One of the key “aha” moments on my road to recovery from Hashimoto’s, came when I decided to try a betaine with pepsin supplement to support protein digestion. I woke up the next morning with more energy than I had felt in a decade!
As I’ve delved more into the world of food pharmacology (food as medicine), I’ve come to realize how important proper digestion is to health, particularly for those of us managing thyroid conditions. People with Hashimoto’s usually experience some level of nutrient deficiencies, food sensitivities, digestive issues, and infections. These symptoms are often caused by a diminished ability to absorb proper nutrients from the food we eat.
This is where digestive enzymes can be a critical tool for improving digestive health. They can help the body break down food, thereby boosting nutrient uptake and reducing the symptoms of Hashimoto’s.
What type of enzymes are best to take? The answer depends on the symptoms you are experiencing, and the types of foods that are problematic for you. There are five types of digestive enzymes that are helpful for Hashimoto’s. In this week’s article, I will focus on vegetable digestive enzymes, which are used primarily to help digest vegetables that can be difficult to break down due to their high starch and fiber content.
In this article, I’ll also be focusing on:
- The gut and thyroid connection
- Why vegetables can be difficult to digest
- Simple solutions to support vegetable digestion
- How veggie enzymes can help you feel better after meals
The Gut and Thyroid Connection
In the world of functional medicine, we often refer to the concept that all disease (and thereby all healing) begins in the gut. The gut performs the all-important role of digesting and absorbing the nutrients we take in. I like to say, “You are what you absorb.”
In a well-functioning gut, the body produces the appropriate enzymes to break down the food that is ingested. Enzymes, such as amylase and maltase, begin their work in the mouth as food is chewed. Further enzymes, such as lipase and lactase, are released by the stomach, pancreas, and small intestine to break down the food particles as they move through the digestive tract, so that they can be absorbed by the body.
However, compromised intestinal function is almost always a factor in people with Hashimoto’s, and oftentimes, the root cause of their thyroid condition.
When the intestinal walls become damaged due to a variety of possible culprits, including high levels of stress, toxins, infections, a deficiency in enzymes, and food sensitivities, the body becomes unable to absorb nutrients, due to the intestines’ inability to break down certain foods. Not only will a person become lacking in key nutrients, but those undigested food particles may damage the intestinal lining, causing or exacerbating intestinal permeability, or leaky gut syndrome (a precursor to autoimmunity).
When toxic substances permeate the intestinal lining and become absorbed into the bloodstream, the body may recognize them as foreign invaders. This causes inflammation in the body as it begins to attack the intruders, and eventually leads to autoimmunity.
When food particles are poorly digested, we are also more likely to become sensitive to them. People with Hashimoto’s are particularly prone to be sensitive to gluten, dairy, and soy, because these proteins are amongst the most difficult to digest and are also the most commonly eaten proteins in the Standard American Diet.
When someone ingests foods that they are sensitive to, they will develop IgG antibodies (which are the same types of antibodies that target the thyroid gland in autoimmune disease), towards these foods. With regular consumption, the immune system attack becomes upregulated as the influx of poorly digested foods triggers the immune system to make more of these types of antibodies.
Additionally, the poorly digested foods will continue to feed the potentially problematic bacteria that live in the gut. (An overgrowth of opportunistic bacteria has been linked to autoimmunity!)
That said, there are ways to improve one’s digestion. Supplementing with the proper digestive enzymes can aid the body in digesting food, thereby increasing nutrient absorption and boosting gut health.
In fact, a 2008 study published in the Alternative Medicine Review found that supplementing with enzymes provided a safe and effective treatment for various digestive issues, including lactose intolerance, celiac disease, and other digestive malabsorption disorders.
There are five types of enzymes that may be beneficial:
Again, this article will be focusing specifically on vegetable digestive enzymes.
Vegetables and Digestion
We all know how important it is to eat our vegetables. In fact, many of my recommendations for healing the body through nutrient-dense whole foods, revolve around fueling the body with nourishing green vegetables. But for some people with Hashimoto’s, a damaged gut and a lack of digestive enzymes can make vegetables difficult to digest, as their high fiber and starch content may be difficult to break down, especially in their raw form.
