Tuesday, March 27, 2012

Dietary Thyroid Treatment: Beef, Green Vegetables, Full-Fat Milk & Butter Normalize TSH in Subclinical Hypothyroidism

Image 1: "Nutritional thyroid medication" - Sirloin of beef in smoked butter (thestaffcanteen.com)
"Hypo- what?" This is probably the answer your grandparents would have gotten, if they had told one of their friends that they suspected to be hypothyroid, or, put simply, had an "underactive" thyroid gland. What used to be medicinal rarity, though, has become more and more of a plague in the course of the last decades. And while "full-blown" hypothyrodism, which is (quite ridiculously) defined by TSH values of >10mU/l, is still pretty rare, the number of people with oftentimes undiagnosed "subclinical hypothyrodism" who have elevated TSH levels, but remain below the more or less artificially defined upper cut-off level, or normal TSH levels, but low levels of the thyroid hormones T4 and, more importantly, T3, is on a constant rise.

"Subclinical" hypothyroidism: Not just a thread to your weight, but also to your health

Aside from the universally mourned weight problems, an inappropriate production or conversion of T4 to the active hormone T3 can have profound health consequences. Among other things it can precipitate to
Image 2: Within the hypothalamic-pituitary-thyroid-adrenal axes (HTPA), the thyroid is involved in almost all  physiological processes in your body (Rhyszard. 2010)
...and many minor health complications. Nevertheless, treatment with levothyroxin (T4; synthyroid) does not consistently resolve all / any of these problems. This is particularly true for the metabolic derangements, such as the persistent hyperlipidemia, of which a recently published review by a reasearcher from the renowned Harvard Medical School states that "trials to date have not consistently shown a beneficial effect of levothyroxine treatment on serum lipid levels in subclinically hypothyroid patients" (Pearce. 2012).

Why would you take medication, when all you need is a whole foods diet?

Against that background the latest results of a case-controlled 3-months small scale (n=54) dietary intervention trial by Marjolein W. J. Kuiper and Ellen J. van der Gaag, the results of which have been published in the latest issue of the Journal of Food and Nutrition Sciences could be of paramount importance (Kuiper. 2012). After all, this is - at least to my knowledge - the first experiment to investigate the (as it turned out) profound effects of a simple dietary intervention, which prescribed the inclusion of
  1. three servings of beef per week,
  2. green vegetables on at least 5 days of the week, and a
  3. daily portion of full fat milk and butter
into the habitual dietary regimen of 54 children with subclinical hypothyroidism, on the plasma levels of thyroid stimulating hormone (TSH), free T4 and BMI.
Figure 1: Vitamin A, iron and iodine content of the foods in the experimental diet and comparable foodstuff; data expressed for 100mg relative to the RDA for children (calculated based on Kuiper. 2012)
In view of the age of the children (1-14 years) the already statistically non-significant changes in BMI, are pretty irrelevant. The restoration of the eleveated TSH levels into the normal range in 74.1% of the patients in the active arm of the study (compared to 25.9% in the patients from the control goup), on the other hand, underlines the role of a well-balanced, nutrient-dense, whole-foods diet that is rich in iron, iodine, vitamin A and the (saturated) fat that facilitates the uptake of the latter.

Eat a whole foods diet now and avoid thyroid problems in the first place

Image 3: If you care about your (thyroid) health you better run, whenever you see this symbol ;-)
And while it is important not to fall for the idea that your diet should consist of nothing else, but the above mentioned foods, the results of this study appear to confirm what many of you probably have long suspected: The current dietary guidelines, according to which red meat must not be consumed more than once a week (better not at all), full-fat milk, cheese and other dairy products should be replaced with their low- to no-fat varieties and those "bad saturated fats" in butter and meats have to be avoided at all costs, could be one of the various dietary and environmental factors which contribute to the initially invoked increase in "subclinical" thyroid disorders within the allegedly "iodine sufficient", iron-toxic and beta-carotene orange (yet retinol deficient) Western world.


  1. I think that it's also important to try to get the organic kind of whole food.

    In the case of milk, UHT milk it's submitted to extremely high temperatures that kills the nutrients that bacteria likes... and also the ones that makes PASTEURIZED milk healthier.

    The same with organic eggs, which have better fat profile, etc.

    But since organic food is much more expensive you'll have to select some of your daily foods, and get the rest from pesticide and detergents enriched foods.

  2. Hey doc,

    now I am quite a bit concerned. I had a blood test done 3 weeks ago, and besides low S-DHEA and Testosterone values, my TSH was 1,3 mUI/L, my T3 74 ng/dL and my T4 5,3 ug/dl...

    Probably everything related to each other?
    I am a 31 years old female training heavy 3x week and doing LISS in the morning (1 hour walking on the park) - ca. 15-16% bodyfat...

    I have an appointment with my gymnecoogist in two weels but I am pretty unsatisfied cos I am not progressing on my training lately :-(

    By the way, I do eat lots of meat and veggies (all kinds), just the full fat diary is not that often on my menue :-)

    I would love to year your thoughts on this!

    1. my assessment is overtraining or undereating or both. You have the classic HPTA downregulation subsequent to your body experiencing a "famine"; from what I gather you are low-carbing as well?

  3. stapedius gigantusMarch 28, 2012 at 12:15 PM

    Good article Prof, thanks!

  4. actually I am not lowcarbing, I am cycling, so OFF-days ca. 100g carbs, ON-days over 250g carbs, so the lack of them shouldnt be the problem I guess... Do you think I should stop cycling and just do high carb everyday instead? I cant just be overtraining, as I just workout 3x a week, and undereating? Well I log my food and control expenditure with my bodymedia, and at the end of the weeks it shows me a small daily deficit, like average: 200kcal/day... means I am eating kinda 1400kcal/week less than I would need for maintenance... Deosnt seem too drastic for me :-(

    thanks for your answers!

    1. This comment has been removed by the author.

    2. When is the last time you took a break from training? 3x a week, depending on the volume of training, intensity, can send you into over-training. From what I gather, not progressing either means one of two things, poor nutrition or overtraining.

      What has been the best judge for me, and allowed me to make the greatest gains, and is just noting how I feel after a workout.
      If I just ran sprints, and my body is burning nicely and I feel amped because "it was a good freaking workout" I am probably not over-reaching.
      However, as soon as my mood doesn't rise after working out, or I end up yawning, cold, tired, feel like I couldn't give it my all after the work, I take a step back. Trust me, you won't lose anything. And you'll gain more. Our bodies need rest. Try taking at least 5 consecutive days off, I usually do a week. (And once a year I'll take off two weeks.)

      Listen to the Prof Doc on this, but this is my personal experience. Good luck!

    3. interesting enough, Eriks first question - yet with the addendum "since when are you 'dieting'" would also have been my next question.


      1) what type of carbs are we talking about here? I hope you don't count carbs from veggies?

      2) I am not familiar with bodymedia, but if it tells you how much calories you need based on how much you expend, it is either a tent you are wearing 24/7 or useless... forget about it and about calorie counting in general
      if you want to improve your health, your physique and your performance count food not calories and start giving a damn about nuances which would translate into the <100kcal realm

      3) give us a representative meal plan for one day in your life

      4) how much fat / what sources do you have in your nutrition regimen?

      5) how much sleep do you get each night and what's the quality?

      6) how long / what type of workouts are we talking about?

      7) do you use stimulants (caffeine or more powerful stuff)?

      8) do you have the FT3 and FT4 values to the thyroid data? That would be important, because if you are very lean, it is possible that you simply have low binding globulins (low test would be another consequence of that) and the free T3 and free T4 would be in order

      9) do you lose weight? I suppose you don't and if anything, then muscle, right?

      Sorry, that these are only further questions and no answers, but try to give as much info as you can, 'cause up to now I still believe that we are dealing with overtraining

  5. Wow, I am overwhelmed that you guys took the time to answer me, THANKS!

    @Erik: Actually, as I had my blood tests done, I was on vacations and did not exercise for at least 10 days (!) I did walk around a lot (hate driving in Sao Paulo) so I was probably walking around for over 3 hours/day, sometimes more, but really easy going, as I was like looking around, shopping etc.

    I actually feel great after working out, a couple hours later I might feel tired - just when I train on a saturday, otherwise I have to work after and cannot allow myself being tired.

    1) on OFF days the carbs come from veggies only. Typical macros: 160g protein, 100g cabs and 70g fat - but on off days I do eat TONS of bread, potatoes, tumpies etc. Yesterday for instance I ate at least 300g bread, which is about 150g carbs, + 700g pumpkin, red meat, tons of salad/tomatoes/zucchinis. 230g protein, 320g carbs, 50g Fat.

    2) bodymedia is being used so farf 24/7 - could drop it but I am still very confused on what I should do, specially after these tests.

