The Keto Diet Podcast Ep. #015: Hypothyroidism and Keto

By December 14, 2018

Hypothyroidism and Keto #healthfulpursuit #fatfueled #lowcarb #keto #ketogenic #lowcarbpaleo

Interview with Elle Russ, writer, health/life coach, and host of the Primal Blueprint Podcast, chatting with us about the importance of a well-functioning thyroid, how the thyroid can become imbalanced, and how keto can play a role in its healing.

For podcast transcript, scroll down.

Show Notes & Links

Thyroid tests: TSH, Free T3, Free T4, Reverse T3, TPO ab (Thyroid Peroxidase Antibody test), and Tgab (Thyroglobulin Antibody test).

Related thyroid tests: DHEA Sulfate, Ferritin, Homocysteine, Vitamin B-12, Vitamin D 25-hydroxy, **If having issues with inability to lose weight, then also test HbA1c.


  • Signs of hypothyroidism (09:35)
  • Thyroid testing (15:35)
  • Carbs and your thyroid (35:25)

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Leanne Vogel: You’re listening to episode 15 of The Keto Diet Podcast. Hey, I’m Leanne from and this is the Keto Diet Podcast where we’re busting through the restrictive mentality of a traditional ketogenic diet to uncover the life you crave. What’s keto? keto is a low-carb, high-fat diet where we’re switching from sugar-burning state to becoming fat-burning machines. If you’re in need of keto recipe food prep inspiration, I’ve prepped a free, 7-day keto meal plan exclusive for podcast listeners. The plan is complete with a shopping list and everything you need to chow down on keto for seven whole days. Download your free copy at

Hey, I’m Leanne from and this is the Keto Diet Podcast where we’re busting through the restrictive mentality of a traditional ketogenic diet to uncover the life you crave. What’s keto? keto is a low-carb, high-fat diet where we’re switching from sugar-burning state to becoming fat-burning machines. If you’re in need of keto recipe food prep inspiration, I’ve prepped a free, 7-day keto meal plan exclusive for podcast listeners. The plan is complete with a shopping list and everything you need to chow down on keto for seven whole days. Download your free copy at Let’s get this party started.

Hey, guys. I hope your 2017 is off to a great start. If you’re like me, I am catching up on all the podcasts and stuff I missed during the holidays. Hopefully you heard the last couple of episodes of the Keto Diet Podcast. If you haven’t, you have a lot to catch up on, lots of great episodes including this one. I guess it’s not totally the holiday season anymore, but if you’re like me, January is a complete blur. I hope you’ve given yourself some time to listen to your favorite podcasts and take some self-care time.

Before we get started with today’s episode, the Awesome Thing this week is Cacao Tea. I am re-obsessed with it. I used to love this stuff a couple of years ago, then I totally forgot it, and it’s back. I get mine from Bulletproof. I’ll include a link in the show notes today. What I love about this is it’s rich in antioxidants. It doesn’t throw off my adrenals like a regular cup of regular coffee would do, but it’s filled with theobromine which is basically like caffeine’s brother. Well, let’s say “sister” because I know there’s a lot of girls listening. Caffeine’s sister that’s a little big more calming so it’s not it’s not as uppity as regular caffeine-based coffee. It helps to maintain healthy serotonin levels for natural relaxation and can be really good for sleep. It’s delicious, it tastes like chocolate, but it’s tea. It’s great. I’m totally obsessed with it. I’ve been drinking it in the mornings with my little rocket-fuel latte and that’s been really successful for me lately.

What we’re covering in this episode are signs of hypothyroidism, how to test your thyroid, actions for healing your thyroid, and carbon-take with hypothyroidism. The show notes for today’s episode can be found at Let’s hear from one of our awesome partners.

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I have no announcements this week. Hopefully, I’ll have more for you next week. Just want to get to sharing this episode with you guys. If you have an idea for an episode for the podcast or if you want to submit praise over and above the review which you can leave by going into, you can email me at

Today’s guest, her name is Elle Russ, she’s a writer, health and life coach and host of Primal Blueprint Podcast. She is becoming the leading voice of thyroid health in the evolution health movement also referred to as “Paleo,” “Primal,” or “ancestral” health. Elle is a certified primal health coach and she sits on the advisory board for the primal health coach program created by Mark Sisson, bestselling author of The Primal Blueprint. Originally from downtown Chicago, Elle lives and plays in Malibu, California. You can learn more about here at

Elle wrote the Paleo Thyroid Solution after consulting with over two dozen endocrinologists, internal medicine specialists and general practice MDs but her thyroid condition was only getting worse and nothing from doctors resembled a solution or even hope. Exasperated and desperate, Elle took control of her own health and resolved two severe bouts of hypothyroidism on her own, including an acute reverse T3 problem. Through a devoted paleo-primal lifestyle, intensive personal experimentation, and radically modified approach to thyroid hormone-replacement therapy, Elle went from fat, foggy, and fatigued to fit, focused, and full of life.

I love that Elle came on the show today. I ask her all of our questions. We didn’t get to the reverse dieting conversation of thyroid, so I will have to find a guest to chat about reverse dieting. That’s still on the docket and very exciting and also ties very closely in line with the thyroid conversation. We went through actions for healing the thyroid, the types of medication that are best, what doctors we can work with, how to find doctors groups for medication help and suggestions. We chat about Hashimoto’s and the baby steps we can take toward healing our thyroid, so lots of good information in here.

If you are metabolically-challenged and you’re frustrated and no matter what you do, you’re not losing weight and your metabolism just feels slow, and you’re frustrated with what doctors are saying to you or not saying to you, today’s episode is going to be right up your ally. I even got to ask Elle about her thoughts on the carbohydrate requirements for hypothyroidism which is going around in the communities of paleo and keto and all sorts of things talking about how carbohydrates are required for thyroid health. I’m really happy that we got into that. Without further ado, let’s get to this interview.