A 2009 study published in the World Journal of Gastroenterology found that conditions related to thyroid abnormalities, including both hyper and hypothyroidism, can be associated with digestive issues.
While all the mechanisms and causes behind these digestive issues are not completely understood at this time, researchers have found that hypothyroidism can delay gastric emptying, and severe cases may lead to disturbances in esophageal peristalsis (which causes large pieces of digested food to be rapidly pushed toward the esophagus by the pharyngeal constrictor muscles). Given that up to 15 percent of patients with hypothyroidism have fewer than three bowel movements weekly, the study emphasizes the need for practitioners to recognize that digestive issues can be related to thyroid conditions.
In some cases of hypothyroidism, an indigestible ball of plant fiber material known as a phytobezoar, which is formed out of undigested vegetable fibers, has been found to cause bowel obstruction. These masses of undigested material commonly consist of vegetable fibers from pulpy fruits, orange pits, seeds, roots, and leaves, but can be formed from any indigestible food fibers. Fibrous foods that are often found in phytobezoars include celery, pumpkin, prunes, raisins, leeks, beets, persimmons, and sunflower-seed shells. Gross, right?
A 2018 study in the Journal of Surgery Case Reports documented an eleven year-old boy who was admitted to the hospital for a bowel obstruction and subsequent surgery to remove the mass from his small intestine. After examining the mass and questioning the boy, it was discovered that he had eaten a large quantity of oranges, including the membrane, a few days earlier. This had caused the mass of undigested fruit fiber to form in his intestines. The authors of the study noted the importance of avoiding large amounts of plant fibers and chewing food thoroughly! While the boy was not noted to have a thyroid condition, this study highlights the importance of proper fruit and veggie digestion.
Interestingly, insoluble fibers, or fibers that do not dissolve in water, which are high in vegetables like leafy greens, corn, celery, and bell peppers, have been shown to mechanically trigger symptoms of irritable bowel syndrome (IBS) as they move through the digestive tract. However, certain fibers — particularly soluble fiber, or fiber that does dissolve in water, such as psyllium — may actually be a helpful treatment for IBS. So perhaps the inability to digest the insoluble fibers is due to an enzyme deficiency, further contributing to the autoimmune cascade and IBS symptoms.
Symptoms of Poor Veggie Digestion
Common symptoms of poor veggie digestion include bloating, gas, constipation, and stomach pain. Symptoms of nutrient depletions that may occur when the body is unable to break down and absorb the nutrients in fibrous vegetables, are much further reaching and may include fatigue, hair loss, muscle pain, and autoimmunity itself.
Poor digestion of vegetables can result in deficiencies of antioxidants such as:
- Vitamin C, which is found in high amounts in cruciferous vegetables, bell peppers, and leafy greens
- Vitamin E, which can be obtained from veggies like red bell peppers, beet greens, and winter squash
- Beta-carotene (a vitamin A precursor), found carrots, sweet potatoes, greens, and winter squash
- Minerals like selenium and manganese, found in spinach and sweet potatoes
Folate is another important nutrient that can become depleted when vegetables aren’t properly absorbed. Common sources of folate include broccoli, asparagus, avocado, spinach, and Brussels sprouts. Getting enough folate from food sources is particularly important for those with the MTHFR gene variation, and can become challenging when veggie digestion is compromised.
(You can read more about the most common nutrient deficiencies found in those with Hashimoto’s here.)
Another clue that vegetables are not being properly digested is when vegetable fibers are found in stool samples. I used to ask this question of my clients, but never did formal tracking, so out of curiosity, I decided to ask some of my readers in 2018 via a survey about digestive health. Ninety-eight people answered the survey, and 82 percent of the readers that I surveyed stated that they had visible plant fibers in their stool. (While this can be easily seen with the naked eye, it can also be confirmed more objectively through stool testing, such as the Doctor’s Data Kit through Direct Labs.)
Solutions for Vegetable Digestion
I’d like to share some strategies to help you overcome veggie digestion issues so that you can help your gut heal, eliminate your symptoms, and prevent nutrient depletions.
