Is an elimination diet necessary for healing Hashimoto’s?

The internet says so. I say, maybe.

Functional medicine and functional nutrition look at foods differently than conventional medicine. We look at foods that are causing inflammation or are creating a toxic burden especially when it comes to autoimmune disease. What I’m looking for in having my clients change their diet is to see if there are foods that are contributing to immune system dysfunction.

The most common diet for doing this is the elimination diet and the various versions of it from the autoimmune protocol to the IFM elimination diet. The AIP diet is really strict. No grains, beans, nuts, seeds, nightshades, dairy, and eggs. Many spices are also included if they fall into any of these categories. Let’s not forget the sugar, caffeine, processed foods, trans fats, alcohol and GMO foods. Some people may need to remove citrus as well but I don’t usually go that far. Removing these foods should improve gut health and bring down inflammation so the body has time to respond properly to things going on. With removing foods, you want to add in healing foods.

One of the most healing foods you can eat is bone broth. It’s so simple to make too. Take your chicken bones after a meal and put them in a pot, add water and cook for 4-5 hours. You can make it even better by adding in onion, carrot, celery, garlic, a little ACV. The last batch I made I used carrot tops from the farmers market, celery, and I always save onion peels from when I use onions for other things and freeze them to use in making broth. I cook mine in the instant pot for 90 minutes so if you have one, that is the quicker way to get broth. I drink it occasionally when I’m just needing a little comfort or feel like my gut just needs some help. I add ginger and mint and salt to taste and then a little coconut milk if I think of it. It’s so filling and feel good and healing.

Also, eating a rainbow. Eat vegetables. More vegetables than fruit. You will get anti-oxidants, phytonutrients. You will get fiber. You need fiber!

You need protein. Your immune system needs protein to work properly and for cellular health.

It is usually recommended that these types of diets are done for a minimum of 2 weeks but ideally for around 6 weeks so that the body has proper time to calm down and heal again. Doing an elimination diet takes a shift in your mindset and it is really helpful to have some support. Some would say you will need a version of this diet for the rest of your life. To this I say, it really depends on your situation and how sick you are, how far your disease has progressed whether it is Hashimoto’s or something else.

Doing this diet can be overwhelming so you can do it in phases. Someone created a program where they walked you through doing it over 6 weeks time which you can do or you can start by removing the most inflammatory foods or the ones we would suspect are the most inflammatory with gluten being at the top of the list. Then maybe remove dairy the next week and then eggs the week after that. Try to get your family on board with this- that will be super helpful.

You will definitely need to do some meal planning, shopping and probably even list making. Thankfully the internet is full of websites that are dedicated to the AIP or elimination diet so you will not have a shortage of ideas for what to cook. There are several cookbooks out there too.

Sourcing the best quality food is ideal but not necessary. If you can find local farmers to buy from you may find that you are getting it for cheaper than in the grocery store these days but truthfully, I have not shopped for meat in the grocery store in years so I could be wrong. I paid $4.00 per pound for ½ a cow last year and that means $4.00 per pound for T-bone steaks and ground beef.

If you find it to be easier to stick to the elimination diet, you may want to clean out your cupboards so that when you go into your kitchen, you have options that will improve your health rather than impede it. And if who ever lives in your household with you can get on board and start eating the same way then that will just set you up for success. When I started to change my diet I cooked separate things for awhile but that did not last long. I got some pushback from my family, especially my husband when I made diet changes. It’s a little embarrassing to admit but when I was toying around with diet changes, I told my husband I was thinking about going gluten free to see if it would help me and he laughed at me. It’s not really ever been an emotionally safe thing to be vulnerable with him so I was pretty hurt by his reaction. I say this because if you are not supported, I want you to know it’s okay- you can still make changes and recover your health and when you get strong enough and healthy enough you can take steps to fix the relationship stuff too. We have to find our voices to be healthy too.

Having your family join you in diet changes is nice because they may have susceptibility to autoimmune disease too so getting them a head start on keeping some of those triggers under control will only benefit them for the rest of their life. But you do what you have to do - you can’t be good to them if you are not good to yourself.

For support you can look for a community but you have to be really careful of these online message board or facebook groups or whatever. Many of them are loaded with people who are not taking a functional medicine approach and they are complaining about symptoms and medications and things like that. They are not uplifting and supportive unless you are wanting to get support for feeling terrible and not fixing why you feel terrible.

You may have been told if you are a vegan or vegetarian that you will not heal an autoimmune condition eating that way. I’ve been to a couple conferences that really just hated on the vegan diet and lifestyle. I am not a vegan and I never will be a vegan but I respect your desire to be vegan or vegetarian. I do think you have to be really really mindful of what you eat when you are eliminating a whole food group. I think that is true for any type of diet- even the paleo diet because that eliminated quite a bit of stuff. With a vegetarian or vegan you have to be really mindful of getting in real whole foods and really good proteins - you can’t be vegan and do AIP- that would be way too restrictive. You may have to use protein powders to get enough protein but try not to make them a part of your everyday diet.

