Physicians and endocrinologists often encounter questions about dietary interventions for patients with thyroid disorders. Misconceptions about thyroid-specific diets are common, stemming from misinformation in popular media and misinterpretations of scientific data. This article addresses frequently asked questions about diet and hypothyroidism, providing evidence-based guidelines.
Understanding Hypothyroidism
Hypothyroidism is a condition where the thyroid gland doesn't produce enough thyroid hormones, which are crucial for regulating growth, cell repair, and metabolism. Affecting approximately 10-15% of individuals, thyroid disorders are prevalent in the general population. While medication is the primary treatment, a balanced diet can alleviate symptoms and support overall health.
Benefits of Dietary Interventions
For individuals with hypothyroidism, including Hashimoto’s thyroiditis, dietary interventions can offer several benefits:
- Improving thyroid function
- Maintaining a moderate body weight
- Reducing symptoms of hypothyroidism
- Addressing nutrient deficiencies that worsen symptoms
General Dietary Recommendations
While there's no one-size-fits-all "thyroid diet," certain eating patterns can be beneficial. A diet low in pro-inflammatory foods, added sugar, and ultra-processed foods is generally helpful. Focus on a balanced and nutritious diet tailored to individual needs, considering calorie intake and any comorbidities. It is not advisable to overly focus on consuming large quantities of specific dietary constituents while completely discarding others. Instead, patients should be counselled on maintaining a balanced and nutritious diet tailored to their individual needs, with attention to calorie intake based on their anthropometry and consideration of any comorbidities they may have.
Beneficial eating patterns may include:
Read also: The Hoxsey Diet
- Mediterranean diet: Rich in vegetables, fruits, lean proteins, and whole grains, which may protect against cellular damage.
- Anti-inflammatory diet: Focuses on reducing inflammation in the body.
- Paleo diet: Emphasizes whole, unprocessed foods.
- Autoimmune elimination diets: Should be followed under medical supervision.
Key Nutrients for Thyroid Health
Certain nutrients play a crucial role in thyroid hormone synthesis and metabolism. Addressing deficiencies can significantly improve thyroid health.
Iodine
Iodine is essential for making thyroid hormones. Deficiency is a common cause of hypothyroidism worldwide, though less so in developed countries due to iodized salt. People who don’t use iodized salt, pregnant individuals, and those following vegan diets are at higher risk of deficiency.
However, excessive iodine can be harmful, especially for those with autoimmune hypothyroidism like Hashimoto's thyroiditis. Consult a healthcare professional to test iodine levels and manage intake. They may advise avoiding iodine-rich foods like seaweed and kelp.
Selenium
Selenium supports thyroid hormone production and protects the thyroid from oxidative stress. Deficiency has been linked to autoimmune thyroid disease. Selenium-rich foods include Brazil nuts, tuna, sardines, eggs, and legumes.
The National Institutes of Health (NIH) recommends a daily upper limit of 400 mcg of selenium for adults. High intake can cause hair and nail loss, diarrhea, nausea, and skin rash. Selenium toxicity can lead to kidney failure, heart attack, and breathing problems.
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Zinc
Zinc is needed for thyroid hormone production and function. Deficiency can negatively affect thyroid function and worsen hypothyroidism. A 2021 study suggested that supplements containing zinc, vitamin A, and selenium may increase thyroid hormone production in people with hypothyroidism. Consult a healthcare professional to determine if a zinc supplement is appropriate.
Other Important Nutrients
- Vitamin D: Deficiency is a risk factor for autoimmune thyroid conditions. Supplementation may be necessary.
- Vitamin B12: Deficiency is common in hypothyroidism. Doctors may recommend B12-rich foods or supplements.
- Magnesium: Low magnesium levels may contribute to thyroid dysfunction. Magnesium-rich foods or supplementation may improve symptoms.
- Iron: Low iron levels can impair thyroid function. Supplementation is often necessary.
Other nutrient deficiencies that may contribute to hypothyroidism may include:vitamin Afolatecalcium
Foods to Limit or Avoid
Certain foods can interfere with thyroid function or medication absorption.
Ultra-Processed Foods
These foods may increase inflammation and oxidative stress, which can worsen markers of inflammation in Hashimoto's thyroiditis.
Examples include:
Read also: Weight Loss with Low-FODMAP
- Processed snack foods (potato chips)
- Soda and sweetened beverages
- Sweetened breakfast cereals
- Flavored granola bars with preservatives
Gluten
If you have celiac disease or gluten sensitivity, a gluten-free diet is recommended. Gluten is found in wheat, barley, triticale, and rye. Hypothyroid patients with celiac disease, non-compliant with gluten-free diet need 50% greater levothyroxine dosage to achieve target TSH. However, there is no evidence that a gluten-free diet alters the natural history of autoimmune thyroid disorders unless it is associated with celiac disease. Thus, a gluten-restricted diet is not recommended for usual hypothyroid patients.
Goitrogens
Goitrogens are substances in soy products and cruciferous vegetables that may interfere with thyroid hormone production. However, most people can enjoy moderate amounts of goitrogenic foods without negative effects. Cooking goitrogenic foods reduces their activity.
Goitrogenic foods include:
- Cabbage
- Russian kale
- Bok choy
- Brussels sprouts
- Soy
- Pearl millet
Cruciferous vegetables like broccoli are low in goitrogens. Limit the regular consumption of large amounts of juice made with raw cruciferous vegetables.
Cassava (Yuca)
Cassava, also known as yuca, is a root vegetable that can be toxic if not prepared properly. The toxins released can slow down thyroid hormone production, so it’s not recommended for people with hypothyroidism.
