For those with thyroid and autoimmune thyroid conditions, there is no diet that fits everyone perfectly.  But I do think it’s a good idea for most people to follow an elimination diet.  For those with Graves’ disease and Hashimoto’s thyroiditis, I frequently recommend an autoimmune Paleo diet initially, which also serves as an elimination diet, as it not only eliminates the most common allergens (i.e. gluten, dairy, corn, soy), but it also removes foods that can interfere with gut healing (i.e. nightshades).

Even though I have written articles and blog posts on eliminating and reintroducing foods, I still commonly get asked questions about this, and so I figured I’d put together a blog post that answers some of the most commonly asked questions.  If there are other questions you have about eliminating and/or reintroducing foods that haven’t been addressed in this blog post please feel free to ask them in the comments section below.

I need to mention that I have gained a lot of my knowledge in this area from Sarah Ballantyne, and so for even more information please visit her website (www.thepaleomom.com).  Another great resource is www.autoimmunewellness.com, as both Mickey Trescott and Angie Alt have used the AIP/elimination diet to help get their health back.  So in this blog post there will be times when I will include links to their respective resources to answer some of these questions.

What’s The Purpose of Following an Elimination Diet?

There are a few reasons why people follow an elimination/reintroduction diet.  First of all, you are trying to see if you’re reacting to certain foods that can be a trigger of your autoimmune condition.  In addition, you are avoiding certain foods which can have a negative effect on gut healing.  This is important because according to the triad of autoimmunity, an increase in intestinal permeability (a leaky gut) is a factor in all autoimmune conditions.

Why Should You Consider Following An Elimination Diet?

As I mentioned in the opening paragraph, an elimination diet will allow you to avoid common food allergens (i.e. gluten, dairy, corn, soy), which in turn can be inflammatory and prevent you from healing.  Similarly, you will avoid unhealthy foods such as refined sugars, fast food, and unhealthy oils for the same reason.  Some healthier foods are also eliminated (i.e. eggs, nightshades, nuts, seeds) because they can potentially interfere with gut healing.

What Foods Should You Eliminate?

If you want detailed information on the foods you can eat and which ones you should avoid, I would highly recommend checking out Sarah Ballantyne’s excellent book “The Paleo Approach”.  There is also some great information on her website, and if you sign up for the Autoimmune Wellness newsletter you’ll be sent some specific lists as well.

That being said, here are the categories of foods you will want to avoid during the elimination process:

• Beans and Legumes
• Grains (including gluten free grains)
• Dairy
• Eggs
• Nightshades
• Nuts and seeds
• Alcohol
• Certain spices

How Long Should You Eliminate These Foods For?

Ideally you want to eliminate these foods for a minimum of 30 days.  Sarah Ballantyne recommends eliminating these foods for 30-90 days.  While many people struggle to follow an elimination diet for 30 to 90 days, some feel so good that they choose to follow it for a longer period of time.

Are There Risks of Following An AIP/Elimination Diet?

When following an AIP/elimination diet you want to eat plenty of fiber-rich vegetables.  If you don’t eat a sufficient amount of these veggies on a daily basis this can have a negative effect on your gut microbiome, as the good bacteria in your gut need the fiber to flourish.  There is also a similar concern with following a ketogenic diet long-term.

When Should You Start Reintroducing Foods?

As I already mentioned, most people will follow the elimination diet for 30-90 days, and then you can start reintroducing foods.

How Do You Know If You Should Follow An Elimination Diet For 30, 60, or 90 Days?

Sometimes it can be challenging to know exactly how long to follow an elimination diet for.  As an example, if you follow the diet for 30 days and notice some positive changes in your health and if you’re not stressed out about following the diet, then it makes sense to go another month or two.  On the other hand, if after 30 days someone doesn’t notice any symptomatic improvement, does this mean they should stop?  Maybe, as while eliminating certain foods can do wonders for someone’s health, many people have other triggers and imbalances that need to be addressed before they start feeling better.  In addition, if someone is stressed out about following this diet then this also needs to be considered, as it’s not a good thing to be in a chronic state of stress over any diet.

What Symptoms Should You Look For When Reintroducing Foods?

Of course not everyone will experience symptoms when reintroducing foods.  For those who do experience symptoms, because everyone is different, the symptoms will also differ from person to person.  For example, someone might experience headaches when reintroducing a specific food, while someone else might experience digestive symptoms when reintroducing the same food.  Here is a list of symptoms that people commonly experience when reacting to a food they are reintroducing:

• Headaches
• Fatigue
• Bloating/gas
• Diarrhea
• Rashes
• Muscle/joint aches or pains
• Sugar cravings
• Caffeine cravings
• Nausea
• Depression

When Reintroducing A “Family of Foods” (i.e. nightshades, nuts) Do You Need To Reintroduce Them Individually?

You do want to reintroduce each food within a family individually.  For example, when reintroducing nightshades, you wouldn’t want to eat tomatoes, eggplant, peppers, and white potatoes all at once.  The reason for this is because you might do fine with one or two of these but react to the others, and if this is the case, you wouldn’t know which of these foods were responsible for the symptoms if you reintroduced them all at the same time.  For the same reason you would want to reintroduce each nut individually.

How Many Days Should You Wait Between Reintroducing Foods?

You want wait at least 3 to 5 days before reintroducing foods.  For example, if you reintroduced egg yolks on Monday, you wouldn’t want to reintroduce the next food until Thursday at the earliest.  In this example, if you experienced symptoms upon reintroducing egg yolks then you would want to wait for the symptoms to resolve before reintroducing the next food.

How Important Is It To Wait 3 to 5 Days Between Reintroductions?

