Hypothyroid-like symptoms, energy balance, and diet quality

Symptoms: fatigue, cold-intolerance, hair loss, decreased libido, constipation… sound familiar?

 

thyroid

Hypothyroid-like symptoms occur relatively frequently during times of rapid fat loss, and this may be at least partially dependent on diet quality.  Another component is the fact of being in an energy deficit, but this is difficult to evade on a weight loss diet.

Jane Plain has a post about how high fat oxidation and heat production induced by low carbohydrate diets is partially responsible for the relatively normal metabolic rate despite low thyroid hormones, similar to the Bisschop and Ebbeling studies discussed below.  And another one, discussing the importance of energy balance.  Sam Knox wrote about carbohydrate restriction and functional hypothyroidism, or lack thereof despite altered thyroid hormones.   Also, Dr. Eades’ first-hand clinical experience; and Anthony Colpo’s take vs. Paul Jaminet’s response.  And more on thyroid biology by Jack Kruse.  Edit: Amber posted about thyroid levels & diet on Paleohacks.

Most agree on one thing: large energy deficit = hypothyroid-like symptoms.

Food choices and diet quality is important, too.

The negative impact of low calorie diet-induced weight loss on thyroid biology and energy metabolism is well established, but this figure from Agnihothri and colleagues sums it up rather nicely (2014):Agnihothri

Rapid fat loss causes a decline in TSH and T3.

And in this study on long-term calorie restriction (3-15 years), a similar phenomenon occurred (Fontana et al., 2006).  However, TSH was normal (unlike in Agnihothri’s study), possibly because they were not actively losing weight:

Fontana

Fontana diet

Note: calorie restricted diet had adequate protein…  low T3 because they’re weight-reduced and hypoleptinemic, and normal TSH because they’re not actively losing weight.

But then there’s this study, which shows active weight loss does not necessarily cause reduced TSH levels, if the diet is ketogenic (Yancy et al., 2005):

Yancy

Yancy diet

Also, this study showed reduced T3 after 11 days on a ketogenic diet, but it didn’t impact TSH or resting energy expenditure , suggesting no hypothyroid-like symptoms (Bisschop et al., 2001):Bisschop REE

Bisschop TSH

And lastly, from the [notorious] Ebbeling study:

Ebbeling

Low TSH and low T3, but highest energy expenditure in weight-reduced patients on very low-carbohydrate diet.

Summary

Agnihothri: Low calorie diet-induced active weight loss: low T3 and low TSH; probably low energy expenditure and hypothyroid-like symptoms.

Yancy: Ketogenic diet, active weight loss: normal TSH.

Fontana: Weight-reduced, weight-stable (CR): low T3, normal TSH.

Bisschop: Ketogenic diet, weight-stable (11 days): low T3, normal TSH, and normal energy expenditure (indicative of no hypothyroid-like symptoms)

Ebbeling: Very low-carbohydrate diet, weight-stable (4 weeks): low T3, low TSH, normal energy expenditure (indicative of no hypothyroid-like symptoms).

 

In all of the above studies, leptin mirrored body fat.  And all of the old Rosenbaum & Leibel studies showed the reduction in thyroid function after low calorie diet-induced weight loss could be repaired with leptin treatment.  Their 2002 paper had it all (Rosenbaum et al., 2002)… replacing leptin levels to pre-weight loss levels, which required roughly 3 mg/d, completely restored thyroid levels and energy expenditure:

Leibel

Carbohydrate restriction appears to throw a wrench in the gears.

We also know from rodent studies that excess carbohydrates, particularly fructose, can induce leptin resistance.  Perhaps by improving leptin sensitivity, carbohydrate restriction attenuates some of the hypothyroid-like symptoms associated with an energy deficit.  This would explain the findings of Bisschop’s and Ebbeling’s studies, and would be in line with the known impact of carbohydrate restriction on lowering plasma triacylglycerols, and the theorized (and somewhat controversial) association between high triacylglycerols and low leptin sensitivity.

