One of the most common questions I receive from people with thyroid and autoimmune thyroid conditions is “What type of diet should I follow?” There is of course so much conflicting information out there, and so it definitely can be confusing. Many healthcare professionals will recommend a Paleo-type diet, whereas others will recommend a Mediterranean diet. Some healthcare professionals will recommend a vegetarian diet for any type of chronic health condition, including thyroid conditions, as well as autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis. Between working with many patients over the years with these conditions, and through the knowledge I’ve obtained through receiving my master’s in nutrition degree, getting numerous nutrition certifications, and attending countless nutritional seminars, I feel as if I have some valuable information to share with you on this topic.
There are so many different diets out there, and so I can’t possibly discuss all of them here. But I’m going to specifically focus on five of them in this post. And then at the end of this blog post I will mention the diet I prefer for people with thyroid and autoimmune thyroid conditions to follow. I realize you might be tempted to skip to the end of the blog post and see what my final conclusion is, but if you are truly interested in expanding your knowledge on nutrition I would recommend reading all of the information.
Autoimmune Paleo diet. Many people are familiar with a Paleo diet. This is based on the diet of our Paleolithic ancestors. The main foods allowed with this diet include grass-fed pasture-raised meats, eggs, fish, fruit, vegetables, and nuts and seeds. Foods that are excluded include grains, legumes, potatoes, dairy products, and of course any type of refined foods, included processed oils. An autoimmune Paleo diet involves the same exclusions, but according to this diet the person should also avoid eggs, nuts and seeds, along with the nightshades.
But what’s the rationale behind eliminating these foods? Well, as I mentioned earlier, the Paleo diet is based on the diet of our ancestors, and since they didn’t consume grains, legumes, potatoes, and dairy products it is assumed that we don’t need to consume these foods either. I definitely can’t argue with this, as while these foods do have some health benefits, those who exclude these foods can still get the necessary nutrients and live a very healthy life. But why are other foods excluded with an autoimmune Paleo diet? Well, the goal is to avoid foods which might result in inflammation and/or affect the health of the gut. Eggs are a very healthy food, and thus are included on a standard Paleo diet. However, egg allergies are common, which is why these are excluded on an autoimmune Paleo diet. Numerous people react to the nightshade family of foods as well. As for nuts and seeds, they have antinutrients such as lectins and phytic acid, and thus can affect the absorption of nutrients, and also can have a negative impact on the health of the gut. And since many people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis (along with other autoimmune conditions) have a leaky gut, these foods are not part of an autoimmune Paleo diet.
My Thoughts: So what’s my opinion of the autoimmune Paleo diet? I must admit that I do like this diet. However, I have found that for some people it is too restrictive. Plus, although it’s eliminating most of the foods people commonly react to, it’s also eliminating some healthy foods which not everyone needs to avoid eating, such as eggs. Once again, many people shouldn’t eat eggs, and I usually do have my patients avoid eggs for a period of time initially. However, some people with an autoimmune condition do fine when eating eggs, which is a great source of nutrients.
Mediterranean diet. The Mediterranean diet is another well known diet, and there is a lot of research which shows that it can help to improve the health of people with certain conditions, such as those with heart disease and cancer (1) (2) (3) (4). This type of diet involves eating a lot of plant-based meals, grains, fresh fruits and vegetables, nuts, legumes, fish, and olive oil. Certain dairy foods such as yogurt and cheese are allowed. Red wine is also permitted. Obviously refined foods and other junk food aren’t allowed. Small amounts of red meat and eggs are permitted.
My Thoughts: The Mediterranean diet is without question healthier than the typical diet eaten by most people…especially those in the United States. Of course there are many foods which are forbidden on an “autoimmune Paleo diet” which are allowed on the Mediterranean diet, including grains, nuts, legumes, and dairy products. While one can argue that some people with an autoimmune thyroid condition can receive good results while following this diet, if they are sensitive to the proteins of dairy and/or have a leaky gut then they probably wouldn’t achieve optimal results while following this diet.