It is very important to wait 3 to 5 days between reintroductions, and the reason for this is because it’s possible to have a delayed reaction to a food.  For example, if you reintroduced egg yolks on Monday and then reintroduced macadamia oil on Wednesday morning, and experienced a headache Wednesday afternoon, while it’s possible the macadamia oil was responsible for the headache, it’s also possible that the person had a delayed reaction to the egg yolks.

How Do You Know The Symptom Is Caused By The Food You Reintroduced?

In the example given above, how would you know that the headaches were caused by the food, and weren’t just coincidental?  The truth is that there is no way to know for certain, and if you experience a symptom that you’re uncertain is related to the food you reintroduce, then I would still recommend to stop eating that food, document the symptom you experienced, and then you can try to reintroduce the same food in the future and see if you experience the same symptom.

What Should You Do If You React To A Certain Food?

Of course you should avoid that food, but this doesn’t necessarily mean that you will need to permanently avoid that food.  If you are certain that you are reacting to a specific food it would be wise to avoid that food for at least 3 to 6 months before attempting to reintroduce it back into your diet.

How Much of The Food Should You Eat During the Reintroduction?

Sarah Ballantyne recommends to go very slowly with reintroducing foods, starting with half a teaspoon and seeing if there are any reactions after 15 minutes.  If not then you can eat a full teaspoon and wait another 15 minutes, and if there are still no reactions to eat 1 1/2 teaspoons, and if all goes well you can reintroduce the next food in 3 to 5 days.

What Order Should You Reintroduce Foods?

Ultimately this is up to you, but it makes sense to start with foods that are most nutrient dense first, and hold off on those that are most likely to result in inflammation.  Sarah Ballantyne divides the reintroduction into four stages, which you can read about in this article (you’ll need to scroll down to the middle):

When Reintroducing Alcohol, Does It Matter What Kind?

Red or white wine is a good place to start, and I would make sure not to reintroduce any grain-based alcohols (i.e. beer, ale), at least initially.  Besides wine, other alcoholic beverages that are not derived from grains include rum, tequila, brandy, sherry, and cognac.

When Can Foods That Aren’t Included In The Reintroduction Stages Be Reintroduced?

This ultimately is your decision, but many advocates of the AIP diet recommend to avoid certain foods on a permanent basis, including gluten, peanuts, etc.  This doesn’t mean that you can’t successfully eat these foods again, but some foods are riskier to reintroduce than others.

Can You Do Food Sensitivity Testing Instead of The Elimination/Reintroduction Diet?

While food sensitivity testing is an option to consider, I don’t recommend this initially for a few reasons.  First of all, false results are common.  Second of all, it’s expensive, especially when you use a good quality company such as Cyrex Labs.  Also, if you do food sensitivity testing, please keep in mind that you need to be eating the food you’re testing for.  As an example, if you have been 100% dairy free for 6 months and did a food sensitivity panel, even if you have a dairy sensitivity you should expect the dairy markers to be negative, and the reason for this is because by not consuming dairy your body won’t produce antibodies.  It’s similar with other food allergens.

When I mention how false results are common with food sensitivity testing, some will argue that the elimination diet also isn’t perfect.  Without question this is true, but it also doesn’t cost hundreds of dollars.  But once again, it’s not just the cost, as the truth is that if food sensitivity testing was even 95% accurate I probably would have most of my patients do it initially.

What’s Your Experience With Eliminating and Reintroducing Foods?

Have you gone on an elimination diet?  If so, please feel free to share your comments below.  How long did you follow the elimination diet for?  Did you have any problems when reintroducing foods?  Thank you for sharing your experience with everyone.

Most people with hypothyroidism have Hashimoto’s, which is an autoimmune condition where the immune system attacks and damages the thyroid gland.  But while Hashimoto’s is the number one cause of hypothyroidism, certain nutrients are important for the production of thyroid hormones.  As a result, having a moderate to severe deficiency in any of these nutrients can also lead to hypothyroidism.  In addition to discussing the nutrients which are important for thyroid hormone production in this blog post, I’m also going to discuss some nutrients which play a role in converting T4 into T3, as well as supporting the thyroid hormone receptor.

Nutrients That Support Thyroid Hormone Production

1. Iodine.  In the world of thyroid health there is a lot of controversy surrounding iodine.  While iodine can potentially trigger or exacerbate the autoimmune response in those people with Hashimoto’s thyroiditis, there is no question that iodine is important for thyroid hormone production.  As a result, a moderate to severe iodine deficiency can cause hypothyroidism.  Iodine specifically combines with tyrosine to form T4 and T3.  There are four iodine atoms in thyroxine (T4), and three iodine atoms in triiodothyronine (T3).

The question many people with hypothyroidism have is whether or not they should supplement with iodine.  Some healthcare practitioners advise everyone with hypothyroidism to avoid iodine supplementation, while others will encourage their patients to supplement with iodine.  In my opinion, any mineral deficiency should eventually be corrected, but there is no doubt that not everyone does well with iodine.  Before anyone supplements with iodine I would recommend conducting a urinary test for iodine, and even if you are deficient I would take at least a month or two to increase your antioxidant status.  It’s also wise to work with a competent natural healthcare practitioner before supplementing with iodine.

2. Iron.  Thyroid peroxidase is an enzyme that plays a role in the production of both T3 and T4.  Thyroid peroxidase converts iodide to iodine, and as I mentioned earlier, the iodine in turn combines with tyrosine, which forms T4 and T3.  As for why iron is important, the reason for this is because thyroid peroxidase requires iron to function properly.  Thus, an iron deficiency can have a negative effect on thyroid hormone metabolism by reducing the activity of this enzyme (1) (2).

