EVIDENCE-BASED DIET FOR HASHIMOTOS: Food to Eat and Avoid

Explore the best evidence-backed diet for Hashimotos: how nutrition influences symptoms & strategies for managing this thyroid condition effectively.

Contents

Introduction to Hashimoto’s Disease

What is Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis is a chronic autoimmune disease where your body increasingly attacks the thyroid gland, leading to an infiltration with lymphocytes (immune cells), scarring and destruction of the gland.

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.

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 And Diet For Hashimotos Disease

Hashimoto’s disease is typically treated with thyroid hormone replacement.

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 is supporting the thyroid–gut axis.

Diet for hashimotos poke bowl with salmon and vegetables

What we know about Diet For Hashimotos Disease

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 modified form of the 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.

This 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 Hashimoto’s. 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 a 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 includes nutrient dense foods, eliminates inflammatory processed foods, plus gluten and dairy both of which seem to be implicated in the pathophysiology of Hashimoto’s thyroiditis autoimmunity in some people.

Make sure you get support from your health professional if you’d like to trial AIP.

Foods to Limit or Avoid with Hashimoto’s Disease

The main foods that seem to be implicated in the ongoing autoimmune process in Hashimotos disease include gluten, lactose in dairy and goitrogens found in brassicas.

Diet for Hashimotos 3 part venn diagram with foods to exclude: gluten dairy and goitrogens

Hashimoto’s and Gluten

Gluten is a protein found in wheat, barley and rye. It has been 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 your circulation can trigger an immune reaction.

One study examined the impact of a gluten-free diet on Hashimoto’s autoimmunity and thyroid function over a 6 month period. Two groups, based on their preference either followed a gluten-free diet or their regular diet. It found that after 6 months, those who followed a gluten-free diet had:

lower thyroid anti-bodies (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 dietary modification you’d like to try to reduce the inflammatory processes of Hashimoto’s.

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 Hashimoto’s disease were also lactose intolerant.

In the people with Hashimoto’s and lactose intolerance who eliminated dairy from their diet for 8 weeks had a decline in their TSH.

This indicates that a dairy-free diet in those with Hashimoto’s and lactose intolerance had a reduction in thyroid inflammation and improvement in thyroid hormone production.

As lactose intolerance is very common among people with Hashimotos thyroiditis, a trial elimination of dairy may be another dietary change you’d like to consider, especially if you are interested in reducing immune inflammation.

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 diverse vitamins and phytonutrients, they can still be included in your diet when they are cooked and are less likely to interfere with the underlying immune inflammatory process.

Foods to Eat with Hashimoto’s Disease

Eat a diet containing nutrient dense foods: lean meats, fish and seafood, as well as plant foods high in nutrients that are anti-inflammatory such as garlic, ginger, leafy greens, herbs, carrots, and pumpkin.

Below are some select nutrients essential for adequate thyroid function and the foods to eat to ensure you have enough in your diet.

DIet For Hashimotos: pictures of nutrient dense whole foods that are suitable.

Vitamin D and Hashimoto’s

Vitamin D is a potent immunomodulator. Low levels of vitamin D are associated with Hashimoto’s thyroiditis. A study of people with Hashimoto’s 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.

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.

Eat for a Healthy Gut Microbiome With Hashimoto’s Disease

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

A study found that people with Hashimotos had a less diverse gut microbiome.

It has also been suggested that the presence of Phascolarctobacterium may be implicated in the development of Hashimoto’s thyroiditis, although 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: Diet for Hashimotos

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

Our top tips for reducing inflammation in Hashimotos Thyroiditis include;