kcal)
- 1 oz / 30g cheese (I can't digest any more than that - constipation) (c. 125kcal)
- 25g beef gelatin
- c. 300g well-cooked potatoes and white rice with my evening meal (c. 300kcal)
- OJ, Cola, honey, gummies / other sugar delivery mechanism ad libitum - I'd say at least 1.5L of juice / cola and whatever, plus minimum 100g sweet sugars (c. 1000kcal BARE minimum - more like 1500kcal)
- A bunch of extra table sugar in. milk etc. (c. 50-100g of table sugar) (200-400kcal)
- Random pickings / grazing at other things - prawns, sausages, vanilla ice cream, fruit (grapes) whatever takes my fancy
- Calves liver once per 1-2 weeks (I can't find good liverwurst to have a small amount daily), occasional oysters

I would say c. 3000kcal is a good estimate, but I don't really measure (the above is an estimate) and never think about portion control anymore. I don't force-feed, but I don't restrict. When I'm hungry, I eat.

MOVEMENT

Fairly sedentary throughout the day. Lots of WFH. At least one gentle walk outside daily though. I also do one single set of one weight lifting exercise every day (Monday Chinups, Tuesday Shoulder Press, Wednesday Lunge etc. etc.) - muscles are being worked, but very low volume and 1 week to recover.

SLEEP

My sleep is not great tbh. I often get to bed too late (old habits die hard), and can take some time to get to sleep. However, I always sleep through the night and always wake up without an alarm. Never wake up feeling rested though.

SUPPS

Thyroid, Fat solubles: D3 (3000IU), K2 (2mg), experimenting with small amounts of vitamin E (100IU max)

Your choice of thermometers isn't a good one, sorry. Those digital thermometers are known to be very unreliable. An old fashioned thermometer would be a better choice.

Because thiamine (B1) deficiency and hypothyroidism both block oxidative metabolism they have very similar symptoms. Thiamine deficiency symptoms include: low temp, erratic pulse, digestive problems, lethargy, brain fog, et. al. I was able to tell that I had a thiamine deficiency/functional blockage by taking about 300-350 mg of thiamine hcl with some water (no sugar); within 45 minutes, my low body temperature went up a full degree to normal and all of my body inflammation disappeared.

I'm also hypothyroid. I took 3 grains (180mg) of prescription desiccated thyroid for 5 years (my optimum dose). But then, I discovered (fall of 2020) that I had a thiamine deficiency/functional blockage. I learned (after supplementing with thiamine hcl for a few weeks) that I needed to lower my thyriod medication dose because my T3 had become dangerously high. This was while I had severe hypothyroid symptoms. My endocrinologist lowered my thyroid med dose down to 135 mgs and I increased my thiamine hcl dose up to 2 grams/day and I stabilized and recovered my health. The thyroid needs thiamine to do its job. Hyperthyroidism blocks thiamine function. Hypothyroidism + thiamine deficiency can be very confusing; I'm really glad I had a good doctor to help me. I get a complete thyroid panel (blood testing) every 6 months.

Questions:
How long have you been avoiding PUFA?
Do you have any amalgam fillings or root canals in your mouth?
Do you supplement with any B vitamins?
Do you drink coffee? How much/day?
Do you drink black tea?
Are you getting thyroid blood panels done?

 

[cremes]

I have a few root canals and crowns. What’s the linkage to thyroid?

 

[BigShoes]

Hi @mostlylurking

Thanks very much for your message.

I had wondered the same regarding the thermometer - it also hurts my armpit (hence the undisciplined readings)... I will look for a better one ... I have three digital ones mind you - all give similar readings (0-0.2F differences MAX).

Regarding B1 deficiency. It is definitely a possibility. I have been on a pretty high sugar diet for almost 2 years. So there is a chance it is depleted. However, I do eat a healthy amount of meat (although I don't have pork every day) and liver, and milk.

I also suspected a thiamin deficiency around a year ago (pure speculation) and had been playing around with B vitamin complexes and B1 supplements. See below to the ones I have tried (possibly not very good):

- Solgar B Complex (containing B1 as thiamin mononitrate)
- Pure encapsulations B complex (containing B1 is Thiamin HCl)
- benfotiamine

I used B complexes for months, and I honestly didn't notice any difference on or off them (I am usually quite observant of changes and am hyper-vigilant of new / worsening symptoms). I no longer use any B vitamin supplement.