Hey Elle, how’s it going today? Thanks so much for joining in.

Elle Russ: Thanks for having me, I’m excited to be here.

Leanne Vogel: Yeah. For listeners that may not be familiar with your work, why don’t you tell us a little bit about yourself?

Elle Russ: Well gosh, I don’t know where to start. I’m a comedian and a writer first and foremost, and then sort of accidentally got into the world of writing this non-fiction book and some other things. Some life problems showed up. I had two bouts of hypothyroidism in a decade and had to actually fix it myself without the help of a doctor which is sort of a rare situation, then lived to tell about it, and then wrote a book for everybody because the book that I wrote was the book I needed to find myself when I was going through this. An accidental foray into the world of paleo-primal health that was never an intentional thing, but a wonderful gift because it really changed my life. Then to be able to help other people is really where I’m at right now.

I host the Primal Blueprint podcast which is the podcast which Mark Sisson, the bestselling author of The Primal Blueprint started a couple of years ago. You and I are both in the same business there with podcast hosting. Primal health, coaching and just trying to get the word out and trying to help people as much as I can.

Leanne Vogel: Fabulous podcast. When you say that you kind of slid into this, you’d never be able to know, like you know a lot of things. It’s pretty phenomenal.

Elle Russ: Thank you so much. I think it’s like when you, and probably people listening, when you have had a health situation and the medical community has failed you, you have no choice but to pick up and research and learn yourself. Hopefully that’s what you do because if you don’t, you might never get better. Really just through the perseverance of trying to solve my own issues is what eventually gets you quite knowledgeable in that arena.

Leanne Vogel: You touch on this so beautifully in your book. Even the title of your book says it all, or the subtitle. A lot of people don’t understand hypothyroidism and a lot of doctors don’t understand hypothyroidism. The tests are all wonky. You said you had two bouts of hypothyroidism, what is that like? Can you explain hypothyroidism and what that does to your body?

Elle Russ: Let me just start off with, everybody listening to this podcast right now has a thyroid gland. If they don’t, they’re dead, and they’re not listening to the podcast.

Leanne Vogel: Yeah.

Elle Russ: That’s sort of like my general opener because the thyroid gland is the master-gland of the body. If for some reason there’s someone listening who had their thyroid removed, they’re on thyroid hormone replacement therapy or they would be dead. If you cannot live without a thyroid gland, what do you think is going to happen when you live with suboptimal, crappy levels of thyroid hormones? You’re going to die a slow death. That’s really what hypothyroidism feels like at it’s height.

At first people might feel a little weight gain. They start to get foggy in the brain. Maybe they’re colder than usual. Those are sort of the onset of some initial symptoms that usually plague people. Then, when you’ve been left undiagnosed or misdiagnosed for several years, those symptoms compound each other. For example, the thyroid gland is the master gland in charge of every metabolic process in your body. That’s why people get fat, usually when they’re hypothyroid, meaning underactive. Also, it’s the regulator and production manifestor of all of your sex hormone. This is why women have infertility issue, miscarriages. You might have fibroid tumors. You might have abnormal bleeding. Men might lose their sex drive. Things will manifest itself in a sexual hormonal level.

The bottom line is, when you’re in a hypothyroid state, you will likely get another disease or affliction of which you would not have normally gotten if you weren’t hypothyroid. Then what happens is you go down this train. Your body is falling apart. You’re becoming a mess, and the doctors are trying to bandaid and patch up all these different things that have happened to you, but they’re not looking at the cause. You can treat someone’s polycystic ovarian syndrome. You can give someone a statin for high cholesterol. It will never get better if you don’t solve the root of the problem. The thyroid is the root of all of these problems. It is the master gland.

Everyone, whether you have a problem or not, should either learn about it through my book or elsewhere about how you optimize your own thyroid gland. It’s very important to take care of, help along its way through nutrients and diet and lifestyle, because it is what is absolutely equal to how you feel on a regular basis.

Leanne Vogel: Beautifully said. Totally. As somebody who’s had hypothyroidism for quite a long time, and once I healed that specifically, I got my period back and all these amazing things started happening.

Elle Russ: Yeah. That’s what happens is you become … The tough thing about it is, it’s like shingles on a house, you start to kind of like, one peels off, then the other. It’s a hard place to be when you’re sick with hypothyroidism because you don’t know what the hell to attack first or what’s causing what. At the end of the day, it’s the thyroid usually. For people out there who have any depression issues, any brain issues, bipolar, anything that’s related to brain and depression, you need to get your thyroid checked properly. That is first and foremost the igniter of depression, when you have low T3 levels in your brain. That’s why a lot of hypothyroid patients are very depress and can’t think straight or have cognitive issues which is what I had.

Anything brain, also cholesterol. People who have issues with high cholesterol, they go in the doctor, the doctor wants to put them on statins. Check the thyroid because usually, once thyroid status is optimized, that all gets back into order. Same with the hormones, you can see how someone would go down a path, have a hormonal abnormality. The doctor says, “Oh, your low progesterone or your testosterone’s low.” Then they’re treating that. They’re trying to give you hormone replacement therapy. You could be in your 30s which is not appropriate necessarily. Right? All the problem was caused by was the thyroid. Everyone needs to look right there first.

Leanne Vogel: I know for myself, when my thyroid is a little bit wonky, I get, not depressed, but just like I’m off. I’m not necessarily all that happy. Then I’m like, “Oh, wait a minute. I need to take care of my thyroid.” That’s a good sign that I’m not taking enough time to nurture that. That’s a really good point.

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Leanne Vogel: Now you mentioned getting your thyroid checked properly. What does that mean because a lot of people will say, “Well, I’ll just go to my doctor and get my TSH checked. If that’s good, we’re fine.”

