How to Manage Hashimoto’s with Food and Diet

Do you feel tired for no reason? Have trouble losing weight? Do you have abrupt mood swings and feel foggy-headed from time to time, even with a full night’s rest? You might want to ask your doctor to check your thyroid. Hashimoto’s thyroiditis is the
How to Manage Hashimoto’s with Food and Diet

Do you feel tired for no reason? Have trouble losing weight? Do you have abrupt mood swings and feel foggy-headed from time to time, even with a full night’s rest? You might want to ask your doctor to check your thyroid.

Hashimoto’s thyroiditis is the most common cause of hypothyroidism (underactive thyroid) in the developed world. This autoimmune disorder that attacks your thyroid and can wreak havoc on your body if gone unchecked, creating some of the symptoms we mentioned above.

There’s no cure for Hashimoto’s, but eating supportive foods and eliminating those that exacerbate the symptoms can mean a major improvement in quality of life and could even put the disease into remission.

The most common treatment for Hashimoto’s disease is hormone replacement therapy in the form of a prescription thyroid medication called levothyroxine sodium. This drug replaces the endogenous thyroid hormone thyroxine. Production of thyroxine is compromised or completely halted over time for patients with Hashimoto’s, leading to decreased thyroid function and a host of symptoms, including low energy, sluggish metabolism, dry skin, hair loss, weight gain, and mood changes, just to name a few (1).

Managing hormone levels through medication is the most common form of treatment for individuals with thyroid problems, but it’s not the only solution. Dietary changes can make all the difference, but how do you choose the diet that’s right for you?

Understanding Hashimoto’s

Hashimoto’s thyroiditis is an autoimmune disease. If you have an autoimmune disease, your body’s immune system mistakes human tissue for pathogens (infectious bacteria or viruses) and attacks it as an invader. If you have Hashimoto’s, your immune system strikes the thyroid gland, and if the disease goes unchecked, it can destroy the thyroid entirely.

As part of the endocrine system, the thyroid makes and releases a number of hormones that are responsible for key functions in our bodies. A healthy thyroid regulates metabolism, heart rate, cholesterol, body weight, breathing, body temperature, and the menstrual cycle. When the thyroid is under-producing hormones, it can’t regulate these functions properly and results in the symptoms we mentioned before — weight gain, fatigue, brain fog, etc. (2)

Autoimmune disorders sometimes occur alongside each other, with your body attacking multiple types of human tissue at the same time. A 2007 Dutch study found an association between Hashimoto’s and celiac disease — an autoimmune disease in the GI tract exacerbated by gluten intake — suggesting that gluten sensitivity could be part of the equation for some Hashimoto’s patients (3).

Other autoimmune diseases, including rheumatoid arthritis and autoimmune gastritis, can occur alongside Hashimoto’s. This leads experts to recommend that autoimmune patients be cross-tested for multiple conditions upon diagnosis (1, 4).

In fact, Hashimoto’s is present in upwards of 40 percent of patients with autoimmune gastritis. Patients with this condition don’t produce enough stomach acid (hydrochloric acid), which can result in iron-deficient anemia in addition to poor absorption of the medication prescribed to treat the disease (something doctors should be aware of when prescribing thyroid medication) (4).

While the medical and scientific communities are working on understanding the root causes of these conditions, we know that chronic inflammation is a cause of autoimmune reactions. We also know that a leaky gut directly contributes to chronic inflammation and that dietary changes can heal leaky gut. The first recommendation for just about every autoimmune protocol is eating nutrient-dense foods that promote gut health.

Hashimoto’s Diet Isn’t One Size Fits All: 5 Diet Plans for Hashimoto’s Disease

There is no single prescriptive diet plan that works for all patients with Hashimoto’s thyroiditis, as every individual has his or her own unique needs. We’ll outline the five most common Hashimoto’s diets so that you can choose one based on your specific needs. Before we get into each option, there are three standard recommendations for anyone with this type of autoimmune disease.