On the other hand, if someone has a non-autoimmune thyroid condition then they might be able to follow a modified Paleo-Mediterranean type diet, which perhaps allows the person to consume some dairy products, and allows a small amount of properly prepared grains, nuts, seeds, and legumes (preferably soaking them to reduce the antinutrients). Some people with Graves’ Disease and Hashimoto’s Thyroiditis seem to do fine following this type of diet, but I usually take a conservative approach and recommend for my patients to be more strict with their diet, especially in the beginning phases.
Vegetarian or Vegan diet. If someone is on a strict vegetarian or vegan diet then little explanation is necessary. A strict vegetarian diet would exclude all meat, fish, and any type of “animal flesh”, while a strict vegan diet would avoid all animal products, including eggs and dairy. Lacto-ovo vegetarians are able to eat eggs and dairy. Lacto-vegetarians eat dairy but not eggs. Pescatarians avoid meat, eggs, and dairy, but they eat fish and other types of seafood.
My Thoughts: Although most of the patients I work with eat meat, I have worked with numerous vegans and vegetarians over the years, and if someone eats a healthy vegan or vegetarian diet then they can receive pretty good results. While some healthcare professionals don’t feel as if someone can restore their health without eating meat, this isn’t always the case. For example, if someone developed a leaky gut due to eating gluten, an infection, or chronic stress, and if this in turn caused the person to develop a leaky gut, then it is possible for a vegan or vegetarian to heal their gut and suppress the autoimmune component of their condition.
However, in order to accomplish this one not only needs to eat a healthy vegan or vegetarian diet and take any necessary supplements (i.e. vitamin B12), but they do need to be careful about eating too many foods which can impair gut healing. For example, the reason why grains, legumes, nuts, and seeds should be avoided when someone has a leaky gut is because they contain antinutrients which can affect the absorption of important nutrients, and they also can directly cause damage to the gut. And of course many vegans and vegetarians rely on eating these foods. Although I recommend for people to avoid these foods when repairing their gut, I’ve had some patients continue eating small amounts of properly prepared nuts, seeds, and legumes and still heal their gut. The problem is that some people don’t do well until they eliminate these foods, and because of this I usually recommend for my patients to avoid them if at possible.
Another problem is that while some vegetarians and vegans eat very healthy, some of them eat an unhealthy diet. I have worked with vegetarians and vegans who only ate a couple of servings of vegetables per day, but ate a lot of grains and legumes. And even if the grains are gluten free, eating large amounts of grains can decrease the absorption of nutrients and affect the health of the gut. And the same is true when it comes to eating large amounts of nuts, seeds, and legumes. Once again, I’m not opposed to some people eating these foods in moderation, but as I have already mentioned, if someone with an autoimmune thyroid condition who has a leaky gut eats large amounts of these foods on a daily basis then it will be difficult to receive optimal benefits.
SCD diet. I’ve had a number of people ask me about the Specific Carbohydrate Diet. Although this isn’t specific for autoimmune conditions, it was designed to help with gastrointestinal conditions such as inflammatory bowel disease, and it can benefit people with other chronic health conditions. Foods which are excluded include cereal grains, potatoes, and dairy products which contain lactose. Of course fresh fruits and vegetables are allowed, as well as meat, nuts and seeds. I’m not going to discuss this diet in detail here, but if you visit the website www.breakingtheviciouscycle.info you can find out specifically which foods are “legal” and “illegal”, and it will give an explanation why certain foods aren’t permitted. The diet has some similarities to the Paleo diet, although there are a few major differences, as with the SCD diet certain forms of dairy are allowed (i.e. homemade yogurt), and legumes are also allowed if they are properly prepared.