Elle Russ: Yeah, this is a real big problem.

Leanne Vogel: I know.

Elle Russ: I’ll let everyone know right now, and they can go back and listen to it or you can put it in the show notes. I want to give everyone just a quick comprehensive rundown of what you’re going to really need if you want to assess the thyroid properly. That is, TSH, Free T3, that’s “free” as in “freedom,” Free T3, Free T4, reverse T3 and then two Hashimoto’s antibody tests. Those five tests right there, are a great comprehensive panel to assess your thyroid. Now, there are related ones as well which are as important, but if you could only do those that I just mentioned, that’s a good start. The others that are related are Vitamin D, 25 Hydroxy, and B12 homocysteine, DHEA sulfate.

If people have issues with losing weight, which is hypothyroid-related, but sometimes even if you’ve gotten on thyroid hormone and you’re doing well, the problem is that often people become insulin resistant while they’re hypothyroid which happened to me. Then, you know, you can get on medication or I should just say thyroid hormone replacement. You’re doing well. You’re feeling great. Life is awesome, but now you’re still fat. That’s the time to check the HBA 1C. That’s a three-months glucose tolerance test. Anything above 5.2 should say, “Hey, you need to watch your carbs.” I had one at like 5.7 which was very indicative of like a pre-diabetic, insulin resistance issue. That’s something that, if people have already gone the whole mile, and gone down the healing process, but then, all of a sudden, this weight is still an issue, that’s when I would check HBA 1C.

Now, of course, there are so many other factors involved here. If you have Candida or you have poor gut health or all of these other things that can contribute to hypo-like symptoms, you need to clean up everything at the same time so that you can eliminate where are these symptoms coming from. Sometimes it’s food related or Epstein-Barr or Candida. That’s why it takes a full overhaul. When you’re in a hypothyroid state, and then you’re trying to fix it, you can use medication, but if you are not addressing all these other issues, then medication your taking is not going to work as well or may never work. You have to do a full force approach to this. It’s actually absolutely solvable. I don’t want anyone out there to think, if they’ve been told by a doctor, you’re always going to suffer from X if you’re hypothyroid. That is not true. That’s a lie. This stuff is solvable. It really is, but it does take patient participation.

Leanne Vogel: Yeah. Why does this happen? You mentioned Candida can cause issues, but I know, in your book, you chatted about the low-fat diet, working out a lot, can also cause hypothyroidism. What sort of activities are people engaging in where this is happening constantly? Like everyone has hypothyroidism it seems.

Elle Russ: It’s an epidemic. 25+ million Americans have it. 60% are undiagnosed. 200 million people worldwide. It’s brutal.

Leanne Vogel: Wow.

Elle Russ: One out of eight women will get it in her lifetime. It’s disproportionately a women’s disease. It’s a tough thing. Here’s the comparison really, the majority of doctors who don’t know how to test, how to assess, what they’re doing, is because they’re relying on 30-40-year-old protocols they learned in medical school that are now outdated and wrong. It was as outdated and wrong as someone 30 years ago would say, “Ooh, don’t eat the fat off of that steak. It’s bad for you.” We know saturated fat does not cause heart disease, period, end of story. The research is out. Well, it will cause heart disease though in the presence of a high-carb diet. If you’re eating a high-carb diet, and your body is busy processing all the sugar and carbs, then yeah. That fat you eat off the steak might go to clogging your artery versus being burned as fuel.

Just as that’s an old paradigm, and we know that now, it’s the same with this thyroid stuff. People have just not caught up. The doctors who have are usually the functional medicine doctors, the anti-aging doctors, the osteopathic doctors that often don’t take insurance or charge more and people just aren’t seeking them out but they should. Endocrinologists are classically the worst doctors to go to for thyroid health even though they should be the experts in it. They’re very rigid, and they’re not even testing the things that matter because they’re too indoctrinated and entrenched in an old paradigm that has since been proven false by the majority of the doctors who know what’s up who are treating the patients coming from the endocrinologists who are still complaining. That’s how it works.

It’s the difference between finding a doctor who geeks out on medicine, is interested in learning and finding an answer for their patient or going to a doctor who’s entrenched in 30-year-old protocols and fears that have since been proven wrong. Do you know what I mean?

Leanne Vogel: I totally know what you mean.

Elle Russ: I want to go to the doctor that’s geeking out and really interested in helping his patients, and those are functional medicine doctor. The doctor in my book, Dr. Gary Foresman who is an integrative primal doctor. He spends a minimum of an hour with everyone and everything’s so individual as far as what tests he might have for me versus someone else.

Unfortunately, the other part of this is that the overall philosophy that a doctor is going to help you. People need to step up and realize that just because someone has an MD from Harvard or Yale does not mean they know what’s best for you or that you don’t even know more about them about a subject. I shouldn’t know more than some endocrinologists about thyroid health, but I do. Why is that? That’s not right, is it? That doesn’t seem right because I didn’t go to medical school. Everybody has ability to research out there. There’s information out there starting with my book and other websites and areas.

People need to step up and start to learn about what they have. I know too many people, the majority of people that I know who are already on thyroid hormone replacement, if you ask them what it is or how it works, they have no idea. The could not describe to you what it all means. That seems a little dumb, doesn’t it? I mean, I’ve been a victim of that myself. I trusted doctors and then got nowhere and then had to step up. That’s another main message in my book. You have to participate. You have to do your research. You have to help your doctor help you.

Leanne Vogel: Yeah definitely. Do you have tips on how to find a doctor that could work with you? If I call them and they’re quite open to chatting with me about things, that’s a pretty good indication. If their first initial appointment is over and hour, that’s also a good indication. Do you have some tips and tricks on how to find these functional medicine doctors and such that could be helpful?

