Hashimoto’s thyroid dietary taboos

According to the current global consensus in the field of endocrinology, there are no universal absolute dietary contraindications for Hashimoto's thyroiditis (chronic lymphocytic thyroiditis). The only ones that clearly require vigilance are Excessive iodine intake , the gluten, dairy, soy, and cruciferous food taboos reported online are all personalized adjustment options, and there is no "must avoid" requirement.

I met a girl who was just diagnosed a while ago. She threw away the iodized salt at home the same day she received the report, bought a bunch of iodized salt and gluten-free bread online, and never touched her usual seaweed and egg drop soup. After three months of reexamination, the antibodies did not drop much, and her TSH increased directly from 2.3 to 12. Originally, she only had high antibodies and did not need to take medicine. Now she had to take Euthyrox. She came to me with a sad face and asked if she had done something wrong. In fact, she just stepped on the trap of "one size fits all". The thyroid gland of Hashimoto's patients has a weaker ability to synthesize hormones than ordinary people. Completely cutting off iodine is equivalent to directly cutting off the production raw materials of the thyroid gland, which can directly induce hypothyroidism.

At present, there are indeed differences in the recommendations of different medical schools regarding iodine intake: the recommendations of routine endocrinology departments are more conservative. As long as the urine iodine test is within the normal range of 100-199 μg/L, there is no problem in eating iodized salt normally. However, it is necessary to avoid long-term consumption of high-iodine foods such as kelp, seaweed, and wakame, and do not supplement iodine.； Practitioners of functional medicine often recommend that patients with significantly elevated antibodies temporarily limit high iodine intake for 3-6 months, and then gradually resume normal iodine intake after the antibodies drop. Both options are supported by clinical data. There is no absolute right or wrong. The core depends on the individual response.

As for the "gluten-free diet" that is the most widely circulated, the cases I have seen are extremely polarizing: There was a young man who worked in design who abstained from gluten for 3 months. His TPOAb (thyroid peroxidase antibody) dropped from more than 900 to 200, and his overall fatigue was much lighter.； There is also a middle school teacher who gave up pasta for half a year and made gluten-free meals at home every day. It was very troublesome. His antibody test did not change at all. He was also irritable every day because he couldn't eat anything that he liked, which made his insomnia worse. The reason for this difference is that the effect of a gluten-free diet on Hashimoto's is based on "leaky gut + molecular mimicry" - some Hashimoto's patients have a damaged intestinal barrier. After the gliadin in gluten enters the blood, its structure is similar to the protein of thyroid cells, which can mislead the immune system to attack the thyroid. However, if there is no leaky gut problem, quitting gluten will have little effect, and will only increase the burden of life. If you really want to give it a try, you don’t have to buy gluten-free flour that costs tens of dollars per pound. First, you should abstain from foods with high gluten content such as pasta, cakes, and pizza for 2-4 weeks to see if there are any changes in your physical condition and antibody levels. If it works, it’s not too late to persist.

There are also dairy products and soybeans that are often included in the taboo list, but the same is true. Some people are intolerant to the casein in milk. After drinking it, they are prone to flatulence and increased inflammation levels. After quitting, their immune status improves and their antibodies naturally decrease. ； Some people are also worried that soy isoflavones will affect thyroid function. In fact, existing research has confirmed that as long as you do not eat two or three kilograms of tofu or drink one liter of soy milk every day, there will be no problem if you eat soy products normally. Many of my Hashimoto friends drink soy milk every day, and their thyroid function has been very stable.

Oh, by the way, there is another widely circulated misunderstanding, saying that Hashimoto cannot eat cruciferous broccoli, cabbage, and radish. This is really half of the truth. Cruciferous glucosinolates will indeed affect the thyroid's absorption of iodine in the case of iodine deficiency, but the prerequisite is that you are deficient in iodine and eat a large amount of raw food at one time. If you usually fry broccoli or make radish soup, those substances will have been destroyed after cooking. That’s almost it. It’s okay to eat a pound a day. On the contrary, the anti-inflammatory and antioxidant effects of this kind of food are good for Hashimoto’s patients. I have seen many people avoid eating more vegetables because of the avoidance of cruciferous vegetables. They have been constipated for several months, which is totally not worth the gain.

I have come into contact with at least hundreds of Hashimoto’s patients, and my biggest feeling is, don’t let “dietary taboos” become a mental burden on you. When many people were first diagnosed, they wanted to implement all the taboos spread online. They didn't even dare to touch hot pot when having dinner with friends, for fear of the presence of iodized salt, gluten, and dairy products. They ate every meal with trepidation, which in turn increased their emotional stress and caused their antibodies to rise faster. In fact, Hashimoto’s itself is a chronic disease related to autoimmunity. As long as you control the intake of iodine, the rest depends on how your body feels: after eating something, you feel tired, your neck is swollen, or your stomach is uncomfortable. Just stop for a while and try. If you are not uncomfortable, eat hot pot when you should, drink milk tea when you should. After all, a good mood is the best immune modulator, and it is more effective than abstaining from ten things.