Early on in my journey with Hashimoto’s, I realized that my own health significantly improved with the use of nutrition. I had a hunch that I was not the only person that could see improvements in Hashimoto’s with dietary changes, though I wasn’t fully convinced that one particular diet was the answer for every single person. When I began working with clients with Hashimoto’s, however, I noticed that the majority of people I did see improvement with had implemented a dietary approach that was very similar to my own.
The question “What is the right diet to heal Hashimoto’s?” is very complicated since we are all different, and although we may have the same condition, different interventions may be required for each of us to heal. As a healthcare professional and scientist, I consider myself to be diet-agnostic. I try not to form too many attachments to any dogmas, be it diets, herbs, medications or other treatment modalities. My goal is to simply try to find the most successful protocols, and to show my clients and readers what works!
That said, there are some common myths and questions I hear about food, the thyroid and Hashimoto’s that I want to address, because many of these myths are based on facts that have been misunderstood. While there may not be a “one size fits all” diet that will work for everyone, there are some diet guidelines that are important to clarify for anyone looking to find the optimal diet for their individual situation.
Some questions that I’ll cover include:
- Do I have to avoid broccoli if I have Hashimoto’s?
- Is raw dairy better than pasteurized dairy?
- Are almonds a good substitute for grains?
- If I’m not celiac, can I eat gluten?
- Should I eat Brazil nuts to get more selenium?
- Is the low carb diet bad for my thyroid?
Myth 1: Goitrogens need to be avoided in Hashimoto’s, so I can’t eat broccoli.
Those poor cruciferous vegetables! Delicious and healthy vegetables like cabbage, Brussels sprouts, broccoli, kale, and cauliflower have gotten a bad rap due to some old nomenclature and outdated patterns in thyroid disease. Goitrogen is a word that was coined in the 1950’s to describe a substance that causes the formation of a goiter, also known as an enlarged thyroid gland. It’s a very deceiving word and can mean a variety of different things for different substances, ranging from suppressing the release of thyroid hormone and changing the way thyroid hormone gets produced in the body, to suppressing the absorption of iodine.
“Goitrogen” is a name for any substance that has the potential to interfere with thyroid function. The tricky part is that not all of them work in the same way. I like to look at research studies and clinical outcomes before I determine if a food is contraindicated for Hashimoto’s.
There are certain goitrogenic mechanisms that make me cautious, such as the inhibition of the thyroid peroxidase enzyme or the inhibition of thyroid hormone release. I do recommend avoiding certain goitrogens that do this, including soy, as well as iodine in excess. I also recommend looking at scientific and clinical evidence that a substance may be harmful to the thyroid. For example, research studies have documented that canola (made from rapeseed) and nitrates found in processed foods have direct toxic effects on the thyroid gland. However, the evidence of harm from other goitrogens such as cruciferous vegetables (broccoli, cabbage, turnip, etc.) is lacking. The goitrogen categorization of crucifers is due to substances known as glucosinolates that are contained within them. When consumed in large quantities, glucosinolates can prevent the absorption of iodine into the thyroid gland.
This was a concern in the 1950’s when the primary reason for hypothyroidism was due to iodine deficiency, and any further changes in iodine levels were potentially problematic. However, since public efforts have been made to add iodine to the salt supplies of most industrialized countries, hypothyroidism induced by iodine deficiency became less of a concern. In fact, Hashimoto’s has become the primary reason for hypothyroidism, responsible for 90-97 percent of cases of hypothyroidism in the United States. Iodine deficiency is not widespread in people with Hashimoto’s, and most cruciferous vegetables do not have enough glucosinolates to induce iodine deficiency. Therefore, eating cruciferous vegetables (unless a person is otherwise sensitive to them) is perfectly healthy for most people with Hashimoto’s and should not impact thyroid function.
In my experience, most cruciferous vegetables are well tolerated and offer health benefits for most people with Hashimoto’s. They help the body detoxify, especially when cooked. Even in their raw state, I have not seen issues with cruciferous vegetables in most clients, with the exception of those with SIBO or small intestinal bacterial overgrowth (because crucifers are high in FODMAPs, which aggravate SIBO), and in those with the CBS genetic mutation or sulfur sensitivity (due to the high sulfur content of crucifers).
For those people that do have concerns about iodine deficiency and crucifers, I recommend steaming, cooking or fermenting the vegetables. This alone will be enough to break down the small amount of glucosinolates contained within the veggies.
You can read more about the breakdown of the science behind the thyroid and goitrogens in this article.
Myth 2: I do not need to get off gluten, because tests indicated that I was not sensitive.
Gluten is a substance found in wheat, barley, and rye. Gluten is a staple of the Standard Western Diet in North America, Europe, and Australia. It is found in bread, cakes, pastries and most processed foods. People with Hashimoto’s are more likely to have celiac disease compared to others, and eliminating gluten has helped some people dually diagnosed with celiac and Hashimoto’s shed their Hashimoto’s diagnosis (ie. their antibodies went into remission, and their thyroid function returned to normal). However, celiac disease is not the only problem related to gluten. My personal and clinical experience has shown that non-celiac gluten sensitivity is one of the biggest triggers in Hashimoto’s. (You can read more about gluten-related issues and Hashimoto’s, here.)