Thyroid Supplements
Avoid thyroid supplements, particularly those containing iodine or L-tyrosine, unless recommended by a healthcare provider. Excessive iodine can worsen thyroid conditions. L-tyrosine works similar to thyroid hormone medication. So, by taking those supplements when you’re already taking thyroid hormone means you can end up with too much thyroid hormone altogether
Foods to Include in Your Diet
A diet rich in nutritious foods can improve overall health and reduce the risk of health conditions linked with hypothyroidism.
- Fruits: Berries, apples, peaches, pears, grapes, citrus fruits, pineapple, bananas
- Non-starchy vegetables: Greens, artichokes, zucchini, asparagus, carrots, peppers, spinach, mushrooms
- Starchy vegetables: Sweet potatoes, potatoes, peas, butternut squash
- Lean fish, eggs, meat, and poultry: Fish and shellfish, eggs, turkey, chicken
- Healthy fats: Olive oil, avocados, avocado oil, coconut oil, unsweetened coconut, full fat yogurt
- Whole grains: Brown rice, rolled oats, quinoa, brown rice pasta
- Seeds, nuts, and nut butters: Almonds, cashews, macadamia nuts, pumpkin seeds, natural peanut butter
- Beans and lentils: Chickpeas, kidney beans, lentils
- Dairy and nondairy substitutes: Coconut milk, cashew milk, coconut yogurt, almond milk, unsweetened yogurt, cheese
- Spices, herbs, and condiments: Spices like paprika, saffron, turmeric, fresh or dried herbs like basil or rosemary, and condiments like salsa or mustard
- Beverages: Water, unsweetened tea, coffee, sparkling water
Optimizing Medication Absorption
Ensure you take thyroid medication on an empty stomach to promote optimal absorption. Avoid beverages, foods, and supplements that could interfere with medication absorption.
- Take medications like levothyroxine at least 30 to 60 minutes before breakfast or 3 to 4 hours after dinner.
- Take your medication on an empty stomach.
- Wait at least 30 minutes before consuming foods or beverages besides water, including caffeinated beverages.
- Avoid taking thyroid medication within 4 hours of taking iron or calcium supplements. Studies have demonstrated that simultaneous intake of levothyroxine with cow’s milk significantly impairs its absorption, likely due to interference from milk’s calcium content. Consequently, it is advised to avoid consuming cow’s milk concurrently with levothyroxine.
Sample 1-Week Meal Plan
Here is a sample 1-week meal plan for an omnivorous person with hypothyroidism:
- Monday
- Breakfast: Scrambled eggs with salmon
- Lunch: A salad with grilled shrimp
- Dinner: A black bean and vegetable stir-fry with brown rice
- Tuesday
- Breakfast: A fruit salad with yogurt and sliced almonds
- Lunch: A grilled chicken salad topped with pumpkin seeds
- Dinner: Baked salmon with roasted vegetables
- Wednesday
- Breakfast: An omelet with mushrooms and zucchini
- Lunch: Bean soup with a whole wheat or gluten-free roll
- Dinner: Shrimp fajitas with corn tortillas, peppers, and onions
- Thursday
- Breakfast: A protein smoothie with berries and nut butter
- Lunch: A cauliflower rice bowl with ground turkey, black beans, salsa, guacamole, cheese, and veggies
- Dinner: Roasted chicken with quinoa and broccoli
- Friday
- Breakfast: Poached or boiled eggs with avocados and berries
- Lunch: Tuna salad lettuce cups with whole wheat or gluten-free crackers
- Dinner: A grilled steak with baked sweet potato and a side salad
- Saturday
- Breakfast: Coconut yogurt with berries and almond butter
- Lunch: A turkey burger on a green salad with sweet potato fries
- Dinner: Pan-fried crab cakes with brown rice and vegetables
- Sunday
- Breakfast: A frittata with vegetables
- Lunch: A quinoa bowl with vegetables and chickpeas
- Dinner: Grilled shrimp skewers with bell peppers and pineapple
Addressing Common Concerns
Weight Management
Hypothyroidism can slow metabolism, making weight management challenging. A healthy diet rich in fruits, vegetables, filling proteins, and healthy fats can help. These foods are also rich in fiber, which may help people feel fuller for longer. Regular exercise, including aerobic and strength training, can boost metabolism and promote weight loss.
Iodine Intake
Maintaining optimal iodine levels is crucial for thyroid physiology. An individual’s iodine status largely depends on their geographical location and the implementation of salt iodization programs at the population level. In individuals residing in iodine-sufficient geographical areas or under successful USI programs, we recommend against consuming specific iodine-rich foods for those with euthyroidism or hypothyroidism, except for pregnant and lactating mothers.
Special Considerations
- Lactose Intolerance: Patients with lactose intolerance may require a higher dose of levothyroxine to achieve optimal serum TSH levels. Research indicated that levothyroxine-treated hypothyroid patients with lactose intolerance and Hashimoto’s thyroiditis experienced a significant decrease in serum TSH levels upon abstaining from milk products.
- Thyroid Cancer: Drawing conclusions from epidemiological studies on the influence of diet on thyroid cancer is challenging due to the multitude of confounding factors present. Given the heterogeneous and conflicting results observed in different epidemiological studies, it is currently not advisable to recommend for or against any diet concerning thyroid cancer.
The Role of Physicians and Endocrinologists
Physicians and endocrinologists play a crucial role in guiding patients with thyroid disorders toward making informed decisions regarding their diet. Despite widespread discussion, there is no scientific concept known as a ‘thyroid diet’. While there is a substantial body of evidence regarding certain aspects of diet and thyroid health, the data are often mixed and contradictory.
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