The Best Hashimoto’s diet [How to Reduce your Antibodies and Autoimmunity with these 5 Diets]
Ever feel like all you get is conflicting information about diet around the internet?
I do too... which is why I'm writing this post.
Today I want to talk about which Hashimoto's diet is best for naturally reducing your antibodies, inflammatory levels and for overall just making you feel better.
If you didn't already know - diet is an absolute critical change you MUST make if you want to get your Hashimoto's under control. In fact, I would go as far as to say that it is probably the most important part of your treatment plan.
Having said that, there are some nuances to making dietary changes that are specific to those with Hashimoto's.
I'm going to be going over several diets and how they impact symptoms and antibody levels. The data we are going to use is from Dr. Isabella Wentz who collected information on 2,232 Hashimoto's patients.
Unfortunately, there just isn't a lot of research money being spent on Hashimoto's because for the most part Doctors consider it just another form of hypothyroidism.
But this data is very actionable and can help you immediately.
Let's dive right in:
What you will learn in this post:
- Why diet is critical to healing Hashimoto's
- Why diet alone isn't enough
- List of diets and how they each impact Hashimoto's and antibody levels
- The recommendation that I give to my patients about diet
- What to do if you have Adrenal problems or Blood sugar issues
Why Diet can't be ignored in Hashimoto's disease
As you should already be aware, Hashimoto's disease is an autoimmune disease. That means your body is literally attacking and killing itself.
The the case of Hashimoto's this attack occurs on the thyroid gland itself! If left untreated over long periods of time this will ultimately result in the destruction of your thyroid.
That means your thyroid won't be able to produce thyroid hormone anymore and you will be left with supplementing with thyroid hormone by mouth... indefinitely.
It doesn't sound pretty, but here's the deal:
You can reduce and even prevent the attack on your own thyroid by making some targeted changes.
Today we are going to specifically be talking about how diet impacts this inflammation and autoimmunity, but don't forget that by itself isn't enough to completely reverse this process. It takes a whole body, multifaceted approach.
You can recall this image that I use to treat Hashimoto's:
Proper diet is step 1 in this process, but there are 5 other critical steps as well.
Why Diet isn't enough to heal Hashimoto's
While diet is a critical component of reducing the inflammation in Hashimoto's, it isn't the end all be all treatment.
In order to heal Hashimoto's you must reduce inflammation.
That means you have to address ALL causes of inflammation including:
- Dietary allergies and antigens
- Gut imbalance (Dysbiosis, SIBO, Gut infections, Leaky gut)
- Physical, emotional and physiological stressors
- Chemical toxins and endocrine disruptors
- Nutrient deficiencies
- Lifestyle changes including improved sleep and exercise
Doing just one of these is a recipe for failure...
There is almost no question that your diet is increasing inflammation in your body, but it's certainly not the only culprit. And in order to reduce all inflammation, each area must be addressed.
Which diet is the best for reducing inflammation and autoimmunity?
Thankfully Dr. Wentz put together a list of data of over 2,200 patients with Hashimoto's and how changing their diet impacted their symptoms AND their antibody levels.
For the first time we have actionable information and data that can be shared with everyone:
This data compares people who went on various types of diets and how it made them feel in terms of their symptoms and what percentage of people had a reduction in antibodies as a result.
This data isn't perfect but it does provide some very helpful information for patients with Hashimoto's.
First: It helps us see that there really isn't a one size fits all diet for every patient with Hashimoto's. Many patients found relief with different diets.
Second: We can see that going gluten free is a HUGE benefit to many people. 88% of patients felt better with this diet and one third of them had a reduction in antibodies as a result.
Third: We can see that if one diet doesn't work for you that you shouldn't give up all dietary changes! You should certainly try another diet to see how you feel.
Let's go over each of these diets in more detail:
Food Sensitivity Diet (Elimination Diet)
What is it?
