In my previous blog, I discussed the basic pathology of Hashimoto's thyroiditis which results from autoimmune inflammation of the thyroid gland. Understanding the root cause is the key to addressing Hashimoto’s and preserving thyroid gland function for as long as possible. 

What do we mean by autoimmune disease? 

This is a condition where your body’s immune system attacks healthy tissues in your own body, mistaking it for foreign invaders such as germs. The location and extent of inflammation determines the specific condition caused. For example, in Hashimoto’s, the thyroid is affected. Whereas in rheumatoid arthritis, it is the joints; in type 1 diabetes, the pancreas etc. Some autoimmune conditions such as lupus can be more extensive, affecting multiple organs and body parts. 

Most of the natural approaches in treating Hashimoto’s are targeted to calming and strengthening the immune system, thus reducing flare ups of autoimmune inflammation. 

Dietary approaches

If I had to pick the single most important intervention for managing Hashimoto’s, this is it! Making good diet choices is the key component of reducing autoimmune inflammation for the simple reason that 80% of our immune system lives in the lining of our gut. So everything we eat and drink has a direct impact on our immune system. 

What to Eat: Follow the principles of the anti-inflammatory diet or mediterranean diet which mostly relies on fresh fruits and vegetables, the more colorful the better! Try to eat food that is natural and easy to digest- your sensitive autoimmune gut will thank you for it.

When picking carbohydrates, try to choose complex carbs that are high in fiber, for example, brown rice, quinoa, sweet potato, beans etc. 

Plant-based and vegan diets have been shown to lower inflammation but may feel restrictive for many people. If you are not a vegetarian, invest in organic or nutrient-dense protein such as DHA-enriched free range eggs, wild-caught fish (instead of farm-raised), organic poultry or free range grass-fed red meat. 

Healthy fats are good for your body’s hormone production and are important modulators of inflammation. Avoid saturated fats in your diet and reach for monounsaturated and polyunsaturated fats such as avocado, nuts, olive oil and coconut oil. Fatty fish such as sardines, anchovies, salmon, mackerel or herring are excellent sources of Omega-3s.  

Fermented foods: Traditionally, many communities incorporate natural probiotic sources in their diet through fermented foods such as kimchi, yogurt, sauerkraut, natto, tempeh, pickled ginger and kefir. Probiotics are healthy live bacteria that are excellent for your digestive tract lining. By building up a good gut microbiome, we can lower inflammation and strengthen our immune systems. 

What to Avoid Eating: Eating processed food with refined sugars, dyes, preservatives, deep-fried foods, sodas and diet sodas, excess alcohol etc introduces chemicals into the gut that can trigger inflammation. This could manifest in many ways: bloating, indigestion, rashes, low energy and mood, joint pain, hair loss etc. Most importantly, it can trigger autoimmune flare ups that can affect any part of your body. 

Many studies have shown a strong link between Hashimoto’s and gluten intolerance. I often get asked by my patients with Hashimoto’s if they should avoid gluten when they have tested negative for Celiac disease. I tell them that even if they do not have Celiac Disease which is an autoimmune condition, they could still have gluten sensitivity, which is a chronic, functional digestive disorder related to inflammation, not allergy. It is possible to do food sensitivity testing for gluten. But another way to check if you are sensitive to it, is to cut out gluten from your diet for 6-8 weeks. If you notice a significant improvement in inflammatory symptoms such as the ones I previously mentioned, then you have your answer. And it would be best to continue avoiding gluten in your diet. 

Supplements and Botanicals/Herbal Remedies:

Selenium: It is a mineral that our body needs for many metabolic processes including reproduction and thyroid hormone production. However we cannot make it in our body and need to get it via diet or supplements. Studies have shown that Selenium can actively reduce inflammation specifically related to the thyroid gland such as TPO antibodies found in Hashimoto's as well Thyroid Eye Disease (TED) related to Graves’s disease or autoimmune-mediated hyperthyroidism. Selenium can be naturally found in eggs, seafood and poultry but the richest dietary source is brazil nuts. 

Turmeric: This well known yellow or curry-flavored spice contains curcumin, a powerful anti-inflammatory that can lower inflammation in pretty much all parts of your body. Curcumin is hard for the body to absorb on its own. Ideally, it is best absorbed when consumed with some healthy fats such as ghee, coconut milk etc and in combination with a little piperine or black pepper extract which can boost curcumin absorption by 2,000%. Cooking turmeric may not provide enough active curcumin, so taking supplements containing isolated or concentrated curcumin may be more effective to alleviate symptoms of chronic inflammation such as joint pain.

Vitamin D: Many people with Hashimoto’s also have low Vitamin D levels. While increasing Vit D with a supplement will not increase the levels of thyroid hormone production (T3 and T4), Vit D nonetheless helps with Hashimoto’s inflammation as it has a role in boosting and strengthening the immune system. 

Dark chocolate is an excellent choice for an after-dinner treat because it is delicious and satisfying but also packed with antioxidants that help reduce inflammation.

Supplements to Avoid:

Iodine: In many countries, iodine deficiency is the cause of hypothyroidism. But do not think that taking iodine supplements will help prevent a Hashimoto's thyroid gland from becoming hypothyroid! Thyroid glands that are affected by autoimmune disease such as Hashimoto’s or Graves cannot process iodine normally. So taking iodine supplements, including those containing bladderwrack, kelp, seaweed etc might actually make your thyroid condition worse. 

Biotin: A high dose biotin found in hair and nails supplements can interfere with many hormone testing assays at commercial labs. So while biotin may not affect the actual function of your thyroid gland, it can make the results of thyroid testing look abnormal due to lab interference. The small amounts of biotin found in general multivitamins is unlikely to cause the same issues with lab testing. 

The Role of Exercise:

Low to moderate impact exercise such as yoga, swimming, treadmill, low impact circuit training or a brisk walk is beneficial for anyone with autoimmune conditions and Hashimoto’s is no different. Regular exercise boosts muscle mass and energy. It also produces endorphins, those ‘happy’ brain chemicals that can be helpful if you also suffer from anxiety or depression which often accompanies having a chronic illness. Exercise is beneficial for lowering inflammation in the body. 

There is no restriction to adding in some cardio or aerobics too but be mindful of your exercise tolerance which could fluctuate depending on your energy reserves or if you are having a symptom flare up. Knowing when your body needs time to rest is an important component of self care.

Yours in good health, 

Ashita Gupta, MD