The thyroid, a small gland shaped like a butterfly located in the throat, plays a crucial role in regulating the body's metabolism. Hypothyroidism, or an underactive thyroid, occurs when the thyroid gland doesn't produce enough thyroid hormones. This deficiency can lead to a slowed metabolism, resulting in symptoms such as weight gain and fatigue. While diet cannot cure hypothyroidism, it can significantly help in managing the condition, especially when co-existing with non-alcoholic fatty liver disease (NAFLD).
Understanding Hypothyroidism and Its Management
Having hypothyroidism means the body lacks sufficient thyroid hormones, which are essential for growth, cell repair, and metabolism. While medication is the primary treatment, dietary modifications can alleviate symptoms and support overall health.
Key points to consider:
- Certain nutrients, like iodine, selenium, and zinc, are vital for healthy thyroid function.
- Some foods can negatively impact thyroid function, worsening hypothyroidism symptoms.
- Certain foods and supplements may interfere with the absorption of thyroid replacement medication.
The Connection Between Hypothyroidism and NAFLD
Non-alcoholic fatty liver disease (NAFLD) is a global health concern, affecting approximately 25% of the adult population worldwide. It is characterized by the accumulation of fat in the liver of individuals who do not consume excessive amounts of alcohol. NAFLD is often associated with metabolic disorders, including obesity, type 2 diabetes, and dyslipidemia. Notably, metabolic syndrome, which frequently accompanies hypothyroidism, is a significant risk factor for NAFLD.
The relationship between hypothyroidism and NAFLD is complex and not fully understood. While some studies suggest a direct link between the two conditions, others indicate that NAFLD in individuals with hypothyroidism may be more related to lifestyle factors such as poor diet and low physical activity.
Read also: Impact of Low-Carb on Thyroid
Essential Nutrients for Thyroid Health
Iodine
Iodine is crucial for the production of thyroid hormones. Since the body cannot produce it, iodine must be obtained through diet.
- Sources: Iodized table salt, saltwater fish, seaweed, milk, cheese, whole eggs.
- Considerations: Iodine deficiency can cause an enlarged thyroid gland (goiter). The wide use of iodized salt has made iodine deficiency relatively uncommon in the United States, but it remains prevalent in other regions. However, excessive iodine intake can worsen both hypothyroidism and hyperthyroidism. Therefore, iodine supplementation should only be considered upon a doctor's recommendation.
Selenium
Selenium is a micronutrient with antioxidant properties that plays a critical role in thyroid hormone production. Thyroid tissue naturally contains selenium.
- Sources: Brazil nuts, tuna, shrimp, beef, turkey, chicken, ham, eggs, oatmeal, brown rice.
- Considerations: Maintaining adequate selenium levels can help prevent thyroid disease and promote overall health. Selenium supplements may be helpful for people with hypothyroidism who have a selenium deficiency, but it's important to stay within the National Institutes of Health (NIH) daily upper limit of 400 mcg for adults to avoid toxicity.
Zinc
Zinc is another nutrient that can benefit people with low levels of thyroid hormones.
- Sources: Oysters, beef, crab, fortified cereals, pork, chicken, legumes, pumpkin seeds, yogurt.
- Considerations: Zinc supplementation, alone or in combination with selenium, has been shown to improve thyroid function in females with hypothyroidism. If a zinc deficiency is suspected, consulting with a healthcare professional is advisable to determine if supplementation is appropriate.
Other Important Nutrients
- Vitamin D: Deficiency is a risk factor for autoimmune thyroid conditions like hypothyroidism.
- Vitamin B12: Deficiency is common in people with hypothyroidism.
- Magnesium: Low levels may contribute to thyroid dysfunction and hypothyroidism.
- Iron: Low iron levels or iron deficiency anemia can impair thyroid function.
- Vitamin A, Folate, Calcium: Other nutrient deficiencies may contribute to hypothyroidism.
Foods to Limit or Avoid
Goitrogens
Goitrogens are compounds that can affect thyroid function if consumed in large amounts.
- Sources: Green cruciferous vegetables like collards, Brussels sprouts, Russian kale, broccoli, broccoli rabe, cauliflower, and cabbage.
- Considerations: Cooking deactivates most goitrogenic compounds, so these vegetables are generally beneficial in regular amounts.
Soy
Some evidence suggests that soy may interfere with thyroid hormone production.
