General Dietary Guidelines

Looking through unfinished blogs, I ran across this one. I wonder about the general recommendations as each person will have their own needs and preferences. Having read through it and made a few minor modifications, I think there is still some value here. These are general principles so adapt them to your own circumstances. I was raised on a farm and never thought eating calf liver was a good idea, for example. I figured, even as child, that there must be a better way to get the needed nutrients.

Proteins

Julia Ross, M.A. advises 20 grams of protein (3-4 oz) at each meal and stresses animal protein foods (Ross, 1999; p.170). Also, shoot for 1-2 oz at snack time. Cold-water fish is a good choice, as it also contains omega-3 fatty acids. Tempeh is a good source of vegetable protein, and whey protein, though more processed, can be very useful. It contains immunoglobulins and L-glutamine that can help heal a distressed digestive tract.

Antioxidant-Rich Foods

""Push the antioxidants,"" says Richard Shames, M.D. (private conversation, May, 2007). Antioxidant-rich foods are necessary to combat free radical damage caused by the inflammatory process. Emphasis on vitamin A containing foods is especially helpful, since vitamin A is often deficient in people with any type of autoimmune condition (Plapp, 2002), whose bodies are often inefficient at converting beta-carotene to actual vitamin A. Other nutrients with antioxidant qualities often deficient in Hashimoto's thyroiditis include vitamins C and E, iodine, zinc, and selenium. (A more complete listing of foods and their nutrient content is available at www.whfoods.org.):

Vitamin & Mineral Rich Foods

Vitamin A and beta-carotene-rich foods: carrots; cooked calf's liver; cod liver oil; eggs; pastured dairy; lightly cooked spinach, kale, collard greens and Swiss chard; winter squashes; red bell peppers; apricots; cantaloupe; sweet potato

Vitamin C-rich foods: red bell peppers, parsley, broccoli, citrus fruits, romaine

Vitamin E-rich foods: lightly steamed mustard greens and Swiss chard, sunflower seeds, almonds, avocado

Iodine-rich foods: seaweeds, especially dulse and kelp (be sure it's very high quality), seafood (free of mercury and wild, not farmed)

Zinc-rich foods: oysters, crab, beef (organic and/or grass-fed), sesame and pumpkin seeds

Selenium-rich foods: Brazil nuts, crimini mushrooms, cod, shrimp, halibut, snapper, oats, sunflower seeds, brown rice

Healthful Fats

4-6 tablespoons per day of the good fats found in avocados, nuts, and seeds (especially pumpkin, chia, and flax), organic pastured butter and ghee, olive oil, and coconut and its oil. Coconut is very thyroid-friendly. The lauric acid it contains is soothing to the endocrine system (Bauman, Shomon, n.d.) and its medium-chain fatty acids digest quickly and provide a superior energy source for the body. It can also be helpful for weight loss (Calbom & Shilhavy, 2003). The milk from the coconut can be used in place of other milks.

Vegetables

At least 4 cups per day (Ross, 1999; p.171). Choose a wide variety of colorful veggies and eat them lightly cooked or raw. NOTE: Avoid eating the brassica family raw, as these inhibit thyroid function. Brassicas include broccoli, cauliflower, turnips, etc. Don't overdo these, in general, though they should be fine in moderation (Shames, private conversation, May, 2007).

Carbohydrates

Go easy on the fruit, grains, and starchy vegetables. Two 1/2 cup servings of fruit per day, plus 1/2 to 1 cup, one or two times per day, of whole grains or starchy vegetables (Ross, 1999; p.171).

NOTE: Soaking or sprouting grains prior to cooking will make them more digestible - an important consideration for those with impaired digestion, which is common with hypothyroid. However, unsoaked is fine occasionally; just be sure to chew well.

Water

At least 8 cups pure, filtered water daily. Avoid water with chlorine and fluoride, as these are halogens and compete with iodine, the halogen the body uses. This can disrupt thyroid function. And remember it is not wise to purchase water in plastic bottles.

Functional Foods

To support people with a wide variety of health issues, a dietary food supplement powder is a great ally. A therapeutic combination can include undenatured whey protein concentrate (or other protein powder for those intolerant of dairy), a blend of algae, cereal grasses, and sea vegetables; a blend of fibers, including flax meal and apple pectin; extracts of highly anti-inflammatory organic fruits and vegetables; and other therapeutic elements such as aloe vera, detoxifying herbs, ionic minerals, probiotic bacteria, and digestive enzymes.

This combination provides easily digestible protein and, with whey, is rich in sulfur amino acids that support detoxification, healing chlorophyll, and anti-inflammatory nutrients to cool an overheated immune system and cleanse impurities from the blood, thyroid and its hormones, and to improve thyroid hormone sensitivity. It can be used as a meal replacement in a shake or just added to warm or cool liquids. Making it with coconut water is a very healthful and refreshing application.

Dietary "tricks" can help hypothyroidism, too. The first is to reduce caloric intake by about 30 percent. Essentially, stop eating before getting full, while still taking in adequate nutrients. Calorie restriction, as it is called, has been shown to improve both immune and thyroid function (Moore, 2006). The second technique, from Dr. Ken Blanchard is to "eat breakfast like a king, lunch like a prince and dinner like a pauper" (Blanchard, 2004; p. 200). This prevents the body from being overloaded with food at night, when it is converting fat to muscle with growth hormone, and to fuel it well during the day to accommodate energy needs.

