The Thyroid Gland is a small, butterfly shaped endocrine gland in an area near the base of the neck. The hormones produced by this gland regulate vital metabolic processes throughout the entire body. A deficiency of these hormones, which causes these hormones to slow in production (and sometimes cease) is called Hypothyroidism.
Receptors for the thyroid hormones are found throughout the body, and any disturbance in the regulation of the hormones can lead to problems in almost every system from the heart, to the GI system, as well as sleep, mood, and the growth of hair, skin and nails, and other endocrine glands particularly the adrenals.
Symptoms develop very gradually and can take years to manifest. The typical symptoms include increasing fatigue and weakness and unintentional weight gain. Other symptoms include dry, rough and pale skin, brittle loss and some hair loss, dry, brittle nails, sensitivity to cold, muscle or joint aches, constipation, depression, irritability, memory loss, abnormal menstrual cycles and loss of libido. If left untreated, symptoms of Myxedema can appear, which include swelling around the lips and nose, low blood pressure, decreased body temperature, unresponsiveness and coma. The latter are considered life-threatening.
Causes of hypothyroidism are several. Iodine deficiency is the leading cause in the world, but in the US is rare due to the supplementation of table salt with iodine and the abundance of salts. However, sometimes high blood pressure is caused by a medical issue where lowering salt is not such a good idea.... it may not be addressing the real cause, and it may cause other issues to develop, some very serious. In the US, the most common cause is Hashimotos, an autoimmunde condition which involves immune-related inflammation and destruction of the thyroid gland, which reduces proper functioning and production of the thyroid hormone. Other causes include surgical removal of the thyroid, radiation therapy of the head and neck, or complications of medical therapies for hyperthyroidism which can be extensive and permanent. Certain medications can worsen or promote hypothyroidism, such as Lithium. There are other, less common causes, such as congenital birth defects and pregnancy.
Nutritional Considerations
Special nutrition considerations need to be observed by clients with hypothyroidism. Since one of the major causes of Hypothyroidism is nutritional deficiencies, this is particularly important. In addition, Hashimotos treatment can be aided and assisted with nutritional corrections. The following foods need special consideration:
•Cruciferous Vegetables
•Fats
•Vegan Diets
•Soy
•Gluten
•Sugars
Cruciferous, or Brassicaceae vegetables, contain glucosinolates that can inhibit thyroid function. Glucosinolates can inhibit iodine uptake, which can result in hypothyroidism and promote goiter formation. Glucosinolate is a sulfur-containing organic anion bonded to glucose, and as it is hydrolyzed by myrosinase it produces a decomposed product – thiocynate, which is known for adverse affects on thyroid metabolism due to competition with iodine.
Please note, as with any food, this does not mean you need to completely eliminate these from your diet; they are powerhouse veggies and should be eaten at least several times a week. But with hypothyroidism, the important thing is in how you prepared them.
Cooking with heat and salt can help deactivate some of the goitrogenic properties. Some of these foods, such as kale and collard greens, can be blanched in salt water. Some of the foods can be cooked as ingredients in other well-balanced dishes. Also, if you are eating a diet that is iodine rich, take iodine supplements, or proper dosages of synthetic thyroid replacements medication, that will help, as well. It’s all in balance…..
The Brassicaceae family of vegetables include Cabbage, broccoli, cauliflower, Chinese cabbage, radishes, turnips, kohlrabi, rutabaga, collard greens, kale, Brussels sprouts, bok choy maca root, and watercress.
Other foods that contain natural goitrigens (compounds that can cause the thyroid gland to enlarge by interfering with thyroid hormone synthesis) include Cassava (the starch that is the basis for tapioca), corn, sweet potatoes, and lima beans. These should be eaten in moderation. A serving of 5 ounces a day or less of cruciferous vegetables is suggested for hypothyroid clients.
Fats are thought of as something we want to stay away from, but this is not necessarily true! Fats, in the right proportions and of the right kind, are very important parts of the human diet. However, if fats are completely avoided, srious nutritional deficiencies can be reported. A no-fat or extremely low-fat diet can negatively affect thyroid health.