There are two ways to do this diet:
1. Blood testing for food sensitivities: Find specific foods that you are sensitive to using delayed IgG food sensitivity testing. Testing for IgG antibodies will find food *sensitivities* that you may be reacting to, but may not be allergic to. You can find more information in the video below:
2. Eliminate foods systematically: Instead of getting the Delayed IgG blood test (my preferred way to start for most patients) you can simply remove the major food groups that most people are sensitive to for 30-90 days.
After 30-90 days you can then begin to slowly reintroduce these food groups back into your body and determine how they make you feel. If you find that eggs make you feel sick, then you cut out that food group and move on to the next.
The most common food groups removed in this diet include: Gluten, Dairy, Soy, Sugar, Artificial Sweeteners, Corn, Peanuts, Eggs and Shellfish. There is no hard and fast rule for what foods to avoid first, but I find removing these food groups seems to help patients the most right off the bat.
Does it work?
According to the data using this diet (either ways noted above) 62% of people reported that they felt better, 4.2% said they felt worse, and 43% had a reduction in antibodies to the thyroid.
- Highest reduction in antibodies
- Moderate percentage of people felt better
- Can be cost effective if you do not get delayed IgG food allergy testing
- Highest percentage of people felt WORSE of this diet
- Testing can be expensive and at times innaccurate
- Requires a lot of time to reintroduce food groups
My Recommendation: This diet is a great place to start but don't be fooled into thinking you HAVE to get a delayed IgG sensitivity test.
It may be necessary for some people, but many patients can get started on this diet right away by just avoiding the major food groups listed above.
Autoimmune Paleo Diet (AIP)
What is it?
The autoimmune paleo diet is an extended version of the paleo diet but also excludes: Nuts, Seeds, Eggs, Legumes, and Nightshades.
You can see the list of the allowed foods below:
- Vegetables (Except Nighshades)
- Fruits (Limited to 15-20 grams of fructose per day)
- Coconut Products
- Fats: Olive oil, Coconut oil, Lard
- Fermented foods
- Bone Broth
- Grass Fed Meats, Poultry, and Seafood
- Non-seed herbal teas and green tea
- Vinegars (including Balsamic without added sugar)
- 1 tsp of Maple syrup and Honey used as sweeteners
- All fresh non-seed herbs
- Grass fed gelatin and Arrowroot starch
Does it work?
According to our data 75% of people felt better, 4% of people felt worse, and 43% had a reduction in antibodies while following the Auto Immune Paleo Diet.
- Moderate percentage of people felt better
- Includes gut healing foods like bone broths
- Good support community online
- High percentage of people felt WORSE on this diet
- Lots of restrictions initially, making compliance difficult
- Requires a lot of time to reintroduce food groups after phase 1
My recommendations: The AIP diet can be VERY helpful for some people, but may be too strict for the majority of patients right off the bat.
I tend to reserve my sickest patients with multiple autoimmune conditions and food allergies for this diet.
I will also move patients to this diet if they have failed on other less restrictive diets.
Gluten Free Diet
What is it?
If you don't already know about gluten here is a quick primer:
Gluten is a name that includes multiple proteins found in wheat, rye and barley. There are two varieties of problems that people can have with gluten:
1. Celiac's disease: People with this condition have an autoimmune response when introduced to the protein which results in damage to the intestines, inflammation and MANY other signs and symptoms. Patients with this condition typically have elevated blood levels of Gliadin, Transglutaminase-2 and Endomysium.
2. Non-celiac gluten sensitivity: People with this condition seem to be intolerant to gluten, meaning that it causes inflammation in their body but it's much more difficult to diagnose because traditional blood tests to gliadin, transglutaminase-2 and endomysium are negative. Gluten sensitive patients still get inflammation and autoimmunity, but symptoms vary by individual and these patients tend to go undiagnosed for a much longer period of time.