Lab testing can be very helpful in determining if you are sensitive to gluten, but unfortunately, testing technology is not perfect. More often than not, false negatives can be seen for common reactive foods like gluten, dairy, and soy. The best test for figuring out if you are sensitive to gluten is doing an elimination diet, where you avoid gluten for 2-3 weeks, then try it again to see if you react to it.
Studies have shown that gluten induces intestinal permeability in all individuals, regardless of whether or not they have celiac disease. And we know that intestinal permeability, or leaky gut, is almost always a factor with Hashimoto’s. Therefore, it only makes sense that eliminating a common irritant like gluten will lead to improved gut health and overall wellness for many people with Hashimoto’s.
In surveying my clients, 90 percent of them felt better on a gluten free diet, while only 10 percent were diagnosed with celiac disease. Going gluten free can help alleviate many symptoms associated with Hashimoto’s, such as fatigue, hair loss, bloating, constipation, diarrhea, pain, acid reflux, weight gain and many others. It can also reduce the autoimmune attack on the thyroid gland.
Going gluten free is one of the first things I recommend when you have a thyroid condition, be it Hashimoto’s, hypothyroidism, or Graves’ disease. My studies have shown that 88 percent of people who do so will feel significantly better. If you have a thyroid condition, I suggest you give it a try for just two weeks to see if you feel better. (Remember, the best test goes by how you feel). You can always go back to how you were eating if you don’t feel any different.
Starting a gluten free diet can be challenging, and many people have setbacks along the way—this is why I developed a quick start guide to help you ease into the transition. Click here to download my Gluten Free Quick Start Guide.
Myth 3: Almonds are a health food, so I should eat them every day.
In an effort to eat a healthier, nutrient dense diet, many people turn to almonds as a substitute for eating grains. This is because almonds are very tasty and quite versatile, can be made into Paleo bread, can be used as a substitute for bread crumbs, and can be eaten as snacks.
Unfortunately, many people can be sensitive to almonds. In fact, after gluten, dairy and soy, almonds are one of the top reactive foods for people with Hashimoto’s. I often see people develop new food sensitivities because they have not yet healed their guts (see Myth #7).
You run a greater risk of becoming sensitive to almonds if you eat them over and over again, day after day. If you don’t react to them now, I suggest rotating almonds with other foods, eating them only every 3-4 days.
Myth 4: The best source of selenium comes from eating Brazil nuts.
Selenium is a trace mineral that plays a critical role in thyroid function, and a deficiency in it has widely been recognized as an environmental trigger for Hashimoto’s. Selenium acts as a catalyst to convert the inactive T4 to the biologically active T3, and helps protect thyroid cells from the damaging effects of hydrogen peroxide that is generated from the synthesis of thyroid hormones.
While selenium is a required nutrient for proper thyroid function, its effect is dose responsive and it is considered to be a narrow therapeutic index supplement. Studies have been done on the specific dose of selenium needed to reduce thyroid antibodies. Doses below 200 mcg were not helpful for reducing thyroid antibodies, and doses greater than 900 mcg per day were found to be toxic.
Many people believe eating Brazil nuts will help boost their levels. However, it’s important to note that the selenium content in Brazil nuts can vary tenfold, depending on where the Brazil nuts were grown. This means that a Brazil nut can contain anywhere from 55 mcg to 550 mcg of selenium. Unless your Brazil nuts were tested for selenium content, you might be unknowingly overdosing or under-dosing yourself. Additionally, many people with Hashimoto’s may be sensitive to nuts, so stocking up on Brazil nuts would be counterproductive.
For this reason, getting selenium from a supplement may be a better option for you. Selenium methionine in supplement form, at a daily dose of 200 mcg, has been clinically tested to show a 50 percent reduction in thyroid antibodies over the course of three months. Some clinicians may even recommend a dose as high as 400 mcg per day.
Supplemental selenium has been found to reduce Hashimoto’s antibodies and symptoms, improve Graves’ disease outcomes, and reduce the incidence of postpartum thyroiditis when taken during pregnancy. I credit selenium supplementation and blood sugar balance with lowering my thyroid antibodies and helping me get rid of panic attacks. My clients report the same results over and over again, along with fewer heart palpitations, more energy and less hair loss. I’ve seen great results with Pure Encapsulations Selenium.
Myth 5: Raw dairy is fine for Hashimoto’s, as it’s only pasteurized dairy that’s problematic.
Proponents of this myth rely on the information that the pasteurization process changes the protein structure of dairy proteins, making them more reactive. However, if you’ve already been sensitized to the dairy proteins casein or whey from drinking conventional milk, then consuming raw dairy, organic dairy, lactose free milk, or goat’s milk may still be a problem.
It is possible that if you drank raw dairy your whole life, you might not have developed a sensitivity, but in general, cow’s milk is difficult to digest for most adults with Hashimoto’s. Goat’s milk is highly cross-reactive as well for those with cow milk sensitivity. Camel milk, however, may be well tolerated by people with Hashimoto’s as the proteins are different enough not to cross-react.