I quit all grains, seeds and seed oils around 10 years ago. Quit eating nuts around 8 years ago (paleo phase). And quit fish oils supps (c. 1g omega 3 per day) about 4 years ago. I track my PUFA (and calories) LOOSELY in a spreadsheet, and would say I get c. 5g per day average incidentally from Beef fat, dairy fat etc. - plant fats and oils are essentially zero and have been for years now.

No fillings or amalgam. I've never had a cavity (according to my dentist). @cremes - I believe the issue is the mercury / heavy metal toxicity.

I do not drink tea, had never drunk coffee before it being recommended here (I've probably had about 10 cups in my entire life), nor cocoa - I don't like hot drinks.

I had one thyroid panel performed Jan/Feb of this year:

Thyroglobulin Antibodies	383	0 - 115	IU/mL	Very high autoimmunity / inflammation - probably been high for years (vitiligo for 14 years c. age 18)
Thyroid Peroxidase Antibodies	400	0 - 34	IU/mL	Very high autoimmunity / inflammation - probably been high for years (vitiligo for 14 years c. age 18)
Thyroid Stimulating Hormone (TSH)	2.7	0.27 - 4.2	mIU/L	Relatively high by Peat standards - Dr's said I was "euthyroid"
Thyroxine (T4, free direct)	17.7	12 - 22	pmol/L	mid-range
Triiodothyronine (T3, free)	4.8	3.1 - 6.8	pmol/L	mid-range

I came to understand from this forum and others that the T3 and T4 blood levels were actually a bit useless (and even TSH), and not really a reliable indicator of tissue saturation / tissue levels. I was told to treat symptoms, not blood values (there are people with TSH below one who still have hypo- symptoms and low temps) - I was initially somewhat skeptical, but the autoimmunity was hard to ignore, and the symptoms matched up perfectly. I could not get reverse T3 measured.

 

[ecstatichamster]

I take 180mcg or T4 and 45mcg of T3 daily in 3 divided doses. My temps reach 98.6 to 99F during the day. I don’t always wake up over 97.5F. It took quite awhile for my body to warm up. It can take several years. I continued increasing gradually a few months at a time and this is a good amount for me. I no longer feel good on less. Good luck on your journey.

 

[BigShoes]

Hi Hamster! Thanks for the comment.

That seems like a very large dose! But possibly accounting for some absorption issues, I see how that could be an appropriate amount. I am hesitant to push any further though at present...

I really hope it doesn't take years to see any changes hahaha - I feel like I'm at the end of my rope.

 

[gunther]

@BigShoes

Sorry to make light, but I couldn't get this image out of my head!

 

[BigShoes]

@gunther haha! "Sign here, please!" shouts my postman through a megaphone so the whole neighbourhood can hear...

 

[mostlylurking]

I had wondered the same regarding the thermometer - it also hurts my armpit (hence the undisciplined readings)... I will look for a better one ... I have three digital ones mind you - all give similar readings (0-0.2F differences MAX).

I've got 5 of the stupid things (digital thermometers). A few years ago, I tried all five of them to see if any would read that my temp was not below normal. Then I called the Acella NP Thyroid hot line to see if there had been a recall on my lot of prescription medication. The rep called me back (on a Sunday afternoon) to help me. By that time, I had found my antique mercury thermometer and it showed my temp to be spot on 98.6 degrees. I told the rep the story and that it seemed to me that digital thermometers are useless. He replied, "10-4". He said that they run into this problem all the time because people think that the digital thermometers work and they don't. I then mentioned the issue to someone at the hospital and they said something like, "well, yeah...." So it's a known issue.

Regarding B1 deficiency. It is definitely a possibility. I have been on a pretty high sugar diet for almost 2 years. So there is a chance it is depleted. However, I do eat a healthy amount of meat (although I don't have pork every day) and liver, and milk.

There is this idea on this forum that Ray Peat was all for a high sugar diet. He actually said that the amount of sugar in one quart of OJ plus that which is in two quarts of milk is an ideal amount for one day. People took that and just ran with it. I also remember that Ray said (somewhere) that if you're going to consume more than that you will need to supplement some thiamine.

