Hashimoto's diet

Hashimoto’s thyroiditis is a complicated autoimmune condition with many layers that must be unraveled for its effective treatment.

Even though conventional medicine may look at each body system as a separate category and is primarily concerned with the thyroid’s ability to produce thyroid hormones, Hashimoto’s is a far more complicated issue than just hypothyroidism.

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The thyroid is part of a complicated body system and does not live by itself in a vacuum, but harmoniously with the other organ systems of the body.

Hashimoto’s isn’t but a manifestation of a broader metabolic, physiologic and immune imbalance, which is why patients with Hashimoto’s often present with acid reflux, nutrient deficiencies, anemia, increased intestinal permeability, food sensitivities, gum disorders, and hypoglycemia in addition to the “typical” hypothyroid symptoms, such as hair loss, weight gain, cold extremities, fatigue, dry skin, constipation, etc.

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In Hashimoto’s the patient’s body becomes stuck in a chronic state of immune system overload, adrenal insufficiency, gut dysbiosis, impaired digestion, inflammation, and thyroid hormone release abnormalities.

These changes often lead to the symptoms of anxiety, depression, insomnia, and chronic fatigue, often seen in people with Hashimoto’s.

This cycle is interrelated and reinforces itself through a positive feedback loop, meaning the cycle is self-sustaining and continues to cause increasingly more symptoms until an external factor intervenes and breaks the cycle.

Clinical and anecdotal experience have shown that simply adding exogenous thyroid hormone supplementation to the mix does not result in full recovery for the majority of thyroid patients.

Additionally, supporting just the thyroid gland often disrupts the normal physiology of other parts of the body, such as the adrenals and immune system, which in turn exacerbates the condition and perpetuates the vicious cycle.

The human body, being a complex system, requires each intervention to be counterbalanced to ensure no imbalances are being inadvertently created in other parts of the body.

Thus, a smartly-designed dietary approach in dealing with Hashimoto’s must always start with the simplest modifications – removing triggers – and be followed with repairing the other broken systems to restore equilibrium and allow the body to heal itself. 

What Is the Right Diet For Healing Hashimoto’s?

Unfortunately, the answer to this question can very complicated, as individual characteristics, past dietary habits, medical history, and genetic factors can all alter the ideal regime for a successful outcome.

Nutrition is one of the few sciences in which multiple answers can be both right and wrong, which is why many people also call it an art.

That means that the are many paths to the same destination and that one man’s meat is another man’s poison.

What is known with certainty, however, is that the three main contributing factors to thyroid autoimmunity are 1) Genes 2) Triggers 3) Intestinal permeability.

While we are not able (yet) to alter and change our genes, we have significant control over their expression by removing triggers, altering our lifestyle and correcting intestinal permeability.

For some, it may be as easy as eliminating excess iodine intake or cutting out dairy or gluten (a major cause of increased intestinal permeability).

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Others may require a significant lifestyle change, including diet and interventions aimed at removing parasitic, fungal, bacterial, and viral infections; avoiding environmental triggers; trading offending foods for healing foods; balancing blood sugar; and practicing stress reduction.

There is great diversity from person to person in the approach someone should follow to resolve a medical condition and that also applies to Hashimoto’s.

In the last decades, multiple diets have been used and reported to reverse Hashimoto’s and other autoimmune conditions.

Such diets include a gluten-free diet, iodine-free diet, Feingold diet, Specific Carbohydrate Diet (SCD), GAPS diet, Paleo diet, soy-free diet, dairy-free diet (especially without cow’s milk products), low FODMAPs diet, the Body Ecology diet, and elemental diet.

The common theme behind all these diverse dietary regimens is they all remove reactive foods.

Most of these diets include animal proteins, are more nutrient-dense than the Standard American Diet (SAD), and remove processed foods.

Many of these diets also recommend gut-healing foods, such as fermented vegetables (i.e., kimchi, sauerkraut), bone broth and gelatins.

Highly plant-based, vegan and vegetarian diets are naturally alkaline-forming and can be extremely beneficial in dealing with any inflammatory condition, including Hashimoto’s; however, there are no official reports of people recovering from Hashimoto’s by just following these types of diets.

Even devout vegans who are nutritionally conscious still can struggle with low body temperatures, hypothyroidism, and Hashimoto’s.

Many former vegans have actually reported improved symptoms of Hashimoto’s following transitioning to a Paleo diet.

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Based on this, we firmly believe that animal proteins may play an important role in building back the health of people with Hashimoto’s.

That said, while meat and fats are important for healing, eating them exclusively (as in a carnivore diet) produces an acidic environment in the body, hindering healing.

Thus, the diet should be balanced with plenty of nutrient and antioxidant-rich vegetables (the suggested ratio is 20 percent meat / 80 percent veggies).

