Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
Learn which diets help Hashimoto’s and Hypothyroidism
The best diet for an underactive thyroid (Hashimoto’s thyroiditis or hypothyroidism) is often one focused on improving gut health.
Tackling underlying autoimmunity and dysbiosis can help to normalize thyroid hormone levels.
An elimination diet based on a Paleo framework is the best place to start for most people.
If a Paleo diet doesn’t ease symptoms like fatigue, brain fog, and digestive issues, you could try moving onto a low FODMAP diet or even the AIP (autoimmune protocol) diet.
It’s important to have a nutritious diet with adequate amounts of selenium, iron, and vitamin D.
Probiotics can help to deal with gut and thyroid symptoms too.
When it comes to foods to eat and foods to avoid, there’s no one thyroid diet chart that suits everyone. Many thyroid issues such as Hashimoto’s thyroiditis and hypothyroidism stem from underlying gut and autoimmune issues that vary in intensity and symptoms from person to person.
While one person with hypothyroidism might be able to eat a wide variety of foods, others might struggle with many gut and dietary sensitivities.
In this article, we’ll look at the three main diets that can help to balance both an unhealthy gut and underactive thyroid, including symptoms such as:
We’ll also investigate key nutrients and supplements that should be part of any thyroid diet chart to help keep your thyroid gland healthy.
The Gut-Thyroid Connection
First, let’s briefly define Hashimoto’s disease and hypothyroidism, and determine why gut and thyroid health are so intricately related.
Hashimoto’s thyroiditis is an autoimmune condition in which the immune system starts to attack the thyroid gland. Registering elevated levels of thyroid peroxidase (TPO) antibodies is the usual indicator of this condition .
Hypothyroidism can sometimes develop from Hashimoto’s and is when your thyroid stops producing enough thyroid hormones needed for efficient metabolism. A high level of thyroid-stimulating hormone (TSH) usually indicates hypothyroidism.
Autoimmune thyroid conditions and poor gut health are often connected via the “gut-thyroid axis.”
When things go wrong with both gut and thyroid health, an unbalanced gut microbiota (dysbiosis) is often the common connection . Dysbiosis is known to cause or be connected with :
Inflammation, increased intestinal permeability, and altered immune responses (remember: Hashimoto’s thyroiditis is an autoimmune disease)
Altered activity of enzymes that impact thyroid hormone levels
Reduced absorption of minerals that are important to the thyroid, including iodine, selenium, zinc, and iron
Brain fog, depression and other cognitive issues that overlap with thyroid symptoms [4, 5]
Research also indicates that when gut problems are dealt with, thyroid health also improves, sometimes considerably.
One small study found a huge average drop in TPO (thyroid peroxidase antibodies (raised in Hashimoto’s patients) when over 2000 patients were treated for H. pylori gut infections . Treating H. pylori has also been shown to improve TSH levels [7, 8, 9].
Treating Blastocystis hominis (a gut pathogen) has been also shown to reduce inflammatory markers, thyroid antibodies, and TSH levels .
Similarly, identifying and removing food triggers is often very helpful for thyroid patients [10, 11]. This is what we see in the clinic week over week.
Your Thyroid Diet Chart: 3 Key Elimination Diets
Given that gut sensitivities are often tied to hypothyroid issues, an elimination diet, which removes problem foods, is one of the best ways to improve both sets of symptoms. An elimination diet involves taking the foods most likely to cause sensitivity out of your diet for a period of time (usually 2-3 weeks) before gradually reintroducing them to see how your symptoms respond.
An elimination diet plan can be modeled on any type of diet, but the best approach is to start with the lowest level of restriction, only increasing the number of foods you eliminate (or modifying the types of food you eliminate) if you don’t get the results you need.
The three elimination diets that we find people get best results with for gut and hypothyroid issues are the Paleo diet, low FODMAPs diet and autoimmune protocol (AIP) diet. Here’s a quick overview before we go into more detail.
Unprocessed, ancestrally focused. Removes or minimizes dairy, wheat, legumes, additives.
General good health, quelling inflammation and autoimmune issues; moderate gut sensitivities.
Eliminates a range of carbs that can create bacterial overgrowth in those sensitive to them.
Inflammatory and other reactive gut conditions such as IBS and IBD; thyroid and autoimmune conditions which have a lot of gut symptoms.
Similar to Paleo but eliminates a wider variety of foods including the nightshade group (e.g. tomatoes, potatoes, peppers).
More intractable Autoimmune and gut conditions; specifically where sensitivity to the nightshade family may be triggering symptoms.
