Published November 23 2015
Many people with Graves’ Disease and Hashimoto’s Thyroiditis follow an autoimmune paleo diet. This essentially allows the person to eat plenty of meat, fish, vegetables and fruit, as well as coconut products. Eggs, dairy, nuts and seeds, legumes, grains, and the nightshade vegetables are all excluded from this diet. This diet can be very challenging for someone who eats meat, but it is of course even more challenging for most vegetarians and vegans. So people who don’t eat meat and fish are faced with eating only vegetables, fruit, and coconut products. But do vegetarians and vegans need to follow a strict autoimmune paleo diet in order to restore their health?
Before I answer this, I’d like to briefly explain why the autoimmune paleo diet is so restrictive. The science behind the autoimmune paleo diet involves avoiding those foods which are common allergens, as well as avoiding foods which have compounds that can increase the permeability of the gut. While it might make sense to avoid common allergens such as gluten, dairy, eggs, and corn, and to avoid foods that can potentially cause or worsen a leaky gut (i.e. nuts, seeds, legumes, grains, nightshades), this is very difficult for most people to do, especially for a vegetarian and vegan. With regards to nuts, seeds, legumes, grains, and nightshades (as well as egg whites), these foods have compounds which can increase the permeability of the gut.
I’m not suggesting that some people don’t need to follow a strict autoimmune paleo diet. However, I don’t think everyone with an autoimmune condition needs to continuously follow this diet. I’ve discussed this in past articles and blog posts, as there isn’t a single diet that fits everyone. While some people thrive on an autoimmune paleo diet, others don’t do well. And as I’ve also mentioned in the past, it’s possible for some people to react to some of the “allowed” foods on an autoimmune paleo diet. But getting back to the “forbidden” foods, how can you tell whether someone can eat some of these foods and still restore their health? The truth is that there isn’t a surefire way to know in advance, and in order to determine whether everyone with Graves’ Disease and Hashimoto’s Thyroiditis needs to completely avoid the “forbidden” foods, we need to ask the following two questions:
Question #1: Does everyone with Graves’ Disease and Hashimoto’s Thyroiditis have a leaky gut?
I have actually addressed this question in detail in a post entitled “Is A Leaky Gut Present In All Autoimmune Thyroid Conditions? [1]” Essentially what I spoke about is how some researchers and healthcare professionals have theorized that everyone with an autoimmune condition has an increase in intestinal permeability. However, remember that this is a theory and still hasn’t been proven, and although I don’t test all of my patients for a leaky gut, I have tested many patients over the years using the Array #2 from Cyrex Labs, and I have also used the lactulose/mannitol test on some patients as well. While many of my patients with Graves’ Disease and Hashimoto’s Thyroiditis have tested positive for a leaky gut, I have had numerous patients test negative for a leaky gut, even though they recently tested positive for thyroid autoantibodies (i.e. thyroid peroxidase, thyroglobulin, TSI).
Do these findings confirm that a leaky gut isn’t present in some autoimmune conditions? Perhaps, although it also could mean that these tests aren’t completely accurate. Truth to be told, no test is 100% reliable, although the frequency of false results with any test should be minimal. With the intestinal permeability test from Cyrex Labs, it is possible to get a false reading if someone is taking over the counter or prescription medication that is suppressing the immune system, such as corticosteroids. Or even if someone isn’t taking anything that suppresses the immune system, if they have depressed immunoglobulins (IgA, IgG, IgM) due to another reason then this can lead to a false result on this test. One can test the serum immunoglobulins prior to obtaining the test, which if normal will minimize the chances of a false negative result.
Question #2: Do nuts, seeds, grains, legumes, and nightshades increase intestinal permeability in everyone?
There is plenty of evidence which shows that gliadin and wheat germ agglutinin (WGA) can cause an increase in intestinal permeability and activate the immune system (1) [2] (2) [3] (3) [4] (4) [5] (5) [6]. The main problem with WGA is the lectin activity, although it’s important to understand that lectins aren’t in gluten-based grains such as rye and barley, but they are found in other grains such as oats, rice, and corn. Lectins are also present in legumes, nuts, and seeds.
Although these foods can potentially increase the permeability of the gut (as can the compounds found in egg whites and the nightshade vegetables), this doesn’t mean that everyone who eats these foods will develop a leaky gut. In fact, I think it’s safe to say that most people who consume small amounts of these foods won’t develop a leaky gut. I’ll also add that I’ve had patients with Graves’ Disease and Hashimoto’s Thyroiditis eat small amounts of these foods and still restore their health. In addition, taking certain precautions such as soaking nuts, seeds, legumes, and even grains can reduce the lectins, enzyme inhibitors, and other compounds, although doing this won’t completely deactivate them.
