Should Everyone With Graves’ Disease and Hashimoto’s Thyroiditis Follow an Autoimmune Paleo Diet?

Many people who have an autoimmune condition follow an autoimmune paleo diet.  This is similar to a “standard” paleo diet, with a few additional restrictions.  While a standard paleo diet allows the consumption of eggs, nuts and seeds, along with the nightshade vegetables, an autoimmune paleo diet excludes these foods.  So essentially the person is allowed to eat meat, fish, vegetables, fruits, certain coconut products, and some spices.  But is this the ideal diet for everyone with Graves’ Disease and Hashimoto’s Thyroiditis?

Before answering this question I’d first like to talk in greater detail about the similarities and differences between a “standard” paleo diet and an autoimmune paleo diet.  Here are the main foods which are allowed on a standard paleo diet:

• Meat (beef, pork, chicken, lamb, etc.) and fish
• Eggs
• Fruits
• Vegetables (including the nightshades)
• Nuts and seeds

Foods which are excluded in a “standard” paleo diet include all grains, legumes, and dairy products.  And of course anything refined should also be avoided.  A standard paleo diet is restrictive with regards to what foods you can eat, although keep in mind that it is nutrient dense, and the goal isn’t to restrict calories.  As a result, while some people do struggle initially to follow a paleo diet, after awhile many of these people do perfectly fine and wish they had followed this sooner.  Many people do better upon avoiding the grains, legumes, and dairy products.  However, when someone also needs to avoid eating eggs, nuts and seeds, along with the nightshade vegetables, this makes it even more challenging.  And of course it’s even more challenging for a strict vegetarian or vegan to follow an autoimmune paleo diet, as they won’t be consuming any meat or fish.

Why Is An Autoimmune Paleo Diet So Restrictive?

Why are so many foods excluded from an autoimmune paleo diet?   Well, there are a few different reasons.  An autoimmune paleo diet excludes foods people with autoimmune conditions are commonly sensitive to such as gluten, dairy, eggs, and corn.  These foods can cause inflammation and/or exacerbate an existing inflammatory condition.  Gluten can directly cause an increase in intestinal permeability (a leaky gut), which is a factor in many, if not all autoimmune conditions.  Other foods such as all grains, legumes, and the nightshade vegetables are restricted because they contain antinutrients which not only affect the absorption of nutrients, but like gluten, can also have a negative effect on the gut.  So it’s not just gluten which potentially can cause a leaky gut, but other foods can potentially cause this as well.  Essentially those foods which are excluded from an autoimmune paleo diet are those foods which can cause gut inflammation and/or an increase in intestinal permeability.

I must admit that I do like the autoimmune paleo diet, and I commonly recommend this to my patients with Graves’ Disease and Hashimoto’s Thyroiditis.  However, there are a few “flaws” with this type of diet:

1) Some people do fine eating one or more of the restricted foods. A good example of this is eggs.  There are many people who are able to eat eggs without a problem, especially egg yolks.  And eggs are an excellent source of nutrients.  With regards to dairy, although I recommend for people to avoid dairy while trying to restore their health, some people with autoimmune thyroid conditions do okay when consuming dairy products.  This is especially true with raw dairy products.  I’ve also had some people with Graves’ Disease and Hashimoto’s Thyroiditis eat small amounts of gluten free grains and still receive good results.  I’ve also had a few patients eat soaked nuts while following the protocol and do well.  The problem is that it’s difficult to predict who will do fine eating some of the restricted foods, which is why many healthcare professionals recommend for all of their patients with autoimmune thyroid conditions to avoid all of these foods.

2) It is possible to be sensitive to the “allowed” foods. Someone can be strictly following an autoimmune paleo diet and then find out that they are sensitive to another food they are eating which is permitted.  For example, they might have a sensitivity to chicken or beef, or even a vegetable or fruit they are eating on a frequent basis.  And while sometimes a person will experience negative symptoms upon eating these foods, other times there won’t be any overt symptoms.  This admittedly can be frustrating, as a person might be following a strict autoimmune paleo diet and might be feeling better from a symptomatic perspective.  But upon doing some retesting they notice their numbers aren’t improving.  For example, someone’s thyroid panel might worsen even though they are feeling better, and  while this doesn’t mean this is due to a food allergen, it is possible.  Perhaps a better example is someone who initially tests positive for an increase in intestinal permeability, and upon getting this retested a few months later the results show that their leaky gut has gotten worse.  Once again, this might not necessarily be attributed to a food sensitivity, although it very well might be.