As I mentioned earlier, due to their high fiber content, vegetables tend to be the most difficult to digest when in raw form. However, there are ways of preparing vegetables that may help with digestion and nutrient absorption.
Cook Raw Vegetables
Raw fruits and vegetables can be difficult to digest if you have a leaky gut, which is why you may need to focus on eating well-cooked foods in the early stages of intestinal healing.
The process of heating and/or puréeing vegetables softens some of the tough fibers, rendering them more easily absorbed. (It also breaks down the goitrogenic potential of cruciferous vegetables, and you can read more about that in my article on goitrogens and Hashimoto’s.)
Once these are tolerated, you can try to work your way back to raw vegetables with the peel. Start by adding in some raw, peeled and puréed vegetables, then progress to raw, peeled fruits and vegetables, and eventually try the unpeeled variety. As you begin reintroducing raw fruits and veggies, you may benefit from vegetable-digesting enzymes, which we’ll discuss in a minute.
Our saliva contains digestive enzymes, such as amylase, that help break down large food particles into smaller bits that can be easily digested by the stomach and gut. Chewing allows the saliva and enzymes to start breaking down the food. Chewing thoroughly also promotes satiety and fullness after meals.
Drink Smoothies or Vegetable Juice
By blending or juicing the vegetables that we consume, the fibers are broken down or extracted for easier digestion. I drink a Root Cause Green Smoothie every morning because it adds an easily-absorbed dose of fiber, antioxidants, and micronutrients to my diet.
Consume Fermented Vegetables
The fermentation process is similar to how the body digests food, so these foods are essentially “predigested” and more readily absorbed. Fermented foods are an excellent way to promote gut healing, as the probiotics that are produced during the fermentation process can be beneficial in balancing your intestinal flora, and can help with symptoms of constipation, digestion and anxiety.
Some of my favorite fermented foods include sauerkraut, kimchi and coconut kefir. (Note: If you have SIBO, fermented foods may exacerbate your symptoms.)
Include Digestive Bitters
These bitter medicinal herbs can include any combination of herbs, roots, bark, fruit, seeds, and flowers from botanical sources. They are defined by their bitter flavor and include a wide variety of plants, including dandelion, burdock, gentian, artichoke, chamomile, milk thistle, motherwort, and goldenseal.
By stimulating the bitter receptors in our mouth, tongue, stomach, gut, liver, and pancreas, bitters promote healthy digestion by increasing digestive secretions. This leads to better absorption of nutrients and natural detoxification of the liver.
Bitters are often taken in tincture form, but another easy way to include them in your meals is to add dandelion leaves, arugula, or radicchio (or any bitter-tasting veggies!) to your salad or smoothie.
Supplementing with Veggie Enzymes
For those who experience bloating and abdominal discomfort after consuming vegetables, or who have noticed undigested vegetable fibers in their stool, a vegetable digestive enzyme that contains fiber-digesting enzymes may help you feel better.
The following enzymes are commonly used to help break down vegetables for better digestion:
- Cellulase, an enzyme that converts cellulose into glucose, is essential for breaking down vegetables, but it’s not naturally produced by the body.
- Amylase breaks down starches to help the body digest starchy and fibrous foods like raw veggies and fruits.
- Diastase, an enzyme that can be found in malt and raw honey, works to break down starches and turn them into glucose for absorption.
- Glucoamylase breaks down the starches in vegetables, rendering them absorbable by the body.
- Alpha-Galactosidase breaks down sugars in complex carbohydrates to relieve intestinal gas and bloating.
- Hemicellulase breaks down hemicellulose, a type of cellulase and component of the cell wall in all plants.
- Invertase catalyzes the breakdown of sucrose (table sugar), especially in high-sugar containing vegetables like corn and beets, which are then converted into fructose and glucose.
Taking these types of enzymes may help reduce gas, bloating, and constipation after vegetable-heavy meals.
I formulated the Rootcology Veggie Enzymes supplement with a specific combination of enzymes, including cellulase and amylase, to help with this process. It also contains the enzymes protease, lactase, lipase, and phytase to help break down proteins, grains, and fats for optimal digestion.
I recommend taking 1 capsule with every meal that is high in vegetables — but be sure to consult with your practitioner before starting them, to tailor the dosage to your individual needs.