The gluten free diet serves to remove ALL sources of gluten including food and products that we don't necessarily eat but still go on our bodies (including toothpaste).
Does it work?
According to the data 88% of people felt better on this diet, 0.73% of people felt worse, and 33% of people had a reduction in antibodies.
- Highest percentage of people felt better
- Lots of free information and guides online
- Good support community online
- Can be difficult to remove ALL sources of gluten
- Lots of gluten free junk food available - easy to eat unhealthy gluten free diet
- Going gluten free isn't enough for most patients
My recommendations: If you have Hashimoto's you should absolutely try going gluten free! That means avoiding all sources of gluten diligently for at least 90 days before you reintroduce them. Don't fall into the trap in thinking that if you have negative blood tests that it will not benefit you.
Going gluten free will not be enough to reduce inflammation and autoimmunity, but it is the necessary first step!
What is it?
Another very popular diet, and for good reason!
In a nutshell: the paleo diet only allows you to eat foods that man would have evolved with. It removes foods that man has introduced that were not normal to our lifestyle as we evolved as a species.
Put into a simple graphic:
Paleo diets tend to be higher in healthy fats with moderate amounts of protein and generally fewer carbohydrates.
One of the dangers of going paleo is actually reducing your carbohydrates too much, because the most common sources of carbs are generally forbidden.
This isn't always a good thing - especially for those with Adrenal and thyroid problems.
Because of this many thyroid patients will adopt a modified type of paleo diet to include some starches as an extra source of carbs.
Does it work?
According to the data 81% of people felt better, 3.2% of people felt worse and 27% of people had a reduction in antibodies after adopting the paleo diet.
- Large percentage of people felt better on this diet
- Lots of free information and guides online to help beginners
- Good support community online
- May not include enough carbs for those with Adrenal problems
- Some people can have problems maintaining body weight due to lower amount of carbs
- May be too restrictive for certain individuals
My recommendations: The paleo diet has major benefits for not only treating autoimmune related issues but in helping people start down a road to a healthy lifestyle.
One of my favorite things about this diet is the online support community and how easy it is to get meaningful and high quality information for free.
This diet isn't perfect, but it's a great place to start for many people because it is anti-inflammatory and excludes gluten at baseline.
Low FODMAP's Diet
What is it?
What in the world are FODMAP's? I'm glad you asked...
It's an acronym that stands for: Fermentable Oligo-Di-Monosaccharides And Polyols.
It's really just a fancy name to describe a class of sugars and carbohydrates that are found in certain foods. FODMAP's can cause gastrointestinal issues like gas, bloating, cramping and irritable bowel like symptoms in certain groups of people.
Those who have SIBO, or candida overgrowth seem to particularly sensitive to FODMAP's and react poorly when eating them.
This diet removes these food groups by eliminating foods that are high in these types of carbohydrates:
- Fructose (Fruits, Honey, High fructose corn syrup)
- Lactose (Dairy products)
- Fructans (Wheat, Garlic, Onion, Inulin)
- Galactans (Beans, Lentils, Soybeans)
- Polyols (Sweetners like xylitol and Mannitol, along with stone fruits such as Avocado)
Does it work?
According to the data 39% of people felt better, 0% of people felt worse, and 27% of people had reduced antibodies while following this diet.
- Will also treat SIBO and Candida overgrowth
- Great Diet for those with IBS
- Zero patients felt worse on this diet
- Smallest reduction in antibodies out of all diets
- Doesn't necessarily exclude gluten
- Smallest number of patients felt better on this diet
My Recommendations: I typically only use the low FODMAP's diet if I know a patient has either SIBO or candida overgrowth or is dealing with irritable bowel like symptoms.
A quick and dirty way to test for SIBO is by eating a meal high in sugar - if you have a "food baby" or bloating in your upper stomach or start to experience lots of gas and cramps, there's a good chance you have an overgrowth of bacteria in your small intestines.