I recommend an iron panel (ferritin, serum iron, iron saturation, TIBC) to just about all of my patients.  While iron supplementation might be required if someone is deficient in iron, this isn’t always the case.  It depends on the cause of the deficiency, as well as how severe the iron deficiency is.  Since vitamin C and stomach acid help with iron absorption, many times it makes sense to have the person supplement with vitamin C and do things to improve stomach acid production, such as consume apple cider vinegar, bitter herbs, and/or betaine HCL.

It’s also important to mention that you can’t rely on the lab reference ranges when determining if someone has an iron deficiency.  I’ve seen many cases where someone’s ferritin or iron saturation was borderline low, yet was ignored by the physician who ordered the test.  In my book “Hashimoto’s Triggers” I dedicate an entire chapter discussing both the lab reference range and optimal reference range of many different blood markers, including those in an iron panel.

3. Tyrosine.  You already know the importance of tyrosine in thyroid hormone production, and how it combines with iodine to form T4 and T3.  While one can choose to take a tyrosine supplement, I wouldn’t recommend doing this unless a tyrosine deficiency has been confirmed.  But of course it’s a good idea to make sure you’re getting sufficient tyrosine from your diet, and some food sources include chicken, turkey, fish, and eggs, although there are also vegetarian sources (i.e. avocados, spinach, and seaweed).

How can you test for a tyrosine deficiency?  Although I can’t say that I commonly recommend amino acid testing to my patients, there are specialty labs that offer amino acid panels.  These panels not only test for tyrosine, but for other amino acids as well.  Genova Diagnostics is one company that offers such testing.

I’d like to briefly summarize the importance of these three nutrients, as in the thyroid epithelial cell, iodide is converted to iodine, and this is catalyzed by the enzyme thyroid peroxidase, which as I mentioned earlier, is dependent on iron.  Iodine then combines with tyrosine to form T4 and T3.  So if there is a moderate to severe deficiency in any of these nutrients there is a good chance it will eventually impact thyroid hormone production.

The Role of Selenium in Thyroid Hormone Conversion

I’ve written past blog posts where I discussed factors that affect the conversion of T4 to T3.  But just to summarize, the thyroid gland manufacturers mostly thyroxine (T4), and this gets converted into triiodothyronine (T3), which is the active form of thyroid hormone.  Approximately 60% of this conversion takes place in the liver, while approximately 20% takes place in the gut.  As a result, having an unhealthy liver and/or gut can affect the conversion of T4 to T3.

The deiodinases are enzymes that activate or inactive thyroid hormone.  There are 3 main types of deiodinases, including deodinase type I, deodinase type II, and deodinase type III.  The type 1 and type II deiodinase enzymes are responsible for the conversion of T4 to T3.  On the other hand, the type III deiodinase enzyme is involved in the inactivation of T4 and T3.  A selenium deficiency can decrease the activity of type I and type II deiodinases, which can result in a decreased conversion of T4 into T3 (3) (4).

It’s also worth mentioning that a few studies have shown that selenium supplementation (200 mcg) can decrease thyroid peroxidase (TPO) antibodies (5) (6).  Selenium is a cofactor of glutathione peroxidase, which can decrease oxidative stress, and thus help with the autoimmune response.  So having healthy selenium levels can not only play a role in T4 to T3 conversion, but can also help minimize the damage done to the thyroid gland by the immune system for those who have Hashimoto’s.

Nutrients That Support the Thyroid Hormone Receptor

Whereas overt hypothyroidism is characterized by an elevated TSH and low thyroid hormone levels, thyroid hormone resistance is characterized by a normal or elevated TSH along with elevated free T3 and/or free T4 levels.  While there are a few different factors that can cause thyroid hormone resistance, certain nutrient deficiencies can play a role, specifically vitamin A and zinc:

1. Vitamin A.  The binding of T3 to the thyroid receptor is retinoic acid-dependent (7).  As a result, having a vitamin A deficiency can be a factor in thyroid hormone resistance.  Some people are understandably concerned about vitamin A toxicity, and thus, when supplementing they will choose to take beta carotene.  Just keep in mind that some people have problems converting beta carotene into active vitamin A (8).

2. Zinc.  Zinc appears to play a role in the health of the T3 receptor (9), and so it would make sense that a zinc deficiency can cause thyroid hormone resistance.

So hopefully you have a better understanding of the different nutrients required for thyroid hormone production, the conversion of T4 to T3, and for supporting the thyroid hormone receptors.  Being deficient in any of these can result in subclinical or overt hypothyroidism.  Please feel free to share your experience regarding these nutrients in the common section below.

Many people with hyperthyroidism want to know what foods they should and shouldn’t eat.  While there is no hyperthyroidism diet that fits everyone perfectly, in this blog post I will discuss five diet tips that can benefit people with different types of hyperthyroid conditions.  So whether you have Graves’ disease, toxic multinodular goiter, or a different type of hyperthyroid condition, most of the information in this blog post will benefit you.

In addition to the 5 hyperthyroid diet tips I’ll be discussing, for those with hyperthyroidism who are struggling to gain weight, I’ll also discuss this later in this post.  While I realize that not everyone with hyperthyroidism will lose weight, when I was dealing with hyperthyroidism I lost a lot of weight, and many of my hyperthyroid patients are concerned about weight loss.  And if you happen to follow a vegetarian or vegan diet I’ll also discuss this below.

Hyperthyroidism Diet Tip #1: Eat whole foods.  I know that many people reading this understand that it’s important to eat a diet consisting of mostly whole foods.  But there are also many people with hyperthyroidism who don’t eat well.  Some people might think they are eating well when they aren’t, but hopefully after reading this you’ll understand what types of foods you should eat, and which ones you should avoid.  It should be obvious that you should try your best to avoid fast food, including fried food, as well as refined foods.  By refined foods I mean highly processed foods, as these foods are stripped of their nutrient content and fiber.  White flour and white sugar are common examples of refined foods.

