What’s the best diet for Hashimoto’s?

Wouldn’t it be nice if we could get an easy answer to such a question? However, as no two people are alike, no one diet fits all.

We are all different and have a unique set of genes, unique microbiomes and throughout life have been exposed to different microbes, toxins and stressors. This makes it difficult to assume that one diet will suit everyone.

Saying that there are some proven dietary approaches or templates that can be followed to start with, which you can then personalise to your unique circumstances.

If you have been researching the subject of the best diet for Hashimoto’s, you’ve probably come across gluten and dairy-free, soy-free, low-iodine, Paleo, and Autoimmune Protocol (AIP) to name the most common.

To help you decide what type of dietary modifications you’re going to try, you may consider:

• the condition you have
• your symptoms (negatively impacting the quality of life or very minor?)
• your motivation
• your cooking skills (are you a novice or have experience in the kitchen?)
• the available time you have to make changes
• help and support available from family members.

All of the above will help you determine the right path for you, but in short, there are two paths you can take.

1. You can either greatly limit or eliminate products that are unhealthy and promote inflammation, such as:

• • added sugar & artificial sweeteners
  • processed foods, takeaways, ready-meals
  • industrial seed oils (e.g. vegetable oil, rapeseed oil, canola oil, peanut oil)

This alone may help you improve your symptoms and reduce inflammation, and it’s a good starting point.

2. Or you can start with an elimination diet for 1-3 months that eliminates a wider range of foods that may be potentially problematic or pro-inflammatory. This is the option I suggest to most of my clients with autoimmune conditions.

An elimination diet is the gold standard for identifying food intolerances and sensitivities. It requires you to eliminate the most common allergenic foods for a period of time during which you address inflammation and your symptoms. Once you’re happy with your improvements, you can then reintroduce each eliminated food one at a time to see if they cause or flare any symptoms.

The most popular elimination diets for Hashimoto’s

And here is where it becomes a bit more tricky as there are many different elimination diets you can try. The most common to consider for people with Hashimoto’s are:

• Gluten, dairy & soy-free
• Paleo
• Autoimmune Protocol (AIP)

Gluten, dairy & soy free diets

The gluten, dairy & soy-free dietary approach is the least strict and it’s a good starting point for many people who want to build on top of the anti-inflammatory approach which involves removing sugar & artificial sweeteners, processed foods, industrial seed oils and alcohol.

Gluten

Gluten, which is found in wheat, rye, spelt and barely, increases gut permeability (aka “leaky gut”) by stimulating the release of zonulin (1).

Zonulin (which actually is a group of proteins) regulates gut permeability and it’s involved in a variety of chronic inflammatory diseases including (1):

• autoimmune (coeliac, IBD, Type 1 diabetes, MS, ankylosing spondylitis)
• intestinal (IBS, non-celiac gluten sensitivity)
• neuroinflammatory (autism, schizophrenia, major depressive disorders, chronic fatigue syndrome or ME)
• metabolic (obesity, type 2 diabetes, non-alcoholic fatty liver disease, gestational diabetes, hyperlipidaemia)
• and some cancers (glioma).

Apart from gluten, there are many other factors that can increase leaky gut, such as alcohol, stress, infections, excessive exercise, IgG food sensitivities, cholesterol and glucose imbalances and nutrient deficiencies, amongst others.

Therefore, it makes sense for anyone with an autoimmune condition to do an elimination diet removing gluten as it may help lower inflammation in the gut and in the body and contribute to reducing the ‘leaky gut’.

Additionally, eliminating gluten may help lower thyroid antibodies which in turn can result in reduced inflammation in the thyroid gland (2). Monitoring the levels of antibodies can be an indication of the effectiveness of dietary and lifestyle changes.

Dairy

Dairy can cause a number of reactions in people. It can cause an allergic reaction – cow’s milk is one of the top eight food allergens. Those who lack an enzyme which breaks down lactose, the milk sugar, can experience lactose intolerance symptoms of gas bloating and urgency after consuming dairy. And some people may be sensitive to dairy and experience symptoms of acid reflux, coughing or blocked nose/sinuses after having dairy products.

Dairy can also be problematic for those with autoimmune conditions if there is an increased gut permeability as milk protein (whey and casein) can aggravate the immune system and exacerbate the symptoms you experience.