Consider that the discovery of beriberi was the result of Japanese people eating white rice (with the bran removed) which caused deficiencies so severe that they got beriberi. If you consume sugar as you have described, you won't be able to get enough thiamine from your diet alone to balance it.

Suggested reading:

Beriberi: The Great Imitator - Hormones Matter

Has beriberi, thiamine deficiency, re-emerged in modern medicine?

www.hormonesmatter.com

How Dietary Mayhem Causes Disease: The Choked Engine Syndrome - Hormones Matter

Diets high in sugar and simple carbohydrates predispose one to thiamine deficiency. Thiamine deficiency leads to dysfunctional oxidative metabolism.

www.hormonesmatter.com

How Can Something As Simple as Thiamine Cause So Many Problems? - Hormones Matter

Is thiamine deficiency too simple to explain the devastating nature of the systemic adverse reactions to some vaccines and medications?

www.hormonesmatter.com

Hiding in Plain Sight: Modern Thiamine Deficiency

Thiamine or vitamin B1 is an essential, water-soluble vitamin required for mitochondrial energetics—the production of adenosine triphosphate (ATP). It is a critical and rate-limiting cofactor to multiple enzymes involved in this process, including ...

www.ncbi.nlm.nih.gov

I also suspected a thiamin deficiency around a year ago (pure speculation) and had been playing around with B vitamin complexes and B1 supplements. See below to the ones I have tried (possibly not very good):

- Solgar B Complex (containing B1 as thiamin mononitrate)
- Pure encapsulations B complex (containing B1 is Thiamin HCl)
- benfotiamine

I used B complexes for months, and I honestly didn't notice any difference on or off them (I am usually quite observant of changes and am hyper-vigilant of new / worsening symptoms). I no longer use any B vitamin supplement.

Oral doses of 100mg of thiamine mononitrate or thiamine hcl, which are the standard amount in a b-complex won't correct a thiamine deficiency. These types of thiamine require high oral doses because they do not get into the blood stream from the gut efficiently.

I quit all grains, seeds and seed oils around 10 years ago. Quit eating nuts around 8 years ago (paleo phase). And quit fish oils supps (c. 1g omega 3 per day) about 4 years ago. I track my PUFA (and calories) LOOSELY in a spreadsheet, and would say I get c. 5g per day average incidentally from Beef fat, dairy fat etc. - plant fats and oils are essentially zero and have been for years now.

That's good. If you are not overweight, Dr. Peat said it takes 4 years to get the pufa out of the system. However, if you are overweight, it takes longer.

No fillings or amalgam. I've never had a cavity (according to my dentist). @cremes - I believe the issue is the mercury / heavy metal toxicity.

That's good. However, there are many sources of mercury in today's world.
suggested reading:

Mercury, Parkinson's Disease, and Thiamine - Hormones Matter

The researchers who detected mercury in the brain in patients with Parkinson’s disease concluded that we should stop burning fossil fuels.

www.hormonesmatter.com

Sources — Mercury Free Kids

www.mercuryfreekids.org

Lead poisoning also wreaks havoc on thiamine function.

Sources of Lead | Lead | CDC

CDC continues to assist state and local childhood lead poisoning prevention programs, to provide a scientific basis for policy decisions, and to ensure that health issues are addressed in decisions about housing and the environment.

www.cdc.gov

In addition, there are a lot of things that block thiamine function; many antibiotics block it for example. Many prescription drugs block it.

I do not drink tea, had never drunk coffee before it being recommended here (I've probably had about 10 cups in my entire life), nor cocoa - I don't like hot drinks.

OK. Coffee and also black tea block thiamine.

I had one thyroid panel performed Jan/Feb of this year:

Thyroglobulin Antibodies	383	0 - 115	IU/mL	Very high autoimmunity / inflammation - probably been high for years (vitiligo for 14 years c. age 18)
Thyroid Peroxidase Antibodies	400	0 - 34	IU/mL	Very high autoimmunity / inflammation - probably been high for years (vitiligo for 14 years c. age 18)
Thyroid Stimulating Hormone (TSH)	2.7	0.27 - 4.2	mIU/L	Relatively high by Peat standards - Dr's said I was "euthyroid"
Thyroxine (T4, free direct)	17.7	12 - 22	pmol/L	mid-range
Triiodothyronine (T3, free)	4.8	3.1 - 6.8	pmol/L	mid-range

suggested reading about the autoimmunity test results:

