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Wow! If that ain’t the most Ray Peat title ever! Beat that old man!

Okay, I don’t expect this post to really appeal to a broad audience. I mean, that’s the most uncatchy title of all-time. Well, other than the fact that I listed enough health problems that virtually everyone will have had some problem with one of those at some point. Maybe that will lure in a few readers.

This post is important though, as there are some very interesting connections between all of these conditions and metabolism/thyroid. Understand some of those connections and you will understand the human body better than most. Be warned that this post will probably jump around a lot and seem a little schizophrenic, but bear with me. I didn’t want to separate it into 5 different posts for the sake of redundancy. Hopefully I can tie this all together at the end and stick the dismount.

As you may or may not know, I have been spending a lot more time talking to people over phone and Skype. This has been incredibly rewarding, fun, and interesting. Enough to where I haven’t done a post in 9 days! How often does that happen!

And there have been many connections of late to the above-listed conditions. For starters, I have worked with a little boy who suffers from very low platelet counts and frequent nosebleeds. Another is a 20-something female that has low T3 and iron-deficiency anemia, recently had the heaviest period of her life, and just broke out with bruises all over her body. And of course, the bleeding gums and bruising issue, which is intimately tied to these other problems, is something that has surfaced at this blog before (but the pieces of that puzzle didn’t stack up at all ? and I have really reconsidered some things since writing the Bruising Easily post ? in fact, increasing vitamin C intake may be the worst thing you can do if you are anemic ? which is probably why eating a bunch of vitamin C-rich fruit and juice can cause or worsen bleeding gums and related conditions? we may discuss this in the next post).

Here is a brief description at what is most likely the core condition for both of these cases (ITP), from NCBI (National Center for Boneheaded Information)?

Idiopathic thrombocytopenic purpura is a bleeding disorder?in which the immune system destroys platelets, which are necessary for normal blood clotting. Persons with the disease have too few platelets in the blood.

ITP is sometimes called immune thrombocytopenic purpura.

Causes, incidence, and risk factors

ITP occurs when certain immune system cells produce antibodies against platelets. Platelets help your blood clot by clumping together to plug small holes in damaged blood vessels.

The antibodies attach to the platelets. The spleen destroys the platelets that carry the antibodies.

In children, the disease sometimes follows a viral infection. In adults, it is more often a chronic (long-term) disease and can occur after a viral infection, with use of certain drugs, during pregnancy, or as part of an immune disorder.

ITP affects women more frequently than men, and is more common in children than adults. The disease affects boys and girls equally.


  • Abnormally heavy menstruation
  • Bleeding into the skin causes a characteristic skin rash that looks like pinpoint red spots (petechial rash)
  • Easy bruising
  • Nosebleed or bleeding in the mouth


In children, the disease usually goes away without treatment. Some children, however, may need treatment.

Adults are usually started on an anti-inflammatory steroid medicine called prednisone. In some cases, surgery to remove the spleen (splenectomy) is recommended. This will increase the platelet count in about half of all patients. However, other drug treatments are usually recommended instead.

The young kid should be an easy fix. I got to actually see this kid over Skype, and he could wear a Cheerio as a necklace. He is underweight, pale, depleted, and anemic-looking. He has a severe low platelet issue and suffers from frequent nosebleeds. And he has been RBTI tested for several months with consistently low refractometer readings (frequent urination could have been stuck in the title here as well), and overly-alkaline urine (constipation-proneness). He is, of course, an enigma to the medical doctors who don’t really know what to do with him.

But all I see is underweight and hypometabolic. His root problem becomes even more obvious when I start mentioning things like ?macaroni and cheese? and mom proudly boasts that her kids didn’t even know what that was until they were like 5 years old ? because they had been eating a ?healthy diet? since birth.

Mom’s intentions were fantastic. Commendable. Raising kids on made-from-scratch homemade food is pretty awesome. That’s love. But kids don’t always do well on all that health food stuff. This kid just didn’t like food and didn’t like eating. Of course, his favorite foods ? like ice cream and things, were really limited. I told mom to supply his favorite foods in abundance ? that the importance of getting him a large amount of easily-absorbable and enjoyable calories trumped absolutely all other concerns about diet. She was like, ?Ice cream ? he’s gonna love you!

A whole entire week later, this is the update from mom?

