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What Diet Should People With Hypothyroidism and Hashimoto’s Thyroiditis Follow?

In the last blog post I discussed a diet for hyperthyroidism and Graves’ Disease, and so it’s only fair that I take some time to discuss the ideal type of diet for those with hypothyroidism and Hashimoto’s Thyroiditis.  Although many people with Hashimoto’s Thyroiditis do great when following an autoimmune paleo diet, others need to make certain modifications.  If you read last week’s blog post you’ll notice that in this post there is a good amount of overlap in the dietary recommendations, although just keep in mind that everyone is different, and not everyone will respond well to the same exact diet.

Just like I did in last week’s post, I’ll attempt to make this easier to understand, as what I’ll do is go through each category of food, and discuss some of the main foods within each category which can commonly be consumed, and which ones should usually be avoided.

Vegetables.  Most people with hypothyroidism and Hashimoto’s Thyroiditis should eat a wide variety of vegetables each day.  I would try to eat at least five servings of vegetables per day, and more than this would be even better.  This includes vegetables such as artichoke, asparagus, broccoli, carrots, celery, kale, lettuce, onions, spinach, squash, sweet potatoes, and zucchini.  Some people reading this probably are wondering if it is a good idea to eat cruciferous vegetables, such as broccoli, cabbage, and kale. A number of years ago I did recommend for anyone with a hypothyroid condition to completely avoid these foods, but the more research I have done, the more I have realized that all of the research studies on goitrogenic vegetables involve giving large amounts of these foods to rodents.  I’m not suggesting that people with hypothyroid conditions should eat large amounts of raw cruciferous veggies, but these are very healthy foods, and in most cases, eating a few servings per day won’t cause any issues in those people with hypothyroidism and Hashimoto’s Thyroiditis.

Those people with Hashimoto’s Thyroiditis will want to be cautious about eating the nightshades, which include tomatoes, eggplant, white potatoes, and peppers.  And the reason for this is because these foods contain compounds which can have a negative effect on the health of the gut.  I discussed this in greater detail in my article entitled “Nightshades and Thyroid Health [1]“.

You might wonder if it is essential to eat all organic vegetables.  Of course this is ideal, although I realize that in some areas it can be difficult to purchase organic food, and it is also more expensive than non-organic food.  However, you really do want to minimize your exposure to pesticides, and while rinsing your vegetables can help, eating organic is best.  If you don’t have access to organic food, or if you can’t afford to purchase organic food, then I would recommend to obtain the Dirty Dozen list from the Environmental Working Group and avoid those non-organic foods which are on the “Dirty Dozen list”, and try to eat vegetables which are on the “Clean Fifteen” list.

Sea Vegetables.  Kelp and other sea vegetables have some health benefits, although they are also very high in iodine.  Although eating foods rich in iodine is different than taking high dose iodine supplements, some people with Hashimoto’s Thyroiditis don’t do well even when eating iodine-rich foods.  This sometimes can be related to a selenium deficiency, as antioxidants such as glutathione are selenium dependent, and these antioxidants are necessary to offset the oxidation reaction caused by iodine.  And so unless if someone with Hashimoto’s Thyroiditis is certain that they have sufficient levels of glutathione and other antioxidants (i.e. vitamin C) I would recommend for those people with this condition to minimize their consumption of these foods.

Fruit.  Most people with hypothyroidism and Hashimoto’s can have a few servings of low glycemic fruits per day, which include apples, avocados, blueberries, raspberries, blackberries, cherries, grapes, peaches, pears, etc.  But how about other fruits such as bananas, watermelon, and cantaloupe?  It really does depend on the person, as while these definitely have some health benefits, bananas have a high sugar content, and melons have a higher glycemic index.  As a result, if someone has blood sugar imbalances it is best to minimize their consumption of these fruits.

I would also recommend to eat at least twice as many vegetables than fruit.  I bring this up because I commonly see the opposite pattern, as it is common for people to eat four or five servings of fruit per day, and sometimes more than this, yet only eat a couple of servings of vegetables on a daily basis.