Vegan and raw vegan diets, in particular, can be extremely helpful for cleansing and detoxifying, especially for those with persistent digestion issues.

A vegan diet may be followed by a few days to a few weeks and may help the body detoxify.

B12 and iron or ferritin supplements should be utilized at this time to prevent deficiencies.

Another approach may be to follow a “semi-vegan” diet, or the “Morning vegan approach”, in which one eats primarily vegan foods (fruits, vegetables, nuts, seeds) for breakfast and lunch, but consumes a meat-based meal for dinner.

Which Of These Approaches Is Right For Me?

While it’s hard to predict who will do well with which approach, generally those with a history of gastrointestinal issues (IBS, GERD, stomach aches, food intolerances); antibiotic and oral contraceptive use; and high-carbohydrate diets will require more time and lifestyle changes for healing.

Variables such as being underweight / normal weight or a younger age at the onset of symptoms (under thirty) may mean more comprehensive and complex approaches must be followed.

The Perfect Diet?

Intestinal permeability is present in all autoimmune conditions and may be caused by small-intestinal bacterial overgrowth (SIBO), dysbiosis, Candida overgrowth, parasites, or food reactions – or, in many cases, a vicious cycle of all of the above.

Many individualized factors should be taken into account when designing a diet for overcoming Hashimoto’s, including individual food reactions, the compositions of one’s intestinal flora, blood sugar abnormalities, depletions, infections, and the person’s ability to digest and absorb nutrients from foods.

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Working with a nutritionist or coach specially trained in thyroid / autoimmune diets may be extremely helpful in developing an individualized healing diet.

The principles of a healing dietary protocol are as follows. The dietary protocol should:

  1. Take the person’s individuality into account
  2. Remove triggering foods
  3. Add healing foods
  4. Replenish nutrients

The following diets are intended for healing but may not necessarily need to be followed indefinitely.

For some, components of otherwise healthful diets such as fruit and fiber might need to be temporarily limited to help with healing.

Considerations For Individualizing The Dietary Approach

The limitation of the FODMAPs and Paleo diets is they do not take into account the individuality of each person.

One person may do just fine with dairy, while another may react terribly to it.

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These diets should thus be used as a guide for developing a personalized approach to overcoming an autoimmune thyroid disorder.

The SCD, GAPS, and Body Ecology diets are programs that focus on healing and sealing the intestinal lining by first removing offending agents and then adding back nutritious foods and probiotics, allowing digestion to catch up.

The programs start with an Introduction Phase.

Think of the introduction phase as a “baby food phase” as these types of “introduction” diets are also fed to babies, who have increased intestinal permeability.

The diets start with easy-to-digest broths, soups, and purees.

They advance to well-cooked meats and vegetables, cooked fruits, fruit juices, and eventually raw fruits and vegetables, introducing one new food every four days or so.

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The GAPS diet starts off like “low-residue diets”, low in indigestible fiber to starve the pathogenic bacteria.

Even with the use of diet and probiotics, changes in bacterial flora happen gradually, and it may take up to two years for the beneficial bacteria to replace the pathogenic bacteria.

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The GAPS and SCD diets need to be continued for one year after the last symptoms before new foods are introduced.

Your body’s ability to digest and assimilate nutrients from foods needs to be considered.

Some people may require digestive enzymes.

In advanced cases, the bacterial flora may be so affected that even fiber in the diet may need to be discontinued for a short period of time, as it feeds the pathogenic bacterial flora (FODMAPs, low-residue, GAPS approach, elemental diet).

Small intestinal bacterial overgrowth (SIBO) may be the cause of a shifted autoimmune response and thus may be responsible for Hashimoto’s and food intolerances.

The GAPS diet, SCD diet, elemental diet, FODMAPs Diet, Body Ecology Diet and the trendy Paleo diet are examples of diets that can be helpful for overcoming small intestinal bacterial overgrowth by “starving” out the pathogens and reintroducing beneficial bacteria.

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Fiber and fruit both can contribute to small intestinal bacterial overgrowth and may also need to be limited.

It is likely that leaky gut has led to the development of IgG / IgA intolerances to multiple foods.

A “baby food” diet may need to be introduced to help prevent further irritation of the intestinal tight junctions in conjunction with healing foods and supplements.

In this case, the person starts by eating the foods that are the easiest to digest, progressing to those that are harder to digest.

In the meantime, supplementation with vitamins and minerals is also recommended as the body is likely not absorbing them (elimination / introduction diet).

Those with protein malabsorption / low stomach acid may benefit from a temporary break from proteins (animal proteins are the hardest to digest), such as in a juice cleanse, elemental diet, or other type of cleanse.

Digestive enzymes should also be used with all protein foods.

An overview of the most helpful dietary approaches is listed as follows, starting with the diets requiring the greatest lifestyle changes to those requiring the fewest.