The most common ways people experience a reaction to dairy include gut reactions (like bloating, diarrhea and acid reflux), as well as lung reactions (coughing, asthma, sinusitis, post nasal drip, mucus) and skin conditions (eczema, rashes, acne).
The thing about dairy reactions, like all delayed food reactions, is that it’s almost impossible to know if dairy is a trigger for you unless you eliminate all dairy for at least 2-3 weeks and see if some of the symptoms you are experiencing are alleviated. You can then slowly introduce dairy back into your diet and notice whether or not your symptoms return.
Dairy was a huge trigger for me, personally, and 60 percent of my clients have reported feeling better on a dairy free diet! (Read more about my acid reflux and dairy story and why you should avoid dairy with Hashimoto’s here.)
Myth 6: Low carb eating is bad for people with thyroid issues.
It may come as a surprise, but carbohydrates are not a required element in our diet. Up to 50 percent of people with Hashimoto’s may have carbohydrate metabolism issues, and a low carbohydrate diet has been shown to be beneficial for Hashimoto’s.
Limiting carbohydrate intake while healing from Hashimoto’s helps balance blood sugar, and will likely lead to feeling significantly more clear headed, energetic, and less anxious. Furthermore, thyroid antibodies have actually been shown to trend downward with this kind of dietary plan.
In a 2016 study, 108 people with Hashimoto’s were randomized to follow a low carbohydrate study diet for 3 weeks, and were then compared to a control group of 72 patients who were given a standard low-calorie diet without food restriction.
After just 21 days, all the patients in the study group on a low carb diet showed a significant decrease in their levels of thyroid antibodies, which are known to indicate how aggressive the attack is on the thyroid gland. While other diet factors came into play, such as the exclusion of dairy, eggs, and goitrogens, the study lended weight to the benefits of low carb-style diets for people with Hashimoto’s.
Some people with Hashimoto’s (though not all) may even benefit from an ultra-low carbohydrate diet such as a ketogenic diet, where high levels of fat are consumed, and carbohydrates are restricted to less than 20 grams per day. While some people report feeling tired after starting a protein/fat heavy diet, this is not always due to needing carbohydrates.
If you’re feeling tired on a diet that is mostly comprised of fats and proteins, this could be due to low stomach acid, which leads to improper protein digestion. Most people with Hashimoto’s have been found to have low or no stomach acid, which impairs their ability to digest protein foods. Improper protein digestion may make a person tired because digestion takes a lot of energy. People who are low in stomach acid may find themselves naturally gravitating towards carbohydrates for energy, as carbohydrates do not require as much stomach acid as proteins do for proper digestion.
To improve digestion while increasing protein, I suggest starting your day with a green smoothie, increasing your veggie intake, and taking the protein digestive enzyme betaine with pepsin. Other options for increasing stomach acid and improving digestion include drinking hot lemon water or taking a teaspoon of apple cider vinegar in a glass of water with protein containing meals.
Myth 7: Diet can heal everything, so If I just eliminate more foods, I will be healed.
While some people have had great success through changing their diets, even going into complete remission from Hashimoto’s, this is not always the case. Don’t get me wrong, eating a nutrient dense diet that is free of reactive foods can do wonders, and is one of the first things I recommend. However, if you’ve been following a specific diet for 3 months and are not seeing results, you likely have a gut infection that is causing inflammation and preventing you from healing.
Gut infections lead to intestinal permeability, which is one of the main triggers of Hashimoto’s. Eradicating most infections will require targeted treatments such as herbs, antibiotics, antifungals or antiprotozoal agents. If the infection is not treated, a person can become sensitive to more and more foods, further narrowing the list of foods that are tolerated.
If you suspect that you have a gut infection, I recommend one the following tests:
- Small Intestinal Bacterial Overgrowth 2-Hr – This breath test from Genova Diagnostics screens for SIBO.
- GI Effects Comprehensive Profile – This panel from Genova Diagnostics uses DNA analysis to go beyond the standard parameters for identifying gastrointestinal disorders.
- GI Pathogen Screen with H. pylori Antigen – This panel screens for ova, parasites, bacteria, fungi, yeasts, and occult blood. It also checks for antigens to Helicobacter pylori, Entamoeba histolytica, Cryptosporidium parvum, and more.
- GI-MAP – This panel includes bacteria, opportunistic organisms, normal flora, parasites, fungi, and viruses. It also measures antibiotic resistance genes and virulence factors that contribute to pathogenicity.
While figuring out the diet that is right for you might take some trial and error, I am confident that, with a little perseverance, you will be able to find the way of eating that will help you to feel better on your healing journey. I created a Hacking Diet eBook to inspire you as you sort through all of the information out there and determine what diet works for you!
P.S. Be sure to subscribe to my email list to get a free book chapter, recipes, Thyroid Diet start guide and notifications about upcoming events.
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Note: Originally published in March 2015, this article has been revised and updated for accuracy and thoroughness.