Hashimoto’s Disease: Beginner’s Guide to What to Eat and Avoid
There is a LOT of advice online about what to eat for Hashimoto’s disease – and a LOT of it just isn’t backed up with evidence. So this dietitian is breaking it down for you: what foods are best? Any foods to avoid? Are there any nutrients you need to watch? This is a big one…so let’s dive in!
Do we actually have the research to tell us exactly what to eat with Hashimoto’s disease (HD)? Not really…although I am not sure that we ever will. Plus, there is no one right diet for all of us. Instead, we do have research to:
A) guide us on what makes for a generally healthy diet
B) understand which nutrients are important in Hashimoto’s
C) know the risk factors and symptoms of Hashimoto’s so we can address them with diet.
This is a big post – there is a lot to consider here – so use the following table of contents to get to the part you need in case you don’t have time to read the entire article.
- What is Hashimoto’s disease?
- Hashimoto’s Disease Symptoms
- What to Eat for Hashimoto’s
- Important Nutrients for Hashimotos
- What Foods to Avoid for Hashimoto’s disease
- Hashimotos and Gluten
- Soy and Hashimotos
- AIP for Hashimotos
- What is the Best Diet for Hashimoto’s?
What is Hashimoto’s disease?
Hashimoto’s thyroiditis is an auto-immune condition that is the most common cause of hypothyroidism in the US. It is more common in women between the ages of 40 – 60 but can be diagnosed at any age. HD is more common in those who already have another autoimmune disorder like celiac disease or lupus and it can increase your risk for heart disease.
Hashimoto’s affects your thyroid, which is a butterfly-shaped gland at the base of your neck, slowly damaging it and decreasing its ability to make thyroid hormones which affect your overall metabolism from digestion to your heart and everything in between.
Hashimoto’s Disease Symptoms
Symptoms of Hashimoto’s are quite non-specific, which can make it difficult to pinpoint their cause:
- difficulty concentrating
- brain fog
- depressed mood
- dry skin
- hair loss
- cold intolerance
- joint pain
- chronic fatigue
- changes in weight
- changes in bowel habits
What to Eat for Hashimoto’s
Before we get started, it’s important to note that overall dietary pattern matters more than what’s on a single plate. The internet is full of fearmongers that would have you believe that putting a teaspoon of sugar in your tea is what caused your thyroid disease which is patently false.
We know that how you eat as a whole can be absolutely transformative for your health – but when it comes to what to eat for Hashimoto’s, health is determined more by what you put on your plate than what you leave off. While the internet (incorrectly) focuses on what to leave off, I prefer to focus on what to eat more of in order to provide your body with the building blocks it needs to heal and optimize function.
- fruits and vegetables such as green leafy vegetables like broccoli, temperate fruits like berries and apples as well as root veggies like carrots and beets. These offer fibre to support the microbiome as well as gut health; plus antioxidants and anti-inflammatory phytochemicals to fight inflammation.
- whole grains such as wheat berries, barley, oats, millet and quinoa. Whole grains have lenty of fibre for the microbiome and digestion, B vitamins, slow burning carbohydrates and protein to fill you up and minerals to prevent deficiencies
- legumes such as chickpeas, lentils and black beans. These are very high in fermentable fibres that support the microbiome, minerals to support the thyroid like iron and zinc as well as plant-based protein
- nuts and seeds such as cashews, almonds, peanut butter and hemp hearts. Nuts and seeds are packed with healthy fats like omega 3 fatty acids (hemp, chia, flax) as well as protein and minerals.
- herbs and spices such as turmeric, basil and cinnamon. Herbs and spices have potent antioxidant and anti-inflammatory benefits and are worth adding generously to provide nutrition and enjoyment to your cooking.
- lactose free dairy or dairy-free alternatives such as coconut yogurt and oat milk. Dairy free milk alternatives offer plenty of calcium to support your bones while avoiding lactose, which is a common intolerance in those with HD.
Important Nutrients for Hashimotos
I think the area of Hashimoto’s nutrition we understand best is which nutrients are important for the overall function of the thyroid. Here are the main nutrients of concern and what to eat for Hashimoto’s so you can make sure you are getting enough. Often a supplement isn’t necessary…go for food first unless your doctor or dietitian recommends otherwise!
Iodine is a critical nutrient for thyroid function. The thyroid takes up iodine from the bloodstream to create thyroid hormones. Adults need 150 micrograms of iodine (250 in pregnancy) which is quite easy to get on a plant-based diet if you use iodized salt at home – it works out to about ½ teaspoon of iodized salt per day. Animal sources of iodine include seafood and dairy; seaweed also contains iodine but in wildly varying amounts so I don’t recommend it as a daily source of iodine.
