Weight loss and thyroid health is a topic that I love to talk about. According to the American Thyroid Association, ~20 million Americans have some form of thyroid disorder and a whopping 60% of these people do not have a formal diagnosis. Your thyroid is a butterfly shaped gland in your neck and has an extremely important job. Your thyroid is in charge of your metabolism. Meaning, your nutrient absorption and heart rate are highly impacted by the health of your thyroid and your body’s ability to convert the hormone it produces into its active form . Your thyroid has such an important job that when it is not functioning at full capacity many of your body’s systems are affected. Hypothyroidism and Hashimoto’s disease (autoimmune) have many symptoms including unexplained weight gain, hair loss, brain fog, fatigue, changes in heart rate, anxiety, depression, memory impairment, constipation, irritable bowel syndrome, muscle weakness and skin conditions.
My hope is that this post will not only empower those who are struggling as I was but also to shed some light on this disease to our family and friends. Many of us who have this disease (autoimmune or not), are way less apt to maintain a social life in the same way as those around us. We are not lazy or boring as many perceive. The truth is, most of us are poorly treated and are just straight up exhausted. The way I often explain it is, we are in just enough discomfort to prevent us from being cool but not enough to prevent us from being responsible. Doctors rarely take it seriously. And our friends sure as heck aren’t going to understand why we are twenty-something years old and going to bed at 8 pm. And this is why I feel as though it is so important for me to share what it was like for me to live with poorly controlled hypothyroid Hashimoto’s and how changing my diet changed my life.
I have lived the struggle of being overweight with poorly treated Hashimoto’s (autoimmune thyroid disease). I was diagnosed at the age of 17 and spent the next 5 years studying, learning, and scrambling for information on how to make myself feel and look better. I was an active teenager and always on a “diet”. Even with exercising two hours a day six days a week and restricting my intake to the point of insanity, I would continue to see the numbers on the scale steadily climb. I would often be ridiculed for my size or bluntly asked if I was ever going to lose weight. I remember desperately asking my first endocrinologist how I should change my diet. Her answer? “This is western medicine. I prescribe pills not diets”. Um, OK. That’s helpful. Not. And while I imagine that she was an extra apathetic human being, the next few endocrinologists I went to were just as helpful. For some reason, there continues to be little to no nutrition education or focus in medical schools. It still baffles me how we recognize the effect of fueling our friggin cars with quality fuel yet we still disregard the impact of food on our own bodies.
So I went to school to be a Dietitian. And I read and studied and applied what I learned to my body. Lots of trial and error. So much error. I wasn’t only suffering from being overweight, but I also had little to no energy, irritable bowel syndrome, anxiety, depression, hair loss, and extremely terrible cystic acne. Hundreds (probably thousands) of dollars spent on dermatologists, holistic doctors, vitamin supplements, creams, face washes etc. I would often travel 3-4 hours just to be seen by a doctor who promised they could help. I shed just as many tears as dollars spent over this skin condition that no one seemed to be able to remedy. It was so bad that my face would randomly start to bleed (especially during something important like a meeting or a presentation). As if being a teenager and college student isn’t hard enough…Let’s add the need to sleep 12+ hours a night and barely feel rested along with terrible physical symptoms that were seemingly outside of my control. Afterall, not even my highly trained doctors could help me.
It wasn’t until I went to a seminar in Boston, MA hosted by Diane Sanfilippo, the author of Practical Paleo and founder of Balanced Bites, that I finally had my “ah hah” moment. I did not go to this seminar with my own health in mind. To be honest, I didn’t even know what the seminar was about. I was just looking to learn about nutrition from a practical standpoint. Up until this point, my nutrition education had pounded the message of “eat low fat”, “eat whole grains”, “just eat in a deficit”, “dairy is not only good for you but it is crucial!” into my head. What a crock of S**t. I would sit in class and eat ziplock baggies full of Go Lean high fiber cereal (because isn’t that a healthy snack?). Then I’d go home and eat more cereal, brown rice, or whole wheat pasta with nothing on it. Because, oh I forgot to mention- I was also a vegetarian for all of this time. That’s what I thought was “healthy”. What a vegetarian means, in the context of a kid who was raised in the 90s and is now a broke college student is, you guessed it, lots and lots of pasta, cheese, beans, and soy. My current self is dying a little inside just thinking about it. And I wondered why my stomach always hurting. Thankfully, all of this was about to change. On one fateful day in a Crossfit gym in Boston, about six or seven years ago, I was introduced to the idea of gut health. The idea of healing my body from the inside out. What does my bloated, distended, exploding intestines have to do with my thyroid? Oh, everything? Huh.
Diane and her friend Liz Wolfe spoke about nutrition from a perspective that I was extremely unfamiliar with. Also, keep in mind, I was still a vegetarian at this point so this whole “Paleo” thing was really throwing me off. Throughout the seminar I had this internal struggle happening in my head:
“But I thought whole grains were healthy?”
“Then why do I feel so sick”
“Isn’t Dairy mandatory? How will I get enough calcium?”