Thiamine and Hashimoto's thyroiditis: a report of three cases - PubMed

As the administration of thiamine led to a partial or complete regression of the fatigue and related disorders, it is reasonable to infer that the administration of large quantities of thiamine restores thiamine-dependent processes. The mild thiamine deficiency suggested by fatigue and related...

pubmed.ncbi.nlm.nih.gov

Effects of Thiamine on Thyroid Fatigue - ThyroMate

Thiamine is one of the eight B Vitamins otherwise known as the B-Complex Vitamins. Studies have shown that Thiamine can help combat fatigue resulting from an underactive thyroid.

www.thyromate.com

also

Allergies, Autonomic Response, and Thiamine - Hormones Matter

Allergies, hypersensitivity reactions or intolerances represent a set of undesirable effects produced by a normal immune system.

www.hormonesmatter.com

Your TSH is high; it causes inflammation. Your T3 isn't really high enough; the test is not calibrated correctly so it's better to be in the upper part of the "normal" range.

I came to understand from this forum and others that the T3 and T4 blood levels were actually a bit useless (and even TSH), and not really a reliable indicator of tissue saturation / tissue levels. I was told to treat symptoms, not blood values (there are people with TSH below one who still have hypo- symptoms and low temps) - I was initially somewhat skeptical, but the autoimmunity was hard to ignore, and the symptoms matched up perfectly. I could not get reverse T3 measured.

My TSH was a .02 when I was at my sickest; it seems like a pretty stupid gauge to rely on to me. However, the free T3, free T4, and reverse T3 are actually helpful to know so long as you understand the test is calibrated incorrectly and take that into account. My 86+ year old endocrinologist is pretty good at deciphering the test results, but then he's had over 50 years of experience. There aren't many like him around though.
see here: Thyroid: Therapies, Confusion, and Fraud

I think it is very important to rely on Ray Peat's work, his articles and his audio shows. I've found that unfortunately there is a lot of misinformation on this forum. Spend the time and effort to read Ray Peat's articles; you will be glad you did!

Here are a couple of handy Ray Peat search engines for you to use:
PeatSearch: a Ray Peat-specific search engine - Toxinless use the search cell that excludes the forum.
also
Bioenergetic Search to search the audio shows.

 

[BigShoes]

@mostlylurking thank you very much for this.

My key takeaways:
(1) try more benfotiamine / thiamin
(2) get a better thermometer or two
(3) more dietary confusion
(4) plus tonnes of other bits - thanks for these - REALLY interesting about the b1 and autoimmunity.

I had actually read about thiamine deficiency c. 1-2 year ago now when I was looking into better b complexes. I think it was Elliot Overton's videos that put me on to it.

I do have some dedicated B1 caps lying around but they're B1 hcl. I thought I had benfotiamine but I can't find it... and I have plenty of niacinamide. However, I stopped taking almost all supps a good few months back because I felt like I was becoming a pill popper: thyroid, adek, b complex, aspirin, minerals, TMG... it felt unnatural, and did a number in my stomach.

I knew about the white rice - but kept away from brown rice (dht suppression?)

I have to say, I'm pretty confused with what to eat and am trying to just follow my intuition:

(1) Too much protein and my hair falls out like crazy the next day (I have tested this many times... I thought it might be the iron in beef (still haven't checked my iron saturation yet), but the same happens when eating too much protein from say white fish, or eggs, or chicken. So I keep to 100-125g (400-500kcal). C. 20% of that from gelatin. I still have no idea why this is happening. The only theories I've heard.are the inflammatory / anti-thyroid effects of tryptophan, cysteine or methionine - but I have no way to know for sure. It certainly.disnt used to happen 10 years ago no matter how much i ate...

(2) Ray says c. 4g of PUFA is a great target, but even pure beef fat is c. 5% PUFA. So that allows for c. 80g fat in total as a reasonable guideline (720kcal + 450kcal protein = 1170kcal)

(3) even to get me to 2600kcal, that's c. 1400kcal from carbs... I.e. 350g carbs, or 450g if I want to go to 3000. The advice is generally "avoid starch as best as you can, but at least have it well-cooked", and tbh I don't think I could stomach 1400kcal of potatoes, rice and yams in a day haha! So that basically means OJ, colas, honey, sugar, fruit, safer sweets to add to the reasonable foundation of animal foods. If only c. 400kcal are recommended from sugar per day (c. 1 quart of OJ), then where should the other calories come from? I'm pretty stumped with what to eat.

