What Diet Should People With Hyperthyroidism & Graves’ Disease Follow?

Although I commonly recommend an autoimmune paleo diet to my patients with hyperthyroidism or Graves’ Disease, not everyone will need to follow the same exact diet.  For example, while someone with Graves’ Disease can usually benefit from following an autoimmune paleo diet, if someone has a condition such as toxic multinodular goiter or subacute thyroiditis without an autoimmune component, then their diet usually doesn’t need to be as strict.  Regardless of what type of hyperthyroid condition you have, hopefully after reading this blog post you will have a better understanding when it comes to the foods you should eat, and which foods you should avoid.

You’ll notice that below I list each category of food (i.e. vegetables, fruits, meats, etc.), and I not only tell you which foods should be eaten in most cases, which foods should be eaten with caution, and which foods should be completely avoided, but I will also explain the reasoning behind my recommendations.

Vegetables.  I look at many food diaries of my patients, and most people don’t eat enough vegetables.  Probably the average person I work with eats two to three servings of vegetables, and I would recommend to at least twice this amount.  It’s also important to eat a wide variety of vegetables.  This includes vegetables such as artichoke, asparagus, broccoli, carrots, celery, kale, lettuce, onions, spinach, squash, sweet potatoes, and zucchini.  Try to eat organic vegetables if possible, although if this isn’t possible then visit the website for the Environmental Working Group and get the Dirty Dozen and Clean Fifteen lists, and make sure to avoid those vegetables (and fruits) which are on the Dirty Dozen list.  If someone has Graves’ Disease and is trying to follow a strict autoimmune paleo diet then they will want to avoid the nightshades, as these include compounds which can have a negative effect on gut health.  And so you might need to avoid tomatoes, eggplant, peppers, and white potatoes.  For more information on this I would read my article entitled “Nightshades and Thyroid Health“.

Every now and then someone with a hyperthyroid condition will ask me if they should eat a larger amount of raw cruciferous vegetables in an attempt to decrease thyroid hormone production.  In most cases, eating a few servings of raw cruciferous vegetables won’t lower thyroid hormone levels.  In some people eating a large amount of raw broccoli, kale, or other cruciferous vegetables might help, although even if it does help this of course isn’t doing anything to address the cause of the problem.

Sea Vegetables.  There is a lot of controversy when it comes to iodine and thyroid health.  Most endocrinologists will recommend for patients with hyperthyroidism and Graves’ Disease to avoid iodine since it’s involved in the formation of thyroid hormone.  However, iodine usually does not lead to an increase in thyroid hormone levels unless large doses are taken, and many people with Graves’ Disease are able to eat some sea vegetables, which are iodine-rich.  On the other hand, some people with hyperthyroidism and Graves’ Disease don’t do well with any iodine, and of course if this is the case then I would avoid these foods while trying to restore one’s health back to normal.

Fruit.  Although I try to eat at least five or six servings of vegetables per day, I’ve always enjoyed eating fruit more than vegetables.  And this describes a lot of people, as I commonly see people eating more fruit than vegetables, although ideally you want to eat at least twice as many vegetables than fruit.  With that being said it’s fine for most people to have a few servings of fruits which have a low glycemic index, although if someone doesn’t have blood sugar imbalances then it might be fine to have some fruits with a higher glycemic index occasionally, such as watermelon and cantaloupe.  But for the most part you want to focus on eating fruits such as apples, avocados, berries (blueberries, blackberries, raspberries, strawberries), cherries, grapes, peaches, pears, etc.  However, if someone has a yeast or bacterial overgrowth then they might need to avoid some of these fruits as well.  And just as is the case with vegetables, make sure you avoid those foods which are on the Dirty Dozen list, and try to stick with fruits on the Clean Fifteen list.

Dairy products and eggs.  I receive a lot of questions about dairy, and although dairy products have some health benefits, many people are sensitive to the proteins of dairy.  As a result, I usually recommend for my patients to avoid dairy products while trying to restore their health back to normal.  Some will ask if it’s okay to eat raw dairy products, or dairy from a sheep or a goat.  The truth is, some people do fine on these other types of dairy, but if someone is sensitive to casein then they still might react to raw milk, or milk from a goat or sheep.  Keep in mind that I’m not suggesting that everyone will need to avoid dairy on a permanent basis, and for more information I would read a blog post I wrote entitled “”Should People With Graves’ Disease and Hashimoto’s Thyroiditis Avoid Dairy?“.

