Hashimoto disease diet: Dos and don’ts

Hashimoto thyroiditis, also known as Hashimoto disease, is an autoimmune condition.

Autoimmunity refers to a process where your immune system attacks your body’s tissues or organs as it mistakenly perceives them as threats. In Hashimoto disease, the immune system mainly targets and damages the thyroid gland, located at the front of your neck, leading to chronic inflammation and eventual tissue damage. 

A common effect of Hashimoto disease is an underactive thyroid (hypothyroidism) that doesn’t produce enough thyroid hormones to sustain body functions.

Untreated Hashimoto may result in signs and symptoms such as:

• slow heart rate
• constipation
• fatigue
• weight gain
• high cholesterol
• high blood pressure
• pain in joints and muscles
• dry skin and thinning hair
• fertility challenges

While Hashimoto disease may cause hypothyroidism, the two terms are not interchangeable. Hypothyroidism can have other causes and isn’t always associated with the autoimmune condition.

There’s currently no cure for Hashimoto. However, medical intervention and lifestyle changes may help you manage symptoms. For example, certain dietary choices may make a difference.

Dietary recommendations for Hashimoto

What you eat may affect how you feel when living with Hashimoto.

Before incorporating new foods or excluding others in your eating pattern, consulting a healthcare professional, like a doctor or registered dietitian, is highly advised. They may order tests before altering your eating plan to assess whether you have nutritional deficiencies or whether you may benefit from a specific eating plan.

Foods to add for Hashimoto

Research does not indicate people with Hashimoto need to follow a specific diet. Still, a nutritious eating plan paired with regular physical activity seems to benefit some people with the condition. 

Information gathered from a 2022 literature review, a 2020 review article, and a 2022 scientific article suggests that the following foods may help you manage Hashimoto.

However, it’s important to note that evidence is still not conclusive on any potential links between diet and this condition. Individual factors may account for potential benefits.

• Omega-3 fatty acid foods: These polyunsaturated fatty acids (PUFAs) may reduce chronic inflammation. Great food sources of omega-3s are fatty fish like salmon, mackerel, and trout. 
• High fiber foods: Fiber works as a prebiotic, meaning it feeds your gut microbiota. A high fiber diet may reduce constipation and high cholesterol, medical issues that may occur with Hashimoto. Good fiber sources include oats, legumes, nuts, seeds, fruits, vegetables, and whole grains.
• Phytochemical foods: Phytochemicals are natural plant compounds, such as polyphenols and flavonoids. They can neutralize free radicals, which are molecules that can damage your cells and cause inflammation. These compounds are found in plant foods like fruits, vegetables, legumes, nuts, and whole grains. 
• Lean proteins: Eating lean proteins can help you feel full without consuming too many calories. Consuming more calories than your body needs can lead to unintended weight gain. Plus, some animal studies suggest that protein intake and thyroid function might be linked, though research involving humans is needed. Lean protein sources include fish, chicken breast, and legumes. 

Ultimately, more research is needed to learn more about which, if any, foods can help improve not just your overall health but Hashimoto symptoms specifically.

Foods to avoid

Evidence is also unclear on how avoiding certain foods might affect Hashimoto symptoms.

The list below outlines some current suggestions based on anecdotal information and preliminary research. Before potentially excluding any food from your diet, it’s best to consult a healthcare professional to learn whether it is suitable for you to do so.