Here is what Kimberly had to say:
“I’ve tried several different products over the years, and I’ve even gotten an ulcer from taking protein enzymes that were too strong! I’m finding that these little enzymes help so much to digest my meals! And such a good price as well! Thank you Izabella for all that you went through so you could have the knowledge to help others like you!”
Getting to the bottom of your own digestive issues can take some time and perseverance, but it is a crucial step toward recovering from Hashimoto’s and thyroid disease. Veggie enzymes have many benefits that can help to relieve many of the symptoms that are experienced with Hashimoto’s, such as constipation, gas, bloating, and abdominal pain. As a bonus, improving one’s absorption of veggies can help increase the absorption of vitamins and minerals and, in turn, address underlying nutrient deficiencies.
If you are experiencing bloating, gas or abdominal pain when you consume fibrous vegetables, supplementing with a veggie enzyme formula (like the one from Rootcology) could help you boost your nutrient absorption and allow you to enjoy that spinach salad!
For issues with low stomach acid, I invite you to take a look at my article about the benefits of betaine with pepsin. I’ve also written an article that covers other types of enzymes that you may find beneficial in addressing digestive difficulties that are oftentimes present with Hashimoto’s.
You can learn more about the healing potential of food with my cookbook, Hashimoto’s Food Pharmacology: Nutrition Protocols and Healing Recipes to Take Charge of Your Thyroid Health.
I hope this information is helpful for those of you who’ve had trouble digesting your veggies.
Restoring gut health is a huge component of getting Hashimoto’s into remission, and taking the appropriate digestive enzymes to assist your body in processing food and absorbing nutrients can help immensely.
As always, I wish you well on your journey to feeling your best!
For continued updates and interaction, please become a part of my Facebook page and follow me on Instagram. I love interacting with my readers! Also, be sure to sign up for my weekly newsletter to get a free book chapter from my book Hashimoto’s: The Root Cause, recipes, a Thyroid Diet start guide, notifications about upcoming events, and my latest research.
- Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012;42(1):71-78. doi:10.1007/s12016-011-8291-x.
- Kvantchakhadze R. Wobenzym in the complex treatment of autoimmune thyroiditis. Int J Immunorehab. 2002;4(1):114.
- Bezoars: What Food Can Cause This Digestive Problem? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gastroparesis/expert-answers/bezoars/faq-20058050. Accessed December 16, 2018.
- Tatekawa Y. Food ileus secondary to citrus fruit associated with a Meckel’s diverticulum: a case report and review of the literature. J Surg Case Rep. 2018 Mar 28;2018(3):rjy057. doi: 10.1093/jscr/rjy057.
- Roxas M. The role of enzyme supplementation in digestive disorders. Altern Med Rev. 2008;13(4):307–314.
- Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;19(3):245-251.
- Daher R, Yazbeck T, Jaoude JB, Abboud B. Consequences of dysthyroidism on the digestive tract and viscera. World J Gastroenterol. 2009;15(23):2834-8.
Please note: Originally published in January 2019, this article has been updated for accuracy and thoroughness.
Jessica Parker says
This is great information! I have been trying to keep my thyroid hormone balance regulated lately and I have incorporated iodine supplements into my diet. I have been taking some from CedarBear! I have noticed a big difference in my energy levels and metabolism
Dr. Izabella says
Jessica – thank you so much for sharing. I an happy to hear you are feeling better. I am very hesitant in recommending iodine in Hashimoto’s. Although iodine serves as fuel for our thyroid and is very important in iodine deficiency hypothyroidism, Hashimoto’s is a different mechanism. It’s like pouring gas into an engine that’s on fire… that’s essentially what’s happening in Hashi’s, thyroid inflammation. Adding iodine to the mix before putting out the fire and fixing the engine may result in further damage to the thyroid. In those with a predisposition to autoimmunity, this has been documented time and time again, in animal and human studies.
I have spent 4 years researching about this issue, and have seen too many people suffering the consequences of adding iodine too soon. My approach is, let’s fix the engine first (usually a gut issue), and then add the fuel once we know that the engine is no longer on fire. Hope that you will check out my books. I do have a chapter on the iodine controversy that references numerous studies as well as the work of Abraham and Brownstein. Here is an article you might find helpful.