1. Elemental Diet

An elemental diet is a liquid diet that is free of non-digestible substances such as fiber, complex carbohydrates, and protein structures.

It contains our essential macronutrients in a state that requires little to no digestion and results in complete absorption.

A low-residue diet, the elemental diet is composed of free amino acids and fat in liquid form.

Amino acids, glucose, fat, and vitamin / mineral supplements are utilized instead of food.

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The elemental diet has been traditionally used for rehabilitation of severely malnourished individuals, bowel inflammation, and diarrhea.

This diet results in reduced secretion of pancreatic and gastric juices, giving the stomach and pancreas a rest from activity and allowing for healing and reduction of inflammation to take place.

As the diet has little residue, it results in slower movement of the GI tract, which speeds up healing.

Additionally, free-form amino acids allow for the body’s own protein to be spared, helping the rest of the body heal quicker.

An elemental diet may be extremely beneficial in kick-starting the process of the thyroid-healing diet.

This diet causes a rapid shift in bacterial flora within one to two weeks.

As an extremely low-residue diet, it requires no digestion and does not provide any food to the pathogenic bacteria, thus starving them.

Clinical trials have shown this diet is effective in reducing SIBO within two weeks in people with IBS, resulting in a substantial improvement of symptoms.

The drawbacks of the diet are that amino acids are expensive and taste pretty disgusting if not properly prepared.

People report feeling nauseated after drinking the solution, and aspiration has resulted when people lie down too quickly following ingestion.

Commercially available formulas (e.g., Vivonex®) contain a lot of artificial ingredients people with Hashimoto’s may not tolerate.

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They also include loads of carbohydrates, which can cause high blood sugar and harm adrenal function.

Additionally, many of the elemental formulas have added iodine.

Some critics of the elemental diets also noticed that symptoms sometimes return after a period of time ranging from months to years.

This most likely happens because people go back to their junk food diets too soon.

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However, if an elemental diet is followed by a grain-free FODMAPSs diet, SCD Diet, or a similar diet, this could result in permanent remission. 

2. Monosaccharide Diets

Monosaccharide diets have a well-established track record for healing digestive issues through the exclusion of disaccharide and polysaccharide carbohydrates over a prolonged period of time.

As sugar molecules, carbohydrates are classified by the number of molecules of sugar bound together.

Monosaccharides consist of a single sugar molecule and are readily absorbed by the small intestine to provide nutrition for the body.

Disaccharides comprise two sugar molecules bound together, while polysaccharides have multiple sugar molecules bound together.

Polysaccharides and disaccharides are too big to be absorbed by the small intestine and must be broken down into monosaccharides to be absorbed into the body

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Carbohydrate Types

Monosaccharide (single sugar molecules)

  • Glucose
  • Fructose
  • Galactose
  • Found in fruit, vegetables, honey
  • Do not require further breaking down by brush border enzymes to be absorbed

Disaccharides (two sugar molecules bound together)

  • Lactose
  • Sucrose 
  • Maltose
  • Isomaltose
  • Found in dairy (lactose) and table sugar (sucrose), from splitting polysaccharides (maltose and isomaltose)
  • Need to be split by brush border enzymes to be absorbed

Polysaccharides (multiple sugar molecules bound together)

  • Amylose
  • Amylopectin
  • Found in potatoes, rice, wheat, and corn
  • Need to be split by brush border enzymes to be absorbed
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Specific Carbohydrate Diet (SCD)

The oldest and most known monosaccharide diet is the Specific Carbohydrate Diet (SCD).

It was originally designed in the 1920s by a physician named Sydney Haas.

This diet was used for overcoming Celiac disease but fell out of favor once gluten was identified as a trigger.

The diet re-emerged after Elaine Gottschall, MS – a biochemist and mother of a child who was helped by this diet – published a book titled Breaking the Vicious Cycle.

Gottschall proposed adapting a Specific Carbohydrate Diet, which removes starchy carbohydrates like those found in beans, potatoes, and most grains.

People with digestive difficulties have a compromised gut flora.

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The theory behind the diet is that under normal conditions, sucrose and other multiple-sugar molecules are broken down by brush border enzymes into the single sugars glucose and fructose, but this does not happen when the flora is compromised.

Instead, the villi are so damaged the molecules do not get broken down.

Since the body can only absorb single sugars, the molecule is not absorbed and becomes food for pathogenic gut flora, resulting in gas, toxicity, and more pathogenic bacteria, thus creating a “vicious cycle”, as the title of the book proposes.

The SCD excludes polysaccharides / disaccharides (starches) for about a year and recommends the use of homemade lactose-free yogurt.

After this diet is followed for at least one year, the villi regenerate and the person regains digestive function, eventually being able to tolerate foods forbidden on the diet.