    3) OFF-Days: meal1: 150g chicken breast with 200g zucchini, 200g tomatoes, some leeks, sour cream dressing - meal2: 150g quark with some egg whites, protein powder (for the flavour), some milk and dried coconut - meal3: 150g beef (lean), lots of veggies (bell peppers, salad, oil dressing), +400g coulifower, as dessert, a small peace dark chocolate (70%, ca. 20g) - meal4: pancake: 1 whole egg, 200g whites, 100g quark, 20g almond meal backed with non-stick spray. As topping some full fat yoghurt. These days I have a deficit from around 500-700kcal

    ON-Days: meal1: salad with tomatoes, peppers and dressing (to "fill up"), then around 60g oats with 250g quark and some milk - meal2: 1 or 2 slices bread with peanut butter, cottage-cheese and some jam - meal3: usually 150g meat (whatever) and ca. 600-700g pumpkin or tunpis or sth similar - meal4 before going to bed, I usually eat tons of bread, like yesterday: 300g bread, 400g cottage cheese, 100g "harzer" cheese (low fat) with some jam/syrup and peanut butter. These days I have a surplus from around 400 - 600kcal

    4) its usually around 40 - 60g/day - one day of the week I eat some "shit" and then it can come up to around 150g

    to be continued...

  6. 5) I sleep more or less 7 hours/day... Actually I go to bed around 23:30 and wake up 7:30 - and I do sleep well (besides having to wake up at night to drop some water)

    6) I do the classical heavy stuff, like BW-chins/pullups, squats, deads, benches, dips - mix some Reverse Pyramid and HIT (just one or two exersises HIT-Style). My workots never take longer than 50min (max. 5 exercises) and as I said, 3x week push/pull split and NO cardio, eventually 1x week some HIIT. I also walk every day - way to work so to say and on OFF days I go shopping on lunch break so that we get maybe 2 hours easy going walking/day

    7) Just coffeine, but somehow doesnt seem to work well lately.

    8) I dont have FT3/4 values :-( just Testo, FSH, Estradiol, DHEA-S, SHGB, TSH and some "Normal" stuff as glucose, cholesterol, triglycerids etc

    9) since two weeks I have been losing a bit of weight, yeah but we all know how innacurate bodyfat-scales are. Alltou, I do have a caliper and the skinfolds are discreasing (assuming I am measuring properly)


    Important points I didnt mention:

    a) I am Intermitent Fasting (16/8 a la Martin Berkhan)
    b) I havent been menstruating since a year more or less (yeah I know, I am going to the doc next week)

    I have uploaded a pic where u can see more or less "how lean" I am. Actually, my goal is to gain muscle, but the way my hormones seem to be now, it seems to be impossible... And I havent been progressing anyway lately. Here: www.marka.ppg.br/outros/me_overview.jpg

    I will tell my gynmecologist to send me to a hormone-specialist cos I definately want to get this solve. As for my gymnecologist, last time he said he could just give me some pils so that I get my menses again, but I dont think its just about the menses but the whole thing, you know?

    THANKS A LOT in advance for taking your time, I really appreciate this!


    1. I reply here to keep the structure intact, although this post follows what anonymous already said and to which I can only nod my head:

      A) Mariana, you DO look great!

      B) I also know more than one woman who was in your position and greatly benefited from "letting herself go" a little more with the result that aside from looking (even) great(er) they also felt much better and became much more outgoing

      ** now let's see what we have here (in your answer Mariana) **

      *) the way you feel after workouts and in the hours following is suggestive of baseline low cortisol (which would be in line with the rest of your hormones), which spikes / is supported by catecholamines when you work out. Once you stop, you feel great until your body got rid of what is left from the workout, then you drop < this is a viscous circle, because most people interpret that as "only when I work out I feel good, so I must work out everyday", when they actually would have to take >1 month off; I am not sure if that will be necessary in your case, as there are a hell lot of other things in the following points which could help

      1) I told you before: Don't count carbs from veggies. My experience (personal as well as observational) is that you can eat as much of those as you want... if anything they will help you lean out. Look at Adelfo he was stuffing himself daily with greens in addition to his baseline level of fast + starchy carbs; when I look at the run-down you gave us in three, I ask myself: Where on earth does this lovely girl get those 75g of fat from? I mean you don't count the 1g of fat from the chicken breast, the 0.01g of fat from zuccini etc. do you?

      concrete advice 1: stop counting carbs from veggies, keep the veggies add "real" carbs from starch of fruit and make sure you do get those 75g of fat in addition to the miniscule amount in your otherwise low fat, low carbohydrate, low calorie diet

      3) ... this is a direct follow up on 2) with things you should consider

      * stop eating egg whites, their nutritional value is 0 compared to the yolk; you will build more muscle and lose more fat with 2 whole eggs than 1 whole egg and 500 whites

      * don't do a caloric deficit of more than 20% < - although I think the previous points factor in as well this is the main culprit here. You are sending a starvation signal on EVERY OFF day - a day, where you body wants to recover and needs nutrients as well (for my liking you are by the way lean enough and chances that you will get rid of whatever fat you are seeing on your body still / I see none / are slim if you are going >-20% calories, simply because your body will believe that he will need the fat the next day to survive)

      * stop using the kcal calculations. Just forget about them and work from where you are at now by just modifying the foods. For me always counting calories was a trap that became muscle wasting and fat-building and it made me borderline orthorexic. Think of foods, not of calories. If adding 5 eggs turns out to be too much after 2 weeks, you cut back on 1 not on the X calories the egg has. This makes you more flexible, more relaxed and more successful in the long run

      4) I mentioned that before, I am missing real oils, like coconut oil or olive oil and - obviously - butter in your plan. I am now also putting something forward you may not expect to hear, but do you restrict your intake of N-6`s? I have seen those hormonal problems in people who did that and added a ton of fish oil on top of it - this combination appears to profoundly downregulate the HPTA function; with your body fat percentage, though, even the former alone (without the additional fish oil) could potentially do the job - how is your skin? dry?
      also check out this one http://journals.lww.com/acsm-msse/Abstract/2000/07001/Dietary_fats_and_immune_status_in_athletes_.3.aspx for the importance of adequate fat and total energy intake in athletes

      [to be continued]

    2. 5) Well, the dropping water goes hand in hand with reduced ACTH (another of the HTPA - related hormones), but 7h of sleep is actually fine if that is regular

      6) your workout regimen is excellent, but your diet is unsufficient to cover that given that you got no reserves to draw upon (at your body fat level) whenever you run out of fuel... you should by the way stop Intermittent Fasting for now, ASAP (more on that further down)

      7) caffeine = does not work, because your body refuses to produce cortisol, which would burn the rest of your precious muscle away and liberate the fat that he believes you will need tomorrow, the next day of starvation (don't take this personally, but this is the way your body must feel with a caloric deficit of 500-700kcal + intermittent fasting)

      8) don't mind. It is after all I know now unlikely that those levels were "high" *I wanted to make a smiley here, but actually it ain't funny, so I left it out*

      9) when I originally asked you this question, I did not imagine how "far" you have already come. You are in a position, where you would probably look better (at least to me) if you did gain a few pounds. So please forget about the scale all-together and stick to the caliper or even better just a measuring tape (I have still to find someone who can do the caliper measurements on him-/herself accurately) - measure your waist 1x week after a large bowel movement preferably in the morning - that's it

      ** additional points **

      a) IF is not compatible with your current hormonal status (and I do even believe that it is not very compatible with being female, anyway), which brings up ...

      b) I don't have to tell you what the Dr. is going to tell you when he will see you, right? He will say: "You got to gain weight!" Now the problem is not so much your weight, but the way you got there and did not listen to your body when the menstrual cycles disappeared in the first place. 1 months of eating at maintenance (less protein and more fat and carbs) would have been enough to get you back on track then. Now you have maneuvered you right into a position similar to the "athletes triad" and with the IF + -500-700kcal regimen on off days, your body will believe you are anorexic (or the environmental circumstances force you to eat like an anorexic). Please don't feel offended by this comment. I am not accusing you of anything and I know that you wanted to do everything right, but from your physiological status quo it does not really matter how you got there (cf. http://www.ncbi.nlm.nih.gov/pubmed/21957879, but in your case the sound training kept the muscles intact, which in turn has your FM/LBM ratio even lower and for the female body this means "by all means, make sure you don't get pregnant!")

      check out these studies
      http://www.ncbi.nlm.nih.gov/pubmed/22252944 and
      as well, you can at least minimize the ghrelin by eating more frequently and MORE in general ;-) never go HUNGRY!, although this will make you feel good (that is the cortisol and if you exercise the catecholamine spike)

      it could, by the way be an option to use an estrogen based contraceptive, partly also in view of bone density (http://www.sciencedirect.com/science/article/pii/S000293789770396X), but this is something I would discuss with your gynecologist

      let us know how things are going!

  7. Jesus, Mariana, you look f-ing great. I am not Dr. A, so take this with a grain of salt, but I still think it is an issue of volume/intensity/intake, and not having the balance quite right. If I were you I would try to gradually add in a few pieces of fruit, both on on and off days. Also, and again, GRADUALLY, I might try to increase the training volume slightly while backing off on intensity, again slightly. Absolutely no training to failure, no forced reps, no killing yourself, at least not for a while. And I would cut WAY back on the non-training activities. Watch your body, see what happens and make adjustments as necessary.