A more definitive test for SIBO would be with a Hydrogen breath test, which can be ordered by your Doctor.
If you didn't already notice there were a few diets that weren't mentioned above but were in the original data.
Namely: Soy free and Grain free.
I didn't elaborate on these diets because they are self explanatory and because for the most part they should be a component of other diets and I wouldn't recommend using them in isolation.
But, to complete the data let's go over them...
Soy Free Diet: 63% of people felt better, 1.2% of people felt worse and 35% had a reduction in antibodies while on this diet.
Grain Free Diet: 81% of people felt better, 0.74% of people felt worse and 28% had a reduction in antibodies on this diet.
Diets you should avoid or proceed with caution if you have Hashimoto's or Hypothyroidism
Having gone through diets that are beneficial to people with Hashimoto's we should also go over some diets that you should avoid if you have this condition.
Some of these diets should be avoided at all costs and others can be used but only if you are working with a skilled practitioner who understands your condition.
Let's dive in:
Low Fat Diets
Why you should avoid this diet:
I'm referring to the typical low fat diet that modern medicine and the conventional media recommends for weight loss and better health.
Despite these widespread recommendations and belief that a low fat diet is somehow healthy for your heart and waistline, none of these reported "facts" are supported by the literature.
Low fat diets (even diets low in saturated fat) have never been shown to be effective for weight loss or heart health but they are unfortunately pushed by almost every Doctor and Cardiologist you may see.
This is especially important for patients with Hashimoto's or Hypothyroidism because these patients commonly have problems with weight. They are often told to "eat less and exercise more" for weight loss.
Hashimoto's patients commonly have cholesterol problems as well (due to low thyroid function) and are commonly told to "eat less red meat". The problem is: these people don't have a cholesterol problem, they have a thyroid problem.
Unfortunately nowadays low fat has become synonymous with high sugar. Foods that have "low fat" or "non fat" on the label should be avoided at all costs.
Quick tip: Some people do better with lower amounts of fat and that's ok. But if you do better on low fat your diet should still consist mostly of fruits, vegetables - not sugar based products.
Very Low Carbohydrate Diet and Nutritional Ketosis
Why you should proceed with caution:
Very low carbohydrate diets are diets that typically have less than 10% of total calories as carbohydrates.
While it is true that many people stand to benefit from these diets - especially those looking for weight loss or those with metabolic diseases like diabetes, these diets aren't for everyone.
Very low carbohydrate diets (especially Nutritional Ketosis diets) can pose problems for people who have Adrenal related issues or difficulty with blood sugar regulation.
Because so many people with Hashimoto's have both problems I don't recommend jumping into these diets right away, until you have optimized your thyroid medication dosing and you have optimized your adrenal/cortisol function.
Any and All Low Calorie Diets
Why you should avoid these diets at all costs:
Despite the fact that calorie restricted diets don't work for weight loss! They can also be incredibly harmful to your thyroid function...
25 days of a calorie restricted diet is enough to reduce thyroid function and T4 to T3 conversion by up to 50%.
Whatever you do, do NOT use a calorie restricted diet if you have Hashimoto's. You will only make your thyroid function worse and it will ultimately lead to more weight gain.
Also avoid the mentality of counting calories - calories matter, but your hormones matter so much more.
Where should you start with your diet?
The next question you should have is: Where do I start?
And the answer is... It really depends on you.
Whatever you do, please don't take the following information as medical advice directed at you. I want to provide some very basic guidelines that I use when evaluating patients to determine which diet would benefit them the most.
There is a catch though:
There is no perfect way to determine who will do best on which diet, sometimes it boils down to trial and error.
Who should consider the food sensitivity diet?
- People who react with itching, swelling, hives, runny nose or post nasal drip after eating certain foods.
- People who also have a personal history of Asthma or eczema.
- People who have failed other more basic diets like Gluten free, soy free or grain free and are still symptomatic.
Who should consider the Autoimmune Paleo Diet?
