Most of the diets for people with thyroid and autoimmune thyroid conditions are quite restrictive. This is especially true with regards to autoimmune thyroid conditions, as most autoimmune diets will advise patients to not only avoid gluten, dairy, and grains, but will usually advise the patient to avoid eggs, nuts, seeds, legumes, as well as the nightshade vegetables. And to top it all off, those with hypothyroidism and Hashimoto’s Thyroiditis are frequently told to avoid goitrogenic foods such as broccoli, kale, spinach, etc. And unlike other autoimmune conditions, many with autoimmune thyroid conditions are also told to avoid seafood and sea vegetables due to the high iodine content. So you might wonder what foods you CAN eat without having a negative effect on your health.
I’d like to begin by saying that there is no single diet that perfectly fits everyone. For example, I commonly recommend an autoimmune Paleo diet to my patients with Graves’ Disease and Hashimoto’s Thyroiditis. As I mentioned in the opening paragraph, one of the foods you’re supposed to avoid while following this diet is eggs. And one reason for this is because a lot of people have a sensitivity to eggs. Another reason is because egg whites have proteins which can have a negative effect on gastrointestinal health. Although I do have most of my patients avoid eggs initially, eggs are very nutrient dense, and not everyone with an autoimmune thyroid condition needs to avoid eggs for a prolonged period of time. This is especially true with regards to egg yolks. So while some people will need to avoid eggs, other people are able to incorporate them into their diet. Others might be fine eating egg yolks but not egg whites.
On the other hand, fermented vegetables such as sauerkraut are allowed on most autoimmune diets, and are a big part of certain diets such as the GAPS diet. However, if someone has a condition such as small intestinal bacterial overgrowth (SIBO), then they might not be able to eat fermented foods, along with some other foods. So hopefully you understand that there are some foods that typically aren’t allowed on an autoimmune diet which some people can tolerate, as well as other foods which are allowed but might not be tolerated by some people.
What’s The Rationale Behind Excluding Certain Foods?
Before I list the foods which most people with thyroid and autoimmune thyroid conditions can eat, I figured it would be a good idea to briefly explain why certain foods are normally excluded.
Common Allergens. This includes gluten, dairy, corn, soy, and eggs. The reason why these foods are excluded is because many people have food sensitivities/intolerances to them. Of course with gluten it can be more serious than a food sensitivity or intolerance, as people with Graves’ Disease and Hashimoto’s Thyroiditis have an increased incidence of Celiac disease, which I discussed in my article “Celiac Disease and Thyroid Health [1]“. But even if someone doesn’t have Celiac disease, they still can be sensitive to gluten, as well as to these other foods. And if someone eats foods they are sensitive to, this will cause inflammation, and in some cases can also cause an increase in intestinal permeability (a leaky gut).
You might wonder why you can’t simply test for food allergies and intolerances. After all, people can have allergies and intolerances to foods other than the ones I mentioned in this post. This without question is true, and although there are numerous labs which perform food intolerance testing, the accuracy of these tests remain controversial. I usually just recommend an elimination diet, followed by the reintroduction of certain foods. Although I realize that there are limitations to doing this, in my opinion it’s more accurate than food intolerance testing, and a lot less expensive. Of course it’s also very time consuming to do this, and so it would be great if there was a lab which was accurate in testing for food intolerances.
Grains. Why should grains be avoided? After all, certain grains such as rice, millet, and buckwheat don’t have gluten. First of all, keep in mind that I’m not “anti-grain”. Although we can live fine without eating any grains, many people can tolerate a small amount of gluten free grains. But one problem is that many people don’t eat a small amount of these foods, which are high in carbohydrates. And in most cases you want to minimize your carbohydrate intake. Keep in mind that I’m not telling you to eat a low carbohydrate diet, but instead to avoid eating a high carbohydrate diet. But a bigger problem than the high amount of carbohydrates is that these foods are also high in certain anti-nutrients, such as phytates. These anti-nutrients not only affect the absorption of nutrients, but can also have a negative effect on the health of the gut.