My Thoughts: Overall I think this is a great diet. Although it is restrictive, for some people with autoimmune conditions it isn’t restrictive enough, as it allows the consumption of eggs, nuts and seeds, along with some types of dairy products. While there are health benefits to these foods, not everyone with a thyroid or autoimmune thyroid condition can tolerate these foods. By reading this some might think I’m anti-dairy, and while I realize that there are some good health benefits to consuming raw and fermented dairy, many people are sensitive to the proteins of dairy, which is why I recommend for most people to at least go on a dairy-free trial. However, as I mentioned earlier, there are some people with thyroid and autoimmune thyroid conditions who can tolerate certain types of dairy such as raw milk, whey protein, goat milk, etc. I discussed dairy in greater detail in my blog post entitled “Should People With Graves’ Disease and Hashimoto’s Thyroiditis Avoid Dairy?”.
GAPS diet. GAPS stands for “Gut and Psychology Syndrome”, which involves an imbalance between the digestive system and the brain. Dr. Natasha Campbell-McBride is the founder of the GAPS diet, and this diet is well known for helping many children and adults with both neurological and psychiatric conditions. The way it accomplishes this is through the healing of the gut. And since an unhealthy gut is a big factor with many chronic conditions, including thyroid and autoimmune thyroid conditions, many people with these conditions can benefit from following the GAPS diet.
I’m not going to get into great detail about this diet, as there is plenty of information online, and there is also a wonderful book available on the GAPS diet. But it’s recommended for people to first follow an “Introduction Diet”, especially those with digestive symptoms, as well as those who have food intolerances. The diet involves eating a lot of meat, fish, as well as fermented dairy and vegetables. Homemade meat and fish stock is one of the primary foods used to help heal the gut. But fermented foods are also very important. Organ meats, eggs, and fruits are part of this diet. The diet goes in stages, as someone will begin the first stage, and then eventually go through the second stage, followed by the third stage, etc. A great benefit of this diet is that minimal nutritional supplements are required.
My Thoughts: I’m a big advocate of the GAPS diet. However, it is a very challenging diet to follow, and although I think most people can benefit from following the GAPS diet, I don’t think it’s necessary for everyone with a thyroid or autoimmune thyroid condition to follow this. This is true even when someone has a leaky gut, as while following the GAPS diet can without question help heal the gut, I usually don’t have my patients with a leaky gut follow a strict GAPS diet. So when do I recommend the GAPS diet to my patients? I usually will recommend this diet to extremely “tough cases”. For example, if someone has a lot of food intolerances and/or a multiple chemical sensitivity then I will frequently recommend for them to follow this type of diet. Once again, this doesn’t mean that other people can’t benefit from following the GAPS diet, but I find that compliance is low, and usually those who have tried many different natural protocols and haven’t receive good results are more likely to follow through with this diet.
However, just because someone doesn’t follow the GAPS diet strictly doesn’t mean they can’t benefit from following certain components of this diet. For example, most people can benefit from eating bone broth, as well as fermented foods. If more people consumed bone broth on a regular basis and ate a good amount of fermented foods daily, along with minimizing their consumption of common food allergens such as gluten, there would be less cases of leaky gut syndrome, and therefore less incidences of autoimmunity.
Obviously there is a lot more to these diets than I covered, as I pretty much gave an overview of each one. In addition, there are some other things I didn’t cover in this blog post which can be important to certain people with thyroid conditions. For example, many people with autoimmune thyroid conditions are concerned about eating foods high in goitrogens, such as broccoli, kale, cauliflower, cabbage, and spinach. I’ve discussed this in greater detail in other articles, and while a few years ago I was completely opposed to people with hypothyroidism and Hashimoto’s Thyroiditis eating goitrogenic foods, I think it’s fine for most people with hypothyroid conditions to eat normal amounts of goitrogenic foods. On the other hand, if someone with hypothyroidism has a moderate to severe iodine deficiency then they might want to be cautious about eating any raw goitrogenic foods. For more information I would read my article entitled “An Update On Goitrogenic Foods and Their Impact on Thyroid Health“.