- People who have multiple autoimmune conditions, multiple food sensitivities and multiple medical problems.
- People who have failed other less restrictive diets.
Who should consider the Gluten Free Diet?
- All patients with Hashimoto's (It's a great first start but usually not enough).
- People with a family history of Celiac's disease, autoimmune disease or Thyroid problems.
Who should consider the Paleo Diet?
- People who have tried going Gluten free but still have room for improvement in their symptoms.
- People with symptoms of a leaky gut (Acne, Depression, Anxiety, Fatigue, Eczema, Environmental/Seasonal Allergies, Post nasal drip, IBS/IBD, GERD, Chronic constipation)
Who should consider the Low FODMAP's Diet?
- People who have Hashimoto's and a have either been diagnosed with or have symptoms of SIBO and/or Yeast or Candida overgrowth.
- People who still have gas/bloating despite adopting a paleo or gluten free diet.
- People who have failed less restrictive diets.
Remember that every patient is different and you should be evaluated based on your personal symptoms.
No two people are exactly alike and that's why every person needs a personalized diet!
Finding your personal diet may take time and trial and error. There isn't a test that can look at your genes, what medical conditions and your personal preferences to magically determine what diet you will do best on.
It comes from trial and error and putting in the effort.
Special considerations for your personal diet
Each of the diets above need to be modified slightly in the setting of certain medical conditions.
I've highlighted some of the more common conditions and how you can consider altering your diet if you have one or more of these conditions...
Blood sugar issues (Pre diabetes, diabetes or metabolic syndrome)
Blood sugar issues are so common that nearly 50% of adults in the United States has either pre diabetes or diabetes.
And Hashimoto's patients are no different. In fact they are at increased risk for blood sugar problems.
How do you know if you have blood sugar problems?
You can have your doctor order the following tests: Hgb A1c, fasting blood sugar, fasting insulin levels. You can also personally check your own blood sugar with a glucometer after eating meals.
Healthy blood sugar levels when fasting are in the 70-80 range. A healthy Hgb A1c is less than 5.5 and fasting insulin levels should be < 5.
If you fall above this range you likely have blood sugar problems...
How does this affect your diet?
Well the traditional advice to fight high blood sugar is to exercise more and eat less. This is the WRONG answer for people with Hashimoto's. Well, it's bad advice in general but especially if you have Hashimoto's.
The best way to address blood sugar issues is by reducing unhealthy fattening carbohydrates and by incorporating high intensity exercise with intermittent fasting routines.
This can pose a problem with Hashimoto's patients because they commonly have Adrenal problems.
My recommendation for people with blood sugar problems:
- Optimize your thyroid medication if you are on it!
- Work out only if you have the energy, and until your dose is optimized I would recommend against high intensity training. Start out slowly with walking and build up as you tolerate it.
- Do not incorporate intermittent fasting until your adrenals have been addressed and your thyroid medication is optimized.
- Avoid calorie restricted diets, they will only make your thyroid worse.
- Eat at least 20% carbohydrates to start with.
- Avoid high sugar foods and opt instead of healthy sources of carbohydrates like vegetables and healthy starches.
Adrenal fatigue is incredibly common in Hashimoto's patients and it should not be ignored!
If you find yourself crashing in the afternoon or NEEDING caffeine to keep you going - then your adrenals are most likely suffering.
The fatigue from Hashimoto's is usually a crushing fatigue first thing in the morning, but as you get up and moving you may tend to have more energy. This energy you get after a few hours comes from your adrenals - and they only last so long.
This cycle is one of the reasons that many people with Hashimoto's also suffer from Adrenal fatigue.
There are a few tips you should know about how to make appropriate changes to your diet if you suspect you have this condition...