Vitamins A, D, E and K are all fat soluble. If you are eating no, or little fat, you could be inhibiting your body’s absorption of essential vitamins. Steam your Cruciferous vegetables, and add a little pat of butter! Make sure that the other components of your diet provide essential fats, or that you are supplementing the fats as well as any of these vitamins that lab testing may show as being lacking. Again, fats may be unhealthy in many ways, but that is often due to inappropriate overuse, or lack of quality of the foods content. Fats that appear marbly in a good cut of red meat is the perfect balance of protein and fat, and the fat is made synergistically to complement the actual meat it is surrounded by. Other fats are good, such as Omega-3’s, etc. If you do not eat proper amounts of fats, among other troubles, you will have difficulty absorbing the vitamins listed above, as well as have difficulty with assimilation of proteins and calcium. Fats are also used to help create hormones and support other endocrine functions.
Vegan Diets are very important to some people for personal, religious or other reasons. Should you choose to lie a strict vegan lifestyle, please be aware that nutritional deficiencies can occur that lead to thyroid disease, as well as other effects of the deficiencies. Animal protein is required to make the thyroid hormone, and to convert it to its active form in the liver. It is very important to at least supplement with minimal animal proteins, there is no other solution for this biological process.
Soy is a wonderful food. However, non-fermented soy foods are believed by many to be a problem for the thyroid, and can also promote goiter while they can be quite healthy for many people. As always, it depends on your entire health picture, the state of your body’s homeostasis, and other dietary intake. Fermented soy products include miso, shoyu, tempeh, natto, pickled tofu, soy sauce, and tamari (there are also other fermented soy products that are not as common in the United States).
The reason non-fermented soy can be a problem for thyroid is because it falls into a category of foods known as Goitrogens, or vegetables and foods that promote the formation of goiter. The Food and Drug Administration’s lead experts on soy, Daniel Doerge and Daniel Sheehan, who originally wrote that there is evidence that ‘some of the isoflavones found in soy, including genistein and equol, a metabolized daidzen, demonstrate toxicity in estrogen sensitive tissues and in the thyroid…isoflavones are inhibitors of the thyroid peroxidase which makes T3 and T4. Inhibition can be expected to generate thyroid abnormalities, including goiter and autoimmune thyroiditis.” However, Doerge and Sheehan have continued research for the FDA, and have refined their findings to state that in order “for soy to cause toxicity, there need to be several factors, including iodine deficiency, defects of hormone synthesis, or additional goitrogens in the diet.”
People probably eat large quantities of non-fermented soy and do not even realize it. They may be eating at fast food restaurants that have soy-based meats, or eating energy bars, natural snack bars, protein powders and breakfast cereals that contain highly processed soy ingredients. Other convenience foods have soy-containing ingredients such as isolated soy protein, textured vegetable protein, hydrolyzed vegetable protein, lecithin, bouillon, msg, monodiglyceride, and plant protein.
The concern with non-fermented soy appears to be over-consumption. By doing an individualized wellness plan evaluation, professionals can determine if you are consuming an overabundance of unfermented soys, and guide you on your intake. By watching the ingredients used in cooking, reading labels, and eating a balanced diet with proper iodine (for YOU!) and a proper amount (for YOU!) of other foods with isoflavones, you can eat soy several times a week and benefit from it. Research has shown that the thyroid-toxic effects of soy are most often seen at levels above 30 mg. per day.
Gluten sensitivity is becoming more and more common. In addition to the fact that refined white flours add no nutritional value and are empty calories, gluten is found in healthy and whole grains, as well. As a hypothyroid client, it is advised that you choose whole-grain varieties of bread, pasta, and rice, which are high in fiber and other nutrients and can help improve bowel irregularity which is a common symptom of hypothyroidism. You are also advised to take your hypothyroid medication several hours before eating or after eating high-fiber foods, as gluten can interfere with the absorption of synthetic thyroid hormones.
Sugars, which come in many, many forms, are most often found as corn by-products and white refined sugars. All persons should modify their intake of refined white sugars; however, with hypothyroidism, the body already has a slowed metabolism. Foods with excess amounts of sugar add lots of calories with no nutrients and can cause weight gain easily, in addition to the normal negatives associated with sugars.
Other considerations for clients with hypothyroidism include:
Excess Fiber can complicate hypothyroid treatment. Dietary fiber can be found in whole grains, vegetables, fruits, beans and legumes, and are often used in supplemental forms to help other conditions. If you have a high-fiber intake, you may need to have your thyroid replacement medication increased, due to non- or deficient absorption.