Dairy products and eggs.  If someone has Hashimoto’s Thyroiditis and is following a strict autoimmune paleo diet, then they will want to avoid all dairy products and eggs.  And there are a few reasons for this.  With regards to dairy, many people are sensitive to the proteins of dairy, especially casein.  Some people do fine when consuming raw dairy, but not everyone.  And the same is true with regards to milk from a goat or sheep.  However, if someone has a casein sensitivity then they might react to all types of dairy, regardless of whether it is raw or pasteurized, or if it comes from a cow, goat, or sheep.  I discussed dairy in detail in a past blog post entitled “Should People With Graves’ Disease and Hashimoto’s Thyroiditis Avoid Dairy? [2]“.  As for eggs, although eggs are very nutrient dense, egg allergies are common, and egg whites include compounds which can have a negative effect on gut health.  With that being said, many people do fine consuming egg yolks.  My current approach is to have people with Hashimoto’s Thyroiditis avoid these foods for one month, and if they are struggling with the diet then they can try to reintroduce egg yolks.

Fermented foods.  Most people with hypothyroidism and Hashimoto’s Thyroiditis can benefit from eating some non-dairy fermented foods on a regular basis.  This includes kimchi, kombucha tea, sauerkraut, and unsweetened coconut yogurt.  Although fermented dairy products such as kefir and yogurt can also benefit one’s health, since I typically have my patients avoid dairy I recommend for them to avoided fermented dairy products.  If someone has a condition such as small intestinal bacterial overgrowth (SIBO) then they probably won’t be able to tolerate fermented foods until this problem is addressed.

Coconut products.  Most people with hypothyroidism and Hashimoto’s Thyroiditis do fine when consuming coconut products, which include coconut butter, coconut milk, coconut oil, coconut flakes, and coconut yogurt.  Plus, there is some evidence that coconut can help to increase the metabolism, which might offer yet another benefit to those with an underactive thyroid.  With regards to coconut milk and coconut yogurt, although you can purchase these at most health food stores, you need to be careful about other ingredients which might be included that you shouldn’t consume, and as a result it might be best to make your own coconut milk and yogurt.  As is the case with fermented foods, if someone has SIBO then they might not tolerate coconut products.

Meat.  Most types of meat are fine to eat, including beef, chicken, turkey, lamb, and pork, although the quality of the meat is of course important. For example, if someone is going to eat beef then ideally they will want to choose 100% grass fed beef.  If someone is eating poultry then organic pasture raised is preferred, although this admittedly is challenging to find in some areas.

Organ meats are very nutrient dense, and so if you like organ meats such as liver and heart then feel free to eat these.  Of course you want to make sure the organ meats are from a good quality source.

Seafood.  There is a lot of controversy over eating fish.  First of all, fish are high in mercury, as well as other toxins.  This is especially true with larger fish, but toxins affect the smaller fish as well, although to a lesser extent.  While some natural healthcare professionals claim that fish which are high in selenium help to offset any adverse effects of mercury, I still recommend to limit one’s consumption of fish to three times per week, and to try to eat fish with a low mercury content.  I’ve discussed this in greater detail in an article I wrote entitled “Seafood and Thyroid Health [3]“.

Nuts and Seeds.  Although nuts and seeds are nutrient dense, they also have lectins and phytic acid, which can have a negative effect on gut health.  As a result, if someone has a leaky gut or another gastrointestinal issue then it probably is best to avoid nuts and seeds.  This is the main reason why nuts and seeds aren’t part of an autoimmune paleo diet, as a leaky gut is common in autoimmune conditions such as Hashimoto’s Thyroiditis, and some feel that a leaky gut is a necessary prerequisite to develop autoimmunity.  If someone is pretty certain they don’t have a leaky gut or other digestive issues, I would still make sure not to eat too many nuts and seeds, although having one or two servings per day is probably fine for most people.  Soaking nuts and seeds will help to reduce the antinutrients and make them easier to digest, although someone with a leaky gut still should be cautious about eating soaked nuts and seeds.  I’m sure some people who add chia seeds and or flax seeds to their smoothies will wonder if this is okay, but if you are dealing with a leaky gut then these should also be avoided, as these also have compounds which can affect the permeability of the gut.