If you’re on a weight loss diet and are experiencing cold intolerance, fatigue, low libido, or any other hypothyroid-like symptoms, consider either upping the calories or lowering the carbs (or this?).

 

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  • greensleeves21

    All the chicks on the Atkins forum who crash like this eventually confess that they’re eating less than 1,000 calories a day & doing low fat. These girls crash hard & lose a lot of hair after just about 6-10 weeks.

    So, up the fat. Eat at least 68% and you’re golden. Also make sure – if you must count ’em – to eat at least 1400 calories a day.

    • Sounds like PSMF. I’m surprised they made it to 10 weeks!

  • Thomas Hemming Larsen

    Great post Bill! Its good that you address some of these overlooked symptoms. As a recovering anorexic I can assure you that I’ve had all of the symptoms. The cold is so excruciating that it completely ruins your life – I’ve many times been scared of walking out the door because I was so cold. The only thing I could think of was getting to bed and feeling warm. ItsTheWoo has written some very good posts about this. Then there’s the hair loss all over the body except for lanugo…
    My TSH level increased and is still a little too high. Anyway, my point was to say that I found that I need to eat more. I’m so sick and tired of people saying ‘even the leanest person has >30.000kcal stored on their body’, I don’t disagree with the math but I simply don’t believe that the body can effectively mobilise them since it has to hold on to some minimum amount. Conversely, I think that’s the reason why obese people so easily lose weight on a ketogenic diet because they have more than enough fat When I first started losing weight on a ketogenic diet I was surprisingly easy despite that I was lean already. I still get these days of ‘extreme hunger’ where I can eat anything in sight even though my stomach is almost hurting but my mind continues to be hungry.
    Sorry if this got a bit out of hand. I just wanted to highlight that all this diet is so context dependent.

    Btw, I recently heard Chris Kresser say on this podcast http://www.thelivinlowcarbshow.com/shownotes/9248/763-guest-host-chris-kresser-and-laura-schoenfeld-discuss-your-personal-paleo-code/ about low carb pitfalls, that nori is not the best source of iodine (I assume that’s why linked to them).

    • Hi Thomas, thanks. All very interesting; I hate cold weather… couldn’t imagine bona fide cold intolerance.

      I think any LC diet-induced increase in leptin sensitivity could only partially compensate for the marked decline in leptin that accompanies weight loss… anyone predisposed to hypothyroid-like symptoms will likely experience them (increased access to fat stores is helpful, but not completely adequate).

      Hahaha yeah, the nori. I was kind of joking, as this seems to be more of a hormonal thing, not iodine deficiency (although more seafood probably wouldn’t hurt!).

      • Thomas Hemming Larsen

        Sorry about the rant – I didn’t mean to derail the post. I think LC diets are perfectly fine as long as you eat enough otherwise you’re going to burn out. My hormone/blood markers were a complete train wreck to a degree where my doctor thought I was dying of cancer. But it doesn’t have to be that way. I think Peter Attia is a good example of a very active guy who keeps carb lower than most and remains very healthy.

        • No worries about the rant, I found it rather interesting.

          I think some people are going to be more susceptible than others (based on genetics, epigenetics, hormones, etc., etc.)… Attia being on the opposite end of the spectrum. Also, doesn’t hurt that he lives in San Diego!

      • Galina L.

        I take an Armour thyroid because my thyroid gland is damaged by immune system, and I know well how cold sensitive one may be. However, Armour thyroid is procured from pigs and has more T3 than a human needs, and on that hormone substitute I am more cold tolerant than it is normal for me, or I experienced on a synthesized thyroid. When I am loosing weight, I am cold only second part of the day, and recently I finally guessed why – the Armour thyroid doesn’t have the delayed release, and by evening its action is weakened. It is easy to check by dividing the dose.

        • Hi Galina, that’s pretty interesting. So, dividing the dose helps?

          I actually wouldn’t have been surprised if there was a circadian aspect to this…

          • Galina L.