In an effort to not be too prescriptive, I've actually found Ray's recommendations to be very confusing. I have taken a step back and tried to just apply the core concepts and figure out something that works for me, but it's been difficult tbh. Still... I do love a nice cola.

Thanks very much for taking the time to message - and thanks for all the links! I really appreciate it, and will read through them all thoroughly.

 

[Jennifer]

Hi @Jennifer ,

Thank you very much for your message, I really appreciate it.

I've been pretty stressed for years really. Still, I do my best to manage it, and reduce it as best as I can, and look on the bright side of things :) I still have a cheerful "disposish" most of the time.

Tbh though, by far the biggest stressor to me is my health (and has been for ages). "The healthy person has a thousand wishes, the sick person has only one". I could bear all of my other problems 100 times over (and be 100 times more helpful at helping others with theirs) if I was feeling well. I find being sick very distressing.

I actually did have an exceptionally stressful week recently (emergency surgery - general anaesthetic - no scars to the torso though, recovery has been okay). But I don't believe this has driven the lower temps - I had intermittently taken my temps a few days in the last 3 weeks or so (prior to the emergency surgery) and was noticing similar low 97s every single time.

Apologies, it's hard to give an exact log, because I haven't been taking them every day, but:
(1) Feb 2023 and before: prior to thyroid supps - generally low 97s upon waking, occasionally rising to high 97s through the day, never above 98.0.
(2) March 2023: upon taking thyroid in the first month or so, I slowly began to measure temps in the mid 98s (as in the photos above).
(3) April / May 2023: I stopped measuring my temps for a while and went by "how I felt" (through April and a good chunk of May). Then decided to begin measuring again because other symptoms weren't improving at all. And every time I've measured, they've been in the low 97s again.

To your other points:
- Pulse - my pulse rate was always relatively high prior to thyroid (and still is), combined with the lower temps. Definitely was (/am) running on adrenalin and stress hormones (you can feel it... you just know). I used to measure my resting pulse anywhere from 85-100. Combine that with low temperatures = stressed individual. Definitely an interesting point about the thyroid finally reducing adrenal output. Although my pulse is still typically 90...
- Milk and cheese - If I could live off of sweetened milk, and cheese, I would. Sadly, I really struggle to digest it... I think it's the casein proteins (that's my theory - I have experimented with lactose powder and am fine with it, and am pretty okay with butter - so I don't think it is the sugars or the fats). I have recently switched to goat milk and have noticed some *slight* improvements, but not much.
- Protein - usually getting 100g-120g of animal protein - I try not to go higher, because it seems to correlate with my hair falling out faster (more hair fall on the comb)
- I salt liberally with cooked meals, but may be lower than the recommendation here.
- Cholesterol - My cholesterol total was slightly elevated before commencing thyroid (205 total) - and I have a relatively high amount of saturated fat and sugar in the diet. So I am *assuming* this is still okay (haven't done blood work since Jan/Feb
- Iron - I was actually recommended by someone here to get an iron panel to check for overload - I still haven't done this yet, NHS will not do it, and I haven't found a place to do it privately just yet. I will look into this again...
- Vit A - possibly, although I do eat liver and dairy.
- Aspirin - I have played around with this on occasion, but don't really like it / don't seem to get much out of it in the short term.
- Prolactin and Estrogen - both were elevated (16ng/dl and 33pg/ml - minimum 2x optimal for a man) - I don't know how I can bring these down - tried so many things.

You’re welcome. :)

Oh, my! Emergency surgery is stressful, for sure. I’m sorry you’ve been dealing with stress for years. I don’t blame you for finding being sick distressing. It absolutely is. Since you struggle to digest milk and cheese, have you tried eliminating dairy from your diet, at least for the time being? Are there any other foods besides dairy and animal protein (beyond 120 g) that worsen your digestion and other symptoms? And how is your stress level around food? Do you experience any anxiety while eating?