A study from 2014 found that there is a high prevalence of lactose intolerance in those with Hashimoto’s. One study showed that approx. 75% of people with Hashimoto’s have issues digesting lactose. It was also demonstrated that limiting dairy, and thus lactose, especially in the morning when the medication is taken, improves the absorption of the medication, resulting in TSH reduction. This means that for those who have experienced the need to increase LT4 doses, those who have had irregular TSH levels or those who are resistant to levothyroxine and still experience symptoms, excluding or at least limiting dairy can be helpful (7)(8).

Soy

There are a couple of reasons why avoiding soy can be advisable for people with Hashimoto’s. Soy can block the activity of the TPO enzyme (which is responsible for producing thyroid hormones) and worsen the autoimmune attack on the thyroid. Consuming a lot of soy can also be problematic because approximately 95% of soy grown in the United States is genetically modified to resist the controversial (yet widely used) herbicide called glyphosate (3)(4). This leads to glyphosate accumulating in the soybeans. There are many serious health issues associated with glyphosate and in 2015 WHO declared glyphosate as “probably carcinogenic in humans” so it’s best to reduce its intake as much as possible (5)(6).

Paleo

If you’ve been gluten, dairy and soy free for 1-3 months but still have symptoms, you may consider following a Paleo-style diet. On top of gluten, dairy and soy, you may consider eliminating all the grains and legumes (so chickpeas, lentils, beans, peanuts – yes, they are legumes, not nuts!), and of course remember to include nutrient-dense foods such as good quality meat, fish, eggs, nuts, seeds, vegetables and fruit. Obviously, processed foods, added sugar and sweeteners and industrial seed oils are also avoided.

The theory behind the health benefits of a Paleo diet is that we as humans haven’t had sufficient time to adapt to properly digest agricultural products (grains, legumes, dairy) for the majority of the time humans have been on Earth they had been hunter-gatherers. Additionally, the plethora of ingredients, additives, colourings and chemicals in modern processed foods have been linked to the rise in chronic diseases, obesity, and allergies.

The Autoimmune Protocol (AIP)

The AIP approach is the most strict but at the same time the most thorough. It’s a step up from the Paleo diet and on top of grains, dairy and legumes, eggs, nuts, seeds, certain herbs/spices and nightshade vegetables (peppers, tomatoes, aubergines, chilli) are excluded. In short, all the foods that have the potential to cause inflammation and increase leaky gut are eliminated for some time so that your body’s inflammation ‘bucket’ decreases. At the same time, nutrient-dense foods such as offal, meat, fish and plenty of vegetables are added to increase nutrients, helping lower the inflammation further.

I’ve written an article about AIP here and you can read about the effectiveness I’ve seen in my practice here.

There are research studies showing the benefits of AIP in Hashimoto’s as well as in other conditions such as eczema, psoriasis, and IBD, but the AIP protocol can be beneficial for any autoimmune condition.

AIP is not designed to be a long-term diet, but it may take a few months before symptoms start to reduce. I don’t think that most people with Hashimoto’s should start with AIP – it’s best to start with a gluten, dairy and soy-free diet or Paleo and see what improvements you get on the less strict approach.

Further dietary modifications

All of these dietary approaches can be further modified based on your unique set of symptoms. For example, if you are suffering from digestive symptoms, a low-FODMAP diet can be helpful. If you react to histamine-high foods, you can consider adapting your diet to low-histamine. It’s important to remember that these additional eliminations are not forever as restrictive diets may have a negative impact on your gut flora and nutrients levels.

Whatever approach you opt to go with, be consistent, don’t cheat and stick with it for a minimum of 4 weeks to ensure you can see if eliminating certain foods can be beneficial for you. Some people may have to eliminate certain foods for longer or even forever, but it all depends on your unique set of circumstances such as the state of your digestive tract or the function of your immune system. It’s always a good idea to address any underlying issues while doing an elimination diet to allow for a successful reintroduction of foods. And remember, the end goal is always to reintroduce as many of the foods you eliminated as possible so that you have a) the most diverse diet you can have, and b) a truly personalised diet that is unique to you.

Next steps

If you’d like my guidance to make sure you have the most nutrient-dense foods possible while doing the elimination diet, or if you’d like my help discussing and deciding the best way forward for you, please book a free 20-minute inquiry call and let’s have a chat.