            Actually, dividing doses just came to my mind couple days ago after I left my comment on Wooo’s blog about individual differences when it comes to diets (http://itsthewooo.blogspot.com/2014/01/there-is-no-one-size-fits-all-diet.html). I started to think why I have cold shakes during weight loss only during second part of the day. I have not tried to check my idea out yet – I am maintaining now. It could be circadian part for sure.

          • Oh, OK. If you do try to check your idea, plz let me know how it goes 🙂

    • Jack Kruse

      Bill I dont want to get in to deep in your blog but you must realize the effect of cold temperatures on the brain and HPA axis, leptin and adiponectin. Cold empties fat cells to provide mitochondria protons when electrons from the diet are poor. The missing piece to the story is water. A proper ketogenic diet requires substantial intake of water. When water is used in the proper circadian seasonal temperature driven something unique happens in water chemistry. Cold water creates a higher exclusion zone. The larger the exclusion zone the more charge separation occurs in water to transfer potential energies to things like the mitochondria. Moreover, a larger exclusion zone creates a boatload of protons. These protons create huge flows of hydronium ions in the face of a low light cycle. This is precisely how things are designed to work in winter. You really need to add Ling and Pollack’s work to this blog and you will begin to see the magic in my CT protocol and why Zeltiq cool sculpting works physiologically.

      • Jack Kruse

        Protons carry a positive charge…….if you can not move them thru your mitochondria positive charges increase and inflammation takes hold. all inflammation is positively charged. Think acids, ROS, and LR. You have to move the separated charges into mitochondria……..who should move them well…….and if they dont you develop molecular chaos and swelling and lose water inside the cell because acids decrease water’s exclusion zone which decreases their redox potential. This destroys mitochondria.

        • “Duff mitochondria*” seem to be at the root of a lot of problems. The connection to inflammation doesn’t surprise me… then you get those beautiful crown-like structures in adipose, liver, and even muscle.

          *as Peter calls them

      • This larger ‘exclusion zone’ seems analogous to one aspect of beta-hydroxybutyrate metabolism… that is, NADH/NAD becomes more reduced while coenzyme Q/QH2 becomes more oxidized. This widens the energy gap, leading to more ATP production from bHB (compared to other fuels).

      • Thanks for the comment, Jack.

        Yes, I definitely do need to read more of Ling and Pollack’s work.

        • Jack Kruse

          When my next blog goes out I hope you read it. It has Ling Pollack Peter and me all in it and how all this ties together.

      • Jack Kruse

        3 years ago I gave you the Cold Thermogenesis protocol. Now we are making head way. Read this from CELL: http://ow.ly/sT7bE

  • Wenchypoo

    All together now–“when you remove carbs from the picture, the picture changes.” I can’t tell you HOW many times I’ve said that to my doctor.

    As for my thyroid, I solved the problem of a sub-clinical low thyroid with DL-phenylalanine, which is a precursor to thyroid hormones, so my body could make up for the loss on it’s own. Now I can run around in 40 degree weather in short-sleeved T-shirts. I stood out in 38 degree weather in sweats just yesterday at the farmer’s market while everyone else was bundled up to the eyeballs, and the only thing that got cold was my hands because they were exposed.

    Sometimes, hot flashes can save the day. 🙂

    • “when you remove carbs from the picture, the picture changes.” <– awesome.

      DLPA: compared to L-PA or even tyrosine: theoretically, less chance of overstimulation, and also improved endorphin/enkephalin signaling. Good choice!

      • Wenchypoo

        I did A LOT of reading up on it before trying anything–your thyroid is too important to mess with.

      • Wenchypoo

        The picture changes–referring to the CMP, the NMR, and urinalysis. It changes to the point that these CW docs no longer know what they’re looking at.

        • Mario

          Totally agree!

          My doc thought ketoacidosis, and probably still does, when I said nutritional ketosis… She tells me “everything in moderation”, thanks, but that got me where I was 5 years ago…

          • johnnyv

            Ask the doctor how to weigh out a moderate amount of botulinum toxin on a set of one gram accuracy kitchen scales.