However, even if eating a small amount of these “forbidden” foods in moderation is safe in many people with Graves’ Disease and Hashimoto’s Thyroiditis, are these foods okay to eat if someone already has an increase in intestinal permeability? Well, I do think that anyone who has a leaky gut does want to minimize their consumption of these foods, and perhaps it would be a good idea to avoid them. But as an example, I’ve had a few patients test positive for a leaky gut using the Array #2 from Cyrex Labs, and on a retest some of them have shown significant improvement even when eating some of the foods which have lectins. On the other hand, I have also had some patients who didn’t show improvement until they eliminated these foods from their diet. So the honest answer is that it is almost impossible to predict who will do fine when eating some of these foods and who won’t do well, which is why many natural healthcare professionals recommend a strict autoimmune paleo diet to all of their patients.
Steps For Reversing Thyroid Autoimmunity If You’re A Vegetarian or Vegan
So if you are a vegetarian or vegan, what is the best approach to take in order to restore your health? Well, most of the same rules apply to those who eat meat, as they want to eat whole foods, avoid the refined foods, do a good job of managing their stress, minimize their exposure to environmental toxins, etc. While diet is of course is important, many healthcare professionals forget that there are other factors that can be improved without trying to convince the vegan or vegetarian that they should eat meat. Keep in mind that I eat meat, but at the same time I respect the choices made by vegans and vegetarians. I think one of the big problems is that many vegans and vegetarians eat a lot of processed foods, although I’m sure there are many reading this who eat a healthy vegan or vegetarian diet.
Anyway, if you are a vegan or vegetarian then these are the steps you should take to reverse the autoimmune process:
1) Consider testing for a leaky gut. Although I don’t test all of my patients for a leaky gut, if someone is planning on eating foods with lectins on a regular basis then it might be a good idea to do some testing for a couple of reasons. First of all, if you have a leaky gut then it would be a good idea to determine the severity of it. And a second reason is because you can do retesting as one of the ways to monitor your progress. For example, if you test positive for a leaky gut and choose to eat some gluten-free grains, nuts, legumes, etc., you might want to do another retest in three or four months to make sure your gut is healing. If it’s not healing then you probably will want to either reduce the amounts of “forbidden” foods that have lectins and other gut-disrupting compounds, or you might want to try eliminating them completely for a few months and then do another retest.
2) Try to follow a strict autoimmune paleo diet for at least one month. I’m not suggesting that you should eat meat if you’re a vegetarian, and if you’re a strict vegetarian you probably wouldn’t listen to me even if I did suggest this! What I am recommending for you to do is to avoid all of the “forbidden” foods for at least one month. In other words, avoid all of the foods which are common allergens, as well as those which have compounds that can increase the permeability of the gut…even if you did a leaky gut test and it came out negative. If after one month you are struggling with the diet, then you can try adding small amounts of some of the foods that are normally excluded. If you choose to do this I would reintroduce each food one at a time, every few days. I would also consider soaking any nuts, seeds, legumes, and grains that you eat, as this will inactive some of the compounds (i.e. lectins) that can increase gut permeability.
3) After the first month, minimize your consumption of the “forbidden” foods. Although you might be fine eating some of the foods which normally aren’t allowed on an autoimmune paleo diet, you still want to minimize your consumption of these “forbidden foods”. So for example, if you are eating soaked nuts, seeds, and beans, along with gluten free grains, I wouldn’t eat large amounts of these foods. This is especially true if you ordered an intestinal permeability test and you tested positive for a leaky gut. But even if this test came out negative I still wouldn’t load up on these foods, as I would try to eat six to twelve servings of fresh vegetables each day, some fruit, and perhaps a small amount of these “forbidden” foods.
4) Supplement with gut healing agents. You might have to take higher doses of supplements such as L-glutamine to help heal your gut. Slippery elm, zinc, saccharomyces boulardii, and vitamin A can also help with the healing of the gut. Fermented foods such as sauerkraut can also help with gut healing, and so you can have one or two servings per day.
5) Make sure you are getting all of the necessary nutrients. Although it is possible to eat a healthy vegetarian diet, I do think that many vegetarians, and most vegans, need to take certain nutritional supplements on a regular basis. For example, while vitamin B12 can be obtained from nutritional yeast, it probably will be necessary to take a vitamin B12 supplement such as methylcobalamin. Although you might not need to take fish oils, keep in mind that most people have problems converting the alpha-linolenic acid from flax oil into docosahexaenoic acid (DHA).
In summary, although many people with Graves’ Disease and Hashimoto’s Thyroiditis can benefit from following an autoimmune paleo diet, this type of diet can be very challenging for a vegetarian or vegan to follow. Of course everyone with a thyroid or autoimmune thyroid condition should focus on eating whole foods, while avoiding the refined foods and sugars. And so if someone is a vegan or vegetarian I recommend for them to follow a modified version of the autoimmune paleo diet for at least one month, which pretty much means following the diet, but of course not eating any meat (eggs and dairy are already restricted). They also will want to consider supplementing with gut healing agents, and in many cases it is necessary to supplement with certain nutrients that are commonly deficient in vegans, such as vitamin B12, DHA, and zinc.