    Many, many years ago a woman I was trying to help was having similar issues, including the no periods for about a year. We tried many things. But it turned out to be that she needed some more carbs and cals (her fat was already pretty high and it ended up coming down a bit), and a few more sets and reps per bodypart, but with less crazy intensity. I was surprised by this, as I was certain she needed less work, not more, as I am a male and barely did what she was doing to start. But it turned out that she needed more work than me, but at a lower intensity. When she finally hit on her balance, her body, almost overnight, got harder and fuller, her skin began to glow, and her periods came right back.

    Good luck.

    PS -- How does one go about selecting a name? I have tried several times, but it doesn't allow me. So I always comment as anonymous.

    PPS -- This is my favorite training blog. I visit every day. Keep up the great work, Doc.

    1. I use my google account to comment, so maybe you can try making one of those. There is a Reply As: drop down box below the comment for me, where I choose my account to respond as.

  8. now I must say WOW!!!

    Thanks, thanks, thanks and THANKS AGAIN!! I am so happy you answered me I cannot describe!! Finally someone who knows what he is talking about, and took time to help me on, I am overwhelmed. THANKS!!!

    Now I dont even know where to start but I dont wanna "bomb" you agan, I am pretty sure you have lots to do.

    1) even thou I am not every day on a caloric deficit, means, on my 3 ON days I still have good surplus so that by the end of the week the deficit is very small (+/- 700kcal for the whole week, -100kcal day average) do you really think my body is in such panic? Hmmm...

    2) Sorry I forgot to mention about the fats: Well I use coconut oil to cook, make dressings for my salads with olive-oil and I do take Fish-Oil caps everyday, 2 pieces of these one with 1000mg Omega-3. Besides that, I use some Butter here or there for my veggies, the almond meal and the eggs... I also eat some "full fat" cottage cheese on OFF days.

    3) Then thing about the carbs is that if I eat too much of them, I will get bloated, I wont look lean the next day - yes I know its just vanity, but when I realise how difficult it was to get there, I dont wanna miss that you know?

    5) What are your thougts about grains in general (bread/oats etc)? Or a simple question: What kinds of food I should NOT eat? Besides the obviously stuff like Fast food and so...

    6) Do you think I should stop cycling the carbs at all?? Just eat more or less the same every day or is it still OK to make carbs highER on training days?

    7) Unfortunately I gain fat really fast. I always observe this when I go on vacations :-( Do you think it has a but to do with my hormonal situation as well? Starvation-Mode? Well, even before "getting that lean" I always gained fat pretty fast... I managed gaining 3kg bodyfat (not even water!!) on 1 week "all inclusive" Vacations :(

    8) Do you think I should keep my training as it is or rather higher volume/lower intensity as Erik just suggested on his last post?

    9) My goal for real is becoming "normal" again (biologically), as well as gain some muscle with minimal fat gains - and keep pretty much lean.

    to be continued...

  9. As for IF: Well my thing is: About a year ago, I was like 6 kg heavier, eating the "classic" 6 meals/day setup with lots of carbs from whole bread, fruits etc... And the thing was:

    a) I was feeling like a marshmallow (bloated/retaining water)
    b) I was hungry ALL the time and very unsatisfied after one of these tiny meals (I can easly eat a 700g steak + veggies in one sitting, believe it or not. Ppl call me "bottomless pit" :D
    c) Guess what? I already had the issue of not menstruating by then, even with more bodyfat, eating overall more etc...

    I didnt have my hormones checked by then but the lack of menstruation doesnt have anything to do with IF. I noticed it actually as I stopped taking the pills, pretty weird.
    It seems I just menstruate when I reach a certain BF level which in my case seems to be around 24%. Have a look here: www.marka.ppg.br/outros/CIMG3719.JPG (I just cut my face out of the pic cos it sucked all the way on that pic and not cos I dont wanna be seen or so, justF FYI :-))

    this is a pic I found, this is more or less how I have to be to get my period again - but then it comes once and disappears again - but this is absolutely way too much BF for me :-(

    Now with IF: I am not doing it because I want to loose fat or so, I am doing it because I love the feeling of eating until saciety, feeling which I never had before (even stuffing myself with veggies etc). Besides that, I like the cycling so that one looks really good every day.

    So, if you really think IF is not good for me, I will think about it. I absolutely LOVE your advices but the thing with IF is the only one I have to think twice before putting in practice.


    Now I have lots to do tomorrow, read all the links you posted :-)

    And I cannot repeat myself often enough: I really apreciate you for taking your time to answer my sily questions and help me out on this, THANK YOU!

    Best regards, Mariana

    @Erik: Obviously thanks a lot for your imput as well, I really appreciate it!

    1. Let me briefly emphasize that I am obviously flattered whenever people perceive me as an "authority", I have yet still met too many "experts" in my life not to be aware that even the best-meaning and most-knowledgeable authority never "knows" everything and that it is always a good idea to keep being a "healthy skeptic" as Chris Kresser once labeled himself and his blog. So take my advice as a basis to make your own decisions and don't follow it blindly, ok?

      That brings up the issue of intermittent fasting, with it obviously not being the underlying cause of your problems, I trust your own judgement that it works better for you than having to worry about 6 meals a day... that being said, the "hunger" you experienced on the former regimen (we don't have to care about the reasons, here) tells me that you are basically starving for years now (at least that is what your body will think), which makes it all the more unlikely that your problems arise from "real" physical conditions, like an under- or malfunctioning pituitary... in a way this is good, because I can already tell you that no doctor is going to be willing to even check for these problems, when he sees your body fat percentage, of which his textbooks told him that it is not normal for a woman (and by the way, you look great on your old picture, as well!). But let's tackle the individual points, now

      1) The overexpression of ghrelin on you low calorie days (of which I have stated above that it is going on for years now) is something you cannot handle at the moment. The cycling has to have an end. Just as you will have to abandon your belief in being able to calculate how much energy you need - that does not work. My reference to the tent in my previous response may have been funny, but in the end even that would only give you a +/-100kcal estimate of your actual energy expenditure. Trust me: It is not worth stressing yourself with that.

      2) *lol* from the fact that I had to look up how much fat "full fat" cottage cheese has, you can conclude that I am thinking in categories not calories (and my life has become easier and my body composition has improved ever since I do that) - for me cottage cheese is in the protein category. Now looking at the label I see that it has 5g of carbs and 5g of fat,... that leaves me with my previous recommendation to discard counting everything. 1 Cup of cottage cheese + a good handful of nuts + 1 banana that would be a small meal and that is what you would count. Baseline protein + fat + carbs (not counting veggies of which you just have as much as you want as often as you want)... easy and stress-free, just as
      *1-2 chicken breasts (depending on the size and your hunger) + onions & eggplant fried in coconut oil + 100g rice (cooked) + salad = 1 regular meal
      *1 large steak + garlic butter + beans + some bacon + 1-2 larger potatoes = another meal

      [more in follow up]

    2. 3) I have come to realize that bloating from carbs more often than not is a problem that is related to electrolyte imbalances. How much salt do you eat? You better make sure you get plenty (if you don't eat processed food you simply follow your taste and put as much salt on your food until it tastes too salty). As I probably said 100x now, only count non-veggie carbs and stick to ~40g in meals away and <100g in meals post workouts and you can be sure that its not the carbs that will make you bloat. If you read Adelfo blog, you may notice that he has been following my advice to take baking soda before workout throughout the prep. Me personally this helped much in avoiding the PWO bloat I was otherwise often experiencing (which is by the way a consequence of low salt and water due to what you lose during a workout AND higher acidity)

      5) You should not eat anything that comes 2-3x processed and that means that most grain products are a no go. I, for my part, have yet to see a whole-grain product with whole grains... I mean if you made flour of it, then processed it 2-3 times to produce "whole grain spaghetti" where the heck are the whole grains in that product? Otherwise you will probably benefit largely from LESS than more dietary restrictions on EVERY level

      6) I would stop cycling carbs aside from doubling the carbs of the meal you eat post workout (compared to off days) - that is still cycling and could have you at e.g. 80g non-workout vs. 120g workout days.

      7) *lol* it is very unlikely that you can gain 3kg of pure fat in one week - even if that would "only" require a caloric surplus 24,000kcal, because your body would have refused to ramp up energy expenditure in response to an increase in calorie intake, it would have been necessary to eat at least 4,500kcal per day to achieve this weight gain, which would still - even in the worst case - have included tons of water (remember that your intracellular stores are depleted as well) and glycogen

      8) Maybe you could do 2x full body workouts the way you did now and for one day simply do something different... what about courses? Does your gym offer anything in the ~45min-1h range you would like to do? An alternative would be to do a full body circuit workout, 45s rest between exercises, three rounds, 6 exercises, 15 reps not to failure to keep your metabolism going but not overtax yourself.