    • Wenchypoo, how much DLPA? (Mario might see if it helps his cold-intolerance)

      • Wenchypoo

        500 mg. X1/day, taken on an empty stomach (I do mine when I first get out of bed). I don’t get hungry until about 10 or 11, so this works out.

        My doc tested me, and couldn’t find anything wrong, yet I was freezing to death in a 70 degree room. That’s when I took matters into my own hands, and have been fine ever since.

        • Mario

          I’ve seen a couple of docs in the past about the cold intolerance and they found nothing.

        • Mario

          Oops, hit “post” a bit to quick…

          Thanks for the DLPA amount recommendation. I’ve done a bit of reading and 500mg seems to be a common amount.

          Is there a brand you prefer over the others?

          • Wenchypoo

            No particular brand–whatever’s cheapest on Amazon.

          • Mario

            Thanks again!

          • Agreed, and some of the bulk powders are dirt cheap.

  • Mario

    OMFG, the symptoms listed at the top all WERE and to some extent still are ME!

    Exactly two years ago, I was at my lightest weight ~129lbs (5’5″) male, 43y/o. Went into my doc’s office complaining of all those symptoms minus the libido because I was kinda embarrassed and thought “that” was just because of all the stress I was under… Doc did ask me about it, and I said; “…well come to think of it ya, it’s kinda low…”, so she ran some tests;

    * Free T3 = 3.4 pmol/L
    * Free Test = 17 pmol/L
    * DHEA-S = 2 umol/L
    Sens TSH = 4 mIU/L
    Free T4 = 17 pmol/L

    * considered low in province of Canada I’m in.

    Other tests were normal, and so my doc simply said my thyroid was fine… At some point I did have an ultrasound of my thyroid and all looked good on that…

    She wanted to send me to a urologist for a consult for TRT, and at first I declined. Then weeks later I asked her for an endocrinology consult, which took about 6 months to get…

    A month or two before the endo consult, I had enough, and abandoned my quest for a male super-model body, and started eating like there was no tomorrow. Still low on refined carbs and sugars, but lots of fruit and snacking on Lara bars. I put on about 20lbs in a short period of time, some fat, and some muscle, but did start feeling better! Some of the above symptoms did (start) to subside.

    When I saw the endo, I was feeling pretty good, and a huge stressor in my life had been resolved. He examined me and said I “looked” good, and said that some of the tests my doc ran weren’t the “best” to run, so he ran some and said he’d call with results.

    He called a couple of weeks later and said all tests came back normal, and that he didn’t need to see me anymore… Things were good for a while, as long as I wasn’t strictly LC/Keto, but as soon as I start(ed) that again, boom, these three symptoms have started returning; fatigue, cold-intolerance and constipation. Didn’t notice any hair-loss and libido was good.

    Stopped LC/Keto and started feeling better again…

    So here I am today, ~150lbs, heavier obviously, fatter, and less muscle mass than I had when working out (which was weight training, no cardio) haven’t worked out in months because was to busy with work and wanted to take a break from it because it was a stressor… Started LC/Keto a while back, and fatigue, cold-intolerance and constipation have started again…

    Been experimenting with RPS for the constipation, and it seems to be helping, but still struggling with the other two symptoms…

    Mario

    BIG P.S. Reading more LC/Keto books and things lately, I learned that when I first started eating lower carb and working out with lots of cardio, 5 years ago, for 3 years – I may have messed myself up mineral-wise because I never consumed any mineral/electrolyte supplements, and was NOT consuming ANY salt, whatsoever, because of a family history with kidney disease… I’ve started supplementing with electrolytes/minerals and himalayan salt – have noticed significant improvement in the symptom of leg-cramping, and a little bit in fatigue, BUT still not 100%… HELP! lol

    • Hahaha awesome (well, not the lingering fatigue & cold-intolerance)… but these are definitely not uncommon.

      As for the cold-intolerance: do a cyclical protein diet… Schedule highest protein intakes for the coldest days of the week 🙂

      And who knows, maybe adding some iodine could actually help in your case… iodized salt, seafood, certain types of seaweed (which Thomas may know more about).