IODINE AND HASHIMOTO’S
I have hypothyroidism I have barrettes esophagus constant heartburn burping and weight gain and hair loss I have been to endocrinologists supposedly I’m in the normal range but I was put on levothyroxine and no change I have done carb free and high fiber diets nothing has helped what can I do to get well again Jeanne email is Jfmcsheffrey@gmail.com
Dr. Izabella says
Jeanne – thank you so much for reaching out and sharing your journey. I am so sorry you are struggling with all of this. My heart goes out to you. <3 The reality is, most people with acid reflux have low acid, not high acid. Depletion in the vitamin B12 is often responsible for inadequate acid production. Furthermore, suppressing stomach acid prevents us from extracting iron and vitamin B12 from foods, resulting in yet another vicious cycle and leading to other digestive problems, anemia, hair loss, and even neurological problems.
Here are a couple of articles that you may find helpful.
HASHIMOTO'S AND LOW STOMACH ACID (How Betaine with Pepsin Can Help with Hashimoto’s)
GOT ACID REFLUX?
USING ENZYMES TO OVERCOME HASHIMOTO’S
CAROLYN BINGER says
Thank you for a great article. I wish you would explain how to take enzymes, Betaine, ox bile. What to take at beginning of meal, during or after? Nothing seems to help my bloating and I’m wondering if I am taking the supplements wrong. Thank you.
Dr. Izabella says
Carolyn – thank you for reaching out. I am so sorry you are struggling with this. For more specific questions on how and when to take particular supplements under normal circumstances, please do reach out to my team by email, at firstname.lastname@example.org and they will be more than happy to help ?
Christine Nordstrom says
I have a unique case I think. I never had symptoms of hypothyroid. No weight gain, no low energy- sometimes feeling cold but not always. At the same time I was going through menapause and have read that women could be misdignosed during menopause with hypothyroid. So I asked my Dr. if I could get off since the bioidenticals were very helpful. He said ok- I did for 6 months felt no different off the meds- but he said he didn’t like my numbers. So I didn’t want to be a fool and went back on. My annual blood work check recently is: TSH .95 and I have been taking armour since 2012. Just switched to NP thyroid. So my question is-can I get off the meds? Also, if I took any thyroid supplements aimed to help -will they interfere with the meds or can I take together? Thanks I have all you rbooks and have learned a lot- thank you!
Christine Nordstrom says
I forgot to say- I have since gotten off the bioidenticals since 2018. My menapausal symptoms are gone but I’ve have been nursing an osteopenia diagnosis for about 10 yrs. trying to concentrate on strengthening my bones. Eating well taking many supplements and weight bearing exercies but alas just turned into osteoporosis! I’m really surprised because I did try to take all the right steps. I feel no pain and I’m not going to let this discourage me. I’ve read that there is a connection to hypothrid and osteoporosis? Is this true? Does the meds cause bone loss? I feel I took the best option? Just shocked and refuse to take fosomax or any other medication for this. Do you have any suggestions?
Dr. Izabella Wentz says
Christine – thank you for sharing. Monitoring progression of osteporosis is a good idea. I have found that nutrient depletions are always a factor in Hashimoto’s and addressing these nutrient depletions can make a HUGE difference in symptoms. Here are some articles you might find helpful:
Micronutrients, Bone Density, and Hashimotos
6 MOST IMPORTANT NUTRIENT DEFICIENCIES IN HASHIMOTO’S
NEW STUDIES ON MAGNESIUM AND THYROID HEALTH
Dr. Izabella Wentz says
Christine – thank you for sharing your journey! <3 The peak onset of Hashimoto’s occurs during menopause, when the body’s progesterone drops, or after pregnancy when a rapid drop in progesterone occurs after the delivery. Please understand, I am not able to advise on whether you should stay on your medications without a comprehensive health assessment. I recommend that you discuss this with your personal doctor. Most people feel best with a TSH of around 1 or lower and with a Free T4 and Free T3 in the upper half of the range. It is expected that your TSH will be very suppressed when optimal on NDT medication. Here is a research article which might help further:
TOP 10 THYROID TESTS FOR DIAGNOSIS
Are there enzymes which are not recommended for those with fructose intolerance?