      9) for both goals you (simply because you are already totally lean) will have to eat at least 101% of what you need. So keeping the caloric deficit is not an option

      wrt to the rest: I already mentioned initially that I do like your "old" look. And although this is probably pretty indiscrete, I would wonder if your boyfriend would not appreciate if he was the only one with a six-pack in your relationship ;-) Or put more simply, you had some minor love-handles, yes, but if your goal is not the unfeminine ultra-lean look many of the fitness competitors have, but rather that of a bikini model, it would not harm you to "soften up" as Dave Palumbo from RX muscle would say... if you are doing that for yourself, because this is your aesthetic ideal, ok. If you are however, like I was once (I don't know if you heard me on Jimmy Moore, but if you didn't you should check out the interview > http://livinlavidalowcarb.com/blog/the-llvlc-show-episode-561-german-physicist-adel-moussa-translating-nutrition-science-into-laymans-terms/13727) doing that because you believe that it will make things easier in general and with the other sex, in particular. I can tell you that you are on the wrong track.
      ^other male readers: Please chime in ;-)

    3. I'll chime in and assume that I can be the final arbitrator due to the wisdom of my advanced, but not yet dementia-riddled (I hope), age. Here's my chime: unless your life depends on winning a bodybuilding contest, reassess your goals and priorities (of which I don't recall reading much).

      The old you was fine, in fact more than fine. 99% of US women would kill to have the old-you body, and the other 1% are certifiable. Are you married? Have children? If not, don't make the mistake I did and wait almost too long to do the most satisfying thing you'll ever do in your life - raise a child!

      Getting healthy should be your goal. You might even stop hanging out on bodybuilding web sites (oops, there goes my budding friendship with Prof Dr Andro) so that you can reset your concept of an optimal body.

      Now I know that some will accuse me of just being a jealous old dude who can never hope to be half as muscular as you are, and they would probably be right. But I'm also a very happy old dude with a 9-years-old reason to realize that health comes very far before lookin' good nekkid.

      (This post will also serve as warning to the good Prof about encouraging people to chime in!)

    4. Hey ProudDaddy,

      Thanks a lot for your imput. I totally agree I should focus on being healty, but I might say its quite frustrating having put so much effort on getting lean, and having perhaps to „let it go..“ - but I will try my best. And perhaps I will even look better by following the Docs advice, as I also heard about ppl who started to eat more and get it easy and got leaner and muscular, so I am hoping for the best!

      No, I do not indend to participate on any BB-Contest or so. Indeed I was married for 5 years, but have no children. By now, as I am "single", I am not intending to have children, but even if I wanted to, I couldnt... But who knows what the future brings?!

      By the way, congrats for your 9 years old "piece of proudness"! :-)

    5. @ProudDaddy: Thanks a lot for your imput. I totally agree I should focus on being healty, but I might say its quite frustrating having put so much effort on getting lean, and having perhaps to „let it go..“ - but I will try my best. And perhaps I will even look better by following the Docs advice, as I also heard about ppl who started to eat more and get it easy and got leaner and muscular, so I am hoping for the best!

      No, I do not indend to participate on any BB-Contest or so. Indeed I was married for 5 years, but have no children. By the way, congrats for your 9 years old proud! :-)

    6. This comment has been removed by the author.

    7. I am in agreement with Andro and ProudDaddy. You look fantastic in that picture. Its hard to stop fretting over weight. It really truly sucks.
      Try to focus on how amazing you look now, and continue to remind yourself that you are looking good. You are DEFINITELY above average in your look in the picture. I am sure plenty of guys on this website would agree and tell you how amazing you look.

      (Sorry about all the deleted comments Prof Doc. I can't quite get what I want to say on my first try it would seem. Haha.)

  10. Hey Doc!

    Once again, thanks a lot for your answer! Dont worry, I am skeptical enough, but as far as I have been reading your blog and other stuff on the internet, I am pretty convinced you absolutely know what you are talking about, so I am very pleased to read advices from you, specially as you mentioned you know girls who have experienced similar issues like me and got better after following your general guidelines. And even your own experiences and so. Anyway, I cannot express my gratitude enough, THANKS!

    Just as background: 3 years ago I was kinda working out like every f*** day, it was more or less 4x week lifting (at least 1,5 hours per session) and 3x a week cardio, high intensity and long duration (about an hour or a bit more) - by then I was waking up every weekday around 6 am, going to the gym and then straight to work. I really didnt take a single day free. I spent 2 years training like that. At the „worst“ phase (where I cut off all and started with HIT 3x/week) I was even training twice a day (4 days/week) so that in the end I was kinda training 11 (!!) times/week by then.

    So I suppose the whole thing about my body being so stressed is coming from that time where I didnt take one single day off to recover, even thou I was not always running on a caloric deficit by then – as I even try to „bulk“ (the „old“ pic I showed - but was probably eating very low fat as my personal trainer told me I should by then)...

    Means I could get my Hormones back to normal following your dietary recommendations, right?
    I mean, as you believe the years of undereating/overtraining messed up my hormones in a way that my body is trying to keep the fat (for the urgent situations) and perhaps avoid building muscle, as they "cost" more on the expenditure, right? I really hope this situation will be reversible, cos if it took two years to mess that up, will it also take two years to bring it back to normal? :-(

    What would happen to me once my hormones get back to normal? I mean, besides having my period back - would I feel the difference somehow on my general well being? Perhaps somehow an increase my metabolism in a way?
    By the way, I am 1,71 tall, 53 kg and ~16% BF, 31 years old.

    Summing up my ToDos:

    1) I shall overall increase calories so that I am not in a deficit. OK, in the end what counts is the weekly balance, right? So if I perhaps „exagerate“ one day, I can compensate the next one so that in the end I try to eat a bit over my needs to bulk.
    2) I shall stop cycling carbs but rather eat more on workout days.
    3) I shall not count calories, just eat a baseline of prot/fat/carbs, keeping the carbs (not counting veggies) around 40g per meal, right? Means, by 3 meals/day I would have 120g carbs from starchy stuff on off-days and > 240g on-days? Also enough fat from good oils, whole eggs, butter and so. Or 40g per day instead of per meal on off days? Just to make sure
    4) I shall avoid processed food - OK but I think I will have to make some exceptions here cos I dont think I can live without my good old Vollkornbrot and some oats :-D But I will try to take it easy.

    As for the salt, I do eat quite a lot of it, at least I am always putting salt on my food :-) My skin? Ohh no idea if its dry or not, but I think it is dry indeed.

    By the way, what are your thoughts on the point that I walk a lot? I walk a lot, on the way to work and on the lunch break. Summing up it might be around 2,5 hours/day. Do you think its too much and might be messing my metabolism as well?

    I know I am not exactly what a man wants to see on a girl., but I dont do that for the men, I do it for myself. I like the way I look so far and somehow I like to see how the body changes, even thou there hasnt been much happening lately.

    I really want to be healthy both mind/body, so I already put my bodymedia away and slowly started already to put your advices on practice.

    Thanks a lot from the bottom of my heart!


    1. The years of more or less failed efforts to lose weight on a (probably) nutrient deficient diet with tons of (over-)training won't make things easier, because this just confirms that you have dug a really deep "Female Athlete Triad" hole, out of which not all woman can crawl back to the surface.

      You got me interested in the topic. I will collect some material and put up a more general post on the issue either this or next week (depending on how long it will take me to review the pertinent studies)

      From what I already know the response to refeeding is very individual, though. In essence, you are absolutely right that you "messed up", but that does not mean that by simply not "messing up" anymore your body won't be able to get back on track.

      That being said, a brief review of the literature suggests that there are three factors you have to keep an eye on dietwise

      1) Total calorie intake (on a day-to-day basis must not be negative / your hormonal rythm, i.e. the secretion of the gonatropins, tsh etc. is diurnal and gives e f**** about your weekly balance) - studies in female athletes suggest that menstruation disappears when the calorie intake is <1650kcal per day (obviously with large variances)

      2) Fat intake - studies suggest that a fat intake below 40g could be a contributing factor

      3) micronutrients - female athletes with the triad have low vitmain A, b-vitamins, calcium, magnesium, iron and zinc - that being said, you should start eating liver 1x a week. Calves liver is actually very palatable (try that one instead of the "grown up" version)

      When your hormones get back to normal, your performance will increase, you will feel better, more stable, won't have to work out to have any energy at all (your metabolism is now probably running at 50%, when the hormones are back up it will be back to normal), will be able to build muscle and lose fat again, will be able to have children, will look great!

      to your individiual questions

      1) you don't need to bulk you will just eat enough on EVERY day ;-)

      2) You can eat the "more" on workout days from 70% carbs and 30% protein, but make sure you get at least 50g of fat every day

      3) that sounds very good!

      4) You can have the Vollkornbrot and the oats, both are not overprocessed, but instead of 4 slices of the bread with one slice of turkey breast on it (e.g.) you have two slices of bread with (each) a big chunk of butter, full fat cheese, salad, tomato, a boiled egg, and chicken breast on top. Add a piece of raw cucumber, Kohlrabi or a carrot (as finger food) and you got yourself a nice portable meal. I am no friend of "you must never eat", but there are foods that should not make up the lions share of your diet and if you eat bread than the bread should be a part of a whole meal like in the example above.