Nuts, seeds, and legumes. Although these foods have some good health benefits, they also have anti-nutrients which can have a negative effect on the gut. And since many people with autoimmune thyroid conditions have a leaky gut, it is best to avoid these foods while trying to repair the gut. In fact, some researchers claim that everyone with an autoimmune condition has a leaky gut, although I’m not sure if this is the case, and I actually discussed this in a post entitled “Is A Leaky Gut Present In All Autoimmune Thyroid Conditions? [2]“.
Nightshades. The nightshade vegetables include tomatoes, eggplant, white potatoes, and peppers. Although these foods do have some healthy nutrients, they also have compounds which can cause inflammation in lot of people, and can potentially cause an increase in intestinal permeability. Soon I’ll be releasing a separate article which goes into greater detail about these foods.
High glycemic index fruit. Although fruit is very healthy, it still is a source of sugar, and thus you want to be careful not to eat a large quantity of high glycemic index fruit on a frequent basis. The higher the glycemic index, the faster it raises your blood sugar levels, and this includes fruits such as watermelon and cantaloupe. This doesn’t mean that eating these foods once in awhile will cause problems, but in order to keep the blood sugar levels stable you want to eat fruit with a lower glycemic index such as blueberries, blackberries, raspberries, strawberries, and apples. This is especially true in those who currently have blood sugar imbalances.
All refined foods and sugars, fast food, and artificial ingredients. I probably didn’t have to include this, but I figured I’d do so just to be on the safe side. Just about everyone reading this knows they should avoid all of these foods, and stick with the whole, healthy foods.
Foods That MOST People With Thyroid and Autoimmune Conditions CAN Eat
Vegetables. Most people reading this know that vegetables are among the healthiest foods. Even though this is true, the fact remains that most people don’t eat enough vegetables. This applies to many people who eat healthy diets, as while every now and then I’ll consult with someone who before working with me was eating five or more servings of vegetables per day on a consistent basis, many people struggle to include a couple of servings of vegetables in their daily eating regime. Not only do you want to eat plenty of vegetables, but you also want to try eating a wide variety of them. I recommend a combination of raw and cooked vegetables.
Are there any vegetables that you shouldn’t eat? Well, I mentioned the nightshade family of vegetables earlier. I’m sure many people who have hypothyroidism and Hashimoto’s Thyroiditis are wondering about goitrogenic foods such as broccoli, kale, and cauliflower. If someone with a hypothyroid condition has greatly depressed thyroid hormone levels and/or a severe iodine deficiency then it might be best to avoid these foods. However, most people can eat small amounts of these foods on a daily basis. And remember that cooking vegetables will help to reduce the goitrogenic activity. I discussed goitrogens in my article entitled “An Update on Goitrogenic Foods and Their Impact on Thyroid Health [3]“.
Fermented vegetables. Most people should eat plenty of fermented vegetables, such as sauerkraut and kimchi. These foods are a great source of probiotics. However, some people are unable to eat fermented foods, such as those who have problems with FODMAPs. I spoke about this more in a blog post I wrote entitled “Should People With Thyroid Conditions Follow a Low FODMAP Diet? [4]“. When someone has problems eating fermented foods it usually is due to intestinal dysbiosis. An example is the condition known as small intestinal bacterial overgrowth, also known as SIBO.
Low glycemic index fruit. Although those who don’t have blood sugar imbalances can eat some high glycemic index fruits every now and then, it still is best to stick with those foods that have a low glycemic index. I mentioned some of these foods earlier, as this includes all types of berries, as well as apples, pears, and cherries. Avocados are very nutrient dense and are an excellent source of healthy fats.
Meat and Poultry. This obviously doesn’t apply to vegetarians and vegans, but for those who eat meat, eating healthy forms of meat and poultry is fine. For example, if you eat beef then you ideally want to eat organic, grass-fed beef. If you eat poultry then you ideally want this to be organic as well. Other types of meat such as lamb, deer, and porcupine are fine to eat, providing you remove the quills before cooking it. Okay, I’m just joking about eating porcupine, although I’m sure it’s a delicacy in some countries. Organ meats are nutrient dense and also can be eaten.