Elle Russ: There’s definitely resources on the web anyone can look up. Even A4M, anti-aging doctors, look up functional medicine doctors. You can go to which is the doctor on my book’s website, look up his credentials and then try to find someone with similar credentials.

One of the things that I talk about in my book, because I talk about the mistakes that patients and doctors make, is that it’s important to pre-assess what’s happening before you go in there. You might want to call and say, “Does the doctor prescribe these various forms of thyroid hormone replacement? Do they test for T3 or do they just test THS and T4?” You can ask some questions about like what do they test and how do they treat? Are they open to these different medications.

Often endocrinologists are only going to prescribe Synthroid which is a T4 only thyroid hormone and they are not going to prescribe anything else. That’s pretty much what you’re going to get when you go to an endocrinologist. You really want to go to someone who’s familiar with treating all the forms of hypothyroidism. That’s T4-only, that’s Synthroid brand name or a T4-T3 combination synthetic, preferably a doctor who knows how to compound T4-T3 is probably going to be more knowledgeable than others. Because if they’ve gone down that road and they can specifically compound down to the microgram for a patient, then they’re probably pretty savvy.

You can ask those questions. Does the doctor know how to compound medication? Do they test reverse T3 and understand how to treat it. There’s a variety of questions. I’ve put that all in my book and there are some other resources on the web. The best website for thyroid health is called That has great resources on there, questions to ask doctors, things like that.

Then there’s also a free Yahoo group called Natural Thyroid Hormone Yahoo group. They have a good doctor list that they have compiled over over the years through patients. If you join that group for free, you can get into the files and look at that good doctor list. They have an international one as well. That’s been a great list that has helped other patients find decent doctors because patients like me are writing reviews or have gone to them and said, “Ah, this doctor is really not good with this, but they’re open to this et cetera.” That’s a great free resource for everyone listening who’s trying to find a decent thyroid doctor. That’s one place to go, it’s called the NTH Natural Thyroid Hormone Yahoo group, and it’s free. It’s moderated by fellow patients like me who’ve kind of gone down this road, and other patients have reported in. It’s just a great resource, one of the many.

Leanne Vogel: Brilliant. I’m going to check that out. I’ve never heard of it before so thanks for the tip. That’s awesome. Say somebody has hypothyroidism, and maybe they’re trying to find a doctor. You mentioned before a couple of actions for healing the thyroid in addition to the medication. Can we go through a couple of those things for those listen for those who are hypothyroid right now and wanting to do something other than just medication?

Elle Russ: Sure. If someone is hypothyroid right now and they want to try to avoid going on thyroid hormone … By the way, I just want to share this one point, I do have a lot of people who’ve contacted me. They’re like, “I don’t want to go on thyroid hormone.” They’re trying to avoid it because they’re somehow scared of it. I just want to tell everyone out there, there’s nothing to be scared about thyroid hormone replacement. It’s giving your body what you don’t need. You’ll die without it. It’s not like some crazy medication that’s manipulating your system like all the ads we see on TV for all these crazy medications. It’s not like one of those. I just don’t want people to be fearful of it.

If someone’s out there and they’re like, “Hey. I really want to avoid this, and I want to try to turn it around naturally.” Number one, Selenium is really important for the thyroid and converting the thyroid hormone. Taking 200 to 400 micrograms per day total of Selenium is something everybody can do to help their thyroid status.

The other thing is adopting a paleo-primal lifestyle. You don’t even have to read my book to figure out what that is. You can go to Mark’s Daily Apple or and do enough research on this top to see what that means. The reason that’s applicable to thyroid health is that adopting a paleo-primal lifestyle when you do it right, is the ultimate in blood-glucose management and adrenal management. Balancing those two things are related to the thyroid. Part of that lifestyle is not doing chronic cardio.

One of the things that could have gotten me into a hypothyroid state and often do with people, is people who are eating a low-fat, low-carb diet, over exercising. These activities send a message to our primal perspective in our body that says, “She’s starving. Don’t give her any more of this fat-burning T3. We’re not going to make her hyper-metabolic right now. She’s running from something, a saber-toothed tiger or she’s starving.” Calorie restriction, particularly when it’s in a low-fat, low-carb paradigm, and eating every two or three hours and being on a sugar-burning hypoglycemic treadmill, those things absolutely will affect thyroid status. To adopt those principals and the lifestyle part of paleo-primal is really important.

Then the other component is food. When it comes down to it, sugar, dairy, and grains are huge triggers of inflammation and also grain’s particularly a trigger of Hashimoto’s. When we talk about auto-immune thyroid issues, diet is key, but also same with other patients because healing the gut is a big part of also thyroid issues.

There are so many things that can happen in the body that can throw a thyroid off. That could be sibo, bad gut stuff, candida. It can be anything that’s inflammation related because, again, when you have something going on like that, even Lyme Disease or a car accident can shake someone into a weird thyroid status for a while. Think about it. Your body’s been traumatized in some way, whether it’s from a food assault or whether it’s a car accident, and the body doesn’t want to become hypermetabolic in those states. It wants the body to fix and work on the inflammation and all the other things going on. It’s not going to allow your body to produce and pump out high-metabolic fat-burning hormone which is T3. That is why people who are hypothyroid get fat, because they have low T3, therefore can’t burn fat.

People who are hyperthyroid who have overactive thyroid glands, their hearts are beating fast, they’re sweaty, they’re pooping all the time and they’re skinny. They can’t gain weight. That’s the other side of it. This is a Goldilocks situation. Hopefully, that gives a good picture of how things can go wrong. Living a paleo-primal existence along with some supplementation and getting vitamin D levels up is very important. Vitamin D should be between like 70 and 90. Ferritin iron storage is huge. That’s a big test I forgot to mention earlier. That should be between 50 and 100. Every woman should probably get that test because we are menstruating females. Often time, if you exercise, you lose more iron than most.