      * Skin: Look into getting enough n-6 fats, as well. Usually it should yet suffice not to avoid them... you may also want to do some research into GLA gamma linolic acid (for women=

      * Walking: Keep walking. As long as it is not intended as exercise to "burn calories" (remember: the more you exercise the less your body will be willing to burn calories while you do that) it is ok

      And the last sentence sounds really good. Keep me posted on your progress and bombard me with further questions (as I said, maybe I will have more answers, when I did my homework on the female athlete triad ;-)

      ah... the semester has started today, so my answers will now take a little longer. Be patient, but if after 48h I did not answer just write a "bump" reminder ;-)

    2. Hey Doc!

      Thanks once again for your prompt answer, really, really appreciated!!

      Yeah it would be awesome if you could write about the “female athlete triad”!! I would love to read about this and I am pretty sure it would help a lot of girls like me around the world.

      Damn, sometimes I think it sucks being female... Why does this only happen to us? Why do the overtrained/low caloric intake guys dont have similar problems as we do when experience such similar situation? Yeah I know, evolutionary reasons... But its unfair :D

      I love liver, should be no problem eating them, I just have to find a good way to prepare it.
      By the way, Iron: I was about to donate blood last week and was refused cos my Iron was too low, so they just gave me some dragees I have to take for a while before going to bed.

      Well, my new macro split should be sth like this for now on:

      - Fat: at least 50g
      - Proteins: at least 100g
      - Carbs: at least 120g on off days and over 200 on workout days (not counting veggies).

      OK, now the macro split raises THE question: On your previous comments you wrote you have cottage into the protein category, but what about the fat and the carbs on it? Shall I really just “ignore them”?

      a. Proteins: I am not supposed to count the traces of protein on my veggies, right? Lets say if beans have 4g protein on every 100g, should this count to my protein-balance?

      b. Carbs: I am not supposed to count the carbs from veggies, OK. But what about the carbs coming from Lactose? Like if I eat my cottage, they still have their 4g/100g carbs. Should be counted?!

      c. Fats: I am not supposed to count the Fat from cottage for instance, right? But fat coming from cheese should be put into account right? Depending on how much cheese we are talking about, it might make the difference. And what about fatty cuts of meat or fatty fish, I suppose they should count as well...

      further on:

      1) How would you actually classify rutabagas (Steckrüben)? Rather veggie or a starchy one? Cos I love them and could eat tons of it (1 kg in one sitting is no problem).

      2) Theoretically there should be nothing against cooking some roaste potatoes (die Bratkartoffeln) if I keep the amount of potatoes in the “prescribed” range and stir fry them with olive oil or butter, right?

      By the way, I heard your interview with Jimmy, pretty cool stuff over there!! I must assume I was pretty surprised once I saw a picture of you on the page, cos I was expecting sth completely different, rather a +50 years old grey haired Doctor steriotyp, you know?! Young and knows already so much about exercise/nutrition, Thumbs up! :-)

      Oh well, I am sorry for you, now its gonna be hard to get rid of me :D
      But I will be always patient, don't worry!



    3. Hi Mariana,

      the low iron was to be expected, to be honest. And if I may remark, you will be way better off with either 1 huge or 2 normal portions of liver if you want to get it back up again, than with those pills of which I suspect they will only give you constipation. Apropos, what is your digestion like? I would venture the guess that you could benefit from taking some digestive enzymes like those from NOW. They will also help you absorb esp. the minerals (on most of which I suspect you will be low) from your meals better and are not too expensive.

      Wrt to the macros, I would hope that you take the "at least" very literally. If I had to give you a rough estimate of what you would have to eat if your system was running normal that would rather be

      75g fat,
      150g protein
      150g carbs

      So, if you want that in "calories" at least 1,800kcal on "off days"

      Wrt to the "ignorance" towards the fat and carbs, the answer is "yes, you want to forget about the caloric content and the exact macronutrient composition of your food" - took me quite some time to realize that this makes life much easier and does set an end to the endless "How much this, how much that" that is just hampering your progress. You bother with that once, i.e. now, when you come up with a reasonable diet. Afterwards you just modulate the FOOD.

      That leads over perfectly into your second question. When I think about what I eat I count

      * Protein: meats, eggs, dairy, fish
      * Fat: Oils, butter, full fat cheese, nuts, fatty meat, fatty fish
      * Carbs: starchy carbs (incl. bread, rice, potato, beans etc.), fruit, the occasional simple sugar I eat, dairy (if significant)

      I guess I will have forgotten some foodstuffs, but you should get the general idea. You combine foods from each category into a meal and know without having to do the math if it is high protein, low fat, medium carb, like cottage cheese with some fruit would be or medium protein, high fat, low carb, like fatty fish fried in coconut oil with cauliflower + with butter

      1) this is a good point... they are borderline in that they do have a pretty high carb content. These would be in the "better monitor intake" category for me, just like carrots

      2) No problem *hmmm! Bratkartoffeln!*; you can also cut the potatoes in chunks, put some oil on them and make your own potato wedges in the oven

      Well, I guess my real students at the real University often think similar. I remember last semester, when I came into the lecture room, attached my USB stick to the computer, loaded the presentation I had prepared and stood there waiting for folks to calm down, everybody must have been thinking I was the prof's student assistant or something. And when I said that I would like to start now, I heard a young lady in the back say to her neighbor: "You know what, I believe that is the professor!" I take events like that as a compliment, though... just like your kind words. Thanks for that.

    4. Hey Doc!

      Needless to say thanks again, right? It will get boring with the time as I am always repeating myself :D

      So, I will put some numbers again so that we keep the clear structure.

      1) Hmmm I thought I would never ever have problems with Iron as: a) I do eat lots of red meat b) as I don't have my periods, I am not “missing” the blood and consequently missing the iron on it - which as far as I know is a common problem with women.

      2) My digestion? Well, as far as my gut goes, I think it could be better. Since I started with IF, my gut works like every 2 days. Before it was almost every day. I guess its still on a “normal range”, isnt it?

      These Enzymes: If you think they are good and they would help me, I believe you!
      Just to make sure, these ones, right? Then I will order them right away!

      3) Besides that, after doing my blood test about a month ago, an Endocrinologist suggested me taking DHEA caps (25 mg/day) - which I've been taking since then. What do you think, can they help or harm? Keep it or stop it?

      4) With the macro spilt, got it, Thanks! As a general idea of going higher on carbs - and as consequence - on calories on Workout days should be OK right? Perhaps keep fat lowER by then? Say like: 150g protein, 50g fat and > 250g carbs on Workout days? Perhaps a bit more cos then I would be around 2000kcals for this day, and this would be roughly actually below my expenditure I guess...

      And now some “flowers” :-)

      It must be a great feeling for you having such feedback from your students, specially because I suppose they will be even more surprised after the classes, as they get to realize how much knowledge you have in this area, congrats!

      Again, thanks a lot for your time!


    5. Hi Mariana,

      1) well, the issue with iron is that athletes need A LOT of it and that its storage, processing and most importantly the production of red blood cells depends largely on optimal nutrient intake and hormonal production; been there myself (low iron) and have found that nothing fixes it like liver (and not overtraining and undereating, obviously ;-)

      2) Normal is somewhat different for anyone, but when I remember one of your previous posts and you eating a ton of veggies, having a bowel movement only every other day could well be part of the reason you feel "bloated". It's not guaranteed that the enzymes will increase the "speed" of your digestion, but they will certainly help with its effectiveness - and contrary to what many people believe this is NOT going to make you fat, because you absorb more of the energy, but the exact opposite, because you absorb more of the "prometabolic" micronutrients - the "bad calories" are absorbed anyway, good digestion or bad, doesn't matter. The product is the right one. If you are in Europe I suggest you check out JGSupplements.com they are - at least to my knowledge - the cheapest over here.

      3) DHEA can help, although I personally would combine it with 50mg pregnenolone (in the end you will yet want to get off those crutches, usually I thusly don't recommend them, if there is no deficiency, but in your case there certainly is and the exogenous, by the way very low dose, hormonal support could help you / in conjunction with the food / to get back on track faster). After all, you are lacking ALL hormones and guess what progrenolone is? It is one step away from cholesterol and quasi the mother of "all" hormones.
      If you have not done that already, check out my previous blogposts on DHEA > suppversity.blogspot.com/search/label/DHEA

      4) Sounds good. Both the 2,000 = absolute minimum and the 50g baseline fats + 250g+ carbs. Remember to count only "significant" carb sources. Broccoli, for example, has ZERO carbs in your calculation, right? ;-)

      *lol* although I do invoke biophysical problems from time to time, you realize that I am no "physician", but a "physicist", right? I am teaching physics, the stuff with the complex mathematics and those tiny particles which are in fact waves, you know ;-)

      Kind regards

      Adel aka Dr. Andro

    6. Hey Doc! Or Adel if I may? :-)

      Cool, I think I am now on the right way!

      Today I just bought me a huge piece of calf liver, gonna prepare it “berliner Art”, with onions, apples and balsamic, hmmm lets see how it works. Plus tons of veggies - and no, I will NOT count the carbs from veggies, don't worry! ;-)

      As for the enzymes, I will order them right away. The price doesn`t matter, and as I am in Germany anyway, Amazon is my all favourite internet-shop!

