The best diet for Hashimoto’s thyroiditis

Hashimoto’s disease is an autoimmune disorder specifically targeting and causing inflammation of the thyroid gland. Hashimoto’s thyroiditis is also called chronic autoimmune thyroiditis. Hashimoto’s is characterized by gradual thyroid failure, due to infiltration of white blood cells and autoimmune-mediated destruction of the thyroid gland. When enough of the normal thyroid gland is affected, the amount of thyroid hormone may be insufficient. If that sounds like hypothyroidism, it is. Hashimoto’s disease is the leading cause of hypothyroidism in the United States, affecting 10% of the population. But because of its autoimmune component, understanding and treating Hashimoto’s is more complicated than simply balancing your thyroid hormones. When your immune system sees your own thyroid as a threat, a multi-pronged treatment approach is best.

“Many patients with Hashimoto’s thyroid disease continue to have symptoms even after starting medications and [seeing] normalization of labs,” says physician and registered dietitian Amy Burkhart, MD, of The Celiac MD. “Because of this, research has begun to look at other factors that may influence symptoms and overall wellness in Hashimoto’s patients beyond medication.”

One of these factors may be diet. While a Hashimoto’s thyroiditis diet won’t cure your hypothyroidism, it can help decrease common side effects of hypothyroidism, like constipation, fatigue, and weight gain, when used in conjunction with medication. If you have Hashimoto’s disease and you’re wondering how to implement some smart changes to your diet, here’s everything you need to know about eating for your health with Hashimoto’s disease.

What is the best Hashimoto’s diet?

While there’s not one best diet for Hashimoto’s, a balanced diet focused on eating whole foods is good for people with Hashimoto’s disease. “Eating a diet rich in vegetables, healthy fats, and quality proteins is recommended for people with Hashimoto’s,” says registered dietitian Jeanette Kimszal of Thyroid Nutrition Educators. “Food that nourishes the immune system is important to have, eating a lot of processed foods high in sugar, unhealthy fat, and salt may trigger autoimmune issues.”

These diet rules hold true for people with hypothyroidism not caused by Hashimoto’s, as well as people with hyperthyroidism (although people who make an excess amount of thyroid hormone often need more calories in their diet than people who don’t make enough). 

Eating whole foods can be achieved with a Mediterranean diet (focusing on lean protein, whole grains, and fresh produce) or a DASH (Dietary Approaches to Stop Hypertension) diet, which is similar to the Mediterranean diet but emphasizes foods low in sodium and saturated fat.

Dietitians don’t recommend keto or paleo diets; it can be too difficult to get important nutrients on these diets, and they usually don’t provide lasting lifestyle changes needed to maintain a healthy thyroid.

There are several other Hashimoto’s diet plans, but Dr. Burkhart says most of them are lacking in evidence as far as their specific benefits for the disease. Still, she adds that “the standard American diet is ‘pro-inflammatory’ [and] any of the protocols that lower inflammation would be an improvement, [while also having] the added benefit of weight loss and lower BMI, which have been directly shown to help Hashimoto’s.” Here are some popular anti-inflammatory diets that may help people with Hashimoto’s.

Plant-based diet

Plant-based diets are similar to vegan diets, focusing on eating foods from plant sources, like fruits, vegetables, nuts, beans, and seeds. The difference is that these diets don’t need to be as strict as a vegan diet; you can eat meat, eggs, and dairy, but would emphasize or prioritize plant-based foods as much as possible.

“A plant-based diet has been shown to lower inflammation,” Dr. Burkhart says. “Because of this, we would assume that a plant-based or plant-forward diet would benefit Hashimoto’s, but there are no studies to date.”

Gluten-free diet

Dr. Burkhart and Kimszal both note that there is often some overlap between people with Hashimoto’s and people with celiac disease or non-celiac gluten sensitivity. Don’t assume that you need to maintain a gluten-free diet if you’ve been diagnosed with Hashimoto’s. However, Dr. Burkhart says it can be beneficial in some cases: “There are currently no studies that have addressed the gluten-free diet’s effect on Hashimoto’s in people with gluten sensitivity or no symptoms after eating gluten, [but] the gluten-free diet does appear to help patients with celiac disease who also have Hashimoto’s.” Consider getting tested for celiac if you have mouth sores, abdominal pain or bloating after eating

Autoimmune protocol diet (AIP)

This protocol is an elimination diet aimed at reducing inflammation, especially in the gut. The goal, says Dr. Burkhart, is to decrease symptoms, balance the thyroid, and decrease the need for medications. There are several foods eliminated in the first phase of the AIP diet, including dairy, gluten, grains, nuts, and seeds, legumes, nightshades, coffee, alcohol, and all added sugars, sweeteners, and additives like nitrates and preservatives.