?I’ve been feeding [him] as much as we can get into him even bribing him with payment if he eats everything I send him for lunch and snack at school. The 1 day he didn’t want to eat and we couldn’t make him, he had a nose bleed that night, so he knows what he has to do. He’s been having ice cream for breakfast, lunch and supper. I send ice cream to school in a thermos frozen overnight. He loves it! I’m kind of not sure when not to give him water, this morning his sugar was at 5.5 ( 2nd pee of morning) without food, and then he had cantaloupe and ice cream for breakfast, and I gave him 1 oz of water b/c his sugar was high and 1 hour later his sugar level was 1.2. I’ve given him some candy now to bring it up. I send him about 16oz of liquid to school 1:1 orange juice and water, yesterday I gave him a bit more water than juice b/c his sugar levels when he got home had been up in the 5’s. So I’m not sure if that’s where I caused a problem or what. I’ve been going into the school and checking him about 11:20 ish during the week and he was always between 2 and 3.5. But I think my sugar drops when I eat too. [He] has gained some weight over the past week at least a couple of pounds, and his energy is wayyyyyyyyyyy better. More than I’ve ever really seen him with, he is even pushing his limits more the little buggar. Any ideas on this water drinking would help, so I don’t get him too low or too high.

Cheers to ice cream!

Anyway, I think he’s rapidly moving in the right direction. Say what you want about ice cream John Robbins (who, incidentally, could also wear a Cheerio as a necklace), but it is the closest approximation to human breast milk of any commercially available food. Ice cream is a miracle food in the right context. It can also make you a ?fatass,? using one of Chief’s terms, in the wrong context (I don’t see myself telling a mom with an obese and diabetic kid who had never had a homecooked meal to eat the same way as this lil? fella ? but fat or skinny, dieting can certainly take you to this state, no matter what your current weight). By the way I told mom to cut out the bribes of course! That is a surefire way to de-motivate him to eat. Pointing out the nosebleed connection to his lack of eating, however, is very motivating.

Will his platelet levels come up?? I think this case study about a woman who received standard medical treatment (which involved barbaric things like spleen removal and other dumb, dangerous, and unnecessary shit that only the medical industry could dream up) followed by treatment for her hypothyroid condition for her Thrombocytopenia shows the metabolic connection pretty clearly?

The case of a 52 year old woman with chronic severe refractory thrombocytopenia is presented. Over a three year period, her platelet count was persistently less than 20 ? 109/litre (normal range, 150?400). She required repeated hospital admission for management of bleeding and received multiple blood transfusions. She was given repeated courses of steroids, immunosuppression, immunoglobulin, and splenectomy, without success, in an attempt to stop the chronic blood loss. Eventually, she was found to be profoundly hypothyroid. On correction of her thyroid deficiency the platelet count returned to the normal range and all bleeding stopped. The platelet count remains in the normal range three years later.

I love the line, ?Eventually, she was found to be profoundly hypothyroid.? I wonder how many times a nurse routinely checked her body temperature to make sure she didn’t have a fever, she busted out readings like 97F and below, and no one paid attention?? Sofa King We Tar Ted. A low metabolic condition should ALWAYS be the very first thing checked whenever any health problem arises ? physical, mental, emotional, or otherwise. And thyroid hormone panels should only be a SMALL part of determining whether or not a low metabolic condition exists ? as circulating hormone levels are only part of the equation (body temperature is only part of the story as well ? as adrenal hormones can raise body temperature too while the thyroid goes on permanent vacation). ?But I digress.

The other case?? The young woman with anemia, a recent super heavy period, sudden appearance of bruises?? Obviously there is a close connection here (BTW ? she has a high body temperature and low thyroid hormone levels, a perfect case in point of what I mentioned above).

First note that every single man in Ancel Keys’s starvation study developed anemia as they lost weight. As you lose weight, metabolism slows down. As metabolism slows down, you form fewer and fewer red blood cells (and platelets, and leukocytes, etc.) ? the result being ‘too little blood,? basically what the word ?anemia? means.

Next consider the changes that fitness superhero John Berardi observed as he dropped from a potentially healthy 10% body fat level (although he was already flirting with low platelet counts, anemia, and leukopenia from the start ? probably from being a calorie-conscious, health food nibbling, exercise fanatic for many years) down to an extremely unhealthy 4% body fat level, as reported in his eBook on Intermittent Fasting?