      They also have these Pregnenlon 50mg, what do you think?

      I would order this along with the Enzymes and another pack of DHEA (same brand as the Pregnenlon), so I will have my “daily cocktail”. Obviously I don't want to take these stuff for the rest of my life, but as for now, if they might help, I am willing to do/pay whatever is necessary. Even if its just a placebo effect, doesn't matter as long as it helps.

      I did read all the topics on DHEA you posted. Well as almost every “supp” or whatever one can take, it seems to work for some, for others not. I think the only way to find out is try it myself, as long as they dont harm...

      By the way, I have my appointment with the doctor tomorrow, I will let you know.
      I am just a bit worried if he might tell me like: “stop taking DHEA or whatever else you might be taking” and just put me on some pills that will make my period come again, but not taking care of the problem as a “whole” you know? It doesn't make much sense to bomb someone with aspirins if its not fighting the actual cause of the problem.

      You're a physic? No way!! :-) I really thought you were rather a “medical” doctor”, not a “doctor of physic” :D - Still, there is no doubts for me that you have more knowledge on the biophysical than most of the “sport doctors” or whatever “nutritional experts” running around :-)

      Thanks once and once again!


    7. I hope they will have some calf's liver at my local butcher, today ;-)

      The "cocktail" should not harm you. The doses is way to low. If anything it will support your natural production somewhat... compared to 99% of the drugs Dr's willingly prescribe to everyone, these "dangerous hormones", as Dr's will tell you are totally benign. I mean, I guess you have read about the 1g(!) DHEA per day study, where the only side-effect (and that in men, who are obviously more susceptible to sides due to the potential conversion into estrogen) was fat loss.
      Now, you are right that the results are inconclusive, but if you give an obese person DHEA (99% of the studies did that) you should not wonder to see very different results from giving it to a healthy, let alone "healthy", but hormonally deprived person, like you.

      I hope you read this before you go to the Dr. but in the end, he probably won't care... *unfortunately Drs believe they know best* - here is an excerpt from a review on treating the Female Athlete Triad. They do not exactly recommend hormonal treatment (and I would not go there, yet, you still have more than enough room for dietary improvements to get the job done), but just in case - the following appear to be the treatment methods of choice

      Estrogen Replacement Therapy Dosing Regimens for Amenorrhea

      Option 1

      One of the following, daily or cyclically (days 1 to 25):

      Conjugated estrogen, 0.625 mg

      Ethinyl estradiol, 0.02 mg

      Transdermal estradiol, 0.05 mg

      Micronized estradiol, 1.0 mg


      Oral progestin, daily (2.5 to 5 mg medroxyprogesterone) or cyclically (5 to 10 mg for 10 to 14 days each month)

      Option 2

      Combination estrogen/progestin oral contraceptive

      Information from Otis CL. Exercise-associated amenorrhea. Clin Sports Med 1992;11:351–62, and Fagan KM. Pharmacologic management of athletic amenorrhea. Clin Sports Med 1998;17:327–41.

      You may also be happy to hear, that my initial research on the issue suggests that ENERGY INTAKE, not current weight is the central determinant for the pathology. This is also the reason, why many women don't get rid of the problems, even when they (mostly against their own will) gain weight; they simply continue to starve themselves again by either doing more exercise or those crazy "I eat much today, and nothing tomorrow" diets - so no caloric cycling aside from the workout PLUS ;-)

      Best wishes & thx for the compliments


    8. Hey Doc!

      So, I am back from the Gynecologist.

      He said my estrogens are very low (no news here), specially the Estradiol (2,10 ng/dL) and of course the FSH (5,5 UI/L). About the other hormones, he said he doesn't think its “that bad”, that my Testo, S-DHEA etc are kinda not high but still nothing which one should really “care” at all... Well, maybe HE doesn't, but I do care anyway :-(

      He prescribed me “Mericomb, 2mg” to be taken for three months (http://www.netdoktor.de/Medikamente/Mericomb-r-2-mg-Filmtable-100008611.html)

      So as I thought, just kinda estrogen replacement. He said it's similar to the pill, but “less strong”. Well, I am just a bit afraid of the side effects, including (of course) fat gain and/or water retention. Just read it is possible that it moves into the range of 1-5 kg range.. Don't like it... What do you say?!

      Well, at least he didn't have anything against me taking DHEA. I just ordered the other stuff today so I will start taking them ASAP.

      Concerning your researches on the Female Triad on the energy intake instead of body weight, sounds great! But I do wonder as you write about the girls gaining weight but still starving themselves and upping the kcal-intake in general:

      a) they gain weight eating the wrong things so there is lot of vitamins/aminoacids etc missing on their diet, so they “starve” despite eating over expenditure and gaining weight?

      b) Increasing energy intake so that there is either a surplus or a deficit will always lead to fat gain in these cases as the metabolism of the girls are already “spoiled”?

      c) The thing with “I eat lots today and nothing tomorrow” reminds me of Brad Pilons “Eat stop Eat”, which shouldn't be actually bad at all?!?

      As for myself, I always “got” my period back after at least 3 weeks of vacation, eating way over my expenditure (and also lots of crap to be honest) > which obviously brought some kilos fat (2 or 3 more or less) - So I wonder if I was just eating waaaaay too much?

      Many many thanks again for your time!

      Best regards, Mariana

    9. Well, the Doc does just what he was taught at the University. You are a woman, so estrogen is your hormone #1 - somewhat right, but that does not change that it does its magic (which is btw in many areas about as important for men, as for women, cf.http://suppversity.blogspot.com/2012/01/intermittent-thoughts-on-building_15.html) only in conjunction with its homies ;-)

      That being said, your estrogen levels are so crazily low, that I honestly expect that nothing out-of-the-ordinary is going to happen - neither weight-wise nor period-wise from the pill alone. In combination with the pregnenolone and your new way of eating, I could yet imagine that this is going to fix your menstrual problems within 2-3 months and that without significant fat gain (I mean, even if your dry skin becomes hydrated again you will gain weight ;-) If you read up on estrogen's role in the body in the link above, you will also notice that it is actually not fattening, but rather helps build / sustain functional mitochondria and burn fat. I would still see this as a work in progress. See how you feel on the mericomb and decide after 1 months if you continue for the rest of the three months.

      Wrt to the weight gain. The reasons are manifold and obviously individual again - here are a few reasons I have read about and some I have come up with myself:

      1) weight gain at below maintenance caloric intake < this is if you asked me the most likely culprit. If you work out like mad and begin upping your calories after a period of severe restriction, but not to the point where you actually eat more than you consume. You will still gain weight, but with the starvation signal only being attenuated, this won't solve your hormonal problems

      2) low protein intake and adherence to the low fat and especially low cholesterol diet (this is obviously a point you won't find in the literature ;-)

      3) the "shit I gained 5lbs" (mostly water, but the girls will ignore this, "so I better diet for another week to keep damage at bay"

      Now, I don't know the intricacies of Brad Pilons "Eat stop eat", but any fasting period beyond max. 18h is nothing but detrimental to your endocrine system, your weight loss etc. You can start seing some health benefits from fasting after 72h again, but anything between 18h-72h will only make you lose muscle and set you up for fat gain. So, don't even think about that ;-)

      You holiday experience, btw. is typical. Eating junk will produce a junky body composition *fullstop* I don't know if you have followed my comments on "physiological insulin resistance"? With your former regimen you were SERIOUSLY insulin resistant, otherwise you would have passed out several times a day from hypoglycemia (I suspect you still had hypo episodes though). The junk food you eat thusly worked its magic on you similar to a type II diabetic with the exception that your fat stores are empty and very able to accommodate for each and every dietary and liver generated triglyceride that is floating in your blood. Stick to the healthy whole food diet, we have discussed and keep doing your workouts as scheduled and "es müsste doch mit dem Teufel zugehen", if you did not feel, look and perform much better in 4 weeks from now :-)

      The triglyceride issue, by the way, brings up something I forgot to ask you: How are your triglycerides, your LDL and HDL levels? I suspect almost non-existent, right?

    10. Hey Doc,

      thanks a lot for the clarification!

      Well, I will start with Mericomb then and see what happens. The thing is, it will be hard to know what will be helping, kinda like one of the points you wrote on your “Sensible Supplementation” article - if it was the Mericomb, the other Pills (DHEA and the other stuff) + the dietary changes - or perhaps everything together...Well, as long as it works and at the end I don't look like a “Michelin Männchen”, then I am Happy! :-)

      I just hope the stuff arrives on Tuesday - because of easter it will take a while to get them on my hands and I am flying on a business travel on Wed, so if the stuff doesn't come until then, then I can only start next week :-/

      As for gain weight reasons you came up with:

      1) do you mean here like just raising the kcals a bit but still being under maintenance might in general not bring the metabolism back to normal and still cause fat gains? Means for me its a quite useless, right? Rather than rise the kcal to the maintenance or a bit above and get in account the weight gain instead but then have the hormones back to normal?