Once you’ve eliminated these foods for 30 days, says Kimszal, the reintroduction phase begins: “This is when trigger foods are added back in, one at a time, about four days apart; once you find your trigger foods, you can move into the maintenance phase, when you continue to avoid foods that may be problematic.” Essentially, the AIP helps you identify triggers for your autoimmune disorder, reducing some of the inflammation caused by your Hashimoto’s. Kimszal recommends working with a registered dietitian to be sure you’re getting enough critical nutrients during the elimination phase and beyond. 

While the protocol may seem drastic (there are a lot of foods cut out during the elimination phase!), it may be worth trying the AIP diet for Hashimoto’s, especially if your symptoms are severe or you haven’t had luck with other diet protocols. Dr. Burkhart points to a 2019 study in Cureus looking at the effects of the AIP protocol in Hashimoto’s patients: the study showed improvement in quality of life and symptoms, lowered BMI, and improvements in inflammatory markers. However, she does point out that the study was short, included a small number of patients, and lacked explanation about some key factors included (there also was no effect on the actual lab values taken during the course of the study). 

7 foods for Hashimoto’s

Kimszal points out that compiling a list of foods to eat for Hashimoto’s is less about specific foods and more about emphasizing the right nutrients, proteins, and healthy fats. Some popular food choices from each category are listed here, but keep in mind that your individual dietary needs may be different.

“Some people will feel better if they don’t consume dairy, [while] others feel better if they don’t have nightshades,” Kimszal says. “It’s important to find a registered dietitian who can help you build a meal plan that works to combat inflammation and make you feel better.”

1. Chicken 

Most diets for thyroid disorders recommend eating lean protein, which means opting for chicken instead of beef or pork. Ideally, eat chicken breasts, rather than dark meat cuts like thighs or legs, since they are leaner, and choose grilled or broiled chicken over fried. As a bonus, it’s better for your cholesterol, too.

2. Fish 

Fish is a one-two punch for thyroid health: Not only is it a lean protein, it’s also high in omega-3s, which some studies suggest reduces inflammation. Omega-3s may even reduce the incidence of inflammatory disease when combined with vitamin D.

3. Non-starchy vegetables 

Starchy vegetables, like sweet potatoes, peas, corn, and white potatoes, are higher in sugar than their non-starchy counterparts. According to the American Thyroid Association, hypothyroidism can lead to increased blood sugar levels, so it’s wise to keep your dietary sugar low. Choose non-starchy vegetables when possible, swapping potatoes for carrots, asparagus, and salad greens instead.

4. Low-sugar fruits

This is the same principle as the non-starchy vegetables: some fruits, like grapes, cherries, and bananas, are naturally higher in sugar, and should be eaten in moderation compared to low-sugar fruits such as apples, berries, and coconut.

5. Complex carbohydrates

Whole grains take longer for your body to digest, keeping you fuller longer and helping you decrease overall caloric intake. They also contain less sugar than simple carbs, like white bread, white flour, and white rice. Incorporate carbs like oats, quinoa, barley, and wheat flour into your diet to satisfy your appetite and reduce sugar.

6. Extra virgin olive oil 

Use olive oil or any cooking oil high in monounsaturated or polyunsaturated fats, like avocado, almond, or even peanut oil. Per the Cleveland Clinic, these healthier fats are better for cooking than butter, canola oil, or vegetable oil—and healthy fats are an important part of your overall diet.

7. Seeds and nuts

Certain nuts and seeds are nutritional powerhouses in tiny packages. According to Harvard Health, chia seeds, flaxseeds, and hemp seeds are loaded with protein, fiber, and omega-3s fatty acids, while peanuts, pecans, almonds, and walnuts are chock full of protein, fiber, magnesium, and a handful of healthy vitamins.

5 foods to avoid with Hashimoto’s

The following aren’t necessarily the worst foods for Hashimoto’s but they can be potentially problematic for thyroid health. 

1. Iodine

Iodine is always on the “caution” list when it comes to the thyroid, but even Kimszal admits it’s a “tricky” nutrient you shouldn’t eliminate entirely. Instead, aim for the right balance (ask your healthcare provider or a dietician for help if you’re not sure what that looks like).

“The thyroid needs some iodine, [but] too much can be harmful and may even cause Hashimoto’s thyroiditis,” Kimszal explains. “If someone is feeling lousy, they should look at their iodine intake and levels.”

Iodine exists in higher amounts in some foods, like seaweed, liver, table salts, and shellfish, but can also be found in medications, face, hair, and skincare products.

2. Nightshades

Similar to iodine, there isn’t an official ruling on whether nightshades (eggplant, tomatoes, potatoes, and bell peppers) are bad for people with thyroid disease. Conventional wisdom says to avoid them because they contain a compound called glycoalkaloids, which may be harmful for some people with autoimmune diseases, but there isn’t a lot of research to back this up. Some people can handle nightshades just fine in moderation. 

3. Soy

Soy is known as a goitrogenic food, which is a food that can interfere with thyroid function. It may also prevent your body from fully absorbing your thyroid medication. Still, it’s often not necessary to avoid soy entirely; you might just want to limit the amount you consume in your diet, and avoid eating soy products around the time you take your medication.

RELATED: What are thyroid nodules?