      • Mario

        The cold intolerance was REALLY bad at one point, and for a long period of time (i.e. a 2-3 years) but now its back to where it was before it got really bad – and I don’t want to get there again, but seems its going in that direction… I live in Canada for f sake, lol. It always occurs after 2-3 hours of sitting and working, even though I do get up an stretch often…

        I eat wild salmon ~3/wk, wild halibut 1/wk, jarred mackerel 1/wk… Typically my “protein choices” are; grass-fed beef, farm fresh eggs, locally farmed bacon, seafood mentioned above, lamb/pork/poultry 1/wk and Mercola grass-fed miracle whey protein supplement if/when necessary…

        What about this DLPA, should I also give it a try?

        So I will try;

        (1) Upping the protein during the week, starting with BF, leaving protein at lunch and dinner as is.

        (2) Cutting protein intake slightly on weekends slightly to compensate, or maybe not, I’ll see.

        (3) Start with some low level iodine supplement.

        (4) Try some seaweed – btw can it also be rolled and smoked, j/k lol.

        Thanks, Mario.

        • Hahaha! smoke some nori, let me know how it goes 😉

          That sounds good. Not sure about the DLPA. Most dietary protein is ~5% phenylalanine… but might need a few grams to see a difference. I’ll ask Wenchypoo.

        • La Frite

          Hello Mario,
          Not sure why you want to be keto/LC all the time. Add starches to your diet (potatoes, parboiled rice, green bananas) and resistant starches, inulin, oligofructose, etc (I mean by that: colon fermentable carbs). The simplest way is to add unmodified raw potato starch (yeah, the white powder that does not mix well with water and gelatinize at high temp): mix it anyway with cold water (like 2-3Tbsp) and drink it as is. My bet is that you will experience a higher body temp. And raw potato starch does not alter the ketotic state, if you want to stick to keto.

          • Hi La Frite, why do you say: “raw potato starch does not alter the ketotic state?” Just curious if this came from FTA or you had a different source…

          • La Frite

            It’s not from FTA. It’s just a guess: because you don’t digest RS, it does not elevate your blood sugar levels. But of course, the starch in raw PS might not be pure RS but something like 70-80% RS. So some starch might be digested by you rather than the bacteria further down. But how much digestible carbs does it take to get out of ketosis ? If you ingest say 40g of raw PS / day, that’s already 8g of water. If 70% of the starch (32g) is RS, that’s 10g max of digestible carbs. Depending on the individual, 10g is nothing or could add up quickly to the rest of the allowed carbs. One has to try and test.

          • That’s pretty much where I stand: RPS has starch/calories; not much, but not zero.

          • Mario has been doing some excellent RPS experiments! See his results here:
            http://caloriesproper.com/?p=4153

          • Mario

            Excellent!? Thanks for the compliment! I am flatulencered! lol

          • Mario

            I initially chose keto/lc to loose weight, remain healthy and for it’s metabolic benefits, but in addition to those – I also found it to be the easiest way to eat. Along with being super easy to stick to because the foods are clearly either great sources of fat and/or protein OR they are very low in carbs. No more guessing, no counting calories, no weighing food, no worring…

            As Bill mentioned, I am currently using several (legal) white powders; GOS, inulin and raw potato starch… I started using them to try and improve my digestion, which they have. They have not affected or improved my cold intolerance yet.

  • On the second part of my keto-experiment, I was on a low-calorie ketogenic diet. The reason for which it was low calorie is because I couldnt each as much as before because I didnt feel hungry. Hunger goes away once your keto-adapted.

    I can confirm that being on a low-calorie keto-diet will not result in any of the effects you were mentioning above.

    http://readandgetrich.com/priviledged-metabolic-state-19-to-14-bodyfat-in-2-months-pics-ketogenic/

    • Awesome progress, Chris!

      I think there’s a spectrum; some people are more susceptible to those symptoms than others. Probably related to genetics, epigenetics, diet, and maybe even climate.

