Dr. Ted Naiman and Low Carb

low carb






I ran into this interview the other day with Dr. Ted Naiman, who is an MD from the Seattle area that promotes low carb as a way of treating diabetes.  Anytime an MD gets this it’s always a cause for celebration, and I don’t mind giving these people props when I see them.

This particular article is an interview by Ivor Cummins, who runs a site called The Fat Emperor, which has risen to be a fairly popular internet site.  Ivor also has a number of videos on YouTube, including this one with Dr. Naiman.  Among Ivor’s interviews is one with Dr. Joseph Kraft, which turned out to be an excellent one, and I’m sure I’ll do a blog post about that one at some point.

I’ll be honest, I never heard of Dr. Naiman until seeing this video, although I do see that he’s got a couple other videos out there and I may check them out and may even do an article on one or more of them.  There’s so much I want to get to on this site and in time that may happen.

Anyway, the interview starts with Dr. Naiman discussing the concern with low carb and thyroid function, and I would have much preferred that he have a lot better idea of thyroid function than he demonstrated here, and that was a major disappointment to me.  However it does give us an opportunity to discuss this a little further here.

Ted believes that a TSH will tell us everything we need to know, which is completely wrong and especially in the context of downregulation of thyroid function with low carb.  All TSH measures is the signals by the pituitary to secrete thyroid hormone, primarily T4, and if it’s too low or too high this indicates that the thyroid gland isn’t working properly.

The thyroid gland can be working perfectly though and your thyroid function can be real messed up, we’re dealing with hormones here, and just because the thyroid is doing its job in secreting thyroid hormones doesn’t mean that the proper amount is getting into our cells.

I’ve discussed this in several articles already but in a nutshell, there are several things that can go wrong between the thyroid gland and the cell, hormones can be bound, which is why we test for free, unbounded T4 and T3, we can fail to convert enough T4 to T3 for various reasons, and we can also convert too much T4 to reverse T3, which is inactive and takes the place of free T3 in cells, creating what is in essence hypothyroidism.

The last part, the reverse T3, is the biggest issue with some people on low carb as far as their thyroid function goes, and you’e not going to be able to tell this with a TSH test, that’s for sure.  The knock against the medical profession is that they stop at the TSH test, where functional practitioners look at these other things when there are symptoms of low thyroid.

So if someone already suffers from this, and this does have symptoms, excessive weight gain, insulin resistance, low energy, feeling cold, and all the other symptoms that are associated with low thyroid, and these symptoms get worse on low carb, one may want to adjust things.

Ted suggests that this is OK, that your engine is revving lower on low carb and therefore the markers will go down and that’s not a problem, but it surely is if one already suffers from hypothyroidism and this is worsened by low carb.

Not a lot of people even know about this effect though so I have to give him credit for that.  This is an issue I have personally though and if I just listened to him, and I did try that once, I get so weak I practically need a wheelchair, and got so bad that I had to choose between going on disability from work or adding more carbs, and I chose the carbs, and the problem improved a lot.

So it’s not so simple as just saying, well don’t worry about this, some people can handle very low carb, others may do better on low carb, some may even need moderate carb.  No one needs high carb though and we agree on that.

The next thing I heard was him saying that the problem with some foods is that they are “empty calories,” and that we should instead seek “nutrient dense” foods.  This is simply crazy though.  I suppose it doesn’t hurt to have more rather than less nutrients, and it’s certainly not good to have a nutritional deficiency, but if you rely on food to provide your nutrition you’re screwed anyway.

Nutrients don’t have a heck of a lot to do with blood sugar other than that though, and if I were there, I would be asking him if there is anything wrong with meal replacement drinks like boost, drinking a lot of them that is, the 41 gram of carbs per serving stuff, and they are actually nutritionally complete so this should be the perfect food for him.

Grains have a lot of nutrients in them as well, in addition to things like gluten and lectins, and we hear a lot about gluten but lectins may be an even bigger deal, and going gluten free doesn’t protect you from this.