Ferritin is absolutely related to thyroid status. Even something as dumb as iron being low can throw off your thyroid. It can be a really dumb fix like just taking iron for a couple months. Some of these things are dumb and easy. It’s worth adopting all of them and trying and sitting there for eight to 16 weeks to see if you have self-corrected and get retested again before going on thyroid hormone if someone wants to try to avoid it. Sorry that was a long answer to that question. Hopefully I got all the components in there.

Leanne Vogel: You got all the things. So many things, I’m like, oh, put a pin in that. Put a pin in that. One of the pins was Hashimoto’s.

Elle Russ: Right.

Leanne Vogel: How do things change with Hashimoto’s? Like the grains and dairy we know, no good. If you have Hashimoto’s, do not do that.

Elle Russ: No good.

Leanne Vogel: No good. Are there other things that people need to be aware of if they have Hashimoto’s versus hypothyroidism?

Elle Russ: Hashimoto’s is a form of hypothyroidism usually. What happens is, it’s not really a thyroid problem, it’s an auto-immune problem that affects the thyroid. That’s the same with Type 1 Diabetes. The auto-immune system gets something wrong. It makes a mistake, and it starts to attack something it thinks is foreign and that’s the mistake it’s making. In the case of Type 1 Diabetes it’s attacking the pancreas. That’s the mistake it’s making. In Hashimoto’s, the mistake is that it attacks the thyroid gland.

Here’s the deal, for people with Hashimoto’s, number one, if it’s caught early, you really have great chance of reversing it and staying off of thyroid hormone and being good if you attack it from a whole food/whole life approach. The food and components really do effect Hashimoto’s. They are absolutely triggered by grains and other inflammatory factors. It’s good news there. If your teenager, your daughter, just diagnosed with Hashimoto’s, if you change things around really quick, you might be able to nip that in the bud. That’s the good news about it.

The bad news about it is that the presence of antibodies equal inflammation. There are two antibody tests for Hashimoto’s. One is seemingly problematic than the other. Here’s why Hashimoto’s is important to look at. Most doctors do not understand that you can treat the auto-immunity part. Even if there’s a patient who has Hashimoto’s and they’re on thyroid hormone and they’re doing well like they’re feeling great. They still might go get their blood tested once a year and have high antibodies, but the doctor doesn’t even think that’s a problem. They just go, “Oh, well they have Hashimoto’s, so of course they’re going to have antibodies.” The answer is no; they shouldn’t.

The goal still for everyone with Hashimoto’s is to get those antibodies as low as possible. Someone on thyroid hormone replacement, doing well with Hashimoto’s, will not feel the rise and fall of those antibodies per se. There’s going to be inflammation going on under the scene. Inflammation equals other inflammatory factors, other autoimmune issues like you’re going down a real bad road for cancers. People who have Hashimoto’s are more likely to give birth to autism spectrum disorder children. There’s lots of reasons to get those antibodies down. Most people don’t even know you can do anything about it.

If you are not on thyroid hormone and you have Hashimoto’s and you have high antibodies, you’re going to feel it. It’s going to feel like … People who are untreated with Hashimoto’s go in and out sometimes of being hypo and hyper because any given day their autoimmune system is attacking the thyroid gland. They might feel like choked up in the neck. Tightness in the throat. They might feel jittery and anxiety-ridden because they have too much thyroid hormone that day and then, a week later, they might feel real low and depressed and hypo. Someone could be misdiagnosed as bipolar in that situation, particularly when you’re a teenager. Those are really things to look at when it comes to Hashimoto’s. The bottom line is, not matter whether you’re treated or not, you can address the antibodies and you should try to. That’s the main message.

In the Q&A section of the book with my doctor, we go into this. There’s other ways to treat this. That’s the goal. One of the success stories in my book, Cara, she had Hashimoto’s for years. She was treated on thyroid hormone. Finally got well, doing well, feeling great. Her doctor still didn’t even realize that she could do anything about her antibodies. Once she learned what I told her, her antibodies went from 300 to 25, the lowest she’s ever seen them in her life. She doesn’t necessarily feel the difference between the 200 and the 25 antibodies, but they’re there on the blood test so they’re there which means inflammation is there. She got it down just by quitting grains. She still has cheats. She’ll still eat a piece of real pizza every now and then. This is not a life sentence to never enjoy a piece of gluten.

In her case, her doctor still, even though she was treated well and compounded medication, doctor still didn’t realize that you could. Fortunately, people with Hashimoto’s have to be a little bit more careful about diet versus other people with hypothyroidism might be able to go off on a bender with gluten or other things because it’s not going to cause as much of an inflammatory response as it would with someone with Hashimoto’s. They have to be a little bit more religious about diet but can nip this in the bud sooner, and you really can and should try to treat antibody levels. Because one autoimmune situation, untreated, will beget another and so on.

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Leanne Vogel: You mentioned previously about blood-sugar levels and carbohydrates. There’s a camp of people that say when you have a thyroid condition, you need a lot of carbohydrates. Then there’s another camp that says a ketogenic eating style or low carb or even a low carb/paleo approach is the way to go. Can we talk a little bit about carbohydrates and the tyroid, and whether it’s necessary?

Elle Russ: Yeah. I’m glad you brought this up. I would love to have a group discussion with everyone in this community who has talked about this because there’s been a lot of misinformation. Number one, people have said that … Well, there’s been studies where when someone goes ketogenic, their levels of T3 lower. First of all, you have to understand that that is a broad-stroke claim that has a lot of nuances to it. Number one, was the person who went keto and their T3 levels lowered, were they already in perfect thyroid health to begin with? Do you know what I mean? Because if people approach a paleo-primal lifestyle because they’re gaining weight and they’re already hypo, I don’t know that a ketogenic state is going to like fix that right away. You know what I mean?