“Then why do I feel so sick”
“But doesn’t meat cause health issues”
“But I don’t eat meat and I still feel so sick”
“Isn’t soy healthy?”
“Ugh I still feel so sick”
“But what they are saying is crazy!”
“Crap, they’re citing legit sources!”
“Also, why do I still feel so sick if I’m doing everything ‘right’”.
Then all of a sudden something snapped. All of these horrible health problems I was having…they were not isolated. They did not each need their own individual treatment to relieve symptoms. They were all related. This was a turning point in my life and in my health and I will always be grateful to Diane for doing what she does. Keep spreading the word, girlfriend.
Despite popular belief, eating “Paleo” doesn’t have to be about chewing on a hunk of meat all day or eating globs of fat from a jar (bleck). I keep putting “Paleo” in quotes because I have never identified myself as “Paleo”. It wasn’t about the community aspect. It wasn’t about being part of some club that looked down on people who eat beans or grains. To me, this was about healing. It was about removing foods that exacerbated my thyroid symptoms and letting myself heal. No dogma necessary. What I took from this seminar so many years ago is this: You CAN change your diet to improve thyroid health and relieve symptoms. There ARE foods that should be avoided when you have hypothyroid/Hashimoto’s (and they aren’t the ones I was avoiding). Eat foods that heal your body. Remove “foods” that cause inflammation or may hurt your body. Eat a lot of non-starchy vegetables. Eat enough fat. Eat enough protein. Eat complex carbohydrates. Focus on nutrient density.
To reiterate, eating strict “Paleo” is not (in my opinion) necessary for everyone. Grains and legumes can be tolerated by many people without issue. And most can easily eat these foods and be successful with weight loss. These foods are not necessarily “unhealthy”. Also, just to be on the safe side here, I am not knocking vegetarians or vegans either. But thyroid disease changes the game. For me, poorly treated Hashimoto’s in the presence of large quantities of dairy, soy, and gluten had put my guts into a state of permeable havoc. So not only did I need to change my diet to support my thyroid health but I also needed to repair my gut, first and foremost. And many of you are in the same boat I was in. I was eating all wrong for what my body was going through. And there are so many men and women out there struggling who are resolved with the idea that they will always feel like crap. Part of the reason for this is because we start to not know what it feels like to feel good anymore. I was starting to forget. And I was starting to accept that being overweight, bald, depressed, and covered in acne was the way that I would stay.
I did not leave that seminar with a belly full of Paleo Kool Aid. I did not take Diane’s or Liz’s word for it. I left that day feeling confused and skeptical. So then I started to read some more. And study some more. Only this time, I had a new path. A new perspective. Not just “How to lose weight with this mother****ing disease I somehow got”. But “how to eat to heal my gut” and “what to eat to improve autoimmune Hashimoto’s symptoms” and “How do I support thyroid health with nutrition”.
For the first two or three years, I continued being a vegetarian. The changes I made were removing grains, legumes, dairy, soy, and processed foods. I stopped drinking milk alternatives with gums and fillers and avoided carrageenan. I stopped eating low fat. I ate carbohydrates in the form of starchy vegetables at every meal. I added fermented foods to my diet and started taking a quality probiotic. I started managing my stress by doing yoga a few times a week. Instead of beating myself up at the gym, I started listening to my body. Focusing on building muscle and interval training. Slowly but surely I started to feel like a human again. My skin to this day is clear (mostly). My guts are no longer exploding on the daily. My mood is stable. I can focus on a task long enough to have worked as a clinical dietitian and now I own my own business. I am 50 pounds lighter without restricting food or spending the massive amount of hours I was at the gym. My body no longer hurts. And I have been on the same dose of thyroid medication for over 3 years. Also…I just feel good. The biggest victory of them all. Seriously, though. I never thought the words “I feel good” would ever come out of my mouth.
Many years later, I continue to follow many of the same principles. However, I now eat legumes weekly and enjoy gluten free grains and dairy once in awhile without negative side effects. I know what works for my body at this point in time. I continue to be symptom-free.
As you probably know by now, I don’t do anything without a very convincing argument backed by some solid research. As a Registered Dietitian, I am well aware that everyone has a different body and every nutritional intervention is extremely person specific. However, if you are following a conventional (and even “healthy”) American diet and you are experiencing similar symptoms, I urge you to give my personal experience and the following information some thought.
The research clearly indicates a link between thyroid disease and gut permeability or “leaky gut”. For autoimmune thyroid disease, this is a what came first, the chicken or the egg situation. But honestly, who cares at this point. Once your gut begins to heal, your thyroid symptoms should begin to lessen. Your gut plays a major role in converting inactive thyroid hormone to active thyroid hormone (T4 to T3). Which is why when your endocrinologist or primary care doc only tests TSH it might come back normal even if you still are experiencing symptoms. Removing food from your diet that may cause inflammation and further gut permeability such as grains, legumes, dairy, alcohol, gums and emulsifiers such as carrageenan is a good first step. It is a good idea to work with a knowledgeable Registered Dietitian Nutritionist and an Endocrinologist during this process so that you can make sure you are not only getting the nutrients you need but also that your medication is adjusted correctly .
