What diet should I follow if I have Hashimoto’s disease?

Scientific literature is citing more and more evidence of the therapeutic effects of a sound nutrition strategy in patients with Hashimoto’s disease. For example, several studies have shown that the consumption of lactose- and gluten-containing foods can have a negative effect on patients, whereas adequate consumption of protein, alimentary fiber, and unsaturated fatty acids can make remission occur more quickly.

What are these correct dietary strategies and how do you make the optimal choice? Let’s focus on several diets that can alleviate the symptoms of autoimmune thyroiditis. 

Autoimmune protocol (AIP) diet

Studies show that AIP helps decrease inflammatory marker levels and improve the quality of life. This protocol involves an elimination diet to decrease inflammation, particularly in the gut. For the first 30 days of the diet, all the following foods are eliminated: dairy, gluten, nuts and seeds, legumes, coffee, alcohol, and anything that contains sugar. 

Next, a phase of reintroduction begins. This means that potential triggers are added one by one at 4-day intervals. These intervals help with observing the person’s condition and to eliminate food groups that impair their wellbeing. This diet can decrease inflammation, which usually results in less severe symptoms of Hashimoto’s disease. 

The autoimmune protocol has similarities with the paleo diet, which is based on the preferences of ancient people who lived in the paleolithic era (the first historical period of the stone age). This diet includes foods which are still available: fish, meat, poultry from pasture-fed birds and animals, vegetables, fruits, and roots. The paleo diet completely excludes grains, dairy, legumes, sugar, and processed oils. 

The autoimmune protocol diet also excludes these products, but only for 30 days; after that, these foods are sequentially reintroduced, and the patient’s condition is monitored. 

It is important to remember that AIP involves serious alimentary limitations. The abrupt exclusion of a large group of foods can result in stress, which may offset the positive effects of treatment. When it comes to AIP, it is better to seek help from a certified dietitian who will develop a personalized diet, taking into account all symptoms and test results. 

Mediterranean diet

The Mediterranean diet is based on traditional dishes from Greece, Italy, and other Mediterranean countries. It involves a lot of plant-based foods such as whole grains, vegetables, nuts, seeds and herbs, legumes, fruits, and vegetable oils. The diet also includes moderate amounts of fish, non-fat poultry, eggs, cheese, yogurt. Red meat and sweets are only eaten occasionally. 

New evidence is emerging of the antiinflammatory and immunomodulatory effects of a Mediterranean diet, which can be beneficial for people with autoimmune diseases. 

For example, in January 2021, investigators from the University Hospital of Messina, Italy, studied the alimentary habits of people with thyroiditis (first group) and those without (second group). They found out that the first group followed a Mediterranean diet in fewer cases than the second group. In contrast, they ate more foods containing animal protein and saturated fats (read meat, dairy, eggs, etc.), refined sugar, and fewer foods containing fiber and antioxidants (such as berries, fruits, and vegetables). 

What should I pay attention to when transitioning to a Mediterranean diet? 

Animal fats. The Mediterranean diet involves partial or complete elimination of animal fats and their replacement by plant-based oils. For example, you will eat poultry or fish instead of red meat, low-fat instead of full-fat dairy products, and olive oil instead of butter. 

Proteins. The Mediterranean diet offers many foods rich in protein. Its most healthy sources are seafood, poultry, hard cheese, and eggs, which should be consumed in moderate amounts. Red meat can only be eaten sometimes.

The Mediterranean diet is all about moderation. Do not eat excessive amounts of such foods as fruits, dairy, and plant- and animal-based proteins

Carbohydrates. For the Mediterranean diet, mostly complex carbohydrates are recommended, such as brown rice, pasta, and yeast-free bread. It is better to avoid bakery products made with white flour and sugar, as they have a high glycemic index. 

Vegetables, berries, and fruits should be eaten every day, mostly raw, although some vegetables can be cooked. However, it’s important to keep in mind that in cases of autoimmune thyroiditis accompanied by diabetes mellitus and/or obesity, consumption of fruit should be limited.

Gluten-free diet

Some studies have found that a gluten-free diet can have a positive effect on the development of Hashimoto’s disease. We discussed the pros and cons of going gluten-free here. Some general principles are listed below: 

• Foods containing wheat, rye, or barley should be excluded if they are not labeled as gluten-free. This includes bakery products, cookies, cakes, pasta, cornflakes, some sauces, ice cream, and even beer. Most common cereals can be replaced by peas, chickpeas, quinoa, millet, or amaranth. Instead of usual flour, try using one made of beans, buckwheat, or corn.
• Look for gluten-free foods. You can even find them among products that typically contain gluten, including canned goods, bread and bakery items, and pre-cooked meals. Pay attention to the label; it should state that the item is gluten-free. 