Thyroid helped improve my digestion, but it didn’t completely eliminate my symptoms. For that, it took an elimination diet in conjunction with thyroid supplementation and a self-love practice but most of my symptoms, many the same as the ones you’ve listed, would clear up within a few days of just eliminating problematic foods from my diet. If you’re doing the right thing for your body, mind and spirit, I don’t believe it will take years to be fully healed. :)

 

[Regina]

Have you been under more stress than usual? If so, could you finally be taking enough thyroid to have lowered adrenaline that was falsely elevating your temp? Do you know what your pulse was prior to and after upping your dose? Given your hypo symptoms and cold extremities, I’m wondering if your lower temp may be revealing a low basal metabolic rate. Some email exchanges with Ray that might resonate:

Thyroid Supplementation Doesn't Help / Causes Issues​

T3, by lowering stress, sometimes reveals a low basal metabolic rate, that was hidden by high stress hormones. The body produces about 4 mcg of T3 per hour, so taking more than that can interfere with regulatory processes. It's helpful to use the resting pulse rate, and the 24 hour temperature curve, along with other signs, such as mood, appearance of veins on the hands, etc. The peak temperature should be in the afternoon.

The temperature rise during the day is the most important thing, since nocturnal stress hormones can give a misleading impression in the morning. Resting pulse rate is another good indicator. Milk and cheese are the best calcium sources.

If you are eating enough protein, about 100 grams, and salt and thyroid, then I would consider the steroids--something might be interfering with your production of pregnenolone and DHEA. Things that could do that would be very low cholesterol, or a deficiency of vitamin A (retinol), or possibly other deficiencies.

If your cholesterol is above 200, and the thyroid supplements didn't warm you up, it's possible that something is interfering with your steroid synthesis, which might be a deficiency of something like vitamin A, or interference from something like iron or carotene. Have you tried a supplement of pregnenolone or DHEA? Were any other hormones, such as prolactin, measured? If you are taking the aspirin regularly, you should make sure to get vitamin K, from kale, liver, or a supplement. Anemia, like cold feet, is a common sign of low thyroid function.

I occasionally see that happen [T3 WILL CAUSE LOW TEMP/PULSE]; sometimes people have had their pulse rate decrease 40 or 50 beats per minute. The temperature of your fingers, toes, and nose helps to interpret the balance between stress and thyroid; your fingers should be less cold as your metabolic rate comes up. In extreme hypothyroidism, the hands and feet can be very cold while the oral temperature looks o.k.; then as the metabolic rate increases, the difference between fingers and mouth decreases.

Ray Peat Email Exchanges - Ray Peat Forum Wiki

raypeatforum.com

Awesome reply Jennifer.

 

[Jennifer]

Thank you, @Regina. :)

 

[Mr Joe]

Have you tested you vitamin D lately and are you getting enough calcium ? Vitamin D deficiency prevent thyroid from working. How is you zinc and copper intake ?

 

[mostlylurking]

thank you very much for this.

You're welcome. Just trying to help.

My key takeaways:
(1) try more benfotiamine / thiamin
(2) get a better thermometer or two
(3) more dietary confusion

I suggest reading about thiamine a lot so you understand it well because I suspect it is an issue for you.

Yes, get a better thermometer. Or Two.

Reading Peat's articles will help with that, I think. Although Peat did mention thiamine multiple times, I don't think that he himself had a problem with it, at least when he was younger and working out his ideas on his main categories of interest. Bringing the problem of thiamine front and center required that I rearrange the importance of some of Peat's ideas; mainly the coffee as I simply could not tolerate it at all.

I had actually read about thiamine deficiency c. 1-2 year ago now when I was looking into better b complexes. I think it was Elliot Overton's videos that put me on to it.

Elliot Overton's videos and his articles are very good; I learned a lot from him. However, I was unable to tolerate TTFD because I had very low glutathione so I stuck with thiamine hcl. Because of this, I would simply extrapolate Elliot's teachings to thiamine hcl. I found Dr. Costantini's website and decided to follow his protocol re. high dose thiamine hcl. There is a lot of good info on his website that I found to be very helpful.

I also found Dr. Derrick Lonsdale's articles to be extremely helpful. I've been able to reconcile Dr. Lonsdale's teaching with Dr. Peat's teaching. It's the different viewpoints about sugar that is the sticking point mainly. Dr. Lonsdale was a pediatrician who treated very sick children; Dr. Peat was a scientist. They both quoted Hans Selye a lot and both are/were focused on optimizing oxidative metabolism so the body can have enough energy to heal itself. I'm reminded of the story of the blind men describing an elephant.