The diet kicks off with an introduction diet that starts with easy-to-digest foods and progresses to more difficult textures over time.

SCD Legal Foods

  • Meat
  • Nuts
  • Most vegetables
  • Fermented foods
  • Seeds
  • Eggs
  • Properly soaked beans
  • Most fruit
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SCD Illegal Foods

  • Sugar
  • Starches
  • Cornstarch
  • Baking powder
  • Chocolate
  • Pectin
  • Potato
  • Maple syrup
  • Molasses
  • Rice
  • All grains (corn, wheat, barley, etc).

A full list of SCD legal and illegal foods can be viewed on the website breakingtheviciouscycle.info.

The SCD is purported to be effective for people with IBS, Crohn’s, Celiac disease, and other digestive issues.

A modified version of the diet has been adapted to treat behavioral disorders and autoimmune conditions and is known as the GAPS (Gut and Psychology Syndrome) diet

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GAPS Diet

The Gut and Psychology Syndrome (GAPS) diet by Dr. Natasha Campbell-McBride evolved from the Specific Carbohydrate Diet.

Dr. Campbell-McBride modified the diet to help her own son.

The GAPS diet starts with a healing phase, which focuses on “healing and sealing” the intestinal lining by removing all irritating foods and providing building blocks for repair, including amino acids, minerals, fats, and fat-soluble vitamins.

Fermented foods and probiotics are also started at a low dose and increased over the course of the dietary program.

The healing phase includes homemade broths, soups, animal fat, well-cooked meats, and pureed well-cooked vegetables (zucchini, carrots, pumpkin), while difficult-to-digest foods such as grains, dairy, fiber, beans, nuts, and raw fruits and vegetables are removed.

The healing phase continues until all gastrointestinal symptoms have resolved.

Although Dr. Campbell-McBride does not provide a specific guideline for how long to follow this phase since individual results may vary, a good period to allow the healing of the intestines may be two to six weeks.

Following this healing phase, foods are gradually added back in during an introduction phase, starting with foods that are the easiest to digest.

Dr. Campbell-McBride reports the healing time may vary and that some people need to stay in the introduction phase for as long as seven months until they are able to tolerate all the foods on the full GAPS diet.

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The full GAPS diet, which is very similar to the Paleo and SCD diets, is continued for one to two years before introducing other foods.

Dr. Campbell-McBride reports that skipping the healing phase or introducing foods too soon may result in difficulty healing and continued food reactions.

GAPS Healing Phase

  • Stews, soups, fermented foods, bone broth, gelatin
  • Meats: all organic (preferred) well-cooked meats allowed
  • Vegetables: only low-fiber, well-cooked, pureed

GAPS Introduction Diet

Gradual introduction of foods, starting with the easiest to digest:

  1. Well-cooked vegetables and meats with soft consistency
  2. Soft vegetables and fruits such as avocados and bananas
  3. Softly cooked eggs
  4. Nut breads
  5. Nut butters, soaked nuts
  6. Raw fruit, vegetables

Paleo Diet

The full SCD and GAPS diets are similar to the popular Paleo diet, which has been gaining attention in mainstream American culture.

The theory behind the whole-food, low-carbohydrate Paleo diet is that the digestive systems of humans have not had sufficient time to adapt to agriculture, let alone processed foods.

The Paleo diet consists of food thought to be eaten during the Paleolithic Era by hunter-gatherer tribes and includes nuts, seeds, meats, eggs, vegetables and fruit.

The diet excludes all processed foods as well as grains.

Eggs, dairy, and sweet potatoes are controversial in the Paleo community.

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Paleo Foods

  • Meats
  • Eggs 
  • Nuts
  • Seeds
  • Vegetables
  • Fruit

One can find many delicious Paleo recipes, and Paleo cookbooks are even available at Costco.

Most Hashimoto’s individuals, however, need to gradually introduce many of the healthful Paleo foods – much like the approach described in the GAPS diet or SCD – rather than diving directly into the full diet.

Rich in fiber, the Paleo diet can be too difficult to digest for many Hashimoto’s patients.

This is one reason why some call Paleo the “big brother” of SCD.

Autoimmune Gut Repair Diet

Dr. Kharrazian, author of the Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal, has recommended a diet similar to the SCD or GAPS diet for healing Hashimoto’s.

On his website, Dr. Kharrazian recommends an Autoimmune Gut Repair Diet that should be adhered to for one to sixty days, followed by reintroduction of foods.

The diet consists of the guidelines below.