Leanne Vogel: Yeah.

Elle Russ: Just going keto is not necessarily going to change a hypothyroidism onslaught. The other thing is, there are so many factors in gut health. Also, do those lower T3 levels effect the person? Are they still hypothyroid? When you’re in a ketogenic state, usually if you’ve gotten there the right way and you didn’t just do it from going from a sad diet and being obese to being ketogenic right away. Let’s say you’ve gotten there slowly. T3 levels might lower but that might not necessarily make the person hypothyroid. It just makes them more efficient at T3. Their body is pumping out less T3 because it doesn’t need to respond to all the onslaught of carbohydrate BS demands that need more T3 to process. If that makes any sense.

If it were true that a ketogenic diet made people hypothyroid, we’d never be here. No one would have successful pregnancies; the population would not have happened. Our ancestors, that means that all of our ancestors would have been severely hypothyroid for years and years. I’m not buying that a ketogenic diet causes hypothyroidism. It may lower T3 levels but does it cause hypothyroidism? Listen there are people that do well at a certain T3 level and people do well at a higher one. It’s individual. I’m not sure that whatever tests or studies that have been done on ketogenic lowers T3, I’m not willing to buy it. I’m not willing to say that ketogenic makes someone hypothyroid. I think that’s what people are afraid of.

I’ve had people write me and go, “Oh, I’m making sure I’m getting enough glucose so that I can produce T3.” I’m like, “What are you talking about?” Here’s the thing, when you become ketogenic, if you’re really in that, you do become calorically efficient, but aside from that, often, the appetite is severely suppressed in a positive way, obviously. Now, the trouble that some people could get into potentially is their appetite is so suppressed, they are not eating enough calories and that could throw someone into a hypothyroid state.

Leanne Vogel: Okay yeah.

Elle Russ: So what’s causing what? I would want to look at whatever studies or claims people are making about this because I’m not buying that, just in and of itself, a ketogenic low-carb diet causes any of these problems. How do we know their thyroid status was even great before they went keto? Again, did they just get little bit lower T3 levels but they were feeling fine or are they saying oh? I’m not buying it. I think there are too many factors involved in this like caloric issues. Because I know people who have gone ketogenic and their appetite is suppressed and then they’re kind of like not eating a lot at all. If you go on that train for too long, then your body is going to get a signal that it’s starving. Then it might hold back on the T3. Do you see what I mean?

Leanne Vogel: Totally.

Elle Russ: Hopefully that makes a little bit of sense, but it’s an area where I wish they would do more studies on because I disagree with the claim. You don’t need high amounts of carbs for thyroid. We’re talking about super-low carb versus normal. I still think any woman at an average height … If you’re super tall you can probably eat more calories. Average women don’t really need more than a hundred carbs a day unless you are a bricklayer or a professional athlete. That’s not working out an hour or two a day. That’s not a professional athlete. Professional athletes workout eight hours a day. A carb level of a hundred carbs total or less per day, between 50 and 100 carbs, isn’t going to throw anyone into hypothyroidism.

Leanne Vogel: Yeah. I think you touched on a really good point. I actually interviewed Dr. Jason Fung, I think, in episode four of the podcast. We were talking about fasting and thyroid. I know for me, myself, personally, being on a ketogenic diet now for two and a half years, I find if I fast too much, it does effect my thyroid. I do need that carb-up practice every once in a while, otherwise I could go days and days without eating and my thyroid suffers immediately. I can just tell. It’s very individualized and I totally agree with you that it’s unfortunate that even in the paleo space, there’s a lot of, “Well, if you have hypothyroidism, you need to eat a ton of carbs all the time.”

Elle Russ: No. In fact, here’s the thing, the opposite is sort of true.

Leanne Vogel: I know.

Elle Russ: I want to tell everybody, if you’ve had hypothyroidism and you’ve suffered, and then you’re on the road to getting better, most likely you have crappy adrenals or severe adrenal fatigue and insulin resistance because, when you’re in a hypothyroid state and you don’t have thyroid hormones for energy, your adrenals are outputting too much, you are craving carbs and sugar. It’s almost impossible to be in hypothyroid state and not eat like crap. Often times you do have too much sugar, you become insulin-resistant. The only way to combat that is to, for adrenals and for the insulin resistance, is to go on a low-carb paleo-primal lifestyle that will balance out the adrenals and the blood sugar.

Almost everybody coming off of a hypothyroid state could benefit from a lower-carb paleo-primal lifestyle.

Leanne Vogel: Word. Drop the mic.

Elle Russ: Exactly.

Leanne Vogel: You mentioned thyroid hormones and them helping you with fat burning. I’ve had a lot of questions from people because this is a ketogenic space and all the women listening are on a ketogenic diet, how can you burn fat when not being ketogenic? How does that happen? How does that work?

Elle Russ: As long as fat is used as your primary fuel source, you don’t have to be ketogenic in order to burn fat. It’s really the macro. Being in a ketogenic state will help anybody burn fat faster and quicker. That’s for sure. You can still be a normal metabolic human being burning fat like a normal person who doesn’t have to go keto. Some people don’t have to go ketogenic because their pancreas, insulin, their whole process, metabolic machinery is working right. The way to make that happen by going paleo-primal is because it is a high-fat, low-carb, moderate protein lifestyle, you are switching off all of the switches that were dependent on glucose. Once you get beyond that for a month and you’ve trained your brain and your body to burn fat as its primary fuel, then it doesn’t really matter if you are keto or not.

However, if you’re trying to burn body fat, like excess body fat, then there are some adjustments you have to make. For example, you can get fat on a high-fat, low-carb diet. In fact, you can kind of get fat on a ketogenic diet. If you just overate fat, some of that would go to fat. You’d still probably feel good and have all the benefits of a ketogenic diet, but you still could probably overload your system. I think if people are trying to burn body fat, it’s key to personalize your fat intake.

