- Hashimoto’s and the Thyroid|
- Hashimoto’s and Diets|
- Paleo Diet|
- AIP Diet|
- Gluten-Free Diet|
- Other Dietary Concerns|
When you think “diet,” you usually think about weight loss.
There are literally hundreds of weight loss diets to choose from, not to mention the less-rigorous approach of following generally-accepted guidelines to eat fewer calories, less fat, less junk food, fewer sweets and smaller portions.
A few diets, though, have very different goals in mind. They’re not designed to cut calories or burn fat, but meant to control specific medical conditions by restricting or increasing specific dietary components.
Hashimoto diets fall into that category. The eating plans are intended for use by people who have Hashimoto disease (also known as Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis or autoimmune thyroiditis), which is an autoimmune disease that causes the body’s immune system to mistakenly attack the thyroid gland. It’s not an uncommon condition; some 14 million people in the United States suffer from it. 
At first the symptoms of Hashimoto’s can be mild, like fatigue, weight gain and muscle aches. They may initially be attributed to other medical issues. The only distinguishing symptom is the appearance of a goiter on the neck, which is really just a swollen thyroid gland. But over time, the symptoms can get worse and in many cases, the disease actually causes damage to the thyroid itself.
An ideal diet for those diagnosed with the condition is designed to fight both Hashimoto’s and the serious thyroid issues that can follow. The diet works to mitigate the autoimmune disease, while also ensuring that the body receives enough of the nutrients that the thyroid needs to function properly.
It’s a complicated balance, and calls for what’s often a complicated eating plan. Here’s a deeper dive.
Hashimoto’s and the Thyroid
All that most people know about the thyroid gland is that it helps the pituitary gland regulate the body’s growth, but that’s far from complete. The thyroid is actually a crucial body organ.
It produces hormones which govern most of the body’s functions, from metabolism and heart function, to brain development and menstrual cycles. So anything that interferes with the thyroid’s function has an enormous impact on health and wellness.
When Hashimoto thyroiditis causes the immune system to attack the thyroid gland, it drastically affects production of those crucial thyroid hormones. And in the majority of cases, it’s the cause of hypothyroidism (also called underactive thyroid), an even more serious thyroid disease.
Hashimoto disease and hypothyroidism can eventually have a major detrimental effect on temperature, blood pressure, cholesterol, weight, mood, and even strength, brain and nerve function. Brain fog, hair loss and changes in weight (Hashimoto’s can cause mild weight gain but hypothyroidism causes more serious weight loss) are often experienced as well.
Many patients believe the two thyroid disorders are the same, but they’re not. Hashimoto’s is an autoimmune disease that slows thyroid function, because white blood cells are attacking the organ to fight a non-existent infection. Hypothyroidism is physical damage that prevents the proper functioning of the gland itself, leaving it unable to produce enough thyroid hormone.
As with most autoimmune conditions, experts don’t know what causes Hashimoto’s. Some believe bacteria or a virus is responsible while others think it’s largely genetic.  Functional medicine practitioners think it could be caused by things like an imbalance in nutrients, environmental chemicals or gut issues. 
In any case, it’s important to have an endocrinology specialist conduct blood test to check your thyroid health and determine whether you’re suffering from Hashimoto disease, hypothyroidism or both. That’s because autoimmune disorders often come in clusters, meaning that Hashimoto patients are also at risk of developing celiac disease, lupus or other autoimmunity issues. The test will determine the amount of thyroid hormones produced, and look for thyroid antibodies (with what’s known as a TPO test) as well.
A change in diet can help fight the effects of hypothyroidism, but it’s usually treated with lifestyle changes and hormone replacement therapy, which involves taking regular thyroid medication. Levothyroxine is the thyroid hormone medication most often prescribed.
An ideal Hashimoto’s diet is designed to fight both problems, battling the autoimmune disease while also ensuring that the body receives enough of the nutrients like selenium, iodine and zinc that the organ needs to produce sufficient thyroid hormone levels. (Too much iodine can hurt some Hashimoto’s patients, so consulting a doctor is always recommended first.)
Hashimoto’s and Diets
Every person’s response to a diet is different, and every patient’s response to a disease is different. That’s certainly true for Hashimoto’s disease and hypothyroidism – and that’s the reason why there’s no “best” diet for patients suffering from either or both of the thyroid problems. Some try vegan or vegetarian diets, but those can lead to massive vitamin and mineral deficiencies.
The two most common diets used to help Hashimoto’s sufferers are the Paleo diet (often with a modification known as the autoimmune protocol, or AIP), or a gluten-free diet. Here’s a look at each.
You are probably somewhat familiar with the Paleo diet (also called the “Caveman Diet”). This approach to eating received enormous attention over the last few years for its ability to help with weight loss, high blood sugar levels and blood pressure control. It’s designed to somewhat mimic the eating habits of our distant hunter-gatherer ancestors in Paleolithic times, largely eliminating foods which became a part of more-modern diets after farming became common.