1. The Paleo Diet
For most patients an elimination diet based on a Paleo framework is the best place to start.
The Paleo diet eliminates a number of inflammatory and potentially triggering foods (e.g. grains, dairy, legumes, processed foods), while not overly restricting carbs and still allowing you to eat quite a wide variety of other foods (vegetables, fruits, lean meats, fresh fish, healthy fats, nuts and seeds). As such, it makes a great starting thyroid diet chart for most people.
While there isn’t much research on following a Paleo diet for thyroid problems specifically, there are a few aspects of this diet that make it a logical and attractive option. For example:
Eliminating gluten can reduce the need for medication in some hypothyroid patients .
Restricting lactose (milk sugar) can help to lower TSH levels for those with lactose intolerance and Hashimoto’s .
If your symptoms improve with Paleo, that’s good news. You can now start to reintroduce the healthy foods you’ve eliminated one at a time to see how that affects your symptoms. The goal is to eat as broad and varied a diet as possible, while maintaining symptom relief.
If your symptoms improve only little, or not at all, as a next step you may want to consider the low FODMAP diet or at least incorporate a low FODMAP focus into your Paleo regimen.
2. The Low FODMAP Diet
The low FODMAP diet, often used successfully by patients with SIBO and/or IBS, can also help people with thyroid dysfunction. It can be a good option to try if the Paleo diet doesn’t seem to ease symptoms enough and particularly if your thyroid diagnosis is accompanied by a lot of troublesome gastrointestinal symptoms like bloating, constipation, or diarrhea.
While this diet hasn’t been studied extensively for its effects on thyroid health specifically, studies have shown that it can lead to improvements in fatigue, one of the most common and debilitating symptoms of thyroid disorders [12, 13].
On a low FODMAP diet, the aim is to starve overgrown or problematic bacteria – so you want to restrict the types of FODMAP carbohydrates that feed these. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, which are categories of starches and sugars that can be fermented by your gut bacteria.
Here’s an infographic to guide you through some of the most common high and low FODMAP foods. You can also check out a vegetarian version.
This is a stricter elimination diet than Paleo, but remember, you shouldn’t need to eat this way forever. Over time you will reintroduce foods and create a personalized thyroid diet chart of foods that exacerbate your symptoms, and those that don’t (bearing in mind this may evolve over time).
If you still haven’t reduced your gut and thyroid symptoms sufficiently with the Paleo or low FODMAP diet, the next dietary trial to consider would be the Autoimmune Paleo diet.
3. The Autoimmune Protocol Diet
The Autoimmune Protocol (AIP) diet, also called the Autoimmune Paleo diet, is a more restrictive option that may be helpful for some people. In addition to grains, dairy, processed foods, and other common dietary triggers, the AIP diet removes additional foods, namely nightshades (tomatoes, peppers, potatoes, etc.), eggs, nuts, and seeds.
These additional foods are restricted because they can in some cases be problematic for people with autoimmune illnesses like Hashimoto’s thyroiditis.
A 2019 study, co-authored by Dr. Robert Abbott from our clinic, looked to see whether the AIP diet would be effective as part of a lifestyle intervention protocol for patients with Hashimoto’s disease. They found that there was no change in antibody levels, but patients did feel better overall and there was some reduction in inflammation .
To read more about getting started with AIP, click here.
But remember because it’s more restrictive, we wouldn’t recommend starting out with AIP — give Paleo and/or low FODMAP a go first.
As with any other new diet, you should try the AIP for 2-3 weeks and see how you feel. If your symptoms improve, try gradually reintroducing the healthy foods you’ve eliminated to see what you can and can’t tolerate. Don’t feel locked in to any diet if your symptoms don’t improve.
Cut Back on Gluten and Dairy Products
In all of the above thyroid diet plans, dairy and gluten are key foods to eliminate at first. If you don’t make any other major changes to your diet these are definitely two to try cutting down on.
That’s because there is some fairly solid research that shows avoiding these can improve thyroid function and thyroid symptoms .
In one study, a diet without gluten reduced thyroid antibodies in women with Hashimoto’s thyroiditis .
In two other studies, lactose restriction and a gluten-free diet led to significant decreases in TSH levels for patients taking synthetic thyroid hormone [10, 11].
Though wheat and gluten sensitivities are common in all patients with thyroid conditions, they are by no means universal and you will have to do your own experimentation to see if you are affected by these intolerances or not. This is why an elimination diet where you remove foods and monitor your symptoms is so valuable. The bottom line is that you should only continue to eliminate foods if they are a specific problem for you.