For example, I’ve made many mistakes here. I once ate way too many calories for me and way too much fat for me. If you’re trying to burn the fat on your body, you’ve got to worry about what fat you’re bringing in.

There are some adjustments and I think it’s got to be personalized particularly for women. Women will be like, “Oh yeah, Bulletproof coffee.” Well, you might have a 400 to 500 calorie cup of coffee, that could be half your day as a woman. If you’re not working out, and you’re a small woman, you’re probably not going to burn more than 1200 that day if you’re just sitting in the office. You’ve got to think. Do I really want to use up all of that with a blast of oil and fat in the morning?

I love Bulletproof coffee. I think it’s great. It’s just that you’ve got to do some tinkering because of what guys can handle or the level of fat my brother can handle or Gabby Reece who’s 6’4″, as she can handle, is going to be different for me at 5’2″. Unfortunately, this takes a lot of personalization and tinkering as you probably know. You don’t have to be keto to be a fat-burner. You just have to have fat as your primary fuel source and you know that by the way that you feel. If you want to take it a step further though and burn excess body fat or have insulin resistance, then yeah, going into a ketogenic state is the next step. Does that make sense? I hope I answered the question.

Leanne Vogel: Yeah. Totally it does. I think in that fat-burning state, if you’re not eating ketogenic, would it be fair to say that, you know, you were saying that the metabolic processes need to be in place in order to burn fat. If you have a wonky thyroid, I imagine your ability to burn fat is going to be a little bit more challenging.

Elle Russ: Oh no. It’s going to be almost impossible. Let me just give everyone a real quick picture. I’m 5’2″, before hypothyroidism hit me, I was 16-17% body fat and between 110-115 pounds. That is athlete level of body. That’s like shape-model kind of like. That was achieved through the old paradigm of eat every two or three hours. I was a sugar burner. I was struggling. I was hypoglycemic. I was also exercising extreme willpower because I was starving all the time. I felt like, “Oh, this is what you have to do to get this body.” Because clearly it worked. I got the body but I was suffering. You can get that same body but you just switch the macros and the paradigm and it’s a much better life. You can sustain yourself. It’s why those diets don’t work and will ultimately fail you.

Sorry, maybe I lost track here. Getting back to the fat burning. I think the problem is that ketogenic is tough and I think it needs to be eased into. I think more than often, I think women are going too much by, and I was guilty of this, percentages or macros or making sure you get your daily. You know what? It’s got to be individual. There are some days when maybe 800 calories is fine enough for me and I’m really not hungry. People be, “Oh, you’re starving yourself.” Well, no. Maybe I’m not. That’s calorically efficient. I had a day where just that seemed right. Then the next day I might be like, “Wow. I want two potatoes.” I might want to over-carb it.

You know, it becomes intuitive over time and that’s what’s great about it. It’s just the tough part is, when you start on the train, people want to be told what to do. You’ve got to get out of the sugar-burning paradigm. It takes some willpower. It does take some kind of calculation and counting carbs. Then, as you know, once you’re in it, you kind of know what you’re doing. You can eye it. You kind of know what things are and you go by what you feel. You’ve probably experienced this where you know how it feels when you’ve eaten too much fat. It feels gross.

Leanne Vogel: Yeah.

Elle Russ: Then you go eh. People don’t want to do that when they just want to be told what to do. Just tell me what to eat. You’re like, “Well, what I tell you to eat this week then might be too much food for you three weeks from now when you become more calorically efficient because the metabolic machinery is changing.”

Leanne Vogel: Yes, then you add your period onto that. I know, right before my period, I’m so starving. I could just eat all the foods. I just need more food in my body, but after that, I’m pretty good. There are days, definitely, where I’m not even hitting 1200 calories. Then there are days where I’m probably over 3000.

Elle Russ: That’s right.

Leanne Vogel: It varies.

Elle Russ: That’s the beauty of it though. Right? You can have a good kind of pig-out day like that and it doesn’t ruin your whole world and put you two steps backwards if you’re on the train. It is individual, and it becomes intuitive. I think that’s what’s fun about it because it’s like you are entering into this new relationship with yourself and this communication with your body and yourself. Now, I will say this, if you’re hypothyroid and screwed up, there’s not going to be any intuition.

Leanne Vogel: Yeah.

Elle Russ: Appetite is going to be off. Everything is going to be off. You’re not going to be able to burn fat, even if you went ketogenic, that probably wouldn’t work. Hypothyroidism is hypothyroidism and if you don’t have those levels to burn fat, it’s not going to happen. I don’t suggest anyone try a high-fat diet if they are seriously hypothyroid because that fat’s probably not going to get processed. But, it’s a good place to go to head down the path. If you’re hypothyroid, maybe start the path of cleaning out the kitchen, cleaning out the grains, cleaning out stuff, getting carbs under 150 a day, preferably around 100 if your a woman. Slowly start to assist your body and that metabolic machinery. Even though it might take you getting on thyroid hormone to fully get there, you can still start the process. Everybody should anyway. It’s sort of the best anti-inflammatory, longevity strategy you could adopt. Right?

Leanne Vogel: Yeah I think those steps are really key. That’s something I did as well to get my hypothyroidism under control. Then, once I was feeling really great, keto came very effortless to me. Now, even my keto approach is very whole food-based. Like you won’t see any cheese or dairy. It also inflames my thyroid, inflames my entire body. It’s important to, like you said, know your body.

I agree with you, there’s not a lot of conversation around women and this eating style like at all. For example, if I drank a Bulletproof coffee every day, I will be a hot mess. That’s not a thing.

Elle Russ: Yeah. It depends on what you think of Bulletproof. Some people are putting two tablespoons of butter. Now we’re really looking at 400 calories of fat. My God.