Gluten-Free Grains.  Although some people seem to do fine eating a small amount of gluten-free grains such as brown rice, buckwheat, and the psuedograin quinoa, these also include compounds which can affect the health of the gut.  As a result, anyone dealing with a leaky gut should ideally go grain-free, at least until the gut has been healed.

Legumes.  These should ideally be avoided while trying to restore one’s health since they also have compounds which can affect intestinal permeability.  This includes black beans, lentils, peanuts, pinto beans, and soybeans.

Soy.  This is yet another controversial topic in the world of thyroid health.  Although a small amount of fermented non-GMO soy might be okay depending on the person, one’s overall consumption of soy should be minimized.  I would definitely look to avoid processed soy products such as soy protein powder, soy burgers and chicken nuggets, soy milk, etc.  I’m not too concerned about a small amount of soy lecithin being consumed, as long as it’s from a non-GMO source.  With that being said, some people react negatively to all types of soy, even soy lecithin.

Sugars.  Having a very small amount of natural sweeteners such as honey, pure maple syrup, molasses, or stevia is usually fine, although there are exceptions.  On the other hand, other sweeteners such as agave, corn syrup, high fructose corn syrup, and sucrose should be avoided.  The sugar alcohols are controversial, as while many people seem to do fine with them, they might have a negative effect on gut health, and they usually lead to bloating and gas in those with small intestinal bacterial overgrowth.  For more information on this I’d check out my blog post entitled “Natural Sugars, Sweeteners, and Thyroid Health [4]“:

Herbs and spices.  Some herbs and spices are usually fine to consume, such as cilantro, garlic, cinnamon, ginger, oregano leaves, and rosemary.  Sarah Ballantyne (author of the wonderful book The Paleo Approach) has done a lot of research in this area, and she has put together a comprehensive list [5] of what herbs and spices are fine to eat, which ones you should be cautious about, and which ones should be avoided.

Oils.  With regards to cooking, consider using coconut oil, although if someone has problems with coconut oil then they can use lard or duck fat as alternatives.  Olive oil shouldn’t be used for cooking, but it makes an excellent salad dressing (I personally use an olive oil/garlic combination on my salads).  Although there is some controversy over flax oil, I think adding some organic flax oil (not flax seeds) to your salad or smoothie is fine in most cases.

Processed Foods.  Obviously these should be avoided while trying to restore one’s health back to normal.  While some people are able to get away with eating processed foods, for others it will have a negative effect on their recovery.  After someone has restored their health back to normal they of course should still to eat mostly whole foods, although if someone has a healthy gut then eating some processed foods on an occasional basis probably won’t be a big deal.

Remember That There Is No Specific Hypothyroid Diet For Everyone

Although these are some general guidelines, just keep in mind that everyone is different.  As a result, there might be some people who are unable to eat the “allowed” foods due to food sensitivities, a yeast or bacterial overgrowth, etc.  On the other hand, some people eat some of the “forbidden” foods yet still receive good results.  The problem is that it is impossible to predict who will do fine when straying from the diet, and who won’t show a significant improvement in their health.  And so while I realize the diet is strict, especially for someone who has gut issues, I would recommend to try to be strict in order to achieve optimal benefits.

So if you have hypothyroidism/Hashimoto’s, then hopefully you have a better idea as to what you can eat, and which foods you should avoid while trying to restore your health.  While the overall goal should be to eat whole foods while avoiding the refined foods and sugars, the type of whole foods you eat can be an important factor in your recovery.

As I mentioned, you ideally want to eat at least twice as many vegetables as fruits, and if at all possible try to buy meats, fruits, and vegetables that are organic.  If this isn’t possible then at least try to buy healthier meats while trying to avoid fruits and vegetables that are on the Dirty Dozen List.  Although following these dietary recommendations alone probably won’t be enough to restore the health of most people, making these changes can lead to a huge improvement in your health, and when combined with other factors will greatly increase your chances of restoring your health back to normal.