How about eggs?  Although eggs are allowed on a standard paleo diet, if you choose to follow an autoimmune paleo diet then eggs are excluded.  And there are a couple of reasons for this.  First of all, egg allergies are common.  But another reason is because egg whites have compounds which can cause or contribute to a leaky gut.  With that being said, eggs are very nutrient dense, and so I usually recommend for my patients to avoid eggs for at least one month, and after this time if they feel the need to reintroduce other foods I will tell them to reintroduce egg yolks and see how they do.

Fermented foods.  These have numerous health benefits, and as a result, most people with hyperthyroidism and Graves’ Disease can consume fermented foods.  If avoiding dairy then of course I wouldn’t consume fermented dairy such as yogurt or kefir, although non-dairy fermented foods such as kimchi, kombucha, sauerkraut, and unsweetened coconut yogurt are usually fine.  However, there are some people who don’t tolerate fermented foods well, including most people with small intestinal bacterial overgrowth (SIBO), and if someone has a severe yeast infection then they also might not do well with fermented foods.

Coconut products.  This includes coconut butter, coconut milk, coconut oil, coconut flakes, and unsweetened coconut yogurt.  Although some sources claim that coconut can increase metabolism, and thus benefit people with hypothyroid conditions, I haven’t come across anyone with hyperthyroidism or Graves’ Disease who experienced an increase in hyperthyroid symptoms due to consuming coconut products.  However, some people with small intestinal bacterial overgrowth are unable to tolerate coconut products, although this doesn’t describe everyone with this condition.

Meat.  If you’re a strict vegetarian or vegan then of course you can skip this section.  One of the biggest problems with hyperthyroid conditions is that in many people it leads to extreme weight loss, and thus eating nutrient dense foods is important.  Although vegetables and fruits are nutrient dense, meat is one of the most nutrient dense foods. And so feel free to eat beef, chicken, turkey, lamb, pork, and other types of meats.  And if you like organ meats then you can eat this as well, as they are even more nutrient dense than “regular” meat.   Of course  one does need to pay attention to the quality of the meat, and try to eat organic whenever possible.  This will help to minimize the toxins you consume, and ideally you also want to choose grass-fed/pasture-raised meat.

Seafood.  Although fish is nutrient dense and is an excellent source of omega 3 fatty acids, due to the mercury and other toxins I usually recommend to minimize one’s consumption of fish to two to three times per week.  Others argue that it depends on what type of fish you consume, as eating fish high in selenium might help to offset the negative effect of mercury and other toxins.  This remains controversial, and so while I’m not opposed to people eating fish a few times per week, I usually don’t recommend eating fish on a daily basis.  And although I’m focusing on fish, this applies to other types of seafood as well.  I talk more about this in an article I put together entitled “Seafood and Thyroid Health“.

Nuts and seeds.  I mentioned earlier how I like fruit, but I enjoy eating nuts and seeds even more.  While I like all types of nuts and seeds, cashews are without question my favorite.  And while nuts and seeds have a lot of nutrients and are part of a standard paleo diet, eating nuts and seeds aren’t allowed for those following an autoimmune paleo diet.  And the reason is because nuts and seeds have compounds such as lectins and phytic acid, which have a negative effect on gut health.  Although soaking nuts and seeds will make them easier to digest and reduce the antinutrient content, if someone has a leaky gut, or another type of digestive issue, it really is best to avoid the nuts and seeds.  To be honest, I’ve had some people with a leaky gut do fine when eating small amounts of nuts and seeds, but I’ve also had people who didn’t do well until they eliminated the nuts and seeds from their diet.

Gluten-Free Grains.  It’s challenging for many people to give up gluten, and for these people it’s obviously even more challenging to avoid grains altogether.  Although someone who is gluten sensitive might do fine eating some gluten-free grains such as brown rice, buckwheat, and the pseudograin quinoa, these can also affect the permeability of the gut.  In other words, even if someone doesn’t have a sensitivity to grains, these potentially can have a negative effect on gut health.

Legumes.  These also have compounds which can cause or contribute to a leaky gut.  As a result, they should be avoided for anyone who has a confirmed or suspected gut condition.  Some examples of legumes which should be avoided include black beans, lentils, peanuts, pinto beans, and soybeans.