4. Dairy

According to Kimszal, people with Hashimoto’s often decide to restrict or eliminate lactose products for a few reasons. Firstly, dairy may interact with thyroid medications because the calcium can inhibit absorption. Secondly, Hashimoto’s patients are more likely to be lactose intolerant, per a 2014 study published in Endocrine. Basically, if you feel better being dairy-free, there might be a good reason why.

5. Cruciferous vegetables

Cruciferous vegetables like kale, broccoli, and Brussels sprouts, are considered goitrogenic. In moderation, these vegetables are probably okay (and even beneficial) for people with Hashimoto’s but it could interfere with iodine levels.

Does fasting help Hashimoto’s?

Intermittent fasting is popular right now—the idea that withholding calories for a period of time, i.e., more than 12 hours, can kick your metabolism into overdrive and help you mobilize stored glucose is not only appealing, but has some science behind it, too. But does it work for people with Hashimoto’s disease and, more importantly, is it safe? Unfortunately, we don’t know.

“Intermittent fasting, which is increasingly popular, does influence thyroid function, but it is unclear at this time how it affects Hashimoto’s thyroiditis specifically,” Dr. Burkhart says. “Because it has been shown to lower inflammation, it may prove to be helpful in Hashimoto’s patients, but the research hasn’t been done yet.” 

Kimszal elaborates: “Research on intermittent fasting only revolves around healthy people and those with a subclinical underactive thyroid. These studies had positive outcomes, [but] it’s hard to say how intermittent fasting will affect people with Hashimoto’s [because it’s an autoimmune condition].” Because of the uncertainty, talk with an endocrinologist and registered dietitian before trying any fasting-based diet.

Can Hashimoto’s be reversed with diet?

Hashimoto’s is a chronic, autoimmune disease. When your body becomes hypothyroid, you will need to take thyroid supplementation for the rest of your life. Thyroid pills give your body back what it needs to function. Consider the thyroid gland like the gas pedal of your body, if you are hypothyroid your foot is “pedal to the metal” and you are only driving 5 mph. With the right treatment plan your thyroid hormone levels should be within the normal range and you should feel well and without symptoms.

Some people call this experience healing their thyroid or reversing Hashimoto’s, but Dr. Burkhart says these are largely anecdotal reports—no research has been done suggesting or proving that you can cure yourself of Hashimoto’s.

Your dietary choices can make a big difference in helping you to feel better. Focusing on anti-inflammatory foods while eliminating foods that exacerbate negative symptoms or interfere with your thyroid medication can help you manage your weight, move your thyroid levels back into the normal range, and generally help you feel more like yourself. 

One 2016 study, for example, found that when participants ate a low-carb diet that was also free of goitrogenic (i.e., thyroid-irritating) foods, they lost more weight and had lower thyroid antibody levels at the end of a three-week period.

In addition to eating a healthful diet, other therapies may help you feel better. Here are some ways people with Hashimoto’s can return their thyroid function to normal levels.

RELATED: What is thyroid stimulating hormone and what do your TSH levels mean?

Medications 

Medication is the only treatment for Hashimoto’s. Diet alone won’t improve your symptoms or your hormone levels. The most common brand-name medication used is Synthroid (levothyroxine). 

Most people can safely take Synthroid, but there are several food and drug interactions related to your body’s ability to absorb the full dose. Some formulations can be taken with food, while most need to be taken 30 to 60 minutes before a meal. The manufacturers of Synthroid recommend avoiding soy products, dietary fiber, walnuts, and grapefruit juice when taking the drug, and suggesting spacing out your dosing at least four hours from any iron or calcium supplements or antacids. You may also want to check with your provider about drinking coffee near the time you take your Synthroid dose, since some studies have shown it can also decrease the efficacy of the drug. It is most important to remain consistent with your thyroid medication dosing schedule. Your physician will check your thyroid levels and, as long as they are within the normal range, continue with your current diet and medication schedule.

Lifestyle changes 

In addition to managing your diet, reducing stress, maintaining your sleep, and getting regular exercise can also influence thyroid function. “Stress is known to affect autoimmune diseases negatively, including Hashimoto’s,” Dr. Burkhart says. “Regular exercise reduces stress, so regular exercise 30 minutes, five times per week is recommended for everyone.” 

If you’re not a runner or big into cardio, don’t sweat it. Dr. Burkhart also says that yoga is known to enhance thyroid function; as a bonus, low-impact activity like yoga can also have benefits on stress and sleep.

Supplements

Your thyroid relies on a lot of vitamins and nutrients to function properly, says Kimszal, including selenium, potassium, copper, magnesium, zinc, iron, omega-3s, and vitamins A, C, D, E, and B.

Before you buy a pharmacy’s worth of supplements, talk to your provider. You may not be deficient in all—or any—of these nutrients, in which case supplementing won’t benefit your thyroid health. “The best way to know if you need to supplement is by getting your levels tested,” Kimszal explains. “This can tell you if you need to take certain supplements.”