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Foods Included

  • Most organic vegetables
  • Fermented foods
  • Most organic meats
  • Low-glycemic organic fruits
  • Coconut
  • Noodles: brown shirataki yam noodles
  • Herbs and spices

Foods Avoided

  • Gluten
  • Dairy
  • Eggs
  • Soy
  • Fungi (mushrooms)
  • Alcohol
  • Beans and legumes
  • Nightshades
  • Sugars (including honey and agave)
  • Canned foods
  • Processed foods
  • Coffee
  • High glycemic index foods
  • Grains (including buckwheat and rice)
  • Nuts and seeds
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3. Pathogen Targeted Diets

FODMAPS

The FODMAPs approach is a dietary intervention gaining attention among dietitians and the mainstream medical community for its potential efficacy in treating irritable bowel syndrome (IBS).

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Used to describe the types of carbohydrates that may be fermentable by gut bacteria, FODMAPs is an acronym for Fermentable, Oligo-, Di-, and Mono-saccharides and Polyols.

IBS is associated with microflora alterations and malabsorption, and FODMAP carbohydrates only induce symptoms in patients to the degree they malabsorb them.

Not all FODMAPs are symptom triggers for all patients- only those that are malabsorbed are likely to play a role.

FODMAPS found in onions, beans and garlic are always malabsorbed and cause gas production in all individuals, even healthy ones.

People with pathogenic bacteria, however, experience additional symptoms due to the toxic byproducts produced.

Reducing the intake of FODMAPs has been a proposed approach that improves IBS symptoms in about 75 percent of those who follow this diet.

IBS has been linked to an abnormal gut flora, and the food we eat can cause a multiplication of the flora.

FODMAPs attempts to starve the pathogenic flora by avoiding foods fermented by pathogens.

Antibiotics and elemental diets are also used for eliminating pathogenic flora.

Unlike the SCD, FODMAPs allows potatoes, gluten-free grains and sugar.

It excludes fruit containing an excess of fructose and polyols, fruit juices, honey, some vegetables (e.g., avocado, eggplant, and onion due to their fructan content), and mushrooms.

It eliminates:

  • Fructose: Apples, mangoes, pears, fruit juice, watermelon, fructose, HFCS, dried fruit, honey, corn syrup
  • Lactose: Milk, ice-cream, yogurt, cheese
  • Fructans: Artichokes, aspragus, beetroot, broccoli, Brussels sprouts, cabbage, eggplant, fennel, garlic, leeks, okra, onions, wheat, breads, cookies, pasta, chicory, inulin
  • Galactans: Beans, chickpeas, kidney beans, lentils, soybeans
  • Polyols: Apples, apricots, avocados, blackberries, cherries, peaches, pears, plums, prunes, watermelon, cauliflower, green bell peppers, mushrooms, corn, sorbitol, mannitol, xylitol

The FODMAPs diet allows some fruits but advises against eating too many of them.

Bananas, blueberries, boysenberries, cranberries, grapes, grapefruit, honeydew melon, kiwi, lemon, lime, orange, raspberry, and strawberries are allowed.

Vegetables included on FODMAPs are carrots, celery, endives, ginger, green beans, lettuce, olives, parsnips, potatoes, pumpkin, red bell peppers, spinach, squash, sweet potatoes, tomatoes, turnips, and zucchini as well as most herbs.

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Gluten-free cereals and grains such as rice, oats, polenta, quinoa, psyllium, sorghum, tapioca, and arrowroot are allowed.

Most dairy products are not permitted unless they are lactose-free.

Sweeteners such as sugar and maple syrup are allowed but not in large quantities.

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Candida Diet

Candida diets are gluten-, dairy-, and sugar-free as well as low-fructose approaches aimed at combating overgrowth of the opportunistic fungus Candida albicans.

This fungus may be present in the bodies of those with Hashimoto’s.

While traditional medicine may find systemic Candida infections controversial, there is evidence that the opportunistic fungus Candida may be overflowing in some people’s guts, especially those who are immunocompromised.

Body Ecology Diet

The Body Ecology Diet is a specific type of anti-Candida diet that may be especially helpful for those with Hashimoto’s.

While the GAPS diet and SCD are grain-free and include liberal amounts of nut, fruit, and fruit juices, the Body Ecology Diet includes some well-soaked, easy-to-digest grains and limits fruit and nuts to starve of the pathogenic yeast and bacteria.

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Additionally, the Body Ecology Diet focuses on foods that create an alkaline environment, allowing alkaline phosphatase to work better to detoxify gram-negative bacteria.

Low-Residue Fiber Diet

The low-residue fiber diet focuses on easy-to-digest foods that slow down bowel transit time.

This diet is used for diverticulitis, Crohn’s disease, ulcerative colitis, and bowel inflammation.

Low-residue foods include meats that are well-cooked and soft as well as most vegetables, which are eaten well-cooked, with only a few being raw.

Juices without pulp are allowed.

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Any fruits and vegetables with seeds should be avoided (e.g., berries and tomatoes).

Popcorn should be avoided as well.