3) Some people find the diet to be too restrictive. I find this to especially be true with those patients who have Graves’ Disease, although sometimes this will also be the case with those who have Hashimoto’s Thyroiditis.  The problem with Graves’ Disease is that the increased metabolism usually leads to weight loss, which can be extreme in some cases.  While some people with an autoimmune hyperthyroid condition will lose a small amount of weight (i.e. 5 to 10 pounds), others will lose 20 pounds or greater.  As an example, when I was dealing with Graves’ Disease I lost over 40 pounds.  Many people find it difficult to gain weight when dealing with Graves’ Disease, and sometimes this is true with Hashimoto’s Thyroiditis patients as well.

Of course everyone is different, and many of my patients with Graves’ Disease do fine when following an autoimmune paleo diet.  On the other hand, others struggle with the restrictive diet.  Although I try to encourage my patients to stick with the diet, if someone is about to break the diet due to the fear of losing even more weight, I’d much rather them eat some “forbidden” yet healthy foods (i.e. eggs, nuts, seeds, tomatoes, etc.) than completely ruin their diet by eating junk food.  And so there are times when I’m fine with people reintroducing one or more of the excluded foods and see how they do.  When taking this approach I will always have them reintroduce one food at a time for three consecutive days.  For example, if someone wants to reintroduce nuts, I’d have them start with almonds, and preferably soak them overnight to help reduce the antinutrients.  Then I would have them eat some almonds for three consecutive days and to pay close attention to any symptoms they might experience.

Who Should Follow An Autoimmune Paleo Diet?

I currently recommend an autoimmune paleo diet to just about all of my patients with Graves’ Disease and Hashimoto’s Thyroiditis.  However, as I just mentioned, I will make modifications if necessary.  Plus, one needs to consider that autoimmune thyroid conditions are a little bit different than many other autoimmune conditions.  For example, there is the concern of goitrogenic foods, which in my opinion isn’t a huge concern in people with hypothyroid conditions.  But it’s still something to be aware of, and I have discussed this in other articles.  Eating foods rich in iodine such as seafood and sea vegetables is commonly recommended with other autoimmune conditions.  And while many people with autoimmune thyroid conditions do fine eating these foods, some people get worse when eating foods rich in iodine.  I’ll soon be releasing an article which talks about the impact of seafood and sea vegetables on thyroid health.

With regards to the restrictive diet, I’m open to patients reintroducing egg yolks after one month if they’re struggling on the diet.  And while I prefer for patients to avoid grains, if adding a few servings of gluten free grains each week will make someone more compliant with the other recommendations then I’m usually fine with them trying this.  The same thing applies with properly prepared nuts.  This doesn’t mean that everyone will do fine eating these foods, but if they are going to stray from the diet I’d rather them eat a small bowl of rice than a bowl of whole wheat pasta or a slice of pizza. Obviously there are certain foods I won’t allow under any circumstances, although just because I recommend avoiding a specific food doesn’t always mean the patient will follow my recommendations while trying to restore their health.  It’s not uncommon for me to receive an email from a patient who ate something they weren’t supposed to, and sometimes it can be challenging for them to  get back on track with the diet.  Just remember that while you want to continue eating well even after you have restored your health back to normal, you won’t necessarily have to follow a strict autoimmune paleo diet on a permanent basis.

In summary, an autoimmune paleo diet is recommended by many natural healthcare professionals to those people with Graves’ Disease and Hashimoto’s Thyroiditis, as well as those with other types of autoimmune conditions.  Although I commonly recommend this type of diet to my patients with autoimmune thyroid conditions, some people do fine eating some of the restricted foods, and it’s possible to be sensitive to foods which are permitted.  In addition, some people find this diet to be too restrictive and therefore have a difficult time sticking to it.  As a result, there are times when I will make modifications to this diet if necessary, although I do encourage people to try to stick as close to the diet as possible for optimal results.