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Hashimotos Diet: Foods to Eat and Avoid for Hashimotos Disease

Discover the best Hashimoto's Diet to manage symptoms and support thyroid health. Learn about foods to eat and avoid for a healthier lifesty


What is Hashimoto's Thyroiditis?


Hashimoto's thyroiditis is a chronic autoimmune disease where your body's immune system increasingly attacks the thyroid gland. Ultimately it leads to an infiltration with lymphocytes (immune cells), scarring and destruction of the thyroid gland with dependance on thyroid hormone replacement.


The alternate medical name is chronic lymphocytic thyroiditis.


There is a decline in thyroid function over time, with:


  • a decline in thyroid hormones (T3 and T4) and

  • an increase in thyroid stimulating hormone (TSH) the brain hormone that is trying harder to stimulate the thyroid to work better.

  • the presence of thyroid antibodies: thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb).  

Symptoms and Causes of Hashimoto's Thyroiditis


Hashimoto's thyroiditis primarily presents with symptoms related to hypothyroidism such as;


  • fatigue,

  • weight gain,

  • cold intolerance,

  • depression,

  • constipation,

  • dry skin,

  • thinning and coarse hair,

  • slow/irregular heart rate and

  • muscle weakness.


Hashimotos diet salad in a bowl

Triggers for Hashimotos Disease


Hashimoto's disease can take years to develop, with the antibodies being positive long before the thyroid function declines.


It is an autoimmune disorder, meaning that your own immune system attacks your own thyroid cells. Hashimoto's thyroiditis is linked to genetic predisposition and environmental triggers.


It is frequently seen in people who have other autoimmune diseases, suggesting a genetic predisposition to autoimmune disorders. Other factors, such as exposure to radiation or certain chemicals and infections, are also potential triggers.


Understanding Autoimmune Inflammation in Hashimotos Disease


Hashimoto's disease is typically treated with thyroid hormone.


In some people, thyroid autoimmunity is associated with persisting symptoms or lower quality of life even when thyroid hormones are in the normal range.


This is thought to be due to symptoms arising from the autoimmune process itself that persists in the thyroid gland as theabnormal immune process is untreated. It is recognised that thyroid autoimmunity has widerspread impacts on the body that only the thyroid gland.


Thyroid autoimmunity (even with normal thyroid function) can have impacts on brain function in terms of neurological or psychiatric symptoms. On the severe end of the spectrum this is known as Steroid-responsive encephalopathy associated with thyroiditis (SREAT). Even with milder symptoms, the majority of studies find symptoms commonly persist after achieving normal thyroid status.


For example one study found that anti-TPO levels over 121.0 IU/mL was associated with significant thyroid gland inflammation (as noted when removed surgically). People who had this level of thyroid antibodies experienced more chronic fatigue, chronic irritability, chronic nervousness, and lower quality of life.


Thyroid autoimmunity is also associated with premature menopause (premature ovarian insufficiency), indicating an impact of autoimmune processes on ovarian function.


When considering diet for Hashimotos disease, we think about including foods that down regulate this immune inflammatory processes by providing supportive micronutrients, phytonutrients, and promote healthy gut bacteria.


You also should avoid foods that trigger inflammation and promote disease-promoting gut bacteria. This supports the thyroid–gut axis.


Hashimoto's Disease Diet- What Does The Evidene Say?


There is no best diet for hashimotos, as there is very little research in this area. However we do know there are important connections between, food, gut, immune and hormone function.


The Role of Food in Immune Regulation


Your diet plays a crucial role in immune regulation, directly affecting your overall health, and specifically the functions of your thyroid.


Some foods are inflammatory and trigger an immune reaction in the immune system situated in the lining of the gut (Gut-associated lymphoid tissue). They can make the gut more porous (leaky gut) and expose food that act as immune triggers to the immune system.


Additionally they can negatively impact the gut microbiome in a way that also promotes inflammation.


