Hashimoto's thyroiditis is among the most prevalent thyroid disorders globally, significantly impacting the quality of life, even with medication. While there's no one-size-fits-all diet, research suggests that specific dietary approaches, like the Paleo diet, may offer relief.
This article delves into the existing research on Paleo and Autoimmune Paleo (AIP) diets and their potential impact on autoimmune thyroid disease (AITD), particularly Hashimoto's thyroiditis (HT).
Understanding the Paleo Diet
The Paleo diet aims to replicate the eating habits of our early ancestors, emphasizing whole, unprocessed foods. It is a classic elimination diet that focuses on omitting foods people are commonly sensitive to in an effort to lower inflammation. The traditional Paleo diet eliminates all grains, legumes, soy, and processed foods. The focus is on replacing the foods you take out of your diet with other nutrient-dense foods, such as organic or grass-fed meats, wild-caught fish, organic vegetables and fruits, nuts, seeds, eggs from pasture-raised hens, and (depending on who you ask) dairy.
Many people, even those not diagnosed with Hashimoto’s, are aware of the benefits of the Paleo diet. It has helped countless people feel better from a wide range of symptoms: fatigue, brain fog, joint pain, gas, and bloating, to name a few. In a survey, a resounding 81 percent reported that they felt better on a Paleo or grain free diet. In the case of Hashimoto’s, the traditional Paleo diet has even helped many people lower - or completely eradicate - their thyroid antibodies.
The Autoimmune Paleo (AIP) Diet: A Deeper Dive
The AIP diet is an extension of the Paleo diet, designed to further reduce inflammation and support gut healing, often necessary for those with autoimmune conditions like Hashimoto's.
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The creation of the AIP diet has been attributed to Loren Cordain, a scientist who discovered that certain foods can sometimes trigger inflammation in people with autoimmune disease. It was further popularized by Paleo authors such as Robb Wolf in The Paleo Solution, and Sarah Ballantyne (also known as The Paleo Mom) in her book, The Paleo Approach. The goal of the AIP diet is to heal leaky gut by removing commonly problematic foods, thereby reducing inflammation in the body and healing autoimmune disease.
AIP Diet Guidelines
The AIP diet involves two main phases: elimination and reintroduction. During the elimination phase, the following foods are avoided:
- Gluten
- Grains (including corn, quinoa, buckwheat, and rice)
- Dairy
- Eggs
- Soy
- Alcohol
- Caffeine
- Beans and legumes
- Nightshades - tomatoes, potatoes (except for sweet potatoes), eggplant, peppers, goji berries, ashwagandha (herb that helps balance adrenals), paprika and other nightshade spices
- Seaweed and other sea vegetables*
- Sweeteners (including honey, maple syrup, and agave) in high quantities (small amounts are allowed)
- Canned foods, processed foods, coffee
- High glycemic index foods
- All nuts and seeds (except coconut)
Foods to include on the AIP diet:
- Organic vegetables (except nightshades and legumes)
- Fermented foods (sauerkraut, nightshade free kimchi, coconut kefir, kombucha, fermented vegetables, and jams)
- Organic and grass-fed meats
- Organic and grass-fed organ meats
- Wild-caught fish
- Fats and oils
- Low-glycemic organic fruits
- Coconut (including coconut milk and coconut oil)
- Herbs and spices
- Hydrolyzed beef protein
- Sweet potatoes
Best Practices for AIP
- Limit fruits to 1-2 servings per day and make sure they are low on the glycemic index (a ranking of how fast carbohydrates are digested)
- Include 6-8 servings of vegetables per day
- Aim for 80 percent vegetables, and 20 percent meat or fish in each meal
- Focus on sauces, dips, and broths
- Incorporate plenty of fats and oils (coconut oil, duck fat, beef tallow, avocado oil, olive oil), cooked at the appropriate temperature
- Don’t eat on the run, and make sure to chew your food thoroughly
- Learn to ferment your own vegetables
- Drink plenty of filtered water
- Don’t forget to check supplement labels to make sure they are free of non-compliant ingredients.
Research on Paleo and AIP Diets for AITD
Systematic Review Findings
A systematic review examined Paleolithic diet (PD) interventions for adults with AITD to determine if diet elements have the potential to successfully reduce thyroid antibodies (Ab) such as thyroglobulin (Tg), thyroid peroxidase (TPO), and thyroid stimulating hormone receptor (TSHR), and improve thyroid hormones (thyroxine (T4), triiodothyronine (T3) and thyroid stimulating hormone (TSH)) or resolve AITD pathogenesis. The review analyzed one randomized controlled trial (RCT), a pilot study, and six case studies, highlighting that ancestral foods, specific supplements, exercise, mindfulness, and excluding modern foods can significantly impact thyroid Ab and hormones. The relevant studies suggest while this dietary protocol can be useful in clinical practice, larger-scale studies need to be conducted.