      2) Well, definitely not my case. Being in Brazil on vacations and eating tons of beautiful meat (with the fat as well) - There is nothing better than beautiful piece Tafelspitz on the Barbecue with lots of salt on it.... :-)

      3) Yeah I can confirm this, but even after dieting (low carb) one week after the vacations, I still have gained around 3 kg, so I assume if I had counted the water as well, it would be > 6kg hehe

      other points:

      a) Do you think fasting over 18h should be then avoided to all costs? Cos sometimes I am around on a business travel and I just have no chances to eat, so it happens sometimes that I fast 20 hours. Next week I will have to see what I do when I am not at home... :-/

      b) You mean in my case that being lean made me insulin resistance, like what you wrote on the marathon runners which are somehow resistant as well? But I don't know, I think since I started with IF, that I am getting more sensitive. Cos before, I was taking one day of the week (saturdays) for a HUGE refeed, lots of carbs and also junk, beer, chocolate etc and the next day, unbelievable: +4 kg more on the scale, sometimes even +6kg (!!!) even thou nobody believed me. Means, I was so bloated from all the sides, probably lots of water into the muscle but mostly subcutaneous - judging by the way I looked next day. Now, however, I can like eat the same (within my feeding window) and will look rather more muscular the next day - with some kgs more, yes but the way I look is not comparable at all to the way I looked before after a refeed. Isnt that a sign that my body is dealing better with the glucose, means I am becoming more sensitive to insulin?

      c) By the way, any good strategies for a “cheat day” :-) If I do (and it will occasionally happen) eat lots of junk, beer, chocolate and go waaaay over my needs for a day, what shall I do the next day, just cut it off a little bit to “compensate”?

      About my cholesterin:

      Total: 200 mg/dl
      HDL: 72 mg/dl
      LDL: 118 mg/dl
      Triglicerydes: 48 mg/dl (“beneidenswert” said the doc as he saw that ahah)

      By the way, yesterday I bought lean ground meat, made some patties and fried it with bio coconut oil.... Geez, the smell alone was divine!!! :-) Now I am sure you will say “but why lean beef”? Cos I have no idea where to buy grass fed meat, so I rather then buy the lean meat and fry it with more coconut oil :-)

      Which brings me to the next question: as far as I know, “bio” doesn't really mean grass fed, right? Perhaps you know where I can buy some stuff of how I can at least recognize whether it's grass fed or not? Or maybe a know Supermarkt which has some grass fed stuff regulary on their product line? I am in Hamburg btw...

      Ohh geez, thanks a lot lot lot again!! :-)
      You cannot imagine how much you are helping me right now and how grateful I am!!


    11. You are right, if you were taking a supplement to increase your performance, it would be unwise to start all three at once, but for now you want to get back on track ASAP. You can "reverse-engineer" what does what by first dropping the pill, then the DHEA and lastly the pregnenolone, later.

      And as I said, I don't believe you will be looking like the "Michelin Männchen", you may be feeling like one, though... but THAT is all in your head. So make sure to have your measuring tape ready to convince yourself that the latter is the case. And let me tell you this: IF you gained 2 inches on your waist you'd still look great! Aside from that, if this happened in 2 weeks, it will be away within another 2 weeks, once you drop the pill again.

      to the individual questions

      1) You are not bringing the calories back "a bit" but back to maintenance. And you will be consistent in doing that. This appears (imho) the only way your body will be willing to go back to normal mode. The problems are inconsistency and a maybe reduced but still existent energy deficit. Not your problem though, because you will be consistent and you will eat enough ;-)

      2) see the "in your head" comment before ;-)

      3) what I say, eating and dieting, eating and dieting, nothing makes you fatter than inconsistency

      a) you should try to avoid the fast, and you cannot tell me that you cannot pack a can of tuna, a cucumber and a slice of bread with butter to have as a <2min snack

      b) you are fine, don't care about the "insulin resistance", your body will switch it off, as soon as it realizes there is a constant supply of nutrients; the reason that the IF helps with this, is btw. that you are not that dependend on glucose (as you are, when you eat many small meals); your body is already burning fat for fuel (switches into this mode in the fasting window), so that the "physiological insulin resistance" is basically unnecessary. Also, you should remember that there is a non-insulin mediated glucose uptake, which is upregulated after a fast. So, I would not think about insulin sensitivity per se, but rather your bodies ability to store the glucose in the right places and this is what your body certainly has become better in

      c) the trick is to just eat as if nothing happened the next day. When you starve yourself your body will never (as a normal body would) just burn off the excess. Unless you are not doing that every week (and you won't because you won't be craving foods so much, when you consistently eat enough), it is not a problem. Just make the "lot's of junk" somewhat less of junk ;-)

      * I am with you on lean beef. It tastes better. No reason to go for the greasy stuff if you don't like it

      * bio is not grass-fed, no. In general your chances to have grass fed beef is maybe even better when you buy Argentinian beef, but honestly, I feel that this is 100% overblown and 50% of the "grass fed beef" is probably fake, anyway (just as the 50% of the "bio" stuff is) - don't freak out about that, it's just unnecessarily raising your cortisol ;-)

      your blood lipids look way better than I expected, by the way, I feared that your cholesterol would be rock bottom, but those figures are actually "beneidenswert"!

      kind regards


    12. Hi Adel!

      Well, the doctor gave me one pack of the pills (one month) and also a receipt where I should buy more 3 packs, so I suppose I should indeed take them for 4 months as it seems... Do you think I should stop taking the pill once I get my period for the first time or rather keep taking them for the next months?

      But geez, 2 inches is a lot!! Then my waist would be even “fatter” than on the old picture I have shown you!! Actually too much for me, lets see... and now that we are heading to the summer, hmm...

      Measuring with the tape: Yeah, I have one of this MyoTapes, they are pretty good but still leave lots of room for unaccurany while measuring. You know, I try neather to breathe nor to release the air while measuring, always measure on the narrowest point and so, but still, I can measure 10 times and will get 10 different results :-( Perhaps I should buy a “normal” measuring Tape instead, cos It seems the results vary a lot if I out these plastic thingy on the front or on the side of my belly.. :-/

      And I know scales are crap but weighing yourself once a week is still OK isn't it? just to make sure I won't gain 1kg within a week, cos this would be definitely too much ehe... Well, I indeed gained a bit of weight (and BF according to the bioimpedance) since I started eating right - 300g - but well, I just hope for the good anyway :-)

      About the point inconsistency making one fat... Hmmm you mean in a daily/weekly basis? Because eating and dieting is more or less what we do when we intermittent fast, isn't it? But why does it actually work - or better said - doesn't spoil the metabolism/hormones of the ones who does it? As you say that the gomathropin does not give a s***** about a weekly balance, and according to - at least the LeanGains protocol you do have a 4x week deficit and a 3x surplus, so kinda inconsistent :-)

      I just worry about being EVERY DAY on an unknown kcal surplus you know? And end up (who knows) just getting fatter but not gaining muscle and/or fixing my hormones.

      You say “avoid to fast”, but you mean now fasting at all or just avoid fasting over 18 hours?
      Somehow I cannot imagine myself not IFing anymore, cos I love to eat big :-) But there is/will be always occasions where I might eat for breakfast, especially when travelling. I cannot resist a good breakfast-buffet and trying lots of stuff I never ate before :-)

      Alright, I won't raise my cortisol on worrying about bio/grass fed beef, I will just buy the regular stuff and use my kerrygold (ehe :-) ) and my coconut-oil!

      But happy to know AT LEAST my cholesterol is OK so far ehe...

      Thank you very much again, I hope its not getting to boring for you to answer my silly questions!


    13. Hi Miriam,

      it is usually worth re-evaluating things after a month. It takes at least 2 weeks for hormonal agents to fully work then min. another week to stabilize. So, after 1 months, you can better judge where the voyage is going. My personal take is that the earlier you get off of it - and maintain keeping your period - the better.

      Don't freak out about the 2 inches, you are not going to gain any. I just wanted to say that even those would not compromise your athletic figure.
      And you know what: The single best thing you could do was to just stop measuring all-together. There was a time, when I stepped on the scale every day and the # on the scale made / or destroyed my day. Ask yourself: Do you want to be a slave to these figures for the rest of your life, or not? For me the answer was no and the result was that I gained roughly 5kg of weight while losing ~5% body fat and finally began seeing my sixpack even when I did not flex the abs. I know it's difficult to give up the "security" the constant measuring gives you, but in the you will not only be happier, but also more successful without the measuring. I know you (and how I was back in the day), when the "measurement" is not to your liking you are falling off the wagon - even if its just "those extra 5-min of training" or the "I don't like my butter that thick"... aren't you sick of that, already?

      And I can only repeat the same for the counting of calories. The intermittent fasting is ok, and in fact it is a nice way to make sure you eat to be 100% satisfied (not just in your head) so that your body's satiety hormones are going to do their job. In the long run, you can obviously modulate the intake on a weekly basis, but YOU cannot modulate any intake, because you simply have NO clue how much you have to eat at maintenance, once your hormones balance back. In the meantime you use the freedom to finally stop obsessing about being able to plan everything (let alone across weeks) - this is madness.