But the truth is that many foods that are perceived as being healthy are actually unhealthy.  For example, while you might understand that pasta from white flour is unhealthy, how about pasta made from brown rice?  Similarly, while eating pizza at most popular pizza chains is unhealthy, how about eating homemade pizza with all organic ingredients?  Let’s take it a step further and assume the ingredients will be gluten free as well.

I’m not going to lie to you, as I’ve had my share of pizza since being in remission from Graves’ disease in 2009.  And I’ve had other “healthier versions” of unhealthy foods.  But there are a few things you need to understand.  First of all, just because a specific food includes organic ingredients doesn’t mean it’s healthy.  Similarly, just because something is gluten free also doesn’t mean it’s a healthy choice.  I gave the example of pizza earlier, but there are many other examples.  Growing up I would almost always have an unhealthy bowl of sugary cereal for breakfast, and these days there are many organic and gluten free versions of cereals, but this doesn’t mean that they are a healthy choice.

Once again, I’ll admit that over the years I have indulged in some of these “healthier versions” of unhealthy foods.  And the truth is that eating these foods on an OCCASIONAL basis is fine for most people.  The problem is that many people eat these foods on a DAILY basis.  Another thing I should add is while I indulge in unhealthy foods every now and then, when I was trying to restore my health in 2008/2009 after being diagnosed with Graves’ disease, I was very strict with the diet.  I’m sure you’re wondering which foods you can specifically eat, and I’ll discuss this shortly.

Hyperthyroidism Diet Tip #2: Eat organic whenever possible.  As I mentioned earlier, just because something is organic doesn’t mean it’s healthy.  So when I say to “eat organic”, of course I’m referring to whole healthy foods.  Sure, if you indulge in something refined then it would be great if this was organic as well.  When it comes to fruits and vegetables, try your very best to eat organic, but you also might want to check out the “Dirty Dozen” list from the Environmental Working Group.  This lists the top 12 fruits and vegetables with the greatest amount of pesticides.  There is also the “Clean Fifteen” list, which has the top 15 fruits and vegetables with the least amount of pesticides.

These aren’t perfect lists, but they still can be helpful.  For example, if you are unable to purchase all organic fruits and vegetables then I would try to avoid foods on the Dirty Dozen list, and stick to those on the Clean Fifteen list.  It’s also important to understand that organic doesn’t mean that the food is free from chemicals.  For example, if a product is certified organic this means that it is grown with no synthetic herbicides, pesticides, or fertilizers, which of course is great news.  So pesticides and herbicides used on organic produce are not synthetic.  But one potential problem is drift, as organic farms are frequently located near conventional farms, and so the pesticides from non-organic farms are likely to contaminate organic farms.   That being said, it still is a good idea to do everything you can to reduce your exposure to synthetic pesticides and herbicides.  And while organic food isn’t perfect, it still has less chemicals than non-organic food.

Hyperthyroidism Diet Tip #3: Eat a wide variety of vegetables.  Over the years I have looked at a lot of food diaries from my patients, and one of the main things I’ve noticed is that many people don’t eat a sufficient amount of vegetables.  And the few who do eat plenty of vegetables seem to eat the same veggies over and over again.  The truth is that most people need to eat a wider variety of vegetables, including myself.  And the reason for this is because the bacteria in our gut feeds off of different fibers in the vegetables we eat.  In other words, eating a greater variety of vegetables will improve the diversity of your gut microbiome, which is one of the keys to optimal health.

So how many different vegetables should you eat?  Well, in 2018 I attended a 6-week online course hosted by probiotic expert Dr. Jason Hawrelak, and he recommended to eat 40 different vegetables per week!  Just to clarify, he wasn’t saying that we should eat 40 servings of vegetables per week, but 40 different types of vegetables.  The truth is that most people don’t eat half this amount on a weekly basis.  So in a perfect world everyone would eat 10 to 12 servings of vegetables per day, and 40 different kinds of veggies per week.

Of course we don’t live in a perfect world, but you should still strive to eat as many different kinds of veggies each week.  I’d say that most people who actually eat vegetables eat 5 to 10 different kinds of vegetables per week.  If this describes you then I would suggest to add a new vegetable once per week, or at the very least once every other week.  If you do this then within a few months you will greatly increase the variety of veggies in your diet.

Hyperthyroidism Diet Tip #4: Consider an autoimmune Paleo (AIP) diet.  This hyperthyroid diet tip is specific to those with Graves’ disease, which is an autoimmune hyperthyroid condition, although some people with other types of hyperthyroid conditions may also benefit from such a diet.  The purpose of an autoimmune Paleo diet is to avoid inflammatory foods, as well to avoid foods that will interfere with gut healing.  A big reason for this is because according to the research, everyone with an autoimmune condition has a leaky gut.  There are numerous factors that can cause a leaky gut, and food is one of them.

So what foods are allowed in an AIP diet?  What I’d like to do is compare the AIP diet to a “standard” Paleo diet, which includes the following:

• Vegetables
• Fruit
• Eggs
• Nuts and seeds
• Meat and fish
• Coconut products
• Healthy oils
• Green tea and herbal teas

An AIP diet is even more restrictive, as it excludes eggs, nuts, seeds, and the nightshade vegetables (tomatoes, eggplant, peppers, white potatoes).  For some people this might seem like an impossible diet to follow, and without question it is very challenging.  However, you need to understand a few things.  First of all, the AIP diet is not meant to be permanent.  I recommend following this diet for a minimum of 30 days, although some people will follow it for a few months.  In addition, the goal of this diet isn’t to restrict calories.  That being said, I would make sure you eat plenty of vegetables, as some people who follow an AIP diet will eat mostly meat and a small amount of veggies, but you really want to do the opposite.