He also feels that it is sufficient to test fasting insulin and there really isn’t a need to test it under load, and I guess it’s at least one thumbs up when any MD wants to test insulin at all.  How we respond to glucose matters a great deal though, especially if you want to make sure someone is actually a type 2, as a type 1.5 will have perfect fasting insulin, it’s their after meal insulin levels that are too low, and if you don’t test for this or do an antibody test you will never know, and will be mistreating them.  They mistreat all diabetics though so this actually doesn’t matter much, and they actually treat type 2’s like they are type 1.5 anyway, but it’s good to know what’s wrong.

If we can identify the autoimmunity if it is present, there are strategies we can use that will look to fix that, and injecting insulin doesn’t fix it, it just manages it, and not so well either.  The plan that makes sense here is to look to fix the leaky gut and other things that may be behind the autoimmunity, but you have to know one has this first.

I don’t want to seem like I am nit picking here, it’s just that this other stuff does give us some things to talk about, aside from his main message that carb restriction is a fabulous idea, and is necessary to some degree in all diabetic patients, all overweight patients, all people actually.

Other than that, the talk is a good one, and Dr. Naiman has treated a great many patients in his practice successfully, normalizing their blood sugar with diet alone, a low carb diet, and without the need for medication, and medication is actually only needed if you’re looking to make someone sicker in the long run anyway.

Ted does get the fact that the problem with metabolic disorders is from hyperinsulinemia, high insulin, and there aren’t many doctors that get this, so he is certainly to be praised for that, as well as for his helping spread the word about this.

In the end, most diabetics can be successfully treated with carb restriction, but the sad thing is, most don’t know this and most doctors don’t either.  Keep spreading the good word Ted!

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2 Comments on “Dr. Ted Naiman and Low Carb

  1. Can I followup on the low carb and thyroid angle? I have had some possible issues here. Can you comment on the following Amber O’Hearn article on a ketogenic diet and thyroid hormones? Do you disagree with its conclusions that a ketogenic diet is fine for thyroid health? How many grams of carbs do you personally need a day for optimal thyroid health? Also, do you see a link between carb intake and other hormones, like IGF-1 and testosterone?


    1. Thanks for sharing the link Jeremy, I see a lot of nonsense in this article, low T3 isn’t a problem for instance.Of course we don’t want to give T4 or even T3 for this, when we see too much reverse T3 for instance, that’s not going to fix this at all. Cortisol does matter here and this doesn’t have anything to do with blood sugar, excess cortisol simply increases reverse T3, when cortisol is high and DHEA is low this is what happens. Now low carb will do this to a certain extent but if one’s adrenal hormones are fine then they can get by no problem it seems. If not, well not so much. Even she admits that keto diets lower free T3, what if your free T3 is already too low, as in disease low, causing metabolic dysfunction and symptoms, do you think the disease is going to get worse when it gets lowered further? Now for me, anything below 100 grams of carbs zonks me, and oddly enough, my blood sugar goes up as well. I am one of the people who need a more moderate carb intake although I’m well aware that most diabetics do fine on lower than this. I suspect that a lot of the symptoms with people who do more poorly arise from not being able to use fat efficiently for energy, and when you are in ketosis, this is a must, otherwise you get pretty weak and sick. Over time, as we look to restore mitochondrial function, this may lessen, so one may have to add some carbs now and may be able to get by with less later. Now low T3, low normal, may indeed be optimal, but not pathologically low, not as low as you can go, this is indeed hypothyroidism in its most fundamental form, this is where the rubber meets the road. One can judge this from symptoms alone actually, if one is low you will know it, and when you restore it somewhat, you will also know it. As far as IGF-1 and testosterone, well ketogenic diets tend to decrease both, and lower IGF-1 levels are common in diabetics. We need to worry about raising this, not lowering it. With testosterone, if you’re a middle aged guy like myself, that can be a concern as well, it’s all about finding the right balance for you. The keto heads really have blinders on and don’t realize that it can be a lot more complicated than a low carb limbo dance. They see any of these issues as an assault upon them, but what we need here is an open mind and we need to consider that while this works in a lot of people, it’s OK that it does not work so well with everyone, the sky will not fall, relax. I should do an article about low carb and IGF-1 actually, it’s on my list, as well as more on IGF-1 specifically. It actually turns out that protein restriction does in IGF-1 more than anything else, and some keto people really restrict protein to get their so called ketogenic ratios up, and that can be a concern. Great questions!

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