I do have some dedicated B1 caps lying around but they're B1 hcl. I thought I had benfotiamine but I can't find it... and I have plenty of niacinamide. However, I stopped taking almost all supps a good few months back because I felt like I was becoming a pill popper: thyroid, adek, b complex, aspirin, minerals, TMG... it felt unnatural, and did a number in my stomach.

Maybe you might want to rethink your choices of these after you spend some time reading Peat's articles? ADEK? Is that a mix of the four oil soluble vitamins? If yes, maybe they aren't balanced to your needs? B-complex is really tricky; I gave up on it and supplement individual b vitamins instead. TMG? It probably would be better to simply eat gelatin, I think.

I knew about the white rice - but kept away from brown rice (dht suppression?)

Brown rice has the type of fiber which isn't a Peaty thing to consume because it "feeds the gut bacteria". I rarely eat white rice but my husband LOVES it so I make it occasionally. Carrot salad, cooked mushrooms, cooked bamboo shoots are better choices because they help keep gut bacteria in check.

I have to say, I'm pretty confused with what to eat and am trying to just follow my intuition:

Use the links I provided to research Peat's diet suggestions. You still have to determine what works for you though.

(1) Too much protein and my hair falls out like crazy the next day (I have tested this many times... I thought it might be the iron in beef (still haven't checked my iron saturation yet), but the same happens when eating too much protein from say white fish, or eggs, or chicken. So I keep to 100-125g (400-500kcal). C. 20% of that from gelatin. I still have no idea why this is happening. The only theories I've heard.are the inflammatory / anti-thyroid effects of tryptophan, cysteine or methionine - but I have no way to know for sure. It certainly.disnt used to happen 10 years ago no matter how much i ate...

Maybe you are sensitive to phosphate (in muscle meat) or sensitive to cortisol? Digesting muscle meat is similar to experiencing high cortisol, at least I remember Peat mentioning that. The iron could be an issue too I guess. Are you eating any dairy? Peat talks/writes about the phosphate/calcium ratio needing to be good which is why dairy is promoted so strongly.

I've experienced severe hair loss a few times, when I was going through severe physical stress, but the last time it happened, a few years ago, I think it was because I was taking too much vitamin K.

(2) Ray says c. 4g of PUFA is a great target, but even pure beef fat is c. 5% PUFA. So that allows for c. 80g fat in total as a reasonable guideline (720kcal + 450kcal protein = 1170kcal)

I eat hydrogenated coconut oil (aka 92 degree coconut oil); it has zero pufa. I also eat butter.

(3) even to get me to 2600kcal, that's c. 1400kcal from carbs... I.e. 350g carbs, or 450g if I want to go to 3000. The advice is generally "avoid starch as best as you can, but at least have it well-cooked", and tbh I don't think I could stomach 1400kcal of potatoes, rice and yams in a day haha! So that basically means OJ, colas, honey, sugar, fruit, safer sweets to add to the reasonable foundation of animal foods. If only c. 400kcal are recommended from sugar per day (c. 1 quart of OJ), then where should the other calories come from? I'm pretty stumped with what to eat.

White potatoes have some protein so they are a better choice. White rice really doesn't have anything redeeming about it (except it tastes pretty good). Yams aren't recommended by Peat because of the fiber (feeds the gut bacteria).

I'm pretty stumped with what to eat.

Are you eating any dairy?

In an effort to not be too prescriptive, I've actually found Ray's recommendations to be very confusing. I have taken a step back and tried to just apply the core concepts and figure out something that works for me, but it's been difficult tbh. Still... I do love a nice cola.

I've found reading Ray's articles to be the most helpful. I always read each one several times; I've found that it helps clear up my confusion.

 

[BigShoes]

@Jennifer - thanks very much for this, and thank you for being so kind.