One of the main concerns with following the AIP diet in those with hyperthyroidism is that because this diet is restrictive it can result in weight loss.  Many people with hyperthyroidism are already losing weight, and they don’t want to shed additional pounds.  I understand this concern, but as I mentioned earlier, the goal of the AIP diet isn’t to restrict calories.  In addition, loading up on carbohydrates might prevent you from losing weight, but you should focus more on nutrient density than eating empty calories.

Hyperthyroidism Diet Tip #5: Avoid genetically modified foods.  Genetically modified organisms are usually engineered to be more resistant to pesticides such as Roundup, and are therefore called “Roundup Ready” crops. Glyphosate is the active ingredient in Roundup. So when you eat genetically modified foods you are being exposed to high levels of glyphosate residues.  It’s worth mentioning that glyphosate might be used on other non-GMO crops such as wheat.  In fact, a 2013 paper by Anthony Samsel and Stephanie Seneff suggested that the increased prevalence of Celiac disease might be due to the use of glyphosate to desiccate wheat and other crops prior to the harvest (1).

What’s the concern with glyphosate?  There are a lot of concerns, as the research shows that glyphosate can cause neurotoxicity and oxidative stress (2), it can promote the growth of human breast cancer cells (3), can have a negative effect on cardiovascular health (4), and can inhibit cytochrome P450 (5), which plays a vital role in detoxification.  In addition, there is evidence that glyphosate can disrupt the gut microbiome (6) (7).

Should Those With Hyperthyroidism Eat Goitrogenic Foods?

Goitrogenic foods can potentially inhibit thyroid hormone production by interfering with the uptake of iodine.  As a result, many people with hypothyroidism and Hashimoto’s are concerned with eating goitrogenic foods, which include broccoli, Brussels sprouts, cabbage, cauliflower, millet, soybeans, spinach, strawberries, and sweet potatoes.  But how about those with hyperthyroidism?  Some recommend goitrogenic foods to those with hyperthyroidism as a way of lowering thyroid hormone levels.  The problem is that this usually doesn’t work, as in the past I tried lowering thyroid hormone levels by having patients eat larger amounts of these foods, especially raw cruciferous vegetables.

I recommend for my hyperthyroid patients to eat plenty of cruciferous vegetables, but only because they are very nutrient dense and help to detoxify the body.  But I wouldn’t expect to lower your thyroid hormone levels by eating large amounts of these foods.  Of course if anyone reading this has had success managing their hyperthyroidism by eating goitrogenic vegetables please feel free to share your experience in the comment sections below.

What Foods Can You Eat To Gain Weight?

As I mentioned earlier, one of the concerns with following a restrictive diet is that many people with hyperthyroidism are already losing a lot of weight.  So a common question I get asked is what foods can someone with hyperthyroidism eat to gain weight?  The truth is that it will be difficult to gain weight through diet if someone has elevated thyroid hormone levels.  For example, when I was dealing with Graves’ disease I lost over 40 pounds, and it wasn’t until I started lowering the thyroid hormone levels until I finally began to gain weight.  So as I mentioned above, I would focus on nutrient density, eating plenty of vegetables, as well as healthy fats, and at the same work on normalizing your thyroid hormone levels.

What If You’re a Vegan or Vegetarian?

While most of my patients are omnivorous, I also have worked with many vegetarians and vegans over the years.  The good news is that those who are vegetarians and vegans can receive good results when following a natural treatment protocol.  The bad news is that it can be even more challenging to eat a “healthy” vegetarian or vegan diet when trying to restore your health.

This is especially true for those with Graves’ disease who are vegetarians and vegans.  As I mentioned earlier, an AIP diet can be beneficial for those with an autoimmune condition.  Many people who eat meat find an AIP diet to be very challenging, and so I’m sure you can imagine that this diet would be even more difficult to follow for someone who doesn’t eat meat (or fish).  A few years ago I wrote an article entitled “Vegetarians, Vegans, and The Autoimmune Paleo Diet“, and if you’re a vegetarian or vegan with Graves’ disease I definitely would recommend reading this when you get the chance.

A Summary of What To Eat When Dealing With Hyperthyroidism

When dealing with any health condition you want to eat a diet consisting of healthy foods, while avoiding the refined foods and sugars. If someone has Graves’ disease then they should consider following a strict AIP diet for a minimum of 30 days, whereas if someone has a non-autoimmune hyperthyroid condition (i.e. toxic multinodular goiter) a “standard” Paleo diet should be fine. I’ll add that while many people benefit from avoiding grains and legumes (both are excluded from an AIP and Paleo diet), some people are able to eat small amounts of these foods with no problem while trying to restore their health.

So hopefully you have a better idea as to what to eat when dealing with a hyperthyroid condition.  The truth is that a lot of the information in this blog post applies to everyone, and not just those with hyperthyroidism.  After all, we should all eat whole healthy foods, eat organic foods, including a wide variety of vegetables, and it also is a good idea to do your best to avoid genetically modified foods.  If you have anything you’d like to share regarding your experience with diet and hyperthyroidism please feel free to do so in the comments section below.

Hashimoto’s thyroiditis is an autoimmune thyroid condition which involves destruction of the thyroid cells by the immune system.  Hashimoto’s is typically diagnosed by the presence of an elevated thyroid-stimulating hormone (TSH) and elevated thyroid peroxidase and/or thyroglobulin antibodies.  Sometimes the thyroid hormone levels will be low or depressed, although this isn’t always the case, as many cases of Hashimoto’s are subclinical, which can make the condition more challenging to diagnose.  Women are affected with Hashimoto’s more frequently than men, and most women are diagnosed between the ages of 30 to 50 years old, although I have worked with patients younger and older than this age range.