Read also: Plant-Based Diet Thyroid Health
- Sources: Soy milk, soy sauce, edamame, tofu, miso.
- Considerations: While some studies indicate that soy has no significant effect on thyroid levels, more research is needed to fully understand its impact.
Gluten
People with Hashimoto’s disease, a common cause of hypothyroidism, are more likely to have celiac disease.
- Sources: Wheat, barley, oats, rye.
- Considerations: Removing gluten from the diet may improve thyroid function in people with Hashimoto’s who do not have celiac disease.
Processed Foods
Reducing the intake of ultra-processed foods and added sugars can improve symptoms, manage weight, and boost overall well-being.
- Examples: Fast food, hot dogs, donuts, cakes, cookies, soda.
Other Considerations
- Timing of Medication: Take thyroid medication on an empty stomach, at least 30 to 60 minutes before breakfast or 3 to 4 hours after dinner.
- Interfering Substances: Avoid taking thyroid medication within 4 hours of consuming foods or supplements containing iron or calcium, as well as antacids, milk, calcium supplements, iron supplements, high-fiber foods, iodine-rich foods, and soy-based foods.
Dietary Guidelines for Hypothyroidism and NAFLD
A well-balanced diet is crucial for managing both hypothyroidism and NAFLD. The Mediterranean diet is often recommended due to its emphasis on fruits, vegetables, whole grains, lean proteins, and healthy fats. This eating pattern is rich in fiber, vitamins, minerals, and polyphenols, which have antioxidant and anti-inflammatory properties.
Foods to Emphasize
- 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 Proteins: Fish, 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: Paprika, saffron, turmeric, basil, rosemary, salsa, mustard.
- Beverages: Water, unsweetened tea, coffee, sparkling water.
Foods to Limit or Avoid
- Ultra-Processed Foods: Processed snack foods, soda, sweetened beverages, sweetened breakfast cereals, flavored granola bars with preservatives.
- Gluten: (For those with celiac disease or gluten sensitivity) Wheat, barley, triticale, rye.
- Goitrogens: (In large amounts) Cabbage, Russian kale, bok choy, Brussels sprouts, soy, pearl millet.
- Fried Foods: Fried chicken, fries, fried snacks.
- High-Sugar Foods: Candy, desserts, sugary cereals.
- Refined Carbohydrates: White bread, pasta, pastries.
- Alcohol: Reducing alcohol intake is crucial.
- Processed Meats: Bacon, sausages, deli meats.
Sample 7-Day Meal Plan
This meal plan is designed for an omnivorous person with hypothyroidism and NAFLD, focusing on nutrient-dense, whole foods.
Day 1
- Breakfast: ½ cup rolled oats cooked with water, topped with ½ cup of mixed berries and 1 tablespoon of chopped walnuts. Sprinkle some cinnamon powder for an anti-inflammatory boost
- Lunch: Large mixed greens salad with chopped cucumber, bell peppers, tomatoes, and ½ cup of chickpeas, dressed with olive oil, lemon juice, and Italian spices
- Dinner: 4 oz baked salmon seasoned with herbs, served with 1 cup of steamed broccoli and ½ a baked sweet potato. Sprinkle a little garlic salt on the broccoli for added flavor
- Snacks: Apple slices with peanut butter, rice cakes with banana, a cup of unsweetened green tea
Day 2
- Breakfast: ¾ cup plain Greek yogurt (2% fat) topped with 5-6 sliced strawberries and a handful of chia seeds. If you like, you can swap the berries for a kiwi or cantaloupe
- Lunch: Tuna salad. Mix 1 can of tuna (packed in water, drained) with diced cucumber, cherry tomatoes, red onion, 1 tbsp olive oil, lemon juice, and fresh herbs like parsley or dill. Serve with whole-grain crackers. Optional: add a spoonful of Greek yogurt
- Dinner: Chicken and vegetable stir-fry. Sauté a sliced chicken breast with 2 cups of mixed veggies (like snap peas and carrots or bok choy and carrots), garlic, and grated ginger in olive oil and low-sodium soy sauce. Serve with ½ cup of brown rice. Optional: Cook the brown rice in low-sodium vegetable broth for more flavor
- Snacks: A handful of almonds, air-popped popcorn
Day 3