Excess or chronic intakes of these inflammatory foods can increase chronic inflammation and contribute to Hashimoto's thyroiditis. The standard American diet (or western processed food diets low in fibre and high in sugar and processed seed oils) is highly inflammatory.


Autoimmune Protocol Diet


Autoimmune Protocol Diet (AIP) is a modied Paleolithic diet. It begins with the elimination of specific foods, dietary additives, emulsifiers, and western dietary patterns that have been implicated in disrupting the flora of the gastrointestinal microbiome and the intestinal barrier.


This diet has been succesful in other inflammatory conditions such as inflammatory bowel disease.


Eliminated foods include:


  • grains,

  • legumes,

  • nuts,

  • seeds, 

  • nightshade vegetables,

  • eggs, and

  • dairy.

  • Tobacco,

  • alcohol,

  • coffee,

  • oils,

  • food additives,

  • refined and processed sugars,

  • medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) should also be avoided.


Included foods include:


  • fresh, nutrient-dense foods, such as eggs, fish, shellfish and leafy greens

  • minimally processed meat,

  • fermented foods and

  • bone broth. 


The elimination period is followed by a re-introduction phase.


Foods are re-introduced one at a time to see which foods are tolerated and for the long term, to have as much variety of whole foods in the diet that are tolerated.


A small study examined the use of AIP for Hashimotos. They followed 16 women who followed AIP for 10 weeks. It found a reduction in inflammation (as measured by hs-CRP and white cell count) and corresponding increase in quality of life.


Six of the women were able to reduce their thyroid hormone dose after the short intervention.

This diet likely works as it eliminates inflammatory processed foods, plus gluten and dairy both of which seem to be implicated in the pathophysiology of Hashimotos thyroiditis in some people.


Maintaining a strict AIP diet long-term is difficult, but it can be a useful short-term strategy to identify food groups that may impact your thyroid and general health. It is a good idea to get support form your health provider before changing your diet and remember to add foods back into your diet if excluding them is not helpful.


Foods to Limit or Avoid with Hashimoto's Disease


Hashimoto's and Gluten


Gluten is a protein found in wheat, barley and rye. It has been extensively studied as a potential trigger of autoimmune thyroiditis or Hashimoto's disease. An immune reaction to gluten in the gut results in antibodies causing coeliac disease.


Coeliac disease and hashimotos thyroiditis are closely connected, and some researchers recommend screening for coeliac disease in anyone with Hashimotos.


Gluten can cause intestinal inflammation leading to impaired absorption of nutrients including the micronutrients selenium and zinc which are critical for producing thyroid hormones.


Furthermore gluten-containing foods can also increase gut permeability allowing more substances to pass into the blood stream that would normally be excreted. This excess of foreign materials in our circulation can trigger an immune reaction.


One study examined the impact of a gluten-free diet on Hashimotos autoimmunity and thyroid function. Two groups, based on their preference either followed a gluten-free diet or their regular diet. It found that those who followed a gluten-free diet had:


  • lower thyroid antobodies (anti-TPOAb and anti-TgAb), and

  • increased vitamin D levels.

  • increased thyroid hormone production as measured by SPINA-GT index.


A gluten-free diet may be one thing you'd like to try to reduce the inflammatory processes of Hashimotos.


Dairy and Hashimoto's Disease


Dairy products contain a sugar called lactose that needs the enzyme lactase to be produced at the gut border to be processed. One study found 76 percent of people with Hashimotos disease were also lactose intolerant.


In the people with Hashimotos and lactose intolerance who eliminated dairy from their diet for 8 weeks had a decline in their TSH, indicating a dairy-free diet in those with Hashimotos and lactose intolerance had a reduction in thyroid inflammation and improvement in thyroid hormone production.


Goitrogens


Goitrogens are naturally occurring substances that can interfere with the production of thyroid hormones by blocking the iodine uptake which may worsen hypothyroidism.