Low-residue diet allowed foods include:

  • Raw Veggies: Lettuce, cucumbers, onions, zucchini.
  • Cooked / Juiced Veggies: Yellow squash, spinach, pumpkin, eggplant, potatoes, green beans, wax beans, asparagus, beets, carrots.
  • Fruits: Applesauce, fruit juices (no pulp), ripe bananas, cantaloupe, melon, papaya, peaches, plums.
  • Protein: Cooked meat (they should be tender and soft, not chewy), eggs.
  • Fats: Butter, oils, smooth sauces.

This basic low-residue fiber diet also allows bread and dairy products, which are not recommended for people with Hashimoto’s.

Deli meats, crunchy nut butters, nuts, beans, tofu, and peas are not allowed, nor are spicy foods, chunky relishes, and chocolate.

Total fiber intake should be limited to 10-15 grams a day.

Problems with Fructose

According to researchers from the University of California, San Fransisco, in the article “The Toxic Truth about Sugar”, published in the February 1, 2012, issue of the journal Nature, sugar should be considered a controlled substance just like alcohol and tobacco.

The authors go even further and suggest that sugary foods should be taxed and sales for kids under seventeen years old should be restricted.

All of these precautions should be undertaken to make sugar less available and encourage healthful choices.

Authors Lusting, Schmidt, and Brinds explain that sugar is not just “empty calories” as some claim, but that an excess of sugar is responsible for many diseases in our society.

In the last fifty years, sugar intake has tripled, and it’s likely responsible for the global pandemic of obesity, altered metabolism, and high blood-pressure.

It contributes to an increased death rate from diabetes, heart disease, myocardial infarction, high blood pressure, dyslipidemia, obesity, and cancer.

Sugar also promotes inflammation and depletes nutrients.

Research shows sugar can activate reward pathways in the brain, just like alcohol, morphine, or heroin do.

Many people experience withdrawal symptoms of headaches, irritability, and lethargy for 1-20 days after kicking their sugar habit cold turkey.

According to the American Heart Association (AHA), the average American adult consumes twenty-two teaspoons of sugar daily, while the average teenager consumes thirty-four teaspoons a day.

This adds up to 156 pounds of sugar per year for the average American, according to the US Department of Agriculture (USDA).

While sugars occur in natural foods such as fruits and grains, most of the sugars consumed in the United States come from processed foods.

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Sugar Metabolism

A study conducted by nutrition researcher and principal investigator Peter J. Havel, Ph.D., of the University of California at Davis showed that fructose and glucose are metabolized in different ways by the body.

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Table sugar, or sucrose, is a disaccharide and contains 50 percent glucose and 50 percent fructose.

Also a disaccharide, high-fructose corn syrup is used in a variety of foods ranging from soft drinks to cereals.

It contains 55 percent fructose and 45 percent glucose.

A simpler sugar (monosaccharide), glucose is a product of photosynthesis and the primary source of energy in every cell of the body.

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Only 20 percent of glucose is metabolized in the liver, while 80 percent is used by other organs.

Excess glucose is converted into glycogen and stored in the liver or muscles to be converted into glucose when the body needs energy.

When blood glucose levels increase, the pancreas releases insulin to help glucose get into each cell to be used as energy.

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Fructose Is Different

Fructose is another monosaccharide, and its natural sources are fruits, vegetables, sugarcane, and honey.

It can exist in foods as free fructose or combined with glucose as sucrose.

The liver metabolizes almost 100% of fructose.

According to Dr. Lusting, fructose is a “chronic, dose-dependent liver toxin”.

In contrast to glucose, extra fructose is stored as fat when we eat too much of it.

Researchers claim excess fructose consumption can lead to liver toxicity similar to the kind seen with alcoholic liver disease.

In one study, obese men and women who drank either glucose- or fructose-sweetened beverages as 25 percent of their calories were followed over a period of ten weeks.

Both groups gained weight during the trial, but the fat distribution was different.

Those in the fructose group added fat in the belly, while the glucose group gained fat under the skin (subcutaneous).

Belly fat has been linked to a high risk of heart disease and diabetes.

Besides that, the fructose group also had higher cholesterol and LDL (“bad cholesterol”) and more often had insulin resistance in comparison to the glucose group.

Some – not all – Hashimoto’s patients have benefited from limiting fructose and implementing a low-carbohydrate or a no-carbohydrate diet (i.e., carnivore diet).

Excess fructose can be taxing on the liver, feed pathogenic bacteria and yeasts, and drive up blood sugar.

As fruits are generally not restricted in the SCD and GAPS diets, many people may continue eating liberal amounts of them after starting a Hashimoto’s diet and will often hit a plateau with their healing process.

Since Proteus bacteria ferment fructose, these people are providing them with ample food, despite cutting out so many things and being ultra-strict with their SCD / GAPS diet.

