Diet for Hashimoto's disease - menu for hypothyroidism. What to avoid?

The Hashimoto’s diet should resemble a healthy, balanced diet based on the Pyramid of Healthy Eating and Physical Activity (2016). Recommendations are as for the general population. It is best to eat 4-5 meals, preferably at regular intervals. However, it is worth knowing that foods may influence the course of treatment. Hashimoto – what to avoid and what to eat?

 

health :Hashimoto – what to avoid and what to eat?

Hashimoto – what to avoid and what to eat?

A healthy balanced diet provides essential nutrients. Including those needed for the proper functioning of the thyroid gland: iodine, iron and selenium. However, you should pay attention to goitrogenic substances found in some products. They may reduce the absorption of one of the thyroid hormones – levothyroxine and worsen the symptoms of hypothyroidism .

What is Hashimoto’s disease?

The development of chronic autoimmune lymphocytic thyroiditis is influenced by the coexistence of genetic predisposition and certain environmental factors. The direct cause is the production of autoantibodies against thyroid cells, which leads to their loss and hypothyroidism.

Autoimmune inflammation of this gland is mainly known as Hashimoto’s disease. Interestingly, the name of the disease comes not from the name of the endocrinologist, but from the Japanese surgeon Hakaru Hahimoto, who described this chronic disease in 1912. Based on the analysis of the removed thyroid glands, he observed that their parenchyma had become fibrotic and atrophied.

Symptoms of hypothyroidism are non-specific. It may be indicated by, among others, regularly felt fatigue, constipation, dry skin, sensitivity to cold, depression and weight gain, and in women, menstrual disorders. Consult your doctor if necessary. The disease may present with a characteristic enlargement of the thyroid gland (so-called goiter).

In the diagnosis of hypothyroidism, the starting point is the assessment of the concentration of TSH and  fT4 hormones in the blood. The basis of treatment is taking levorotatory thyroxine (L-T4). In most cases, this therapy alleviates the symptoms of the disease and improves the quality of life.

What we eat affects the absorption of the drug used to treat Hashimoto’s disease. The recommendation is to take L-T4 on an empty stomach, 30 minutes before breakfast, preferably with a small amount of water (e.g. half a glass). Products containing soy may reduce the absorption of levothyroxine in the small intestine.

  • Find out more about  Hashimoto’s tests.

Hashimoto’s disease and gluten

Strict adherence to a gluten-free diet is recommended in cases of diagnosed celiac disease , wheat allergy or non-celiac gluten sensitivity. In a patient with Hashimoto’s thyroiditis who does not co-occur with these diseases, a gluten-free diet is not necessary. Despite the fashion for its use, there is currently no evidence of the effect of this diet in supporting the treatment of chronic autoimmune thyroiditis without a coexisting gluten-dependent disease.

A gluten-free diet involves not only the elimination of gluten, but also other valuable ingredients provided by cereal products – i.e. fiber , protein, iron, zinc , magnesium , folic acid and other vitamins (e.g. B12).

Do you have Hashimoto's?  Check if you are allergic to gluten.Do you have Hashimoto’s? Check if you are allergic to gluten.

People with celiac disease are at increased risk of constipation due to lower fiber intake compared to people who eat meals containing gluten.

Introducing a gluten-free diet without the supervision of a doctor and dietitian, often with little variety, may lead to nutritional disorders. There have been reports that such a diet, compared to a normal, healthy diet, contains more sodium and saturated fatty acids, and is also characterized by a higher glycemic index of products. There is also work showing that it may contain more arsenic compared to a traditional healthy diet. Excessive arsenic consumption may increase the risk of heart disease, diabetes and cancer.

From the perspective of nutritional value, a person on a gluten-free diet must face a number of difficulties. Therefore, if there are no medical indications, it is not worth making your life difficult. The situation is different in people diagnosed with celiac disease or non-celiac gluten sensitivity, where a gluten-free diet (and in the case of wheat allergy – wheat elimination diet) is the lifelong treatment of choice.

Patients with Hashimoto’s disease are at risk of celiac disease – this means that these two diseases tend to co-occur. According to the 2019 guidelines of the UEG (United European Gastroenterology) society, in risk groups it is worth checking whether the patient does not have celiac disease. It is estimated that a large percentage of people still do not know that they have this disease. It is estimated that people with first-degree relatives with celiac disease have a 5-10% risk of developing the disease.

Complications of celiac disease include osteoporosis , depression and fertility disorders, but people with this disease also have a 2-4 times higher risk of developing small intestine lymphoma. To reduce the risk of complications of celiac disease, it is important to strictly follow a gluten-free diet. It should be started only after the doctor has carried out appropriate diagnostics and confirmed the presence of a gluten-dependent disease.

Diagnosis of celiac disease should ideally be made in a person who is on a regular diet containing gluten – that is, eating at least one meal containing gluten every day for at least 6 weeks. This is due to a simple relationship – the level of antibodies that are determined in the serological test for celiac disease increases in the blood as a result of the patient eating foods containing gluten.