AIP Diet Pilot Study Results
A pilot study investigated the efficacy of a 10-week online health coaching program focused on the AIP diet for women with Hashimoto's. The study revealed statistically significant improvements in HRQL, particularly in physical role functioning, emotional role functioning, vitality, and general health. Clinical symptoms decreased from an average of 92 to 29. Inflammation, measured by hs-CRP, significantly decreased by 29 percent. Weight and BMI also saw statistically significant decreases.
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Interestingly, there were no statistically significant changes noted in any measure of thyroid function, including TSH, free and total T4, free and total T3, or thyroid antibodies. However, the study suggested that the AIP diet may decrease systemic inflammation and modulate the immune system, as evidenced by changes in white blood cell counts. Additionally, six out of the 13 women beginning the study on thyroid replacement medication decreased their dose of hormone replacement medication after the 10-week intervention, while all three of the women who began the study without the use of hormone replacement medication continued without the use of medication (as of the final post-intervention study visit). The authors of the study speculate that we would observe an eventual decrease in thyroid antibodies and a decreased need for thyroid medication, as well as further changes in immune and inflammatory markers, in participants adhering to the AIP dietary principles for longer periods of six to 12 months.
Anecdotal Evidence
Anecdotally, the Paleo diet is said to have been introduced in the 1970’s with the book The Stone Age Diet by Walter Voegtlin, but it has significantly gained in popularity over the past ten years. I’m sure many of you have seen these resources at your local bookstore, your go-to health food store, and even at Costco. It’s a very exciting time to be on a Paleo diet!
Potential Benefits of Paleo/AIP Diets for Hashimoto's
Based on the research and anecdotal evidence, Paleo and AIP diets may offer the following benefits for individuals with Hashimoto's:
- Reduced Inflammation: AIP may decrease systemic inflammation and modulate the immune system as evidenced by a decrease in mean hs-CRP and changes in white blood cell (WBC) counts.
- Symptom Relief: Many individuals report relief from symptoms like joint pain, muscle aches, fatigue, bloating, diarrhea, brain fog, tinnitus, and skin rashes.
- Improved Quality of Life: Studies have shown significant improvements in HRQL, particularly in areas like physical and emotional role functioning, vitality, and general health.
- Potential for Medication Reduction: Some individuals may be able to reduce their thyroid hormone replacement medication dosage under medical supervision.
Considerations and Cautions
- Iodine Deficiency: The Paleo diet may lead to iodine deficiency due to the exclusion of iodized salt and limited consumption of iodine-rich foods like seafood and seaweed. Monitor iodine levels and consider supplementation if necessary.
- Nutrient Deficiencies: Restrictive diets can increase the risk of nutrient deficiencies. Careful planning and potentially working with a registered dietitian or nutritionist are crucial to ensure adequate nutrient intake.
- Transition Period: There may be a transition period before you start feeling better on the AIP diet, especially if you are new to coming off gluten, dairy, and processed foods. Research suggests that casomorphins (from the dairy protein casein) and gliadorphins (from gluten, a protein found in wheat) can bind our “feel good” endorphin receptors, much like the morphine found in addictive drugs can.
- Individual Variability: Each case of Hashimoto’s is unique, and many of us have additional food sensitivities that are deregulating our immune system. People with Hashimoto’s often have sensitivities to a wide range of foods - particularly to gluten, dairy and soy - which are all omitted on the traditional Paleo diet.
- Not a Replacement for Medical Care: Dietary changes should not replace conventional medical treatment for Hashimoto's. Work closely with your doctor to monitor thyroid function and adjust medication as needed.
Getting Started with Paleo or AIP
If you're considering a Paleo or AIP diet for Hashimoto's, it's crucial to approach it strategically:
- Consult with Healthcare Professionals: Discuss your plans with your doctor and a registered dietitian or nutritionist to ensure the diet is appropriate for you and to address any potential nutrient deficiencies.
- Start Gradually: If the AIP diet seems overwhelming, begin with a Paleo diet and gradually eliminate additional foods as needed. Committing to a 100 percent gluten-free diet is an important first step, and 88 percent of readers with Hashimoto’s have indicated that they felt better after going gluten free.
- Focus on Nutrient-Dense Foods: Prioritize whole, unprocessed foods like vegetables, fruits, healthy fats, and quality protein sources.
- Plan Your Meals: Meal planning can help you stay on track and ensure you're getting adequate nutrition.
- Listen to Your Body: Pay attention to how different foods affect your symptoms and adjust your diet accordingly.
- Reintroduction Phase: After the elimination phase, systematically reintroduce foods one at a time to identify any specific triggers. This allows you to create a diet for the long term that is tailor-made for you.
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