Goitrogen-containing foods include cruciferous vegetables (e.g. broccoli, cauliflower, kale), millet and soy products.


Cooking these foods reduces their goitrogenic properties.


As these foods provide many vitamins and phytonutrients they can still be included in your diet when they are cooked.


Foods to Eat with Hashimoto's Disease


Vitamin D and Hashimotos


Vitamin D is a potent immunomodulator. Low levels of vitamin D are associated with Hashimotos thyroiditis. A study of people with Hashimotos and vitamin D levels found higher vitamin D levels were associated with decreased risk of Hashimotos. With every 5 ng/ml increase in vitamin D levels there was a 19 % decrease risk of Hashimotos.


For foods high in vitamin D, eat:


  • salmon,

  • tuna

  • sardines and

  • liver.


Don't forget to get adequate sun exposure as well.


Selenium and Hashimotos


Selenium is needed for the production of an enzyme called glutathione peroxidase which can help protect the thyroid gland from oxidative damage.


In Hashimotos disease, selenium supplementation has been shown to reduce thyroid peroxidase antibodies, reduce inflammation and improve quality of life measures in people with Hashimotos.


Foods high in selenium include:


  • brazil nuts,

  • seafood,

  • meats and

  • whole grains.


hashimotos diet - plate containing prawns, quinoa, tomatoes, arugula and avocado

Foods High in Zinc


Zinc is an important mineral for the immune system. A deficiency in zinc can lead to immunological deficiencies including increased inflammation which may worsen Hashimotos thyroiditis.


Foods high in zinc include:


  • oysters,

  • red meat, and

  • pumpkin seeds.


Gut Microbiome and Hashimoto's Disease


The gut microbiome has been implicated in the development of autoimmune diseases including Hashimotos.



It has also been suggested that the presence of Phascolarctobacterium may be implicated in the development of Hashimotos thyroiditis, althought more research is needed in this space.


To improve gut diversity, try eating foods that promote good bacteria including:


  • fermented foods like kimchi, sauerkraut and kefir,

  • prebiotic fiber found in fruits, vegetables and whole grains, and

  • probiotic supplements.


The Takeaways: Hashimoto's Diet


A diet focused on eliminating inflammatory foods and incorporating nutrient-dense, anti-inflammatory foods can be beneficial for those with Hashimoto's disease.


You can trial avoiding gluten and dairy, reducing consumption of goitrogenic foods, and increasing intake of vitamin D, selenium, zinc and gut-healthy foods, to see if you experience a reduction in symptoms and improved thyroid function.


Further research is needed to fully understand the role of diet and the gut microbiome in Hashimoto's disease.


Consult a healthcare professional for the best Hashimoto's diet for you to optimize your health.

_____


Dr Deborah Brunt is menopause doctor with additional interests in female hormonal health. She works in Dunedin, New Zealand.


She also provides menopause health coaching internationally through her MenoThrive program to support optimal health habits for aging well so you can live your best life.


Book a consult with Dr Deb Brunt | Ōtepoti Integrative Health | Book Now


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REFERENCES


Roy A, Laszkowska M, Sundström J, et al. Prevalence of Celiac Disease in Patients with Autoimmune Thyroid Disease: A Meta-Analysis. Thyroid. 2016 Jul;26(7):880-90. 

Krysiak R, Szkróbka W, Okopień B. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto's Thyroiditis: A Pilot Study. Exp Clin Endocrinol Diabetes. 2019 Jul;127(7):417-422.

Ransing RS, Mishra KK, Sarkar D. Neuropsychiatric Manifestation of Hashimoto's Encephalopathy in an Adolescent and Treatment. Indian J Psychol Med. 2016 Jul-Aug;38(4):357-60. 

Asik M, Gunes F, Binnetoglu E, et al. Decrease in TSH levels after lactose restriction in Hashimoto's thyroiditis patients with lactose intolerance. Endocrine. 2014 Jun;46(2):279-84. 

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