• Gluten: You may be more likely to develop Hashimoto if you have celiac disease. If this is your situation, or you have an allergy or sensitivity to gluten, a gluten-free diet may help. However, the 2022 review article referenced above notes that people with Hashimoto but who do not have gluten allergies or intolerances may not note much difference when avoiding gluten. If you’re unsure, you can consult your healthcare professional to explore whether going gluten-free is worth a try for you. 
• Lactose: The 2022 review mentioned earlier notes that around 3 in 4 people with Hashimoto also have lactose intolerance. If you cannot tolerate lactose, or are not sure you do, avoiding all dairy foods like milk, cheese, and yogurt may be a good idea. If you are not sure, you can talk with your healthcare professional to learn more about when a lactose-free diet is suitable. 
• Uncooked goitrogens: According to a 2016 intervention study, goitrogens can interfere negatively with thyroid function, potentially worsening some symptoms of Hashimoto. Goitrogens are compounds found in raw cruciferous vegetables like cabbage, turnip, and radish. Cooking these vegetables significantly reduces the goitrogenic effects.
• Certain minerals: A 2023 article notes that the minerals calcium and magnesium may reduce the absorption of thyroid medications. If you are taking thyroid hormones, you may need to limit or avoid mineral supplements and foods high in these minerals, like dairy products, around the time you take the medications. Spacing them out for at least 4 hours may be indicated. It’s highly encouraged to talk with your healthcare professional to determine the medication schedule that works best for your situation.
• Iodine: This is another mineral to be cautious with if you have Hashimoto. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains that too much iodine can alter your thyroid hormone levels. So it’s important to talk with a healthcare professional before taking iodine supplements, iodine-containing medications, or eating iodine-rich foods like seaweed.
• Coffee: A 2017 review found that coffee may reduce the absorption of thyroid medications, so it may be best to limit or avoid it.
• Processed foods: As described by the 2022 review referenced earlier, ultra-processed foods like soda, chips, baked goods, and fried foods may promote inflammation. However, it’s not clear if this directly affects Hashimoto symptoms. Regardless, these foods are often high in calories. Consuming more calories than your body needs can contribute to unwanted weight gain.

Is there a specific diet for Hashimoto?

Because individual responses to foods vary, there isn’t a one-size-fits-all eating plan for Hashimoto. 

One 2023 review suggests that the Mediterranean Diet may benefit those with thyroid disorders. For instance, it may protect against thyroid autoimmunity, improve thyroid function, and reduce inflammation. However, the researchers emphasize that more studies are needed on the topic. 

The Mediterranean Diet prioritizes vegetables, unsaturated fats, fish, and dairy foods while minimizing meat and highly processed foods. 

Research is also promising for the Autoimmune Protocol Diet (APD). For example, a small 2019 intervention study found that it improved symptoms in most participants.

The APD involves eliminating certain foods that may cause inflammation and then gradually reintroducing them once symptoms improve. This can help identify individual trigger foods. For instance, the APD can help you learn whether following a gluten-free diet is helpful. 

Supplements for Hashimoto

Some individuals with Hashimoto may benefit from supplementation. 

The 2022 literature review, 2020 review article, and 2022 scientific article referenced earlier suggest that the supplements listed below can help some people with Hashimoto. However, research is not strong in this area, and more studies are needed to learn more about supplements and thyroid health. 

• selenium
• iodine
• magnesium
• zinc
• copper
• vitamin D
• omega-3 fatty acids

You can discuss these options with a healthcare professional before taking them. During your visit, they may order tests to check whether you have any nutrient deficiencies.

Further, as explained earlier, too much iodine may negatively affect thyroid function in some people, so it’s important that you do not take this supplement without first receiving approval from your healthcare professional.

Treatment for Hashimoto

Levothyroxine is the first-line treatment for clinical Hashimoto.

Levothyroxine is a synthetic version of the natural thyroid hormone thyroxine (T4).

Branded levothyroxine medications include:

• Synthroid
• Levoxyl
• Ermeza
• Tirosint
• Euthyrox
• Unithroid

If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Follow the links on drug names for savings on that medication, or search for a specific drug here.

Summary

Which foods to eat and avoid with Hashimoto disease may depend on the individual.

For instance, some people may need to avoid gluten and lactose, while others will not reap any benefits from doing so. If you’re unsure, you may try avoiding these foods for a few months and assessing if your symptoms improve. 

While research is still not clear on the link between diet and Hashimoto, overall health may improve when reducing highly processed foods and increasing nutritious whole foods. For example, prioritizing whole grains, fish, vegetables, nuts, and seeds is beneficial in promoting positive health outcomes.

It’s most beneficial to work with healthcare professionals specializing in treating Hashimoto. They are best qualified to provide tailored recommendations. They may also advise you on whether you need to take supplements or medications. 

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