Things to Avoid

Gluten: Hashimoto's, as mentioned above, occurs at a greater rate in those with celiac disease than in the general population. The gluten molecule is very similar to thyroid tissue, and it is thought that the immune system identifies the thyroid gland as gluten and attacks it.

Aspartame: Aside from its other known toxic effects, Aspartame appears to be particularly problematic for the thyroid gland (Bauman, in Shomon, n.d.).

Iodized Salt: Even though the thyroid gland depends on iodine to produce hormones, this is not the way to get it. It is not possible to eat enough salt, in the first place, to get the daily recommended dosage of iodine (150 mcg). Nor is it advisable to consume such a highly processed product, the grocery store versions of which often contain aluminum and dextrose (Bauman, Shomon, n.d.). Sea salt, unprocessed and containing trace minerals, is a far better choice.

Unsaturated Oils (including canola oil): There is speculation that these contribute to hypothyroidism. Whether it is because they contain so much inflammation-promoting omega-6 fatty acid, or because they are generally rancid even before they are bottled (or go rancid in their clear bottles) is not known.

Soy: Also disruptive to the endocrine system, and considered a toxin by some, though it is the isolated and concentrated isoflavones that pose the greatest risk, according to Ken Blanchard, M.D. (2004; p. 190). He points out that infants fed soy formulas are more likely to develop autoimmune conditions later in life than those who are not. Depending on soy as a primary source of protein is not recommended. Even small amounts have been shown to have powerful hormone disrupting powers and can lower concentrations of T3 (Ross, 1999; pp. 204-205). The exception to this is fermented soy foods, such as tempeh, natto, and miso.

SUPPLEMENTATION

Because Hashimoto's thyroiditis can result in reduced digestive capabilities, it is a good idea to support digestion with enzymes, HCl and probiotics when necessary, and to supplement with extra quantities of the nutrients most often found lacking with this condition.

Whole foods-based multi-vitamin and mineral: Take as directed.

Extra antioxidants: Take as directed daily (Shames & Shames, 2005; p. 97).

Extra essential fatty acids: From fish or flax.

1,000-2,000 mg per day, two divided doses (Shames & Shames, 2005; p. 97; Ross, 1999; p. 245).

Extra B vitamins: Either in supplement form or, preferably, use nutritional yeast.

Calcium: 250-300 mg (1-2 at bedtime) (Ross, 1999; p. 245). Calcium and iron need to be taken two hours before or after thyroid medications so as not to interfere with their absorption.

Magnesium: 200 mg 2 times daily (Ross, 1999; p. 245; Shames & Shames, 2005; p. 97).

Selenium: Supplementation with selenium (200 mcg) for a period of 3 months has been found to significantly reduce thyroid peroxidase autoantibodies (TPOab) titers and significantly improve well-being and/or mood (Toulis & Anastasilakis et al., 2010).

NOTE: Selenomethionine form preferred. Do not exceed 400 mcg daily if pregnant!

Iodine: If the multiple doesn't contain 150-200 mcg iodine, kelp supplementation - 2-3 g daily - should provide adequate amounts (Balch, 2000; p. 451). Dr. Mercola (in Shomon, N.D.) recommends 5 g daily. (Supplementing directly with high-dose iodine is very controversial, with physicians obtaining erratic results, and should be either avoided or done with extreme caution until more is known about it.) Daily low-dose iodine supplementation (200 mcg a day) has been shown to reduce antibody levels in people with Hashimoto's (Rink, Schroth, Holle, & Garth, 1999).

Vitamin D3: Often low in those with autoimmune conditions, it is necessary for optimal immune function (Hayes, Nashold, Spach, & Pedersen, 2003). It is also required for thyroid hormone production (Shames, in Shomon, 2007). 1,000-5,000 IU daily to bring up levels. Maintenance doses will vary.

L-Tyrosine: One of the thyroid's hormone building blocks. Many sources recommend 500 mg twice daily, but others feel that levels of this amino acid are rarely low enough to warrant supplementation (Shames & Shames, 2005; p. 108).

Chromium: 200 mcg daily, if it's not included in the multiple (Ross, 1999; p. 245)

Iron: If testing shows a deficiency. Calcium and iron need to be taken two hours before or after thyroid medication so as not to interfere with its absorption.

Zinc: If testing shows a deficiency. 50 mg daily (Balch, 2000; p. 452).

Thyroid glandular: These have been shown to be very effective; 50-100 mg twice daily. They are made from desiccated thyroid glands of either pigs or cows (use those from non-BSE cow-raising countries), from which most of the hormone has been removed. Dr. Shames likens them to decaffeinated coffee: there's still a little bit in there (private conversation, May, 2007). Because of this, they also contain T1 and T2, other thyroid hormones that may exert a physiological effect.

Additional supplements, recommended by Dr. Shames, are extra free-form amino acids daily (two 500 mg capsules), taurine (two 500 mg daily), and proteolytic enzymes on an empty stomach for inflammation (Shames & Shames, 2005; p. 97).

Vegans may have to add the nutrients commonly missing in adequate amounts from an animal-free diet: extra B12, D, some L-Carnitine, zinc, and selenium (Ross, 1999; p. 244).