If you have hypothyroidism, it is important that you do not take iodine supplements unless under the express recommendation of your doctor as too much iodine can also affect function. In fact, excess iodine intake may be associated with the development of autoimmune thyroid disease.
The thyroid is a selenium-rich tissue. Selenium has antioxidant effects in the body as well as being important for the production of thyroid hormone. You need 55 micrograms (60 in pregnancy) of selenium daily. Eating just 1 Brazil nut a day will give you the selenium you need (about 65 micrograms); excess selenium is definitely to be avoided as it can be quite harmful so just pop a Brazil nut at breakfast and call it a day!
Vitamin D is often associated with bone health but it is also a critical nutrient for proper immune function and inflammatory response. Vitamin D is rare in our food supply, and humans have evolved to produce vitamin D in their skin upon exposure to UV radiation from the sun. However, for those of us who live far from the equator and live indoor lives, this production is scarce.
If you are able to, have your vitamin D levels tested so your physician can tailor your effective dose. In absence of this, 2000IU of vitamin D3 is a safe and conservative dose for life. The Endocrine Society of USA suggests that 1500-2000 of D3 will raise blood levels to adequate levels.
Zinc deficiency is common in Hashimoto’s – it is important for the health of gut cells as well as immune function. Deficiency can also lead to hair loss. Adult men need 11mg of zinc daily, while women need 8mg. Zinc is needed for thyroid hormone production, so get more from pumpkin seeds, flax seeds, nuts, legumes and whole grains.
Not getting enough magnesium is pretty common, and magnesium supports healthy immune function. Magnesium is found is nuts, seeds, cooked spinach, legumes and whole grains. I love hemp hearts for their magnesium as well as their omega 3 fatty acids! Men need 400mg (420mg after age 30) and women need 310mg (320mg after age 30) daily.
Iron deficiency is also common in Hashimoto’s, so eating more iron-rich plant foods – such as lentils, tofu, cashews and molasses – will help you prevent deficiency that can interfere with thyroid function. Menstruating adults need 18mg while non-menstruating adults need 8mg daily. If you menstruate, taking a multivitamin that contains a small amount iron (4-10mg) is fine but ensure that you do not supplement with higher dose iron supplements unless advised by your doctor as excess iron is harmful.
What Foods to Avoid for Hashimoto’s disease
I know that I said I prefer to focus on what to eat more of…but this blog wouldn’t be complete unless I addressed all the questions around food elimination. Here is what you need to know.
Food intolerance and Hashimotos
Lactose intolerance is common in Hashimoto’s disease, occurring in perhaps three-quarters of those with HD. You may find that going dairy free helps to reduce symptoms of gas, bloating or diarrhea. As well, lactose intolerance can influence bioavailability of the thyroid medication. Lactose-free dairy is widely available but dairy free is delicious, nutritious and easy on the planet! Find your favourite plant-based milk and experiment making creamy sauces out of plants. You won’t miss the dairy!
Constipation, gut dysbiosis and gut barrier dysfunction (AKA leaky gut) is also commonplace in HD. These two underlying issues can make you feel like you are reacting to lots of foods. Before you eliminate, investigate! Food elimination can cause further issues such as weakened gut microbiome, nutrient deficiencies and even food intolerance.
Hashimotos and Gluten
I suspect that the idea that those with Hashimoto’s should avoid gluten derived from the connection between celiac disease and HD. The HLA genetics that predispose someone to Hashimoto’s can also predispose someone to celiac disease. If you have low thyroid, it is wise to also get screened for celiac disease as it is more common in those with HD than those without it. Likewise, if you have celiac disease, it is important to manage your nutrition to minimize risk to the thyroid from iodine or selenium deficiencies, which are possible in celiac disease.
But what about if you don’t have celiac disease? It has been suggested that immune cross-reactivity may occur between gluten and thyroid antigens, but the evidence is scarce and mostly theoretical.
One recent pilot study (34 people), found that a gluten free diet appeared to improve thyroid hormone and vitamin D levels after 6 months, but we would need a lot more evidence here before we could say with certainty that it will be effective for all. If other nutritional approaches have not worked for you, and you suspect you’d feel better with gluten, get help from a dietitian to ensure you are meeting your fibre and nutrient needs as well as how to enjoy delicious gluten free meals! FYI: most of the plant-based recipes on this site are also gluten free.
Soy and Hashimoto’s
The internet loves to hate on soy. So let’s clear this up: soy does not harm your thyroid as long as you are getting the iodine you need. Same for any of the ‘goitrogenic foods’ that are on the internet like kale. Get your iodine, eat normal amounts of soy foods and greens and your thyroid will be fine.