Characteristics of selected gluten-dependent diseases
 Celiac diseaseWheat allergyNon-celiac gluten sensitivity
DefinitionA chronic autoimmune disease occurring in people with a genetic predisposition, characterized by inflammation of the small intestine. Its symptoms are closely related to an inappropriate immune reaction to the presence of gluten in the diet.Abnormal immune response to various wheat proteins.People who, despite the exclusion of celiac disease, experience symptoms in the digestive tract or other systems. Symptoms of the disease appear after consuming gluten and disappear after its elimination from the diet.
SymptomsFor example: abdominal pain, diarrhea, unintentional weight loss, less often anemia, depression; Symptoms may resemble irritable bowel syndrome, but they may also be asymptomatic.For example: abdominal cramps, nausea, vomiting, but also possible contact urticaria, contact dermatitis, angioedema, allergic conjunctivitis, allergic rhinitis, asthma (so-called asthma), eczema, anaphylaxis.For example: abdominal pain, flatulence, changes in bowel habits (diarrhea or constipation), anorexia, headache, fatigue, pain in muscles, joints, legs, skin lesions, anemia. Symptoms may resemble irritable bowel syndrome, celiac disease or wheat allergy.
Diagnosticsanti-tTG or anti-EMA antibodies in the IgA class together with the concentration of total IgAin case of IgA deficiency, anti-tTG or EMA IgG testsparents of children with positive serological tests should consult a pediatric gastroenterologist or pediatricianin adults, unlike children, small intestinal biopsy with histopathological evaluation is always mandatory if serological tests are positiveinterviewIgE blood serum tests or prick-by-prick skin prick testscomponent (molecular) diagnosticsoral challenge testexclusion of celiac disease and wheat allergy, then attempt to eliminate gluten and challenge

The effect of iodine on Hashimoto’s disease

Iodine is an element necessary for the synthesis of thyroid hormones. However, its high consumption is associated with a higher risk of developing Hashimoto’s disease, but may also cause the progression of existing problems. Large doses of iodine, which may come from medications (e.g. amiodarone), foods rich in iodine and radiation, may exacerbate both hypothyroidism and hyperthyroidism.

The American Thyroid Association does not recommend iodine supplementation because not only is it not beneficial, it may be harmful. It increases the risk of excess hormones of this gland. A healthy thyroid could cope with excess iodine, but if the function of the cells of this organ is disturbed, this situation is toxic for them and may worsen the symptoms of the disease.

You should not consume too much iodine.  Be careful with foods with salt.You should not consume too much iodine. Be careful with foods with salt.

Daily dose of iodine

The recommended dose of iodine consumed in people with thyroiditis is the same as in the general population (for a given age group). We should avoid large amounts of iodine – so products containing a lot of it should be consumed in moderation. According to standards, the recommended iodine intake in healthy adults is 150 µg/d – at the AI ​​(adequate intake) level.

This demand increases in women during pregnancy (up to 220 µg/d) and lactation (up to 290 µg/d) – in this group, it is recommended to supplement with potassium iodide preparations at a dose of 150 µg/day and meet the rest of the requirement by consuming table or iodized salt. water.

Examples of foods that are a source of iodine
table salt (iodized)*, fish (e.g. cod, mackerel), seaweed, seafood, cow’s milk and dairy products (e.g. yellow cheese), some bottled waters, sardines, tuna, hazelnuts

*Sea salt contains small amounts of iodine

The American Thyroid Association does not recommend the use of supplements and other products, including herbs, whose producers advertise them as products supporting the treatment of hypothyroidism (due to the lack of strong evidence confirming their effectiveness). The exception are products whose effectiveness has been proven in reliable clinical trials.

Hashimoto’s disease and selenium

Selenium is one of those microelements that both too little and too much supply is unfavorable. Therefore, scientists recommend caution and consider the expected benefits and possible risks.

Based on available scientific evidence, elemental supplementation is not recommended in the treatment of thyroiditis. The beneficial impact of such a strategy has not yet been demonstrated. Moreover, more and more data suggests that its too high concentration obtained through supplementation may be associated with unfavorable effects – including an increased risk of certain diseases, e.g. prostate cancer in men .

Due to the role of selenium and selenium-containing enzymes in the functioning of the thyroid gland, it is worth paying attention to food sources of this element and ensuring its appropriate content in the diet. The daily intake of a person with Hashimoto’s disease should be the same as that of a healthy person.

Selenium is found, among others, in:  in Brazil nuts.Selenium is found, among others, in: in Brazil nuts.

Daily dose of selenium

According to the standards, the daily intake of selenium in the population of healthy adults should be 55 µg/d – at the RDA (Recommended Dietary Allowance) level – the recommended daily intake. It is higher in women during pregnancy (up to 60 µg/d) and lactation (up to 70 µg/d). It may be particularly practical to reach for Brazil nuts – just 1-2 nuts allow you to meet the daily requirement for the element, and at the same time provide fiber, magnesium, potassium and beneficial unsaturated fatty acids.

Examples of foods that are a source of selenium
Brazil nuts, offal, meat, breakfast cereals, seafood, fish

In the case of both iodine and selenium, the content of these elements in cultivated food depends not only on the plant species, but also on the content of these elements in the soil.