      • Mario

        Chris, great progress indeed!

        As Bill mentioned though, there could be a shit-load of other factors why not everyone will achieve your results – age, how overweight someone was, how long they were overweight for, stress, personality type… man, the list can go on, and on…

  • Mario

    Hey Bill,

    Couldn’t find DLPA locally, but I can order it from iHerb.

    Curious how different L-Tyrosine might be or if there are any concerns taking that over DLPA? I’ll assume similar amount if it’s similar to DLPA.

    Mario

    • Tyrosine can cause some agitation / anxiety if you’re predisposed.

      Also, D-phenylalanine is thought to enhance endorphin/enkephalin signaling. Could experience a boost in mood.

      • Mario

        You mean even more agitated/anxious/irritable than the “old” man I already am? j/k lol

        WIll hold-out for DLPA to arrive from iHerb in a week – thanks!

    • Wenchypoo

      I originally started out with tyrosine, but was still getting cold flashes immediately after hot ones. That’s when I consulted Dr. Google, as well as the PDR for Herbs + Supplements (I own a copy-2011), and decided to try DLPA out. I’ve been with it ever since.

      • Mario

        Great to hear – I’ve ordered DLPA from iHerb and it should arrive in several days. Thanks again!

  • Mario

    DLPA is due to arrive today, but I started this week with an iodine/kelp supplement, as well as going to sleep between 10-10:30. I’ve noticed a significant improvement in mood, energy, and possibly my cold intolerance. It’s been a MUCH colder week than normal up here in C(hill)anada, yet I haven’t had any severe cold issues as before. The only other thing I’ve changed is RPS = stopped…

    Something else I thought about trying in the past when I was REALLY cold intolerant, but never followed through with, is SCFL, it’s worked wonders in the evenings…

    SC = scotch in a FL = flask 🙂

    • you might have actually been deficient! Another hypothyroid-like symptom is constipation, so the iodine might help there, too.

      SCFL Ha!

  • Mario

    Sadly, still cold intolerant.

    DLPA and iodine supplements haven’t seemed to help at all.

    Over the w/e, my wife reminded me (read: made fun of me in front of the family) about the day, way back, when I tried Niacin, I think it was 500mg. Zi took it after my GP had mentioned Raynauds…

    Man oh man, did I ever flush. Drove myself to the ER, was around midnight, so my wife was the only one to see me, and to remind me… lol

    Maybe I should try 100mg of Niacin, otherwise I’ll be buying a flask… And/or moving south…

    • “moving south” +1!

      Sucks about the cold intolerance. If you try the niacin, let me know how it goes.

      • Mario

        I decided to take my iodine supp in the morning, instead of at dinner time, to see if it would help with my typical late morning cold intolerance issue. But as luck would have it, I had a window seat at the Starbucks I worked from today, so the sun kept me warm, I’m pretty sure…

        Earlier this evening, while at home working, I started getting cold and decided to try some Niacin. Went with a 50mg dose of it, it’s not the anti-flush kind, that stuff is supposedly potentially not good for liver and not as good as the flushing kind for circulatory affects.

        I didn’t flush and not sure if I warmed up because of it, or not. Will try again tomorrow late morning while working to see how it goes…

      • Mario

        Just took two hits of 50mg of niacin, separated by 30mins, and shortly after second hit, the flush started.

        I am not a fan of it, it feels really weird, and hasn’t helped my fingers warm up, and the tingle I’m getting in other places bugs me big time.

        Prior to the second hit, I think I did feel my feet warming up a bit, my lower legs certainly did, but then I took the second hit and boom!

        I don’t know if I’ll try just 50mg later on, or tomorrow… Maybe I should just go back to eating carbs, buying a flask, overdressing more than I currently do, damn this is so frustrating.

        When I was overweight I was always hot and sweating, and I could wear shorts up until November or when the first snow fall would hit… All that’s gone after loosing weight and eating low carb.

        Bring back the RPS, I’m atta loss… lol

        • RPS was helpful for your cold intolerance?