Limiting fructose can often be a major breakthrough and help people overcome blood sugar imbalances, gut dysbiosis, and anxiety.

How Much Fructose Is Too Much?

Dr. Mercola, a well-known integrative physician, advises that fructose consumption should be limited to 25 mg daily for most people.

For those with a high risk of or who are already suffering from a health condition, it would be wise to lower fructose intake to 10-15 mg daily.

Natural sweeteners such as agave and honey also contain fructose, so their consumption needs to be limited.

Dr. Mercola recommends stevia or glucose (sold as dextrose) as alternative sweeteners.

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While table sugar should not be consumed by anyone who wants to be healthy, those who suspect they may be struggling with a bacterial or Candida overgrowth also need to limit the amount of fructose (from fruit and honey), nuts, and baked products for six to twelve weeks to starve the pathogen.

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How Much Fructose Are You Getting from Your Diet

FoodServing SizeFructose (Grams)
Lime1 medium0
Lemon1 medium0.6
Cranberries1 cup0.7
Passion fruit1 medium0.9
Prune1 medium1.2
Guavas2 medium2.2
Date1 medium2.6
Cantaloupe1/8 medium melon2.8
Raspberries1 cup3.0
Clementine1 medium3.4
Kiwi1 medium3.4
Blackberries1 cup3.5
Star fruit1 medium3.6
Cherries (spur)1 cup4.0
Cherries (sweet)103.8
Strawberries1 cup3.8
Pineapple1 slice4.0
Honey1 teaspoon4.0
Grapefruit1/2 medium4.3
Boysenberries1 cup4.6
Tangerine1 medium4.8
Nectarine1 medium5.4
Peach1 medium5.9
Orange1 medium6.1
Papaya1/2 medium6.3
Honeydew1/8 medium melon6.7
Banana1 medium7.1
Blueberries1 cup7.4
Date (Medjool)1 medium7.7
Apple1 medium9.5
Persimmon1 medium10.6
Watermelon1/16 medium melon11.3
Pear1 medium11.8
Raisins1/4 cup12.3
Grapes1 cup12.4
Mango1/2 medium16.2
Apricots, dried1 cup16.4
Figs, dried1 cup23
Adapted from Mercola.com

4. Trigger-Removing Diets

Diets that aim to remove triggers often help remove autoimmune conditions – but only as long they are followed.

Dairy-free, soy-free, gluten-free, egg-free, iodine-free, nightshade-free, and other avoidance diets have been reported to aid in healing Hashimoto’s.

Some may improve after going gluten-free, others benefit from eliminating dairy, and others need to eliminate a multitude of foods.

The best practice is to follow an elimination diet to identify triggering foods instead of blindly embarking on one of these diets.

For most, these diets may just be a remission and not a cure, unless they are combined with nourishing foods and probiotics that fix the intestinal permeability.

What to Put In

When we think about diets, we generally think about what we need to remove.

The other key of a healing diet, however, is what we add.

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It’s easy to get caught up in removing suspected foods while still having deficiencies in beneficial bacteria and nutrients that prevent the thyroid and intestines (which house the immune system) from healing.

Dietary programs focused only on what to avoid are not as successful as those that consider what to add to restore optimal function.

A diet for healing Hashimoto’s needs to include bone and meat broths, gelatin, protein, saturated fats, and fermented foods to help rebuild the intestinal lining.

Meat, liver, and vegetable juices are used to help replenish depletions.

Fermented foods such as lacto-fermented cabbage, coconut kefir (fermented coconut water), and vegetables should be at the center of this diet.

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The diet should be balanced with enough vegetables to provide a healing alkaline environment.

If you were to pick just one intervention to follow in your Hashimoto’s healing diet, we would recommend starting to incorporate traditionally prepared fermented vegetables into your diet.

Fermented vegetables are the best way to get to the root cause of unbalanced intestinal flora.

Before we had refrigerators, people relied on traditional food preparations such as fermenting vegetables to keep them edible.

Most traditional cultures ate fermented vegetables for the majority of the year.

These vegetables were full of beneficial lactobacilli bacteria, which have coevolved in a symbiotic fashion to keep us healthy.

Dr. Mercola suggests that fermented cabbage may contain as much as 1 trillion colony-forming units (CFUs) of beneficial microbes per serving, compared with the 10 billion CFUs per usual capsule of expensive high-dose expensive probiotics.

Fermented vegetables are prepared by chopping the vegetables, sprinkling them with sea salt, and sometimes adding water or culture starters.

The vegetables are then placed in jars or other containers that can be sealed to keep the air out for one to two weeks.

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The beneficial bacteria normally present on vegetables ferment the vegetables and create a characteristic sour taste.

After the fermentation process is completed, the beneficial bacteria start dying off within one to two weeks.

Refrigeration slows down the fermentation process and keeps the beneficial bacteria alive.