  • Focus on whole, unprocessed foods that don’t exacerbate inflammation in your body. Fill your plate with fruits, vegetables, nuts, seeds, and organic meat, dairy, and eggs. Avoid highly processed foods.
  • Eat gut-supportive foods such as bone broth and fermented vegetables and juices. These help heal the gut lining and populate the large intestine with healthy bacteria, which support the immune system and proper digestion of nutrients.
  • Reduce sugar intake. Not only is sugar inflammatory, it also disrupts immune function, and for those with an already misfiring immune system, adding sugar to the mix can exacerbate the problem.

In addition to those changes, here are the most commonly recommended strategies for Hashimoto’s so that you can choose the best diet for your unique situation.


Because we know that gluten sensitivity — even if it’s not in the form of full-blown celiac disease — is very often a contributor to symptoms, most holistic professionals will recommend cutting gluten (5, 6).

Gluten is a protein found in wheat, barley, rye, and spelt, so this means eliminating foods containing those grains or flours. Luckily, gluten-free options for crackers, breads, pastas, and even beer are in great supply these days, but it’s important to pay attention to ingredients.

Many gluten-free options use high-glycemic ingredients like potato starch, white rice flour, and tapioca starch, which can spike your blood sugar. Blood sugar spikes can cause flare-ups for those with an autoimmune disorder. In fact, we’ll discuss the low-glycemic diet as one of your options shortly.

We recommend prioritizing foods that are naturally gluten-free (those unprocessed foods we mentioned at the beginning of this section) before seeking processed gluten-free options. That being said, there are some good choices out there. Choose seed crackers, whole grain pastas and breads, or entirely grain-free options if you choose to continue to eat these foods.

Going gluten-free is a great place to start because it’s among the least restrictive options for a Hashimoto’s diet, but often it’s not enough to fully quiet the attack of symptoms.


The paleo diet — based loosely on the way humans ate during the paleolithic era — is not only gluten free, but grain free. It emphasizes healthy protein sources (pastured or wild game, eggs, bone broth, and fish), minimally processed fats (coconut and avocado oil), nuts, seeds, fruits, and vegetables.

It excludes dairy, legumes, potatoes, grains, alcohol, and all processed foods, especially refined sugars, flours, oils. It does allow for moderate use of maple syrup, raw honey, and coconut sugar, since those forms of sugar go through minimal manipulation before making it into your grocery cart.

This type of eating is a bit more restrictive than simply going gluten-free, but it has the added benefit of cutting out more potentially inflammatory foods and adding in nutrient-dense replacements. Dr. Westin Childs, an osteopathic doctor focused on thyroid problems, notes that in patients who adopted either a paleo or gluten-free diet, over 80 percent felt better. About 30 percent of patients had a measurable reduction in thyroid antibodies (6).


AIP stands for autoimmune paleo. Some people choose this option at the outset because it is one of the most effective in easing inflammatory symptoms. This diet takes the paleo diet a step further and eliminates foods known to trigger allergic responses in patients with sensitive immune systems. The restrictive nature of this diet can make it relatively challenging to stick to long-term.

In addition to the restrictions of the paleo diet, AIP also eliminates dairy, eggs, nuts, seeds, any spices derived from a nut or seed, and a family of vegetables called nightshades. Nightshades include all members of the pepper family, potatoes, certain berries, eggplant, and tomatoes (6, 7).

Low-Glycemic Diet

A low-glycemic diet is another way to attempt to reduce flare-ups associated with Hashimoto’s. The glycemic index (GI) is a measurement that determines how much a particular food raises a person’s blood glucose. A low GI is less than 55. Glycemic load (GL) uses the GI and applies it to a typical serving size for that food. To calculate glycemic load, multiply GI by the grams of carbohydrate per serving and divide by 100. A low GL is between 1 and 10; moderate is 11 to 19; high is 20 or higher (9).