Fish. Fish is the best source of omega 3 fatty acids, has other nutrients, and is a good source of protein. Of course fish also has toxins, and while the larger fish and the farm-raised fish have the greatest number of toxins, there are still toxins present in smaller, wild fish. With that being said, in most cases it is fine for people to have two or three servings of wild fish per week. Some healthcare professionals feel that it’s fine to eat fish on a daily basis as long as the selenium content is greater than the amount of methylmercury, although I’m still cautious about people eating more than three servings of fish per week.
Coconut. Most people with thyroid and autoimmune thyroid conditions can also eat coconut products without a problem. Of course there are some people who can’t tolerate coconut, including some people with SIBO. But most people can have some coconut milk, coconut yogurt, and I highly recommend coconut oil for those who can tolerate it. With that being said, you do need to be careful about some of the processed coconut products sold at health food stores, as some people will react to the other ingredients included. This doesn’t mean that you can’t eat any of these products, but you want to read the labels carefully, and you might also want to consider making your own coconut milk and yogurt.
Other Foods. Many herbs and spices are allowed such as basil, cilantro, garlic, ginger, oregano, parsley, rosemary, and thyme. Apple cider vinegar is allowed, as is olive oil. Drinking green tea and many herbal teas are fine.
Additional Foods That SOME People With Thyroid and Autoimmune Conditions Can Eat
Eggs. Although eggs are a common allergen and therefore can’t be consumed by some people, not everyone with an autoimmune thyroid condition will need to avoid eggs. And since eggs have many different nutrients and are a good source of protein, if someone doesn’t react to eggs I think they should eat them. As I mentioned earlier, many people do fine eating egg yolks but should consider avoiding egg whites.
Soaked nuts and seeds. As I mentioned earlier, the main reason nuts and seeds should be avoided is because they can have a negative effect on the gut, and many people with autoimmune thyroid conditions have a leaky gut. Lectins are a big culprit, and soaking nuts and seeds will help to reduce the lectin content. I’ve had some people with a leaky gut eat soaked nuts and seeds and not have it affect their recovery. On the other hand, I’ve also had some people with a leaky gut follow a strict autoimmune Paleo diet while eating soaked nuts and seeds, and on an intestinal permeability retest they showed little or no improvement. Although there could have been other factors responsible for this, it very well might have been the nuts and seeds. One of the benefits of nuts and seeds is that they make a great snack, as they are a good source of protein and fiber, and don’t raise the blood sugar levels. But in some cases they can also prevent a leaky gut from fully healing.
Raw dairy. I realize that raw dairy isn’t available in all states, and for some people who wonder why I would specifically list raw dairy and not pasteurized dairy, I would read my blog post entitled “Should People With Graves’ Disease and Hashimoto’s Thyroiditis Avoid Dairy? [5]“. I also should let you know that I frequently don’t have people reintroduce any type of dairy while following a natural treatment protocol. But I realize this diet is very restrictive, and while many people don’t do well with any type of dairy, some people can tolerate raw dairy. And some people also seem to do fine with dairy from a goat or sheep. Although I don’t encourage people to add dairy into their diet, if someone is struggling to follow this diet and they request to reintroduce dairy, I will usually allow them to do so and see how they respond. However, it’s important to only reintroduce one dairy product at a time for three consecutive days, as it’s possible to react to one type of dairy, but not to react to a different type.
Other foods. Can people safely consume other types of foods? For example, I’ll commonly get asked if someone can eat a small amount of gluten free grains, such as gluten free oats, rice, or a “pseudo grain” such as quinoa. Earlier I gave the reason why grains are usually excluded. And while eating rice, or gluten-free bread or pasta is better than eating whole wheat bread or whole wheat pasta, even gluten-free grains have antinutrients, spike up the blood sugar levels, etc. With that being said, there are some people who are able to eat small amounts of gluten-free grains without a problem. But if someone has a leaky gut and/or blood sugar imbalances then I would strongly consider going grain free.