Aside from the extremely important process of healing your gut, there are a few other nutritional changes that those with thyroid disease should consider.
Do NOT crash diet or restrict carbohydrates as this will markedly decrease thyroid function . You may be tempted to keep dropping your calories because you are still not losing weight (And this is what everyone keeps telling you to do). However, this is a prime example of why it is so important to change what you eat…not just how much you are eating. Calorie restriction has been shown to greatly reduce the conversion of inactive T4 thyroid hormone to active T3 [4-6]. This is a big part of why those of us with hypothyroidism become so frustrated with weight loss. It is not as simple as calories in vs calories out. Every time we reduce calories in an effort to lose weight we are actually hindering our progress further. Moreover, the low carb trend keeps re-surfacing. Low carb or the ketogenic diet is not the answer to weight loss and especially not for anyone who is affected by thyroid disease. Insulin has an extremely important function in converting inactive thyroid hormone to active thyroid hormone. When you cut out or greatly reduce carbohydrates in your diet you are not only preventing insulin from doing its job but you are also depriving your gut of necessary prebiotics which can lead to dysbiosis and perpetuate your thyroid symptoms.
Remove Soya (soy) - yeah, I know soy is considered a “health” food. And without getting on my soap box about how processed or genetically modified it is, there is good evidence that supports the fact that soy products block the absorption of thyroid replacement hormone. Moreover, the isoflavonoids in soybeans actually prevent thyroperoxidase (TPO), an enzyme involved in the production of thyroid hormone, from doing its job .
Consider avoiding gluten with Hashimoto’s. Gluten can not only cause “leaky gut” by breaking apart the tight junctions of your intestine, but it also bears a striking resemblance to thyroid tissue. This molecular mimicry, in the presence of poor gut integrity, can promote an autoimmune reaction. Meaning when you eat gluten your body wants to attack the invading gluten molecule but is actually attacking your thyroid tissue.
Consider avoiding or greatly reducing dairy if you have Hashimoto’s or symptoms of dysbiosis. The casein in dairy products acts similarly in your body as gluten causing an immune mediated reaction. Dairy also contains protease inhibitors which promote gut permeability. As already discussed gut permeability not only leads to immune mediated reactions but also systemic inflammation which can negatively affect thyroid health and your weight loss efforts. Are we seeing a trend between our gut microbiota and our thyroid health yet?
Iodine may be helpful for those with hypothyroid because it supports thyroid activity. If you have Hashimoto’s, do not supplement with iodine as this can entice autoimmune flare-ups.
Do not avoid cruciferous foods (broccoli, cauliflower, brussel sprouts etc). Instead, try to mostly enjoy them cooked as the process of cooking reduces the goitrogenic substances. The health benefits of these foods far outweigh any negatives. These foods contain high amounts of vitamins, minerals, and anti inflammatory components.
This may seem like an overwhelming list of restrictions. But there are many foods that support thyroid health and many recipes that make these foods taste great. See below for some examples. (Note: these are not comprehensive lists)
Gluten free carbohydrates: white potatoes, sweet potatoes, parsnips, rutabagas, carrots, squash (acorn, butternut, spaghetti etc), plantains, and all fruit. For those who tolerate grains and legumes: quinoa, rice, oatmeal, black beans, lentils, kidney beans
Protein: eggs, poultry, fish, red meat, sea vegetables such as kelp or nori (caution with Hashimoto’s as these are high in iodine), hemp seeds, nutritional yeast etc
Fat: seeds (sunflower, sesame, hemp, pumpkin etc), nuts (almonds, cashews, pistachios etc), nut and seed butters, avocado, olives, coconut, olive oil, coconut oil etc
Fermented Foods: Kimchi, sauerkraut, kombucha, fermented vegetables, kefir
Eat as many vegetables as you can!
Here is what a day of eating might look like:
Breakfast - 2 eggs, ½ avocado, sauteed veggies, and sweet potato hash browns (or check out these frittata cups for work week mornings)
Snack - Almond Butter & apple slices
Lunch - Salad with baby kale, tomatoes, red onion, sunflower seeds, grilled chicken with homemade balsamic vinaigrette
Snack - Raw veggies and Tahini dip or cauliflower “hummus”
Dinner - Kimchi Fried “Rice”
I can not stress enough the importance of healing your gut and changing your diet to support thyroid health. Those with thyroid disease are a largely undertreated population, in my opinion. If you are struggling like I was and find yourself battling thyroid disease symptoms, don’t wait to make changes to your diet. If you don’t know where to start, make an appointment with me (Here) and I can help you get on the right track to support your gut and thyroid health.
Disclaimer: These recommendations are not to be followed in place of medical advice. Always consult with your primary care physician prior to changing your diet.
Note: you may need antibiotic therapy should you be suffering from small intestine bacterial overgrowth. Discuss the possibility of this with your doctor.
- Mahan, L. Kathleen., Escott-Stump, Sylvia., Raymond, Janice L.Krause, Marie V. (Eds.) (2012) Krause’s food & the nutrition care process /St. Louis, Mo. : Elsevier/Saunders