- Breakfast: Morning boost smoothie made with 1 cup of spinach, ½ banana, 1 tablespoon of flaxseed powder, and 1 cup of unsweetened almond milk
- Lunch: A large salad with 3 oz of grilled chicken strips, mixed greens, cherry tomatoes, and a light vinaigrette
- Dinner: Hearty lentil soup made with cooked lentils of your choice, sautéed onions and garlic, cumin powder and paprika (add any other spices of your choice), and low-sodium vegetable broth. Add cooked seasonal veggies for fiber and flavor. Serve with a slice of whole-grain toast
- Snacks: Carrot sticks with 2 tablespoons of hummus, mashed avocado on toast
Day 4
- Breakfast: ½ cup rolled oats cooked with water, topped with sliced banana or some peaches, and 1 tablespoon of chia seeds
- Lunch: Turkey and avocado wrap using a whole-wheat tortilla, filled with lettuce, a sliced tomato, and cucumber slices, with salt and pepper. Add a dollop of Greek yogurt if you want a “creamier” feel without mayonnaise
- Dinner: Sheet pan chicken and veggies. Toss 4 oz chicken breast and 2 cups of chopped vegetables (zucchini or squash and red onion) with 1 tablespoon of olive oil and herbs. Roast at 400°F (200°C)
- Snacks: A small pear, a boiled egg
Day 5
- Breakfast: Loaded scrambled eggs with 2 eggs, sautéed mushrooms and onions, and a handful of spinach. Add a dash of any spices you like. Serve with a slice of whole-grain toast
- Lunch: Turkey lettuce wraps. Sautee lean ground turkey with low-sodium soy sauce, minced ginger and garlic, the whites of green onions, and a little sriracha sauce or chili paste for heat (you can use paprika to reduce the spice level). Garnish with the chopped greens from the green onion and wrap in lettuce leaves to eat. Swap turkey for tofu to make it vegan
- Dinner: Quinoa bowl. Top ½ cup of cooked quinoa with ½ cup of black beans, ¼ avocado (sliced), and a generous spoonful of pico de gallo made with chopped tomatoes, onions, serrano or jalapeno peppers, a little cilantro, and lemon juice
- Snacks: A handful of walnuts, roasted chickpeas
Day 6
- Breakfast: Savory steel-cut oats cooked in water and low-sodium vegetable broth and garlic powder. Top with a poached egg, green and red peppers (saute them if you don’t like them raw), and fresh herbs of your choice. Swap the peppers for lightly blanched spinach or bok choy if you prefer
- Lunch: Chickpea salad sandwich. Make chickpea salad with canned chickpeas, chopped tomatoes, cucumber, herbs, and your favorite vinaigrette. Add to whole-grain toast slices. Optional: add lettuce leaves for more crunch
- Dinner: 4 oz baked cod with lemon and dill, served with 1 cup of roasted asparagus and a small side salad
- Snacks: A mandarin orange, Greek yogurt with blueberries, or pear slices
Day 7
- Breakfast: Smoothie made with 1 cup of kale, ½ cup of frozen mango or berries, 1 tablespoon of almond butter, and 1 cup of unsweetened almond milk
- Lunch: A large spinach salad topped with 2 hard-boiled eggs, slivered almonds, and a light balsamic dressing
- Dinner: Turkey meatballs (made with lean ground turkey) in a no-sugar-added marinara sauce, served over 1 cup of spaghetti squash
- Snacks: A small bowl of mixed berries, carrot sticks with a spoonful of almond butter
Additional Lifestyle Modifications
- Regular Exercise: Engage in moderate- to high-intensity aerobic exercise and strength training to boost metabolism and promote weight loss. Aim for at least 150 minutes of moderate activity per week.
- Weight Management: Losing 5% to 10% of body weight can significantly reduce liver fat and inflammation.
- Hydration: Drink plenty of water to keep your liver healthy and flush out toxins.
- Quit Smoking: Smoking can worsen both hypothyroidism and NAFLD.
The Role of a Dietitian
Working with a registered dietitian can be invaluable for individuals managing both hypothyroidism and NAFLD. A dietitian can help:
Read also: Managing PCOS and Hypothyroidism with Diet
- Identify food sensitivities.
- Develop a balanced eating plan tailored to individual needs and preferences.
- Provide guidance on meal planning, grocery shopping, and cooking.
- Offer support and motivation to make sustainable lifestyle changes.