A Paleo eating plan features a heavy emphasis on vegetables, fruit, nuts (and oils from the latter two), fish rich in omega-3 fatty acids and lean meats (preferably game or meat from pastured and grass-fed animals). Mostly or completely eliminated: grains, dairy products, potatoes and legumes (including beans, peas, lentils and peanuts), refined sugar and salt – and as you’d probably expect, all processed and junk foods.
The reason this diet is considered “good” for those who suffer from Hashimoto’s disease, and other autoimmune diseases, is that dairy, grains and processed foods are most likely to produce autoimmune reactions. There’s an added benefit as well; the Paleo diet is also an anti-inflammatory eating regimen, thanks to its concentration of lean proteins, fish and seafood, veggies and fruits, seeds and nuts, and healthy fats like olive oil and avocado.
There are some drawbacks to the Paleo diet, however. It eliminates many important nutrients and fiber which are contained in whole grains and legumes, and also could leave patients short of the calcium which is found in dairy. Dietary supplements are often required when following this diet. The other issue is that some of the foods often suggested in published Paleo guidelines, like grass-fed meat and wild game, are so expensive that it’s difficult for many people to follow the diet as designed. However, they’re not necessary inclusions in Paleo when adequate dietary advice is followed. 
Often referred to by the shorthand terms “AIP” or “Autoimmune Paleo,” the Paleo diet with autoimmune protocol takes the Paleo rules a step further. It’s still grain-, sugar- and dairy-free, but it also eliminates eggs, nuts and seeds, almost all types of sweeteners, and nightshades – vegetables like tomatoes, eggplant, peppers and potatoes.
In what may be even worse news, foods that come from seeds and nuts like chocolate and coffee (cocoa beans and coffee beans are really seeds) are also prohibited, as are alcohol and NSAID pain relievers like ibuprofen and aspirin.
That may seem mind-boggling, but the purpose is to eliminate the maximum number of foods that can create an inflammatory or autoimmune response. Here’s the news that may make you feel a bit better about the AIP diet, though: it’s an elimination diet.
In other words, you “reset” your system for several weeks by avoiding all foods that could cause a reaction. Then you slowly add back foods, one-by-one, to determine which ones actually worsen your condition and which ones don’t affect you. So after a while, you could be back to what you might consider a more-normal diet.
The AIP diet is most commonly prescribed to treat a leaky gut, because it allows holes in the intestine to heal and inflammation to subside. But it’s also been found quite effective for those suffering with Hashimoto’s disease. 
One rationale for prescribing a gluten-free diet for those suffering from Hashimoto’s disease is that thyroid tissue has a similar molecular structure to gluten, the protein found in most grains. When a Hashimoto’s patient eats gluten, the theory goes, the body mistakes it for the thyroid – and launches a new autoimmune response that makes Hashimoto disease symptoms worse. 
To be clear, only one small study has shown that avoiding wheat, rye and barley will specifically help those suffering with Hashimoto’s disease.  However, celiac disease (for which a gluten-free diet is almost mandatory) and Hashimoto’s are both autoimmune conditions – and it’s quite common for patients to suffer from both.
Even more compelling are surveys showing that nearly three-quarters of Hashimoto’s patients believe that they have a gluten sensitivity, and almost nine out of ten say they feel better after going onto a gluten-free diet. So while there’s no scientific evidence that eliminating these sources of food sensitivities can help fight Hashimoto’s disease, it’s one of the diets that endocrinologists recommend most for their patients with the condition.
Gluten is found in grains like wheat, rye and barley. Eliminating it means eliminating all foods made from common grains including bread, pasta, cereal, baked goods – and yes, beer. (Don’t get too down, though; some gluten-free beers have received good reviews .) That means a gluten-free diet features the usual lineup of healthy foods like lean proteins, fruit and vegetables, with only starches and grains like buckwheat, millet, sorghum, rice and soy allowed (along with packaged products certified to be gluten-free).
Other Dietary Concerns for Thyroid Patients
As previously mentioned, patients who suffer from both Hashimoto’s disease and/or hypothyroidism are likely to be deficient in several important nutrients. The most common deficiency is in selenium; food sources like Brazil nuts, tuna, halibut, eggs and grass-fed beef can provide the missing amount. 
Zinc and iodine are other minerals which may need to be supplemented with bountiful amounts of eggs, protein and dairy. Patients should speak with their doctor or nutritionist to discuss the possible deficiencies and how to resolve them, although the best bioavailable sources of zinc and iodine are shellfish and seaweeds. 
One other common deficiency in Hashimoto’s sufferers is in Vitamin D. Regular exposure to sunlight or eating certain foods can help with that, but usually not enough to overcome the problem. In most cases, Vitamin D supplements are required.
There’s one more possible concern. A food group which, although not excluded in the diets we’ve discussed, can be a big problem for Hashimoto patients: cruciferous vegetables. Most of them contain substances called goitrogens, which can limit or block thyroid hormone production when eaten in large amounts. Consumption of vegetables like broccoli, cauliflower, kale, cabbage and bok choy should be strictly limited unless they’re cooked or fermented.