That’s a lot of math for every meal! A simpler way to think about GL and GI is to consider carbohydrate intake. Foods that have a lower GL are low-carb foods, including leafy greens, non-starchy vegetables, beans, and certain fruits like berries, grapes, small apples, and cherries. For a good list of foods and their GI and GL, check out the chart at Ultimate Paleo Guide.

Why adapt a low-glycemic diet? Studies show that wild swings in blood sugar (due to sugary or high-carb foods) can damage the pancreas and the thyroid (8). Both are critical in healthy hormone production and metabolism. In fact, the pancreas is responsible for the insulin release that creates a crash after a carb-heavy meal.

We mentioned some of the symptoms of hypothyroidism earlier: fatigue, weight gain, mood swings. You might notice some of these same symptoms if you’re addicted to a high carbohydrate diet. Intense cravings and crankiness between meals, brain fog, and exhaustion after eating indicate such a problem.

Researchers in India found a link between hypothyroidism and insulin resistance (10). Insulin resistance occurs when the body stops processing insulin properly. If gone unchecked, it can ultimately result in Type 2 diabetes. The constant overproduction of insulin can damage the thyroid as well (11). Try the low-glycemic diet if you want to stabilize your blood sugar, protect your thyroid, and allow your body to maintain a healthy immune system.

Allergy Blood Test and the Elimination Diet

If you’ve tried some of the diets we’ve outlined, but find that you’re still experiencing symptoms, it might be time to get an allergy blood test or try an elimination diet. This is the most involved and complicated route to go for a Hashimoto’s diet because it’s tailored specifically to each individual, based on testing. Choosing this route might take a bit more time, but in the end, it could be the best solution.

There’s an established link between allergies and autoimmune response. Medical professionals can test for food sensitivities and allergies through blood tests and provide you with a list of foods to avoid based on your results.

While it might seem like this takes out all of the guesswork and creates the best diet for you, these tests aren’t always completely accurate. It’s possible to be sensitive to a particular food without having an antibody for it in your blood. In fact, some people test negative for all types of gluten allergies and sensitivities but still do far better when they eliminate it from their diet.

We know that Hashimoto’s patients tend to fare better without gluten, so relying on a blood test alone isn’t sufficient. That’s where an elimination diet comes in.

The eight most common food allergens are (12):

  1. Cow’s dairy
  2. Eggs
  3. Wheat
  4. Tree nuts
  5. Peanuts
  6. Shellfish
  7. Soy
  8. Fish

Most holistic health professionals will also add sugar, corn, and caffeine to the list of foods to eliminate in the initial phase of this diet (6). The most effective way to successfully test if you have a reaction to any of these foods is to eliminate them all for one to three months, paying attention to when your symptoms have subsided. Once you’ve stopped experiencing symptoms, slowly add each food back, one at a time, waiting at least a week or two before adding another. If reintroducing a food causes a return of your symptoms, you know you should keep that food out of your diet.

The elimination diet accompanied by a blood test to find any uncommon allergies is the most personalized approach to finding your optimal Hashimoto’s diet. It can feel like a challenging proposition to eliminate all of these foods, but if you’ve suffered through the low energy and mood swings of Hashimoto’s, you may be ready to make a big change. Ideally, you’ll be able to add some of these foods back to your diet successfully without the recurrence of symptoms.

Take Care of Yourself

Lifestyle changes like these are not always easy to make, and there is a lot of information to process when picking an action plan for Hashimoto’s. Choose a diet plan that doesn’t immediately stress you out, and if you feel overwhelmed, ask for help. There’s a growing movement of holistic and functional medicine doctors out there who understand the need for a comprehensive approach to managing Hashimoto’s.

Making diet adjustments step by step might be the easiest way to tackle a Hashimoto’s diet. Start by adding nutrient-dense foods and crowding out some of the more processed foods that might be in your diet. Living with an autoimmune disorder is an ongoing journey, but it doesn’t have to be a struggle. Take your time as you experiment with the right diet to help you heal.

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