Leanne Vogel: That’s so much.

Elle Russ: Maybe one pat of butter guys and a little sprinkle of MCT oil.

Leanne Vogel: Totally. Like what’s wrong with just putting … Usually, I do a teaspoon of a couple of different fats and equals like a tablespoon. I’ll have that for breakfast and then I’ll eat a couple of hours later. Sometimes I wake up, for example this morning, I was like, “I need to eat right now.” It’s nice to have that variability but you’re so right. In any “Dieting Space” when we’re following a protocol of any kind, it’s like, “No. This is what they tell me I need to do. This is what I’m sticking to, no if, ands or buts about it.” I see people hitting a wall every single time and getting frustrated, and it’s just because the eating style they’re trying to achieve may work for them, but it needs to be tweaked.

Elle Russ: Yeah. It’s almost like too much of a rigid approach. I know you know this. This is the calls I get from my friends who have gone paleo-primal low-carb. It happened to me the other day. My friend called me and she was like, “Uh gosh. You know what? I love being paleo-primal. Can I just say, I went the entire day, didn’t eat, had 15 meetings, blah, blah, blah, blah, blah. It’s only 3 o’clock now and I’m totally fine, and I’m starting just to get a little hungry.” That’s an amazing sense of freedom.

I had that happen to me the other day. I literally went on an eight-mile hike. All I had had was a cup of bone broth. I didn’t even fat. I just had a cup of bone broth that morning went on an eight-mile hike at 8: 30 in the morning. After the hike, my friend who’s kind of a sugar-burner, she was like, “Are you hungry?” I’m like, “No, I’m not.” Then I literally didn’t eat until 3 or 3: 30 that day.

Leanne Vogel: Amazing.

Elle Russ: That sounds crazy to people. They’re going to be, how did you? Because I was completely sustained. My body was fueling itself off of ketones and fat. There’s was no suffering whatsoever, not mentally, not physically, in fact, those are the moments that you know you’re on the right track because it feels crazy after something like that to go, “I actually could walk another five hours. I’m not even tired. My brain works great.” It almost feels like this shouldn’t be happening. It goes against what we all kind of think and know.

If you’re listening out there and you’re thinking, “Oh, it’s impossible. I could never do that.” No. You could. That’s how we’re designed. We were designed to go that long. We were designed to hunt and gather and be able to go days without food and not have drops in mental or physical energy and performance. That goes right back to the primal blueprint, how we are mapped out as humans. That’s what our genes expect of us. That’s why it sucks so much and it’s such suffering to be on a hypoglycemic, Zone, South Beach, eat every two or three-hour train. That’s why it doesn’t feel right.

Leanne Vogel: It’s exhausting.

Elle Russ: What living being in this world do you know that has to eat every two or three hours or they’re going to freak out? Are you kidding me? Dogs can eat once a day or go days without. There’s not any other animal or living being that has food disorders. We are the only one, and it’s because we’ve gone so far away from how we’re designed. Once you get back into that, then these freedoms and being able to go all day or just not even think about food. That’s the freedom, not thinking about food. Anyone listening who’s a food addict or struggling with that, this is the way to fix it. It’s kind of the only way to fix it.

Leanne Vogel: Yes. Totally completely, that was my experience as well. Once you’re free from food, you don’t have to think about it. You don’t have to stress about it. It’s quite a freeing and amazing feeling.

Elle Russ: It really is because it feels crazy to think about food all the time. I’ve been there. I know what it’s like. I want to say to anyone listening, you know, there is an end. It’s not like oh, you’re cursed. I used to think I was cursed. I was like, why do I have problems? Why am I thinking about food all the time? I don’t see other people struggling with this. When is this ever going to go away? I was afraid for myself. I almost went to Over Eaters Anonymous at one point. I talked about that in my book. I thought it was something inherently wrong with me.

Everyone listening who’s got this problem, you just need to know that unbeknownst to you, you’re in a sugar burning state that fuels your need for sugar. When you take just 21 to 30 days to get off that train and onto this one, you will banish those obsessions forever and your life will be so free. I’m still, to this day, so grateful for that.

Leanne Vogel: Yes, as am I, completely. Thanks so much for coming on the show. That went so quickly. I can’t even. I have so much more questions for you. Where can people find more from you. I know you mentioned at the beginning but feel free to share more things.

Elle Russ: Sure. If you want to find more about me, you can go to that’s or Instagram, Facebook, and Twitter _ellruss or Paleo Thyroid Solution. If anyone is interested, you can check in on our podcast, the Primal Blueprint Podcast. We do new episodes every Wednesday morning. Anyone fee free to reach out. The book is called The Paleo Thyroid Solution. It’s available at Barnes & Noble or and it’s really cheap and an easy resource and meant to serve as a bible and a manual for people who are on the road to recovery here.

Leanne Vogel: It’s fabulous. It’s so good. You need to grab it everyone. I’ll include links to everything Elle just mentioned in the podcast notes which you can find at Thanks so much for coming on.

Elle Russ: Thank you so much for having me.

Leanne Vogel: That does it for another episode of the Keto Diet Podcast. Thanks for listening in. You can follow me on Instagram by searching healthful pursuit where you’ll find daily keto eats and other fun things. Check out all of my keto supportive programs, bundles, guides and other cool things over at and I’ll see you next Sunday. Bye.

This entry was tagged: eating high-fat, eating keto, eating low-carb, fat-adapted, how eat keto, keto basics, keto diet, keto for women, keto life, ketogenic diet, ketogenic for women, ketosis, low-carb paleo, paleo, thyroid, what is keto

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Hi! I'm Leanne (RHN FBCS)

a Functional Medicine Practitioner, host of the Healthful Pursuit Podcast, and best-selling author of The Keto Diet & Keto for Women. I want to live in a world where every woman has access to knowledge to better her health.

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