[This is my adrenal profile after Residency using DUTCH urine testing indicating early adrenal fatigue with elevated cortisol and cortisone levels]
My recommendations if you have diagnosed adrenal fatigue:
- Eat a moderate amount of carbohydrates in your diet, 15-30% of total calories are healthy carbs. Experiment with what works best for your body (start out at 20%).
- Don't be afraid to eat meals more frequently if you need to. You may need to eat every 2-3 hours in the beginning.
- Eat protein with every meal and have an especially high protein breakfast (at least 40 grams).
- Make sure to eat enough sodium (salt)! If you are having salt cravings you can put 1/2 to 1 teaspoon of salt in a tall glass of water and drink that in the morning. Make sure to add salt to your food as well.
- Avoid caffeine and alcohol! Caffeine puts excess strain on your adrenals every time you consume it.
Gut and digestive problems [SIBO, Candida, Irritable bowel syndrome, Inflammatory bowel disease, Leaky gut, Reflux/GERD]
Gut and digestive problems are also VERY common in Hashimoto's.
Unfortunately several things can go wrong when your thyroid is low...
Low thyroid hormone leads to slower peristalsis (the movement of your GI tract) leading to constipation and an increased risk for for reflux, bacterial overgrowth and yeast overgrowth.
Not only that but about 20% of T4 is converted to T3 in the GI tract itself! This means that any problems of the GI tract result in lower thyroid hormone which results in more GI issues... A vicious cycle.
It can be difficult to break the cycle and the first step starts with getting on the right kind of treatment protocol, but there are also some dietary special dietary considerations you should consider:
- Consider a low FODMAP's diet.
- Make sure to add fermented foods into your diet daily (Kimchi, Kefir, Beet kvass, Sauerkraut, etc.) - Go easy on fermented foods if you have SIBO.
- Add in probiotics in the form of Soil based organisms (My preferred probiotic is Prescript Assist). Lactose based probiotics may make some GI issues worse.
- Consider advanced stool testing for definitive diagnosis (It's hard to treat if you don't know what you're treating!).
- Consider adding 1-2 cups of Bone broth to your diet each day (helpful for repairing gut lining).
A Word About Goitrogens
What are goitrogens?
Goitrogens are compounds that limit your thyroid from taking up iodine and may lead to decreased thyroid function.
The standard point of view is to avoid these foods if you have thyroid problems.
So what's the big deal?
Foods high in Goitrogens include: Cruciferious vegetables (Bok choy, Broccoli, Brussel sprouts, Cabbage and Cauliflower), and some other foods - peaches, pine nuts, pears, soy milk, soy beans, etc.
Some people are so worried about thyroid function that they completely avoid these food groups!
The truth is that it would require a VERY large amount of these foods to have a meaningful impact on your thyroid gland. What's more is that the goitrogenic effect of these foods can be limited by how you prepare them.
Having said that I have some recommendations:
- Limit yourself to 6-8 servings of these foods per week and when preparing make sure to steam your produce (to remove goitrogenic compounds).
- Eat foods high in both selenium and Iodine, this includes foods like: [High Iodine] kelp, kombu, hijiki, arame, cod, dulse, iodized salt, wakame, shrimp, eggs, tuna, nori, prunes, banana. [High Selenium] Brazil nuts, tuna, halibut, sardines, ham, beef, turkey, chicken, egg, spinach.
I hope this gives you some direction in how to approach your diet with Hashimoto's.
Just remember that your diet is a highly individualized thing. It should be something you are constantly working on, tweaking just for your body.
One thing I would caution against:
Don't fall into the trap that if a certain diet worked for someone else that it will work for you.
Every single one of us is different - just like we all look different on the outside, on the inside we all have different needs.
And remember, if you have any questions or concerns about your health make sure to talk to a qualified and knowledgable functional medicine practitioner!
To finish, I'm curious to know - what kind of diet has worked for you? Which ones have you had success with in lowering your antibodies or just improving your symptoms?
Let me know in the comments below! :)
You can also read more about my practice style and how I treat patients here.