          • Mario

            I believe it may have been, so I am going to start using it again, but this time ONLY 20gr/d.

            Still going to use GOS 1/d.

            I am also going to start eating a bit more fruit, in the form of berries, than I have been. I’ve been uber low carb eating some blueberries only 1/wk, and way back when I was feeling much better, but putting weight on, I was eating fruit/apples and larabars daily, so maybe I just went too low on the carbs. Will start off with ~1oz of berries per day.

            For a couple of weeks I am going to make breakfast a whey protein shake to try and cut down on some of the fat energy I consume – still want to loose some of the extra weight I put on… fyi I’ve found this this mercola whey protein to be the best, and I’ve tried a lot…

            http://proteinpowder.mercola.com/Miracle-Whey-Protein.html

          • 20 grams… I’d start lower, at least until the GI side effects subside. Like maybe 1/4 teaspoon?

          • Mario

            Today was second day using 20g and nowhere near as much gas as with 40g that I was using before.

            Tomorrow I will look at dropping dose a bit, maybe what you suggested, maybe a bit more, promise no more than 10g!

  • Tess Howell

    I can’t use tyrosine OR dlpa — they both cause my essential tremor to come back! (it’s gone on a VLC diet with thyroid-support supplements.)

  • Mario

    I’ve started using RPS (Bob’s Red Mill Unmodified Potato Starch) again to try and deal with the constipation and cold intolerance issues that seem to creep up when I go LC/Keto. I tried 40g/1d in the past but the gas and bathroom issues were insane…

    This time around I started with 10g/1d and it only made a slight difference/improvement in my symptoms. So I bumped it up to 20g/1d and that seems like it might be the magic number, for me at least… It’s been a few days and the difference/improvement has been noticeable, yet not insane like at 40g/d.

    I think dosage based on size/weight may be better than a fixed dose for everyone. I believe Richard and Tim at Free The Animal recommend starting with 40g/d, but they are probably big guys, I am not, I’m 5’5″ and 149lbs. So 20g/1d seems to be working great – I will give it some more time and report back, but so far, after a few days, it’s looking good.

    • Thanks for the update!

      I suspect a lot of people might be overdosing, which is why 100% of them get gas… but as we were discussing earlier, I wonder if this is an indicator of efficacy. Ie, no gas = no microbe activity = no benefit?

      • Mario

        Welcome and thanks for fielding my questions.

        I guess the only real way of knowing if my microbe is benefiting is getting some poop sampled? I’ll ask my GP about that when I go see her next, but for the time being I’ll simply monitor my cold intolerance, which does seem better btw, and the lack of problemos in the #2econd department…

  • Mario

    Been a few more days on 20g/1d of RPS and between 25g of berries 1/d or 2/d. Things seem to be going well, no gas the last couple of days. BM’s good, not urgent… Cold intolerance seems greatly improved, though when out shoveling snow, had a raynauds episode on big toe and one next to it, on left foot.

  • Mario

    Weighed in this morning at 148lbs, down 1.5 from two weeks ago.

    Negative energy balance has been a result of switching my breakfast from bacon, eggs, or steak, to 32g whey protein shake with 20g RPS 5g maca powder and 25g frozen blueberries = basically I cut out some fat from my diet…

    Still on RPS 20g/1d alls good and no gas! I did a rare second dose yesterday afternoon, with kefir, whey protein and blueberries = no gas!

  • Mario

    Oh, and feeling way better than when I was eating super low carb and super high fat… And cold intolerance has greatly improved! Still keto according to Ketostix.

    Rest of my daily food consumption has remained the same…

    May go back to having my americano’s without 3tbs of 35% cream to try and loose a bit more fat.

    • Nice! Glad to hear cold intolerance is getting better.

      Also, yup, that’s what I was thinking: carb intake can increase without impacting ketosis if energy deficit also increases.

      • how much do you think it can increase?

        • ya gotta measure. This is *hugely* dependent on a lot of factors; can’t put a number on it. The only way to know is to measure.

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