      And let's be honest: THERE IS NOTHING TO WORRY - when you gain too much weight, you just cut out one of 10 eggs ;-) But you forget about cutting out the egg today so that you can ... tomorrow, if you ... in three weeks < this is orthorexia (and I am not quite sure if not 90% of the hard core of Martin Berkhans follower are orthorexic already).

      You don't let yourself go, when you feed yourself appropriately!

      ^ Remember that. And also remember that you cannot plan everything in life. I know that's scary, but hey, that's life! Wouldn't it be boring, otherwise?

    14. Hi Doc,

      thanks! yeah you are right. I will do it and see how it works! Well its always easier said then done, specially me being the way I am for the last few years... So changing is not that simple but I will do my best and I am sure I will make it, exactly as I managed in the past to stop exercising every f*** day with no rest and sometimes even twice...

      THANK You! You will thou still read lots from me on your future posts anyway! I will keep you update!

      Best regards, Mariana

    15. Your last comment sounds honest, positive yet still somewhat verunsichert - I am sure you are going to make it. Don't worry!

      And I know that it is difficult (and I found it even scary), so if you need "geistigen Beistand" let me and the SuppVersity readers know.

      Viel Erfolg!

      Adel aka Dr Andro

  11. ...there is no doubts for me that you have more knowledge on the biophysical than most of the “sport doctors” or whatever “nutritional experts” running around .


    1. thx Angel, I appreciate your appreciation =)

  12. Isn't it possible that the TSH normalized because of the additional calories in the treatment group, or was this a caloric-controlled experiment?

    1. Hi CJD, it would be possible, but we would have seen differences in weight gain, then. Other than for the average over-training cross-fitter the total caloric intake rarely is a problem for children. Eating real food instead of junk, on the other hand, is... unfortunately mostly because their stupid parents eat the same junk.

  13. I've been having ongoing trouble with exercise and thyroid test results for a few years now. I'll start from the beginning...

    A few years ago I used to do 3 full body workouts a week, I did this for about 2 years and I never thought to take a break, I never even took a week off. I did get quite strong however eventually the gains stopped and before I knew it I was getting weaker. I also started getting seriously ill during the workouts, my hair was falling out, and I was in a bad state in general.

    I had some blood tests and my TSH was around 9 (range 0.5 to 4.5) so my TSH was too high, indicating possible underactive thyroid, they tested my Free T4 also though, and it was 17.5 (range 12 - 22) so my Free T4 indicated that I didn't have a thyroid problem, my thyroid was obviously producing enough T4.

    I started thyroid hormone treatment, levothyroxine, I got my tsh down to about 1 then I hit the gym again, but my TSH began to raise again and within 2 weeks I was getting really ill during workouts again. They raised the thyroxine dose and got my TSH back down again, but I continued to get ill and get weaker from working out.

    I later had a private adrenal test done, they tested my reverse T3 also, according to the test result I had a severe level of adrenal fatigue, the doctors wouldn't accept this test result however because adrenal fatigue isn't supposed to be a real illness, at least it's not accepted as such.

    The thyroid hormones were not helping, and considering my T4 was fine to begin with, I took myself of thyroxine and stopped all exercise, at first my TSH went up to about 14, then over a few months it dropped right down to 3, which is within the normal range, but some still a little high, most people claim you should have a TSH of about 1. I was back into the normal range though, without being on any medication.

    I started exercise again several months ago, and I have gained a lot of strength, and dropped my body fat levels from around 15% to 10% i do a split routine, 4 times a week, it's only about 30-40 minutes per session.

    I still get my thyroid tested every 6 weeks, and there's a problem, my TSH has been gradually going up, it's now at around 10, and my Free T4 is 16. So TSH is raised well over the range and my T4 is normal. I don't seem to have symptoms of hypthyroidism and I am still getting stronger at my workouts, I also do not get sick anymore during my workouts, not like I was 2 years ago. One problem I am having though is i'm not sleeping well, I struggle to get to sleep, I wake up multiple times and overall i'm in bed for less than 7 hours, probably getting about 6 hours sleep at best.

  14. I discused with the doctor about starting thyroid medication, we agreed that if my T4 is normal and I have no symptoms, even with a high TSH, then I should not take thyroid medication, and we should keep monitoring it for now.

    Now i'll talk about status and nutrution.

    Male, 5 foot 11, just under 180 lbs, dead on 10% body fat on my last measurement which was over a month ago.

    I eat 6 times a day on 4 days of the week (workout days) and 5 times on non workout days.

    Workout day (2700 calories)
    9.30am 2x egg, 2x toast, apple, cottage cheese (500)
    12.30pm wholegrain rice, tuna, tomatoes, peppers, banana (450)
    3.30pm 600ml chocolate milk (450)
    5.30pm sweet potatos and haddock (500)
    8.30pm 2x egg, 2x toast, cottage cheese, plain fat free yoghurt (450)
    11.30pm almonds, tuna, cottage cheese, green beans (350)

    Non workout day (2250 calories)
    10am 2x egg, 2x toast, apple, cottage cheese (500)
    1.30pm wholegrain rice, tuna, tomatoes, peppers, banana (450)
    5pm sweet potatos and haddock (500)
    8.30pm 2x egg, 2x toast, cottage cheese, plain fat free yoghurt (450)
    11pm almonds, tuna, cottage cheese, green beans (350)

    According to online calorie calculators my maint is about 2700 calories a day and so I wonder if I am undereating. I am sat around for most of the day though so it's not like i'm expending a lot of energy, I live a pretty inactive lifestyle, as I work from home self employed on computers, i'm pretty inactive really.

    This is all a mystery for me, its been a real nightmare trying to get to the bottom of the problem. The main question is why is my TSH indicating underactive thyroid, yet my T4 indicates normal thyroid. Why did I get so ill from working out 2 years ago, was that the fault of the thyroid or was something else behind it? I just don't know where to go from here, all I know is my TSH has been getting higher for the past few months and there must be some kind of problem, I just don't know what or if I can do something to prevent it.

  15. One thing that is glaringly obvious is that my TSH raising seems directly linked to exercise, if i'm hitting the gym, then my TSH is raising, Free T4 seems uneffected.

    I have been looking at nutrition as the main culprit, but I really don't see how I could eat 3000 calories a day without eating some high calorie rubbish. It seems weird to eat that much food, and I am scared of getting fat.

  16. Some may say I just have a mildy underactive thyroid, but with my free T4 being normal, could that really be the case? I could so easily take thyroxine and hope it solves my problem but i don't want to do the wrong thing, if the thyroid isn't at fault then taking thyroxine is not wise.

  17. I may bump my calories up with an extra meal each day, i could add oats + milk + scoop of whey protein and a little manuka honey for my breakfest and add an extra 400-500 calories a day, i'll be eating 6 times (2700 calories) on my off days and 7 times (3150 calories) on my workout days.

    Think it's worth a shot considering all that i've explained?

  18. I forgot to mention my age, i'm 27 years old.

    1. first off, I am not an MD, so I cannot give you any direct advice. I will yet voice some thoughts on what comes to mind, when I hear this story.

      1) A high TSH is very unusual for exercise or diet induced hypothyroidism. If you starve yourself and overtrain, your TSH will be low AND your hormones will be low.

      2) It is not adequate to test TSH and T4 only. With the tests you got done, you cannot even exclude that you were effectively HYPER- not hypothyroid. It is not likely, but possible and hair loss and fatigue are symptoms of hyperthyroidism, as well.

      3) Your current MD is right throwing T4 at a whacked HPTA where lack of T4 is not the problem would be plain out stupid.

      4) From what I hear I seriously doubt that dietary changes will fix the problem

      5) for further medical interventions, free T3, reverse T3 and a 4x /24h salivary cortisol test would be indicated

      6) possible underlying problems would be in the conversion of T4 to T3, which could be identified by low / very low levels of free T3, or (and from your exercise intolerance this seems more likely) profound adrenal problems; spec. low cortisol

      7) if the latter, i.e. cortisol seems suspect an ACTH test could be done to check adrenal function

  19. I've had a short synacthen test done at the hospital before to test adrenal function and it came back fine, it was a saliva adrenal/cortisol test that showed a problem, but medical science doesn't accept them.

    On the high TSH, i'm not sure if it means different in different parts of the world, based on some websites i'd assume it does. In the UK a high TSH indicates you're not getting enough T4 or T3 usually.

    0.5 to 4.5 is the uk range for TSH, 0.5 and below indicates an overactive thyroid and 4.5 and above indicates an underactive thyroid. So my TSH being 10 indicates underactive thyroid however my Free T4 levels are fine.

  20. I've had my T3 tested a few times too, it's normal.

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  24. I have craved beef my whole life. When I eat it I feel great! When I quit or do not eat enough I feel sluggish and out of sorts. Our bodies know what we need. So for me, and my clients, I say listen to your body! IT KNOWS! When I eat beef, potatoes and green veggies like my body craves... I do not crave sugary foods at all.