The effect of iron on Hashimoto’s disease

Many symptoms of the disease resemble iron deficiency anemia – e.g. weakness, poor concentration, headache and dizziness, pale skin and mucous membranes, and dry skin. Hence, these two diagnoses are sometimes confused.

Iron also affects thyroid function, so in addition to selenium and iodine, you should also ensure an adequate supply of this ingredient in your meals. Especially if, in addition to Hashimoto’s disease, there is autoimmune gastritis or celiac disease, which may reduce the degree of its absorption. Iron deficiency may impair thyroid function because one of its enzymes becomes active when bound to heme supplied by iron.

Iron occurs in food in two forms: heme iron (better absorbed) found only in animal foods and non-heme iron found in food of plant origin.

Examples of foods that are sources of iron
Products of animal origin: offal (mostly pork), beef, pork, lamb, turkey, scallops (St. James mussels), mutton, duck, chicken, rabbit.
Products of plant origin: spinach, almonds, cereals, dry legumes (e.g. lentils, chickpeas, beans, soybeans), seeds and nuts, dried apricots, dried plums, dried figs, chard, parsley, dill, sorrel, avocado .

Hashimoto – vitamin D

Recommendations for vitamin D supplementation are those for the general healthy population. Due to the unfavorable angle of incidence of sunlight in our latitude and the inability to meet the demand for this ingredient in nutrition, in Poland it is recommended for healthy people:

  • exposure to sunlight for at least 15 minutes a day between 10 a.m. and 3 p.m. (without sunscreen) in the months from May to September,
  • and vitamin D supplementation in a dose appropriate for age, body weight, health condition, complexion, lifestyle, including dietary habits in the remaining months, or throughout the year if exposure to solar radiation is insufficient (for healthy adults, the recommended dose is 800- 2000 IU/day, while in breastfeeding women and during lactation the recommended dose is 2000 IU/day).

Also find out what vitamin D contains and what the standards are. How to check its level?VITAMIN D3

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Soy and Hashimoto’s disease

A person with Hashimoto’s disease should pay attention to foods containing goitrogenic (goitrogenic) substances. They may exacerbate thyroid problems by reducing the absorption of levothyroxine and through competition with other thyroid hormones.

If you consume soy and the soy isoflavones it contains, increased doses of the drug may be necessary. The optimal strategy is to eat soy regularly and in moderation, already at the stage of determining the dose of the drug. Then the possible impact can be taken into account at an early stage.

It is not necessary to completely give up products containing goitrogenic substances – moderation is advisable. Ensuring an adequate supply of iodine seems to be crucial. When the availability of iodine in food is low, the effect of goitrogenic substances may be more pronounced than with its adequate content.

Examples of foods that are sources of goitrogenic substances (goitrogens)
dry legumes (e.g. peas, beans, lentils, chickpeas), cabbage, Brussels sprouts, cauliflower, broccoli, turnips, kale, cassava roots, tapioca, soy and products based on or with soy (e.g. tofu, tempeh, drink soy, soy sauce)

Hashimoto and other health problems

Many people complain about problems with weight control. Hypothyroidism may be associated with a slowdown in metabolic rate. It is important to follow a rational diet that provides the nutrients the body needs and maintain an appropriate level of physical activity. Tempting, but unfortunately often unbalanced low-energy diets, apart from the increased risk of the so-called yo-yo effect, may adversely affect the functioning of the thyroid gland.

A person with Hashimoto’s disease may struggle with excess body weight and/or high cholesterol levels , which may in turn increase the risk of developing other diseases, e.g. circulatory system.

Constipation may also be a persistent problem, e.g. when following a gluten-free diet in people with comorbid celiac disease. In case of each of the above-mentioned problems, it is worth consulting a doctor and a dietitian. Below are some suggestions for dietary and physical activity modifications that may help with these problems.

Hasimoto’s thyroiditis and health problems – dietary recommendations
Selected problemSample dietary guidelines
High cholesterolavoiding trans fatty acids in foodlimiting the consumption of saturated fatty acidsincreasing the consumption of products containing fiberadding products containing phytosterols to the menu (e.g. nuts, margarine enriched with sterols/stanols)weight controlengaging in regular physical activity
ConstipationGradually increasing your intake of foods containing fiber (e.g. vegetables, fruits, whole grains, seeds and nuts)increasing fluid intakeIt is important to try to defecate after each mealModifying the diet and other lifestyle elements are usually the starting point in the treatment of people with constipation.
Overweight and obesityWe encourage you to read articles on the diagnosis of overweight and obesity  and  the treatment of overweight and obesity 

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The presented medical information should not be treated as guidelines for medical treatment for each patient. The medical procedure, including the scope and frequency of diagnostic tests and/or therapeutic procedures, is decided individually by the doctor, in accordance with medical indications, which he determines after reviewing the patient’s condition. The doctor makes the decision in consultation with the patient. If the patient wants to perform tests that are not covered by medical indications, the patient has the option of having them performed for a fee.
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