The Keys To Any Successful Diet
Although it’s nice to have a specific diet to follow which tells you which foods you should specifically eat and which foods you should avoid, there are a few key factors which apply to pretty much any healthy diet:
1. Eat whole foods. Every healthy diet will encourage you to eat whole, healthy foods, while avoiding the refined foods and sugars. Arguably the biggest reason why many people have chronic health issues is because they eat too many refined foods and sugars, as well as too much fast food. So regardless of whether you choose to follow a Paleo diet, the GAPS diet, or if you want to eat a vegetarian diet, you want to focus on eating whole foods.
2. Avoid common allergens. Food allergies and intolerances can be major problems, and the reason for this is because a person can be intolerant to any type of food. And of course not all of the diets eliminate all of the common allergens. For example, while a Paleo diet eliminates gluten and dairy, it includes other common allergens, such as eggs. Of course that’s the purpose of an autoimmune Paleo diet, as this is even stricter than a “standard” Paleo diet. The Mediterranean and SCD diets allow the person to eat some forms of dairy. But once again, even if someone eliminates all of the common food allergens, it is possible to be sensitive to a food which is allowed with most of the diets. And while someone can obtain a food intolerance panel, these are expensive, and false results are common.
3. Eat plenty of vegetables. Every healthy diet I know of encourages people to eat plenty of vegetables. However, this still remains the primary challenge I see with my patients, as while some of them do an excellent job of eating fresh vegetables on a daily basis, most still don’t eat enough veggies. This is even true for some people who eat vegetables daily with lunch and dinner, as someone might have a small salad each day with their lunch and a serving of steamed vegetables with dinner and think they are doing a good job of eating vegetables. This is true when compared with most people, but everyone should eat at least three servings of vegetables on a daily basis, although eating five or six servings would be even better. And to be honest, for someone with a chronic health condition who has multiple nutrient deficiencies, eating five or six servings of vegetables per day might not be enough. For example, Dr. Terry Wahls is a functional medicine doctor who was diagnosed with multiple sclerosis, and she feels that people with autoimmune conditions should consume six to nine cups of vegetables per day.
4. Biochemical Individuality. Dr. Roger Williams came up with the term Biochemical Individuality. While it would be great if everyone with an autoimmune thyroid condition did great when following an autoimmune Paleo diet, the GAPS diet, or any other specific diet, the truth is that not everyone needs to be on the exact same diet. This still leaves many unanswered questions. Does everyone need to eat meat and vegetables, while going grain-free? Or is having some grains, legumes, nuts, and seeds okay for those with conditions such as Graves’ Disease and Hashimoto’s Thyroiditis? Or perhaps a vegetarian or vegan diet is the most effective? Unfortunately there is not one diet that perfectly fits everyone, as while I do recommend an autoimmune Paleo diet to most my patients, I’ve learned that not everyone responds well when following this type of diet. Plus, keep in mind that we all have our personal biases, as if someone has been thriving on a vegetarian or vegan diet for many years then it’s natural for them to assume that most other people will do equally well on the same type of diet. And the same concept applies to a Paleo-type diet, or any other diet.
In summary, there is a lot of confusion when it comes to the type of diet people with thyroid and autoimmune thyroid conditions should follow. In this blog post I’ve discussed the benefits of an autoimmune Paleo diet, the Mediterranean diet, a vegan or vegetarian diet, the SCD diet, and the GAPS diet. There are pros and cons to each of these diets, and of course there are many other diets out there other than these, such as the Zone Diet, Blood type diet, etc. Regardless of which diet you choose, you of course want to make sure to eat whole foods, which includes eating plenty of vegetables. You also want to try avoiding common allergens, which can be challenging since different people will have different food intolerances. And of course it’s important to consider the concept of biochemical individuality, as while I would love to say that everyone with a thyroid or autoimmune thyroid condition should follow a specific diet, the truth is that there is no diet that is a perfect fit for any specific condition.