Caffeine has been found to block or impact the absorption of levothyroxine (synthetic thyroid hormone) If you are a coffee or other caffeine drinker and have not started reducing your caffeine intake yet, wait at least 30 minutes after taking your medication before having your caffeinated drink.
Vitamin D deficiency is extremely common in Hashimotos. Be sure your levels are monitored and that you are supplemented appropriately with Vitamin D. It is very important to have your levels tested, and to have an experienced practitioner advise on diet and particularly supplementation, since Vitamin D (actually a hormone) is not naturally in many foods.
What foods benefit hypothyroid clients?
The following foods can be beneficial in the diet for hypothyroid clients. As always, consult with your holistic nutrition practitioner and follow her guidelines which are individualized for you. Some of these foods may not be appropriate for every client, due to other combos of health conditions and other contraindications per individual.
The omega-3 fatty acids found in fatty fish (wild salmon, tuna, trout, sradines) are known to decrease inflammation, help the immune system and lower the risk for heart disease, but for the hypothyroid client, it is important to know that fish is a good source of Selenium – which is most concentrated in the thyroid.
Nuts are another source of Selenium, and are an option that can be used as a stand-alone snack, used in salads, butters, and other preparations. A small handful a day is enough to get the nutrients needed, and not contribute excess fats (as nuts are very high in fat!). When eating Brazil nuts, only 4 nuts are required, and this type of nut has also been linked with lowering bad cholesterol.
Antioxidants, including cherries, blueberries, sweet potatoes and green peppers are important. There are many other antioxidants out there to enjoy; make sure you take your other health considerations and your practitioner’s advice on amounts and frequency.
Seaweed/Kelp contains a high concentration of iodine. If you are eating a cruciferous vegetable, it can be a good idea to pair it with seaweed or kelp, even if the kelp is used as an ingredient to supplement another dish in the meal. Seaweed also offers a high abundance of Vitamins A, B, C, E and K. Too much iodine is not good for the hypothyroid client, as well, as it can cause goiter. Be sure to take your practitioner’s advice regarding the addition of this food if you are on a high-iodine diet already, or take iodine supplements, thyroid glandular supplements, or synthetic thyroid replacement.
Dairy: yogurt. Because Hashimotos can also lead to changes that contribute to gut issues such as heartburn, foods such as yogurt with good bacteria may help regulate the other bacterias. If you have taken numerous antibiotics, or are currently on a course, this is an important part of your diet to reintroduce the good bacteria. If you are vegan, allergic to dairy or for other reasons are not able to eat foods high in probiotics (see probiotic client handout), pre- and probiotic supplementation may be recommended on your Wellness Plan.
Beans and legumes are an inexpensive and delicious way to get protein, antioxidants, complex carbohydrates, and numerous vitamins and minerals. As they are high in fiber, they can both help and hamper. Many hypothyroid clients have constipation issues, so the fiber can be a help. But, excess fiber is also contraindicated on those who take thyroid replacement. Make sure your wellness plan takes your overall fiber content into account and discuss with your practitioner.
Supplementation is advised after evaluating your other conditions, current dietary habits and prescribed medications by your practitioner, as well as evaluating labwork. It is very important to have this assessed by a holistic nutritionist and registered natural health practitioner to make sure the recommendations will apply to you, and will address the unique problems combinations of issues can cause. Remember – ‘supplements’ do not ‘replace’ nutrients. They ‘supplement’ your diet. However, if you have been eating properly for your medical issues and for good health in general, there is a possibility you may have absorption issues, or you may have physiological reasons for your body not converting certain nutrients into others needed once inside the body.
Acupuncture treatments can help stimulate the endocrine system, as well as address symptoms and consequences of an imbalanced endocrine system. Other energy medicine modalities such as Scalar, reflexology, and targeted treatments can, as well.
Hypothyroidism is a common medical issue, and one that is recognized as oftentimes being of nutritional deficiency origin. It is very important to see a holistic nutritionist in addition to your general practitioner and endocrinologist. Happy healing!
Lisa C. Baker, CNC, RNHP, is a certified Nutritional Counselor, and also holds a certificate in Complementary and Integrative Health. She is a member of the American Nutritional Association, the International Association of Natural Health Practitioners, International Institute for Complementary Therapists, and is a Registered Natural Health Practitioner by the IANHP. She is currently enrolled in a Doctor of Naturopathic program.