Dr. Izabella says
GT – thank you for reaching out. I recommend that you discuss this with your healthcare practitioner. The advice of a skilled medical practitioner who is familiar with your health history is always best. <3
I have food sensitivities to almost all of the veggies you mentioned that we need! I haven’t eaten them for 2 1/2 years. I wonder if I tried the vegetables now, even though I still have lots of gas within an hour of eating a meal (no bloating) if I would need to take the veggie enzymes just to make sure. I’m hesitant to add the veggies back in (night shades are a definite issue, still). Your thoughts about what to take as a supplement since I’m not eating the vegetables? I do take Milk Thistle 150mg once a day. Food sensitives are: almonds, broccoli, cabbage, carrots, cheeses, chia seeds, cucumber, green pea, kale, kelp, lettuce, malt, mushrooms, oats, potato, spinach, walnuts, watermelon. Tested positive to gluten, casein, soybean, milk. This is in addition to the foods not allowed on the API diet. My gut is much better after eliminating all these foods, but I still wonder about not eating the vegetables. Help
Dr. Izabella Wentz says
Lynda – thank you for reaching out and sharing your journey. <3 You should be able to add most foods back within three to six months after healing your gut. Exceptions would be gluten, dairy, and soy. Some people may need to eliminate all three of those foods indefinitely. The kinder you are to your gut, eating nurturing foods, taking probiotics, and undergoing infection protocols, the more you should start seeing an improvement in gut function. You should also be monitoring how your bowel movements look. Your stools should be well-formed and brown in color. If they’re too light or too dark, that could be an indication that your gut is not functioning properly. Make sure that your food is well-digested in your bowels and are not in particles, as well as ensure that you’re not alternating between constipation and diarrhea. Watch your bowel movements, monitor how your stomach is feeling, and make sure you are not experiencing constipation, diarrhea, stomach pains, acid reflux or bloating—these are indications that your gut still needs to do some healing. As your gut heals, eventually you will be able to start tolerating more foods. For questions about the Veggie Enzymes please email my team at email@example.com and they will be happy to help.
Hi, I’ve been struggling for years with gut issues. I have Illietis and I don’t eat gluten etc, but noticed lately that everything I eat goes right thru me. I go to the bathroom at least 5 times a day. I have no bloating but do get gassy when I eat for example avocados, lentils etc. I’ve never taken enzymes or a prebiotic. Will these helping? I’m menopausal and have been diagnosed with every kind of thyroid issue, you name I’ve had it. I’m having a really hard time looking for a functional integrative doctor. I looked thru your list and have had no luck. I am desperate
Dr. Izabella Wentz says
Joanne – thank you for reaching out and sharing your journey. ❤️ We know that intestinal permeability (aka leaky gut) is present in every case of autoimmunity and often precedes the development of Hashimoto’s. Symptoms of leaky gut may include bloating, diarrhea, constipation, stomach aches, acid reflux and irritable bowel syndrome. According to the Institute of Functional Medicine, many people develop IBS 5-10 years before an autoimmune diagnosis. I was one of them and didn’t take my gut health as seriously as I should have. Gut problems are often caused by infections like H. pylori, parasites like Blasto, SIBO, an imbalance of bacteria, and enzyme deficiencies or food sensitivities (especially to gluten, dairy, and/or soy). Even stress can be a factor in gut permeability. Here is an article you might find interesting.
6 DIFFERENT ROOT CAUSES
IMPORTANCE OF GUT HEALTH
PANCREATIC ELASTASE, FAT DIGESTION & HASHIMOTO’S
Will these enzymes also work for gut issues related to removal of the gallbladder? I have not been able to digest vegetables well at all since I had mine removed.
Dr. Izabella Wentz says
Kathy – thank you so much for following. <3 Please understand, I am not able to advise on whether the Veggie Enzymes would be appropriate for you and your specific health needs without a comprehensive health assessment. I recommend that you discuss this with your personal doctor.