Thus, if you’d like to get the full benefit of fermenting foods, make sure that they are stored in the refrigerator to preserve beneficial bacteria.

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Fermented vegetables are not the same as the grocery store sauerkraut that contains vinegar and has been pasteurized to kill any beneficial microflora.

“Wild Fermentation” by Sandor Katz and “The Body Ecology Diet” by Donna Gates are excellent books with recipes for fermented vegetables.

You may be able to buy raw, live fermented vegetables from farmers, health food stores, and co-ops.

We like to make our own fermented vegetables by using a fermentation kit.

Fermented coconut meat and coconut water are also delicious options.

Tula’s CocoKefir makes a delicious coconut yogurt and coconut water kefir.

We highly recommend the book “Digestive Wellness” by Dr. Liz Lipski for more guidance on healing diets. 

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Recommendations

The most comprehensive dietary approach would be as follows:

  1. Elemental Diet for one to two weeks, followed by
  2. Low-residue, low-FODMAP, gut-healing diet (GAPS Healing / Intro) for one to four weeks
  3. Introduction diet, adding one well-cooked SCD / GAPS legal food every four days and observing for symptoms
  4. Modified full Paleo / SCD / GAPS: one to two years
  5. Introduction of low-allergenic grains

The Elemental phase is a primarily liquid diet, with the addition of vitamin, mineral, and probiotic supplementation.

This type of diet can cause weight loss and thus may be inappropriate for those who are underweight.

The second phase introduces soups with pureed low-residue vegetables, well-cooked meats, fresh juices (mostly from vegetables), gelatin, fermented coconut water, and probiotics.

The third phase starts introducing more solid foods and may utilize digestive enzymes with proteins.

General Recommendations For Gut-Healing Diet

Start with well-cooked foods that are the easiest to digest: soups; boiled, cooked and pureed vegetables; and meats.

Once those are tolerated, you can add some raw pureed vegetables (we like to use the Dynablend).

Then add foods with easy-to-digest textures such as avocados.

Continue in this fashion, moving forward with peeled raw fruits and vegetables and eventually advancing to eating raw vegetables with the peel.

All foods should be well-cooked and ideally rotated every few days.

Wait until diarrhea and flatulence stop before moving to the next level.

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One suggestion is to move up each level weekly, with the understanding that sometimes progression may take more or less time, depending on your needs.

While eating raw foods is beneficial for most people, those with leaky gut may need to avoid eating whole raw foods until the gut is well-healed.

Cooking vegetables makes them easier to digest, as does pureeing them. While fiber is touted as a health food, it is difficult to digest.

Humans do not produce cellulase, the enzyme used to break down fiber, and depend on good bacteria to break down the fiber in foods.

This can be problematic in those with dysbiosis or SIBO as the fiber may end up getting fermented by the pathogenic or overgrown bacteria, causing side effects and immune imbalances.

Transitioning Off The Diets

With the exception of the Body Ecology, GAPS, Paleo, and SCD, most of the diets discussed in this article are healing diets and not meant to be continued long-term.

Once you stay on the diet for three months to two years, you may be able to make the transition to a less-restrictive diet.

From an evolutionary perspective, we are big believers in diets based on traditionally prepared fermented foods such as the one promoted by the Weston A. Price Foundation and the Body Ecology Diet.

Monosaccharide diets like GAPS, Paleo, and SCD are also helpful as long as they are balanced with enough veggies.

Takeaway Points

✔ A personalized elimination diet should be used to determine individual intolerances.
✔ Modified monosaccharide diets help heal the gut.

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✔ The Elemental diet is helpful for intestinal bacterial overgrowth.

✔ Inclusion of animal protein, bone broths, fats, and fermented foods can be helpful for healing.

✔ Fermented vegetables are the most important food to include – we repeat, fermented vegetables are the most important!

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About George Kelly

George Kelly M.Sc is a Sports Nutritionist, Functional Nutritional Therapy Practitioner (FNTP), and Metabolic Type expert. He is the CEO and lead author of Metabolic Body.


References

[1] https://pubmed.ncbi.nlm.nih.gov/20224145/
[2] https://pubmed.ncbi.nlm.nih.gov/22778791/
[3] https://pubmed.ncbi.nlm.nih.gov/22825366/
[4] https://medlineplus.gov/ency/patientinstructions/000200.htm
[5] https://pubmed.ncbi.nlm.nih.gov/21951333/
[6] https://www.todaysdietitian.com/newarchives/072710p30.shtml
[7] https://www.theibsnetwork.org/diet/fodmaps/
[8] http://www.breakingtheviciouscycle.info/p/the-intro-diet/
[9] https://drknews.com/autoimmune-gut-repair-diet/


MEDICAL DISCLAIMER

This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Metabolic Body nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.