What is Hashimoto's thyroiditis?
Hashimoto's thyroiditis is an autoimmune condition characterized by inflammation and gradual deterioration of the thyroid gland. It leads to hypothyroidism, which can in turn make weight management difficult.
What I note in reading discussions of this disease is that medical treatment focuses on managing the effects and not the causes. As an inflammatory disease we may wish to investigate further causes of inflammation.
What are the causes?
Taking a little dip into medical literature, we see that some of the triggers for this condition could be the following:
- Genetic predisposition
- Pathogen exposure (various viruses and bacteria)
- Environmental exposure to "iodine, drugs, infection, smoking, and perhaps stress" [2]
Evidence for dietary impact
The paleo diet community has developed numerous anecdotes of management of Hashimoto's thyroiditis with "paleo"-style eating. I'll summarize how to do this at the end of this post below. For the moment let's look at some of the discussions that can be found online:
A note: while hunting for these online resources, I ran across a couple links of more dubious quality. Essentially, whenever I see blood type listed as a mechanism for determining anything, I think of it as a red flag for unreliable information. While blood type does provide information to the body about foreign cells and substances, leading to potential immune responses, it seems like a far cry to choose further behavior (like eating drastically different types of food) based on variations in blood type. I remain skeptical of any such approaches to food. Also, I found someone discussing why he doesn't recommend the paleo diet for Hashimoto's, and then he proceeds to discuss in a video all the reasons why managing digestive tract inflammation is important, which is ostensibly what can be accomplished with paleo eating.
So, what to make of the links above? Probably the takeaway is that further study is needed, but for those for whom treatment has hit a wall, experimenting with food intake may provide one mechanism by which you can take action to experiment with mitigating this condition.
Theory to practice
I dislike use of the word "diet" as a verb, because it has almost a punitive connotation, but I will still use it as a noun to refer to food intake. If you want to try changing your diet, think of it as a food experiment. You can go back to the way you were eating, but you can for the moment do an experiment to see if you can better manage conditions that are in your way. From the discussions above it appears that some people have had success with implementing paleo-type eating to manage Hashimoto's thyroiditis. It may be worth a try but this can be a fairly restrictive approach to diet. The idea is to limit or eliminate foods that tend to result in inflammatory immune responses. From my experience with these types of diets, you can get some useful information from experimenting with them, but then I tend to revert to the minimum level of compliance that I need to feel good. For instance, I found that if I have too much wheat I get itchy skin, occasional small water blisters on my skin, and a higher probability of excessive anxiety. So, I keep the wheat intake limited, but I still let myself have a little bit every now and then. From what I can see with managing Hashimoto's disease, there may be more of a need to be strict about managing different inflammatory foods. I would suggest following eliminating foods in the following order, and giving a few days to a week at least to see if you notice any effect. You may have to go through the whole list or go deeper in to the paleo "autoimmune protocols" that various people have put together. I used to listen to the Robb Wolf podcast and he spent a while talking about autoimmune protocols because of his own health issues.
Anyways, to step into this, I think about food adjustments of two types: inflammatory foods, and macronutrient balance and quantity. For inflammatory control, start by completely eliminating various types of food, and then slowly adding things back to see what you can tolerate. Here's the order I'd suggest to try, bearing in mind that you may need to eliminate all of these:
Anyways, to step into this, I think about food adjustments of two types: inflammatory foods, and macronutrient balance and quantity. For inflammatory control, start by completely eliminating various types of food, and then slowly adding things back to see what you can tolerate. Here's the order I'd suggest to try, bearing in mind that you may need to eliminate all of these:
- Wheat and wheat products, including beer
- Other grains and grain substitutes other than rice (also including quinoa)
- More irritating legumes such as peanuts, soy, other beans (like baked beans, not stringbeans or frozen peas)
- Unfermented dairy products (milk, mozzarella cheese)
- All grains and legumes, including buckwheat
- Sugar and refined polyunsaturated vegetable oils (canola, soy, corn, etc.)
- All dairy products
- Eggplant
- All nightshade plants (eggplant, peppers, tomatoes, potatoes)
- Nuts
- Other potential sources of allergic/immune reaction that you may suspect are issues. For instance pineapple, shrimp, or other specific foods, or foods with sulfites and other preservatives and artificial ingredients.
Paleo eating is quickly summarized as eliminating grains, legumes, and dairy, and eliminating consumption of processed foods. Focus on eating green vegetables, starch vegetables (sweet potatoes, carrots), and grass-fed or wild-caught meat.
In my case, I find that I don't need to make it past level 6 in the list above. What is most important for me to feel good is to avoid shrimp and crustaceans completely, minimize added chemicals like preservatives and food dyes, limit but not eliminate eggplant, and limit my wheat and legume intake, although I still have some of these regularly. When I have too much wheat, or too much peanut butter, I notice that I don't feel as great as I normally do.
With regards to macronutrient content, that is a separate story from the food choices above. Here, you need to think about the overall percent of calories you get from fat, protein, and carbohydrates. This is probably something for a detailed post some other time.
I found that it was helpful for me to increase my fruit consumption when I was stepping into paleo eating, but eventually I cut back my fruit consumption so that I could lower my overall sugar intake. Sometimes a switch to paleo eating can result in stepping into a ketogenic (extremely low carbohydrate) diet, but some of the discussions above regarding Hashimoto's recommend maintaining carbohydrates as a more significant portion of food intake. I find that it's difficult to stay on ketogenic diets in the long run due to social eating, and also I exercise enough and with enough intensity that taking in some carbs after exercising keeps my energy levels well maintained. But the first time I played around with low carb eating, after I made it past the sugar withdrawal in the first 3 days I was amazed at how wonderful it was not to get insanely hungry due to blood sugar crashing. That helped me lower my overall food intake, which helped reduce my weight.
If you want to add some exercise to this situation, consider doing so in a way that doesn't build additional inflammation:
(Keep most of your exercise to gentle activities like walking, but occasionally do short burst activities like half an hour of weights, 10 minutes of sprints, etc.)
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