I definitely do feel better without dairy (it makes me nasally, and upsets digestion), but I struggle to get any meaningful amount of calcium otherwise... I understood that the calcium in leafy greens is pretty much non-bioavailable (bound to oxalates) and I really don't fancy limestone CaCO3 supplements long term. Meat digests very easily for me - no problems with digestion, but higher meat intake definitely correlates with much higher hair fall on the comb the next day (like 3x an already concerning amount at baseline). Sometimes starches cause bloating. I am very selective around foods due to just generally sensitive digestion, but I wouldn't say it causes me anxiety or any worry - only the health problems themselves do.

I was really focused on elimination diets for years in an attempt to (a) get healthier, but also (b) possibly help to reverse vitiligo (to no avail). I grew up on the standard western diet, then ate the same thing but way more when I started lifting weights at 18, then "paleo" (no grains) at 24, lower carb paleo at 26, carnivore at 28... by 29 I realized I needed carbs and started adding back in honey and milk, and then found Ray's work (c. 3 years ago now) and have been trying to recover from there. I think I felt my best when I first switched to paleo at 24 - everything else has only led to worsening of symptoms. However, that may just be the gradual decline of an unhealthy discontented individual hahaha! Also I would not be able to go back to eating like I did then - I don't think I could digest that variety of foods.

Hi @Mr Joe - I have not tested lately. My vitD in January was a bit low, so I have been supplementing quite a bit over the past few months (c. 8000 IU for a couple of months, then tapered down). I have also gotten some sun in recent weeks. I measured my blood levels at 47ng/dl in October 2021 though, and tbh my symptoms now are pretty much the same as they were then (possibly a little worse - but the same kind of hypo- symptoms - it's really starting to take a huge toll) - so I would be surprised if low VitD was the only cause. I will get vitamin D levels checked on my next blood test.

 

[BigShoes]

@mostlylurking thank you very much - I will definitely read up on thiamine further, and look for some better thermometers.

I seem to remember tolerating benfotiamine okay so I might try that again - I definitely only took a few of them though, so I can't think where the pot has gotten to..... I do have 100mg thiamin HCl caps though so could give them a try again instead.

Very interesting about Dr Lonsdale's work (honestly, I hadn't heard of him) - I will read up more. And funny story about the blind men describing the elephant :) same idea but from a different perspective.

Yes ADEK as in the fat solubles. I don't use A anymore, but have taken anywhere from 3-8000 IU of D3, 100IU E, 2mg-8mg of K2 at times. I don't take them in a combo - apparently it's not good to take E and K together. Interesting on the vitamin K and hair loss......... I hadn't made that connection.

The TMG was actually for the methyl- groups. I had actually suspected that I had been over-supplementing B vitamins, and that I may have used up all methyl- groups (or be under-methylating). I didn't take this for very long at all though - who knows... I was / am clutching at straws.

And yes, I have been concerned about calcium to phosphate ratio for some time - I struggle to digest much dairy (I think due to the casein) - I believe I only get about 800-1000mg of calcium per day without using supplements, I have approximated phosphate at around 1200-1500... I had seen some forum users saying that looking for specific ratios is pretty unhelpful and orthorexic - was advised to shoot for c. 1g of calcium and not to worry too much about phosphate unless extremely high (basically, don't have too much meat, avoid grains).

 

[Jennifer]

Oh, it’s my pleasure, @BigShoes. :)

Thank you for elaborating. When you say you don’t fancy limestone CaCO3 supplements long-term, I’m guessing that includes eggshell powder, huh? And were you intolerant to dairy as a child? Unless you have a true dairy allergy, I doubt you would have to avoid it indefinitely. If I’m understanding your timeline correctly, you began supplementing thyroid this year? Was that your first time ever, meaning, you weren’t supplementing it when you did elimination diets/paleo and carnivore in the past? If so, you may find that removing dairy from your diet temporarily, while supplementing thyroid, is enough to get you out of your current state and accelerate your healing.

I love dairy too and kept trying to make it work until I had developed a severe allergy to it (anaphylaxis). I wasn’t intolerant to it as a child so it seemed to me that it was the result of my sick state at the time. Because I was so hypo and struggling to eliminate dairy—it constipated me—it fueled an overgrowth in my small intestine (SIBO) and exacerbated my symptoms. As soon as I went on an elimination diet (seafood, gelatinous broth, fruit juice, coconut water and fat) and began supplementing thyroid, the infection was gone within a few months and I was able to tolerate dairy again and today, it’s my most tolerated food. The majority of my calories come from it.