If you are taking thyroid medications, however, you need to know one thing: soy can interfere with your absorption of your medication. The fix? Don’t eat tofu with your meds. Instead, wait 2-4 hours after your morning medication before you consume soy foods.
AIP for Hashimotos
The autoimmune protocol diet (AIP) is a type of highly restrictive paleo-style diet that eliminates a lot of (most?) different foods:
- nightshade vegetables
- hyper-processed foods like fast food and snack bars
I have a lot of concerns with AIP. Yes, it’s true that the way we eat in North America contributes to our dis-ease. However, I’m always surprised that instead of taking the most logical (and effective) steps – such as greatly increasing vegetable intake, eating fewer added sugars or white flour, etc – we immediately look to elimination diets as the solution.
Elimination diets are usually a drastic change from our hyper-processed food world, so in the short term, it really feels like they are doing something. However, the negative effects start to show themselves as time goes on. For example, there is a strong psychological effect of following such restrictive diets that can lead to feelings of isolation and food fear. In addition, following AIP to a T means that it would be very difficult to get all of the fibre you need to support your microbiome as well as increasing nutrient deficiencies like magnesium. It’s worth noting that few can follow this plan for the long term, which leads to frustration as well as the potential for NEW food intolerances as you reintroduce foods back into your diet after avoiding them for so long.
“Sure dietitian, but what about the research?” Well, there ain’t much. One small pilot (17 people), that tested a comprehensive lifestyle program that included AIP, found that there were no significant changes in thyroid function, although inflammation and quality of life scores improved.
This trial is too small to have confidence that this highly restrictive approach works. What’s more, improvements in these trials might be related to other factors, such as having intense social + medical support for your condition, decreased inflammation as an effect of weight loss or simply eating more whole foods, which can be done by less restrictive means.
Does millet wreck your thyroid? I also want to mention millet here because someone asked in the comments; there is a tiny amount of evidence that pearl millet may be associated with thyroid function even when iodine is adequate. When I say tiny, the paper I just referenced offered two citations for the statement. In determining what to do with this information, we have to weigh multiple factors:
- here are several varieties of millet available, not just pearl: for example, the type Bob’s Red Mill sells is proso millet and we have no data on these kinds of millet for your thyroid.
- The data we have comes from a region where millet is a major staple of the diet and also malnutrition is common so we can’t be sure about the real world effect of eating millet in usual amounts in the North American diet.
- I would not advocate for removing millet from your diet unless all other lifestyle and dietary strategies did not offer adequate results. Then, under your practitioners guidance, trial a 12 week elimination to see if things improve.
So, What is the Best Diet for Hashimoto’s?
We do not have one evidence-informed diet that we can recommend with certainty for those with Hashimoto’s disease. However, we do know enough to guide us in making some general recommendations. The best dietary pattern will:
- Fight inflammation. Oxidative stress and inflammatory response are thought to be important in so minimizing oxidative damage through food choices while providing nutrients to help prevent and repair damage is wise.
- Support a healthy gut microbiome. We know that maintaining a healthy microbiome is an important part of a healthy immune response. Also, that the gut microbiome in HD might be imbalanced. That means fibre, and plenty of it – as well as decreasing intake of saturated fats from animal sources which may increase gut-barrier dysfunction and microbiome changes.
- Nutrient dense. Your body needs plenty of nutrition to support healing, but decreasing thyroid function also means decreased metabolic rate, so you generally need less food overall. Choosing whole plant foods, which are nutrient dense, more often will help get the nutrients we need even when our appetite declines.
- Supports a healthy heart and digestive function. Both constipation and increased cholesterol can be an issue in HD, so getting enough fibre is critical. Enjoy a wide variety of plant foods to get all the different types of fibre you need…but you must increase fibre slowly so as not to make things worse. And drink plenty of water to help the fibre do its job!
For this reason, I recommend a general anti-inflammatory diet like I write about in Eat More Plants Cookbook that is high in nutrient-dense whole plant foods which is a safe and healthy dietary pattern that you can maintain for life.
What this looks like in practice:
- eat mostly whole plant foods like fruits, vegetables, whole grains, legumes, nuts and seeds
- consider the plate method: ½ your plate fruits and vegetables, ¼ plate whole grains or starchy vegetables and ¼ plate protein
- know that your pattern of how you eat is more powerful than never having a (lactose free) ice cream again
Every body is different – there is no one right way to eat. Focusing on dietary pattern is powerful because it leaves room for life! For the foods you enjoy, for cultural and ethical considerations and for acknowledging which foods make you feel your best…and which ones don’t. Working one-on-one with a dietitian can help you achieve this balance and discover the best dietary pattern for YOU.