The goal of this blog post is to discuss 7 things people with Hashimoto’s thyroiditis should know about treating their condition naturally.  Some of these I’ve discussed in greater detail in other articles and blog posts, but I figured I’d put together an updated post which included some of the main things you should know about Hashimoto’s.  I’ve also included links to some blog posts I’ve written in the past which go into greater details.

1. Finding the autoimmune triggers of Hashimoto’s can be challenging.  In order to reverse the autoimmune component of Hashimoto’s (or any other autoimmune condition) it is necessary to find and remove the autoimmune triggers.  There are many different factors that can trigger an autoimmune response, including food allergens (i.e. gluten, dairy), stress, infections, and chemicals.  The two main ways I look for triggers in my patients with autoimmune thyroid conditions are through a thorough health history and by ordering certain tests (i.e. blood tests, adrenal saliva test, comprehensive stool panel).  Not everyone will need to order the same tests, as while some functional medicine practitioners require all of their patients to order the same tests, I determine which tests someone needs based on the person’s health history.

As many reading this already know, I’ve written a book called “Hashimoto’s Triggers”, which is the most comprehensive book on finding and removing the triggers associated with Hashimoto’s.  Of course I’m a tad biased since I’m the one who wrote the book, but I think after reading it you’ll agree that it’s quite comprehensive.  I do need to warn you that it’s a very thick book (over 500 pages), but you don’t need to read the entire book to benefit from it, as I designed it so you can easily pick and choose to read the chapters that are of interest to you.  As of writing this blog post the Kindle version of the book is only $3.99 (it’s also available in paperback).

2. Diet alone usually isn’t the solution.  I mentioned that food allergens such as gluten and dairy can be triggers, and while eating a healthy diet consisting of whole foods is important for anyone looking to restore their health, eating well alone usually won’t be sufficient to reverse the autoimmune component of Hashimoto’s.  So just to clarify, if you eat a lot of inflammatory foods then it will be difficult, if not impossible for you to achieve a state of optimal health.  However, you probably will need to do more than eat well to restore your health.

For example, a small percentage of people with Hashimoto’s are able to achieve a state of remission by avoiding gluten alone, while many others who follow a strict autoimmune Paleo (AIP) diet don’t notice much of an improvement in their symptoms and lab results.  This doesn’t mean that an AIP diet can’t be beneficial in some people with Hashimoto’s, as even if food isn’t a trigger, an AIP diet is anti-inflammatory and can aid in gut healing.  So by all means make sure you avoid common food allergens and eat well overall, but if doing this doesn’t help much with your hypothyroid symptoms or test results please don’t get discouraged, as this probably means that you have other triggers that need to be detected and removed.

3. Don’t overlook the impact of infections and chemicals.  Many people with Hashimoto’s focus on avoiding potential food triggers such as gluten, dairy, and corn.  Although this is a wise thing to do, as I mentioned earlier, changing one’s diet alone usually isn’t sufficient to reverse the autoimmune component.  While food can be a trigger, please don’t overlook the impact that infections and chemicals can have on your immune system.

We live in a toxic world, and all of the chemicals we’re exposed to are a big reason for the increased prevalence of autoimmunity.  Obviously you won’t be able to completely eliminate your exposure to environmental chemicals, and so the next best thing is to do everything you can to reduce your exposure to them.  This includes purchasing organic food, drinking purified water, using natural household products, consider purchasing an air purification system, etc.  It’s also important to do things to help with the elimination of toxins from your body, including eating plenty of vegetables, consider using an infrared sauna to sweat out the chemicals from your body, and perhaps even incorporating enemas and colonics.

As for infections, these include bacteria such as H. pylori, viruses such as Epstein-Barr, and parasites such as Blastocystis Hominus.  Just as is the case with environmental chemicals, we’re all exposed to bacteria, viruses, and parasites.  While I do recommend natural antimicrobial agents at times to my patients to help combat infections, the best thing you can do to minimize the negative impact of certain pathogens is to always work on improving the health of your immune system.

4. A healthy gut is necessary for optimal immune system health.  According to the triad of autoimmunity, in order for an autoimmune condition to develop one needs 1) a genetic predisposition, 2) exposure to an environmental trigger, and 3) an increase in intestinal permeability (a leaky gut).  Since most of the immune cells are located in the gut, it makes sense that having a healthy gut is a requirement for a healthy immune system.  So what can you do to optimize the health of your gut?  I discuss this in great detail in my book, but one of the main things you can do right away is read my blog post entitled “What Is The 5-R Protocol?”  As I discussed in this post, you need to remove the factor that is causing the leaky gut, followed by replacing certain factors (i.e. digestive enzymes, dietary fiber), reinoculate with prebiotics and probiotics, repair the gut, and rebalance your body.

5. Some people with Hashimoto’s need to take thyroid hormone replacement.  I realize that this doesn’t relate to treating Hashimoto’s naturally, but I thought it was important to bring up.  Many people reading this are already taking thyroid hormone replacement such as levothyroxine, or natural desiccated thyroid hormone (i.e. Armour, Nature-Throid).  On the other hand, there are some people with Hashimoto’s who don’t need to take thyroid hormone replacement.  That being said, there are also people who should be taking thyroid hormone replacement but refuse to do so.