Soy.  While fermented soy products which are not genetically modified might have some health benefits, soy also has compounds which can have a negative effect on gut health, and thus it really is a good idea to minimize one’s consumption of soy products.  While some people do fine eating a small amount of fermented soy, I would make sure not to eat any nonfermented or processed soy products such as soy milk, soy protein powder, soy chicken nuggets, soy ice cream, etc.  For most people, having a small amount of non-GMO soy lecithin isn’t an issue.

Natural Sweeteners.  This is yet another controversial area, as some sources recommend to avoid all sweeteners, even those that are natural.  Many people with hyperthyroidism and Graves’ Disease seem to do okay with small amounts of natural sweeteners such as honey, pure maple syrup, molasses, and stevia.  Some people do okay with small amounts of sugar alcohols, although they might have a negative effect on gut health, and are usually problematic if someone has a condition such as SIBO.  You should try to avoid other sweeteners such as agave, corn syrup, high fructose corn syrup, and sucrose.

Herbs and spices.  Many herbs and spices are fine to use, including garlic, cilantro, ginger, cinnamon, oregano leaves, and rosemary.  Sarah Ballantyne, who is author of the wonderful book The Paleo Approach, has done a lot of research in this area, and she has an article where she listed those herbs and spices which can be safely consumed in those with autoimmune conditions such as Graves’ Disease, and those herbs which should be avoided or used with caution.

Oils.  Coconut oil is usually the best option for cooking, although if someone is unable to tolerate coconut oil then they can instead use lard or duck fat.  I don’t recommend olive oil for cooking, although you can add olive oil to your smoothie, or use it as a salad dressing.  Organic flax oil is usually fine to consume as well.

Refined foods and sugars.  Just about everyone reading this knows that processed foods shouldn’t be consumed when trying to restore one’s health back to normal.  I’d be lying if I told you that I never eat any processed foods, but I still try to eat mostly whole foods, and when trying to restore one’s health you really do want to be strict.  It’s not uncommon to receive emails from my patients asking if it’s okay to cheat every now and then and have a slice of pizza, a piece of birthday cake, some ice cream, etc.  The truth is that some people who are trying to restore their health back to normal cheat every now and then and don’t experience any adverse effects, while others who stray from the diet don’t do well and suffer serious setbacks.  Since it’s impossible to know who will do fine when cheating and who will suffer consequences, I recommend for everyone to be strict and avoid the refined foods and sugars when trying to restore their health.

Reminder: There Is No Specific Hyperthyroid Diet That Fits Everyone

While it would be great if there was a single diet that fit everyone with hyperthyroidism and Graves’ Disease, the truth is that since everyone is different, it is common for people to follow slightly different diets.  For example, after initially avoiding eggs, one person might be able to successfully reintroduce eggs or egg yolks, while another person might need to avoid eggs completely.  Or if someone has a condition such as SIBO they might need to avoid eating fermented foods and certain fruits which are high in FODMAPS.  While many people with Graves’ Disease can benefit from following an autoimmune paleo diet, those with hyperthyroid conditions who don’t have autoantibodies can usually do fine following a standard paleo diet, which means they probably will do fine eating foods such as eggs, nuts, seeds, and the nightshade vegetables.

As I mentioned earlier, it’s common for people to ask if they can reintroduce foods that normally should be avoided.  And of course some of my patients don’t ask, as I’ll have some patients who simply eat foods they know they shouldn’t eat.  Remember that I’ve been through this as well, and so I know from self experience that it is challenging to eat a strict diet.  Just remember that certain foods are forbidden for a reason, and after you have restored your health you should be able to eat a wider variety of foods again.

So hopefully you now have a better understanding of the foods you can and can’t eat while trying to restore the health of your hyperthyroid condition.  Obviously the overall goal is to eat whole foods while avoiding the processed foods and sugars, but this doesn’t mean that all whole foods are allowed.  Certain whole foods can be problematic, which is why some people with Graves’ Disease will need to avoid them while restoring your health.  Also keep in mind that while eating well is essential to receive optimal benefits, other factors are also important such as doing a good job of managing stress, taking quality nutritional supplements, minimizing one’s exposure to toxins, etc.