As you can see in the table above, my total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides all increased. While some might suggest this is a result of the high meat and high fat/low carb intake ? and that this increase is a problem ? many well informed physicians and physiologists would suggest otherwise. Well-respected naturopathic physician, Dr. Bryan Walsh, suggests that increased cholesterol levels ? within certain limits ? can actually be an indicator of better health; especially when the cholesterol/HDL ratios are lowered and the triglyceride/HDL ratios decrease, as they both did during my experiments. In his words: ?When it comes to blood lipids, I’d much rather have those after results than the before results.

Moving in the opposite direction of my cholesterol levels, significant decreases in my haemoglobin, red blood cell, white blood cell, and platelet counts were observed. While this may indicate a nutrient deficiency (not good), it also could indicate a decrease in bone marrow cell production (due to the negative energy balance and the intermittent fasting) or even an increase in the efficiency of these cell lines (which could actually be a good thing).

Again, after talking with Dr. Walsh, we concluded that my chronic negative energy balance probably led to the decrease in cell production at the bone level. This probably contributed to some of the fatigue I experienced during my experiments. I’d be interested in measuring these values again after a few months of weight stability, a bit higher training volume, and a few more calories. Perhaps these will come back to my pre-testing values.

Both thyroid hormones and testosterone are sensitive to energy balance. In other words, when energy balance is negative, these tend to drop. Therefore, I expected this small decrease in hormone levels. However, I’m not worried about the reductions since they’re very small.

In studies with more extreme energy deficits, testosterone and thyroid hormone levels drop to well below the reference range values. Since mine saw only small decreases, I didn’t suffer any testosterone or thyroid related problems, and I ended up preserving most of my muscle mass and strength while getting extremely lean. I’d say these drops aren’t anything to worry about.

To the contrary, according to Dr Walsh, with intermittent fasting, these reduced values could mean that I was becoming more efficient at using these hormones, reducing my requirement for their production. While this is pure speculation, there may be some merit to the idea. In fact, if intermittent fasting does contribute to increased lifespan/longevity, this potential increase in physiological efficiency may contribute to the effect.

Before continuing, I can’t resist commenting on the above. Oh yeah dudical dudes! It is totally like a good thing when you see a rise in LDL and simultaneous drop in testosterone. These are hallmarks of aging in men, but ?could mean? increased longevity in a parallel universe or something. And a drop in platelets, WBC, and RBC all below the reference ranges for these values?? Health-o-rama to yo mama! I know what you should do! Increase training volume and see what happens! When in doubt, go workout! And then post pictures of your neato?abs?while brushing off the most obvious signs of health destruction to ever show up in a blood test as potentially being a good thing!

Hey boys, why don’t you get together and pursue work in a field that your intellect is more suited for. I hear Wrigley field is running low on peanut vendors. The start of the 2012 season is just around the corner! Job openings are posted HERE.

Walsh is correct that a rise in cholesterol can be a good thing ? when there is a simultaneous rise in testosterone, RBC, WBC, hemoglobin, and platelets!

Alright take it easy. These guys are actually both pretty smart. We all make mistakes, me more than most in the health/nutrition world, and they are thinking about things intelligently. Dr. Bryan Walsh actually seems to be light years ahead of most health practitioners. Berardi is certainly a step up from Bob and Jillian, even acknowledges that his health decline stemmed from being in a calorie deficit in the passage above,?and his free eBook on intermittent fasting shows many signs of intelligent thought.

Okay, so case #2 is much more complex and even more interesting. We will stop here and continue this in a later post, as it ties in exercise, autoimmune tendencies, gluten, vitamin C’s interaction with iron (fascinating), repeated crashes to 0.0 on a refractometer on a daily basis, and so much more. Well, a little bit more at least.

As a final note to those who are finding this site for the first time and thinking that your platelet/bleeding/bruising/ITP/anemia problem can’t stem from the same problem as an underweight kid, and you’re thinking ?Hey I ate lots of ice cream on my way to developing this condition,? it can, and probably does, stem from a similar root problem. I would be more than happy to try to help you solve your own health mystery ? hopefully before you lose your spleen or completely obliterate your entire system with corticosteroid abuse.