When I was dealing with Graves’ disease I chose not to take antithyroid medication, which is commonly recommended by endocrinologists to manage hyperthyroidism.  I took an antithyroid herb called bugleweed, but unfortunately there is no herbal replacement for thyroid hormone.  Once again, I’m not suggesting that everyone with Hashimoto’s needs to take thyroid hormone replacement, but you need to understand that having sufficient levels of thyroid hormone is very important.  Thyroid hormone affects every cell and tissue in the body, and as a result, it can be harmful if someone has depressed thyroid hormone levels, especially for a prolonged period of time.

6. Numerous factors can be responsible for the fatigue people with Hashimoto’s commonly experience.  One of the most common symptoms people with Hashimoto’s experience is fatigue.  Many times this is due to low or depressed thyroid hormone levels.  However, there can be other factors responsible for the fatigue.  This includes compromised adrenals, certain infections, and even nutrient deficiencies.  So if you balance your thyroid hormone levels and yet are still experiencing fatigue, then this is a clear sign that something else is responsible for your low energy levels.  As a result you might need to focus on improving the health of your adrenals, or perhaps there is an underlying infection such as Epstein-Barr, or a deficient nutrient (i.e. iron, vitamin B12) that is causing your fatigue.

7. Some people with Hashimoto’s initially present with hyperthyroidism.  Although most people with Hashimoto’s will eventually experience overt or subclinical hypothyroidism, initially hyperthyroidism is common due to the destruction of the thyroid follicles, which causes the release of thyroid hormones into the bloodstream.  This transient state of hyperthyroidism can be mistaken for Graves’ disease, as the person’s thyroid panel might also be consistent with a hyperthyroid pattern (depressed TSH and elevated thyroid hormone levels).  This is referred to as Hashitoxicosis, where the person has Hashimoto’s antibodies, tests negative for thyroid stimulating immunoglobulins (the antibodies associated with Graves’ disease) but presents with hyperthyroidism.

What Have You Done To Treat Naturally Treat Your Hashimoto’s Condition?

Hopefully you found the information in this blog post to be helpful.  I’d like to know what you have specifically done from a natural standpoint for your Hashimoto’s condition, and so please feel free to share your experience in the comments section below.  Have you tried finding your autoimmune triggers?  Did doing so help with symptoms such as fatigue and brain fog?  What have you done for gut healing?  Thank you for sharing your experience with everyone!

Many patients with Graves’ disease experience hair loss, and while this might not be the most concerning symptom someone with this condition has, it is still very distressing for many people.  This is especially true since Graves’ disease (as well as most other autoimmune conditions) is more common in women, and I can tell you that over the years I have worked with many women with Graves’ disease who were stressed out the most over their hair loss.  I’ve written other blog posts and articles on hair loss, but I wanted to put together an updated post that focuses on Graves’ disease and hair loss, because while I do see hair loss in people with hypothyroidism and Hashimoto’s thyroiditis, it is more common in those with hyperthyroid conditions.

When I begin working with someone who has Graves’ disease, of course I want to address the underlying cause of their condition, but initially I want to make sure the person is safe since it’s quite common to have an elevated resting heart rate.  Many endocrinologists will try to lower the person’s resting heart rate through the use of antithyroid medication (i.e. methimazole, PTU) and/or beta blockers (i.e. propranolol, atenolol).  Natural antithyroid agents such as bugleweed and high doses of L-carnitine are also an option to lower the thyroid hormone levels, while herbs such as motherwort and hawthorn can act as natural beta blockers.

It’s worth mentioning that sometimes taking antithyroid medication or herbs will help to decrease the person’s hair loss, while other times the person will experience more hair loss upon taking these.  I’ll talk more about this later in this post, but before we specifically discuss Graves’ disease and hair loss I want to make sure you have taken the necessary steps to start lowering your thyroid hormone levels.  So if you have uncontrolled hyperthyroidism then this needs to be addressed first.

Why Do People With Graves’ Disease Commonly Experience Hair Loss?

The main reason why people with Graves’ disease experience hair loss is due to the thyroid hormone imbalance.  While either high or low thyroid hormone levels can result in hair loss, as I mentioned earlier, it seems that high thyroid hormone levels more commonly result in hair loss.  Based on what I just said here, it might seem obvious that in order to stop the hair loss you simply need to lower the thyroid hormone levels.  While normalizing the thyroid hormone levels will usually cause the hair loss to stop, it frequently will take a good amount of time for this to happen.

The Impact of Antithyroid Medication and Herbs on Hair Loss

I’ll add that taking antithyroid medication such as methimazole or PTU can either improve or exacerbate the hair loss.  I’ve worked with Graves’ disease patients who took methimazole and had an improvement in their hair loss, while others had their hair loss worsen upon taking antithyroid medication.  Some people with Graves’ disease don’t experience any hair loss until they start taking antithyroid medication.  Frequently what happens is that the person takes too high of a dosage of methimazole, which can make them hypothyroid, and this can also cause hair loss.

Bugleweed is an antithyroid herb that can also help to lower thyroid hormone levels.  Because this herb isn’t as potent as antithyroid medication it’s less likely to cause a huge “swing” in thyroid hormone levels over a short period of time.  As a result, taking bugleweed usually doesn’t cause hair loss as much as antithyroid medication does, although you also need to keep in mind that bugleweed isn’t effective in everyone with hyperthyroidism.  In other words, taking bugleweed doesn’t always lower thyroid hormone levels.  Antithyroid medication is more effective, but there is also a greater risk of side effects.

As I’m sure you know, antithyroid drugs and herbs don’t do anything to address the cause of the problem, and so while they might help with hair loss by lowering the thyroid hormone levels, it’s still important to address the underlying cause of the condition.  In other words, if all you do is take antithyroid medication or herbs, this might temporarily help with hair loss associated with Graves’ disease, but once you stop taking these thyroid hormone-lowering agents the hyperthyroidism is likely to return, along with the hair loss.