Probiotics: An Essential Thyroid Supplement
Because of the close link between your gut health and your thyroid health, a probiotic supplement may be able to help a lot. This is more than just theoretical: there’s growing evidence that links taking probiotics with better clinical indications for people with Hashimoto’s or hypothyroidism.
A meta-analysis of 10 randomized, controlled clinical trials concluded that probiotics can improve depressive symptoms .
A 2020 clinical trial involving patients with hypothyroidism found that synbiotic supplementation (a combination of probiotics and prebiotics) reduced the need for the thyroid medication levothyroxine after 8 weeks . Synbiotic supplementation also led to improvements in fatigue.
Probiotics help to fight H. pylori and SIBO, which are associated with thyroid dysfunction [17, 18].
What we don’t have yet is enough information to tell us exactly which strains of probiotic work best. But experience with patients shows a triple therapy probiotic (lacto/bifido blend, Saccharomyces Boulardii, and soil probiotic) can bring great results.
Other Vital Nutrients for Thyroid Health
Thyroid diet charts can be overly focused on foods and nutrients not to eat. But there are also a handful of essential nutrients that play a vital role in thyroid hormone production and activation . We’ve laid these out in the table below:
Where to Get It
Needed for the formation of thyroid hormones (T3 and T4)
Needed for activation/inactivation of Thyroxine (T4) hormone. Also has helpful antioxidant/anti-inflammatory effects
Brazil nuts, meat, liver, fish, shellfish, spinach
Needed for the action of a key enzyme in thyroid hormone synthesis
Meat, animal offal (organ meats such as liver), nuts and seeds (e.g. pumpkin and chia seeds), cocoa and bitter chocolate, sardines, seafood, oysters
Helps balance thyroid levels. A deficiency is linked with increased antibody titers against thyroid antigens
Flax seeds, pumpkin seeds, millet and other whole grains, meat, buckwheat, oysters
Protective against autoimmune conditions
Oily fish, eggs and sunshine. A daily supplement is a more reliable way to get it
Helps reduce elevated thyroid antibodies and thyroid stimulating hormone (TSH). Inositol may work in part by improving the thyroid gland’s sensitivity to TSH
Citrus fruit, cantaloupe, bananas, raisins and fiber-rich foods. A quality myo-inositol supplement can be useful to lower TSH and TPO antibodies in hypothyroid patients [20, 21]
An unhealthy gut will have a harder time absorbing the above key thyroid nutrients, which is why a well-rounded, gut-focused plan is so vital.
Iodine: A Double Edged Sword
Though iodine is vital for the basic functioning of the thyroid gland and the manufacture of thyroid hormones, too much can be as bad as too little. For the most part it is therefore not a good idea to supplement with iodine.
In fact, multiple studies have shown iodine supplements may also actually increase the overall incidence of hypothyroid conditions, including goiter and autoimmunity [22, 23, 24].
Sometimes short term iodine restriction can benefit hypothyroid patients:
In one study, a third of hypothyroid patients returned to normal thyroid function after 21 days of iodine restriction 
In other research, 63% of patients decreased their high TSH values by iodine restriction 
In short, to optimize your thyroid function, food sources of iodine (or at most a low-dose iodine supplement) is probably the best way to go. And if you already have Hashimoto’s or hypothyroidism, check with your health practitioner before making big increases in your intake of iodine.
What About Goitrogens?
Certain food components — called goitrogens — are thought to block the absorption of dietary iodine and to increase the chance of an enlarged thyroid gland (goiter), caused by the body struggling to make enough thyroid hormones.
Goitrogens are found in the highest amount in cruciferous vegetables, which includes kale, broccoli, brussels sprout, spinach, and cabbage. Soy foods also contain some goitrogens.
But before you consider banning tofu and healthy green veggies, it appears that normal, moderate consumption of goitrogens is considered safe, even if you have a thyroid condition .
You should only eliminate these foods if you notice symptomatic reactions to them.
Boiling or steaming foods also reduces goitrogens. So to minimize any potential problems it could be a good idea to serve cruciferous veggies cooked rather than raw.
Tying it All Together
In conclusion, there is no such thing as a “one-size-fits-all” thyroid diet chart. A nutrient-dense Paleo-style diet is a good starting place for many with impaired thyroid function and the underlying autoimmunity, inflammation, and gut dysbiosis that often comes along with it.
Backing this up with probiotics can increase your chance of a complete resolution of thyroid and gut symptoms, including fatigue, bloating, and brain fog.
That said, thyroid issues can sometimes be more complex. You can arrange an appointment with one of the highly qualified practitioners at the Ruscio Institute for Functional Healthcare to receive more personalized care.
The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.
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