I’ll also have some people wonder if they can reintroduce some of the nightshades. Although some people can eat nightshades without a problem, other people can’t eat them without experiencing symptoms such as joint pain, headaches, and other symptoms caused by these foods. Nightshades can also potentially cause a leaky gut, and so if someone has gut issues but isn’t experiencing any negative symptoms while consuming nightshades, then it still would be a good idea to avoid these foods.
“How Do I Know If I Can Eat These Additional Foods?”
At this point you might be wondering how would you know if you can eat eggs, soaked nuts and seeds, raw dairy, etc. I usually will have my patients follow an elimination diet. I’ll typically have them follow an autoimmune Paleo diet, and then after one month if they are struggling and feel the need to reintroduce certain foods I will usually have them start with eggs. I would have them reintroduce eggs into their diet by having them eating one or two eggs daily for three or four consecutive days and to pay close attention to any symptoms they might experience. Once again, it might be wise to only reintroduce egg yolks. If they experience any symptoms (i.e. headaches, increase in fatigue, etc.), but are unsure whether or not it is related to the food they reintroduced, or if it’s just a coincidence, I will have them cut out the food again for a few weeks and then they can try reintroducing it back again. Although this method isn’t perfect, if someone pays close attention to the changes in symptoms they usually can tell if they are having a negative reaction to a specific food. As I just mentioned, eggs is one of these foods, and although I don’t frequently recommend for people to add raw dairy into their diet, if someone does this and has a sensitivity to the proteins in dairy then they will usually be able to tell if they are reacting upon reintroducing the dairy.
On the other hand, it can be a different story with soaked nuts and seeds. With eggs and dairy, these foods are not part of an autoimmune Paleo diet because many people have allergies or intolerances to them (although as I mentioned earlier, egg whites can have a negative effect on the gut). With nuts and seeds, as well as beans/legumes, while someone also can have an allergy or intolerance to these foods, the primary reason why they are excluded from this type of diet is due to the negative effects they can have on gastrointestinal health. Eliminating these for one month and then reintroducing them might not result in any symptoms unless if you have a true allergy, or a problem breaking down fats due to another problem (i.e. bile/gallbladder problem). So while some people with thyroid and autoimmune thyroid conditions eat soaked nuts and seeds and do fine, other people don’t do well until they eliminate the nuts and seeds from their diet.
Focus On Nutrient Density
Even though one might find the diet to be restrictive, just remember that the goal isn’t to limit your caloric intake. I realize that it might seem challenging to eat enough calories with such a limited diet, but just keep in mind that there is a difference between foods that are high in calories and foods that are nutrient dense. For example, a bowl of rice will be higher in calories than a bowl of kale, but the bowl of kale will have a much higher nutrient density. To be fair, nuts and seeds are nutrient dense foods yet are excluded from an autoimmune Paleo diet, but most of the other foods listed are nutrient dense.
Also keep in mind that there is no single diet that will fit everyone. Earlier I gave the rationale behind excluding certain foods, but not everyone will need to avoid eating these foods while trying to restore their health back to normal. And what makes it even more frustrating is that with certain foods there is no surefire method to confirm that it is safe to eat this food, or if it should be avoided. Some doctors like myself use an elimination diet, others might use food sensitivity/intolerance testing, while some doctors use applied kinesiology, which involves muscle testing to see if a certain food is allowed or should be avoided. All of these methods have limitations, which is why many healthcare professionals recommend for everyone with an autoimmune condition to avoid all of the potentially problematic foods.
In summary, although most people who follow a natural treatment protocol will be put on a restrictive diet, it’s important to understand that there is no single diet which will be a perfect fit for everyone. While myself and many other doctors will recommend for those who have Graves’ Disease and Hashimoto’s Thyroiditis to be put on an autoimmune Paleo diet, not everyone needs to avoid all of these foods. On the other hand, at times some people might not be able to tolerate some of the “allowed” foods. So while many people will benefit by avoiding the common allergens (gluten, dairy, corn, soy, and eggs), going grain-free, avoiding nuts, seeds, and legumes, along with the nightshades, and fruit which have a high glycemic index, not everyone who is trying to restore their health will need to avoid all of these foods. Also remember that you don’t want to worry too much about consuming foods high in calories, but instead want to eat foods with a high nutrient density.