What Are Other Causes of Hair Loss?

Although elevated thyroid hormone levels are the most common cause of hair loss in people with Graves’ disease, this doesn’t mean that there can’t be other causes as well.  Let’s look at some of the other common causes of hair loss in people with Graves’ disease:

• Nutrient deficiencies.  Nutrient deficiencies are common in those with Graves’ disease, and nutrient deficiencies can cause hair loss in general.  In fact, many people who are suffering from hair loss will take nutritional supplements on their own to see if they will help.  Some of the nutrient deficiencies that can cause or contribute to hair loss include zinc, iron, selenium, biotin, and gamma-linolenic acid (1).  When looking to address nutrient deficiencies, it’s important to look into factors that can cause these deficiencies.  Remember that Graves’ disease is an autoimmune condition, and since most of the immune system cells are located within the gastrointestinal tract, having a healthy gut is necessary for optimal immune system health.  But many people with Graves’ disease have an unhealthy gut, which in turn can affect nutrient absorption.  For example, H. pylori is a potential trigger of Graves’ disease, and numerous studies show that H. pylori can affect iron absorption (2) (3), which can result in hair loss.  Other causes of malabsorption (i.e. Celiac disease, inflammatory bowel disease) can also affect the absorption of nutrients that play a role in hair loss.  It’s also important to mention that overdosing with certain nutrients can cause hair loss.  This includes selenium, vitamin E, and vitamin A (4).  So while it’s important to correct nutrient deficiencies, you want to make sure not to take very high doses of certain nutrients, especially over a prolonged period of time, as this can lead to a toxicity that results in hair loss.
• Sex hormone imbalances.  Imbalances of the sex hormones (estrogen, progesterone, testosterone) can cause hair loss.  Elevated thyroid hormone levels will commonly cause sex hormone imbalances.  Frequently correcting the hyperthyroidism will resolve the sex hormone imbalance, although sometimes additional action will be required to balance the hormones.
• Alopecia areata.  Alopecia areata is an autoimmune condition that causes hair loss on the scalp, face, and sometimes on other areas of the body.  A 2018 study showed that alopecia areata is significantly associated with Graves’ disease and Hashimoto’s thyroiditis (5).  However, it’s important to mention that frequently alopecia areata will develop first, many times in childhood, although it’s also possible for thyroid autoimmunity to precede alopecia areata.

Please keep in mind that it’s very possible for those with Graves’ disease to have more than one factor causing hair loss.  For example, while hyperthyroidism is the most likely cause, the person might also have nutrient deficiencies that are a factor.  In this situation not only will the thyroid hormone levels need to be balanced, but the nutrient deficiencies need to be addressed as well.  As I mentioned earlier, if someone has hyperthyroidism that leads to sex hormone imbalances, lowering the thyroid hormone levels may resolve the sex hormone imbalances, although this isn’t always the case.

Can Diet Alone Help With Hair Loss?

I mentioned how nutrient deficiencies are a potential cause of hair loss.  Because of this you may wonder if eating a nutrient dense diet can correct such nutrient deficiencies, and thus resolve the hair loss problem.  Although it’s important to eat nutrient dense foods, many times supplementation is necessary to correct nutritional deficiencies, and then once this has been accomplished the goal should be to maintain healthy nutritional levels through diet (although I’ll add that sometimes supplementation is still necessary).  Just remember that having a healthy gut is necessary for the optimal absorption of nutrients.

How Long Does It Take To Reverse Hair Loss?

As for how long it takes to reverse hair loss, this of course depends on the person, as well as the cause of the hair loss.  If hyperthyroidism is the sole cause of the person’s hair loss it can take a few weeks to a few months before the hair loss stops.  The same thing applies to sex hormone imbalances.  Moderate to severe nutrient deficiencies will take time to correct, and so if this is responsible for the hair loss then it will usually take longer for the hair loss to stop and grow back.  Based on what I’ve said here, while some people start noticing their hair loss improving within a few weeks of taking measures to correct their hyperthyroidism, for some people it will take a few months before they notice a significant improvement.

What Can You Do To Help With Graves’ Disease Hair Loss?

After reading this post you probably have a pretty good idea what you can do to help with your hair loss, but I’ll list them below in bullet point format:

• Correct the hyperthyroidism.  This is the most common cause of hair loss in those with Graves’ disease, but of course even if someone isn’t experiencing hair loss it’s important to lower the thyroid hormone levels.
• Balance the sex hormones.  Once again, correcting the hyperthyroidism many times will help to balance the sex hormones.  But when this isn’t the case you might need to do other things.  One thing I didn’t mention earlier when discussing sex hormones is that having healthy adrenals is important in order to have healthy sex hormones.  And many people with Graves’ disease have adrenal problems.  So while many doctors will resort to giving bioidentical hormones to their patients with sex hormone imbalances, evaluating the adrenals is a good first step before doing this.
• Correct nutrient deficiencies.  I’ve also discussed how many people with Graves’ disease have nutrient deficiencies, and certain nutrient deficiencies can cause hair loss.  I also explained how it’s important to address the cause of the nutrient deficiencies, and how overdosing with selenium, vitamin A, and/or vitamin E can cause hair loss.

What’s Your Experience With Hair Loss?

If you have Graves’ disease and have dealt with hair loss please feel free to share your experience in the comments section below.  Are you still experiencing hair loss, and if not, how long did it take for your hair loss to stop and grow back?  If you took antithyroid medication, did this improve or worsen your hair loss?  Did you take any nutritional supplements, or do anything else naturally that helped?  Thank you so much for sharing your experience with everyone.