• Eat probiotics. Coconut yogurt or kefir,  sauerkraut, and kombucha are all sources of good bacteria. These bacteria improve intestinal flora which decreases inflammation, resulting in the alleviation of autoimmune thyroiditis symptoms. 

• Pay attention to protein consumption. If you are a vegetarian or vegan, try eating more beans and nuts. They are gluten-free and help to satisfy your protein requirements.

Intermittent fasting

Intermittent fasting is a diet that involves dividing your 24 hours in two periods: fasting and eating. 

The fasting period means that you cannot eat anything but you can drink water or zero-calorie beverages, like tea or coffee without sugar, milk, or cream. 

The eating window is  the period when you should consume your daily amount of calories. It may include two to three large meals or several small meals. The first meal after fasting should preferably be the most calorie-abundant, the second a bit less, and so on, so that the last meal is very light. 

Studies show that intermittent fasting can bring the following benefits:

• It decreases systemic inflammation in the body which is known as one of the main markers of autoimmune disease
• It decreases oxidative stress
• It increases resilience
• It decreases insulin-resistance (a condition of decreased tissue sensitivity to insulin which can lead to metabolic disorders)

Intermittent fasting is a pretty flexible system. A person can decide on the duration of the fasting period. There are several models of intermittent fasting: 16:8 (16 hours of fasting and 8 hours for eating), 18:6, 20:4, 23:1. The 16:8 scheme is the most popular one. There are no strict rules about the timing of these intervals: some people prefer to skip breakfast while others are more comfortable without dinner. 

Foods that can help alleviate Hashimoto’s disease symptoms

A complete change of diet is not for everyone. It may be easier to start mitigating the symptoms of Hashimoto’s disease  by introducing healthy fats, proteins, and carbohydrates. 

These products will make your diet healthier: 

1. Chicken. Most diets permit lean proteins, and chicken is considered an adequate alternative to pork or beef. Steaming chicken or cooking it in the oven will also help maintain healthy levels of cholesterol. 
2. Fish improves the functioning of the thyroid gland, as it contains not only protein but also Omega-3, which decreases the inflammation.
3. Non-starchy vegetables such as zucchini, cucumbers, asparagus, and leafy greens contain less sugar than potatoes, peas, or corn. Hypothyroidism can lead to an increase in blood sugar levels, body mass growth, and a worsening of the general condition, so it’s best to avoid starchy vegetables. 
4. Complex carbohydrates such as whole grains, rice, quinoa, millet, and buckwheat take longer to digest, maintain a feeling of fullness for longer, decrease overall caloric consumption, and contain less sugar than simple carbohydrates. These foods, when included in your daily diet, will make you feel healthier in general. 

Foods that can worsen Hashimoto’s disease symptoms

This is a list of foods that most often aggravate the condition of patients with Hashimoto’s disease. They shift the balance in the thyroid gland’s functioning (in cases where it is already destabilized):

1. Iodine is traditionally considered an element promoting thyroid health, but its excessive consumption can negatively affect Hashimoto’s disease symptoms. Sea algae, liver, salt, and shellfish contain a lot of iodine, so it is better to be cautious with these foods. 
2. Goitrogenic foods, which include the cabbage family: broccoli, potatoes, sweet pepper, and soy. They inhibit the synthesis of thyroid hormones, which causes additional complications in patients with Hashimoto’s disease. They can also disrupt the absorption of medication administered for thyroid disease. One study has shown that in people who had avoided goitrogenic vegetables for three weeks, the level of anti-thyroid antibodies decreased.

To sum up

More recent studies have shown emerging evidence of the effects that dietetic changes can have on Hashimoto’s disease. The results look promising; some diets can help decrease the disease symptoms. 

Several aspects worth remembering:

• It is not necessary to abruptly drop your habitual diet and start anew. This can lead to stress, and you will be unable to follow a new diet for a long time. If you have decided to change your alimentary habits to decrease Hashimoto’s disease symptoms, you can start with a flexible scheme, for example, a Mediterranean diet. This may help to adapt to limitations and later, if needed, shift to a stricter diet.  
• Think of a diet not as your destination, but as your starting point. Eating healthy does not replace pharmaceutical therapy, but can decrease symptoms and quicken remission. 
• Before starting any diet, talk to a physician. They will take your test results, symptoms, and medical history into account and will help to develop and adapt a personalized diet for you.