Making all these diet changes might feel tricky, especially breakfast. I remember really worrying about what I was going to eat when I just went gluten free. It was a big deal. I couldn’t do peanut butter toast anymore or most cereals- none of what I ate for breakfast helped my blood sugar ever. At the time I wasn’t a huge fan of eggs and if you are doing AIP you can’t have eggs to start with anyway so what do you have for breakfast?

Sweet potato hash (https://www.outofthewoodsnutrition.com/help-for-hashimotos-blog/2020/4/23/breakfast-hash) , breakfast sausage, coconut milk yogurt, leftovers. I started out eating a lot of leftovers and made what I called breakfast soup which was a basic soup - chopped onion, celery, carrot sauteed in olive oil in a dutch oven, then I added locally made breakfast ground breakfast sausage or made my own with ground pork and seasonings- I think maybe this recipe came out in my newsletter long ago. I’ll put it out again soon so sign up for my newsletter if you want the recipe. Then I added bone broth- about 4 cups and would add zucchini at the end so it didn’t get too mushy. You can do a hash of grass fed beef, zucchini, summer squash, onions and top it with an avocado. You’re not doing grains on AIP so gluten free toast is out of the question. Leftovers, as I said is always a good option.

Other options for the rest of the day might be soup for lunch or a really big salad with a good sized amount of protein- 4 oz at a minimum.  On the weekends, I make one or two chickens and then use that meat all week long. I buy chickens locally too and my last order was for like 15 or something like that- I was buying for 4 people and now we are down to three and one of those three is not always home for dinner so I need to learn to cook for two people. Even my husband isn’t home a lot for dinner so what’s the fun in cooking when no one is there. So I will throw two chickens in a dutch oven and cook at 300 for 4 hours or so and then all that meat just falls off those bones. Then I use the bones, liver, heart, gizzard, neck bones and make broth. I freeze the broth either in freezer bags or in jars- gotta be careful with the jars though or they can crack open.

You can do cauliflower rice and avocado and spices, then you can grill some meat and veggies for dinner and do some berries for dessert.

Finding the time for this takes some effort. Dedicate a day to prepping for at least the first half of the week and then maybe mid week you prep for the rest. You can get great meal prep containers at Target now. Batch cook. If you are making burgers, double what you need so you have leftovers. If you are making fish- same - just double it so you can have leftovers.  Use a crockpot, instant pot, air fryer- whatever makes life easy for you. Cook double the veggies so you can throw some of them into a salad the next day.

You have to make an effort to be prepared too for things like travel- plan around flight departures and arrivals and can you stop at a store on your way to your hotel, what kind of food is in the airport? I live in Minneapolis and our airport is really great. I always know I have great food options when I am traveling at least from my home town- other airports, not so much. Bring food with you if needed. Things like meat sticks, jerky, Epic bars, apples. All great travel options in a pinch. Even now you can get prepackaged olives and green beans in little snack packs.

Getting on this diet or just cleaning up your eating you may see joint pain disappear, your digestion can improve, pain may lessen or go away, thyroid antibodies may go down over time (they actually probably will go down but I don’t want to make promises), psoriasis goes away all with just diet changes. If things don’t get better then you can start thinking about testing for things like inflammation and other stuff that might just be in the way of making you feel better.

So start with diet, then we maybe look at gut health, healing the gut, looking at stress, lifestyle factors and kind of go from there. You may need to do some stool testing and maybe we find overgrowth in small intestinal bacteria or parasites or maybe your body just needs more gut healing foods or we need to figure out the right ratio of macronutrients for your body. It’s all a big puzzle that we need to figure out. Maybe you should not be eating a ton of fermented foods. If you don’t get better on an elimination diet, it could be that you are just feeding a beast in your belly with ferments and so we can do some testing to see if that is a problem.

Another thing to address might be your toxic load/burden and again the stress and how connected you might or might not be to other people, how happy you are. It all plays a role.

Working with me looks like this:

We are going to talk about your medical history, we will discuss any recent labs or labs can be ordered, we will talk about medical nutrition therapy and we will talk about any questions you have- things as simple as what you can eat for breakfast if that is what you need help with. We can do a 3 month package where we meet biweekly if you need that type of support or we can just meet one time or three times. Whatever works for you.

Oops! I forgot to take my medication. Plus, how’s your poop? Episode 17.

ITunes Review: 

Stephanie, Thank you so much for a wonderful podcast. I love that you keep it real while answering difficult questions for us. You have a very calming and peaceful voice and I am always so encouraged listening to your podcasts. Keep them coming. We are listening and learning. 

What do you do if you forget to take your medication? 

Half life- a half life in the world of medications means the amount of time it takes for the concentration of the medication in your blood plasma to reduce by half.  Said another way- it is how long a drug stays in your system or the amount of time it takes for the effectiveness of a drug to reduce by half. 

If you are taking levothyroxine, the half life is 6-7 days and up to 9 or 10 days if you are dealing with hypothyroid conditions. If you have hyperthyroid conditions then it can be as little as three days. Nothing seems to be easy with this disease. 

Levothyroixine is a common treatment and most likely what your doctor will prescribe unless you have a doctor open or more knowledgeable in thyroid health. 

For practical purposes we will go with a 7 day half life for levothyroxine. When you take this medication, around 80% of it goes through your system over a longer period of time, like several hours. 

According to the Williams Textbook of Endocrinology, missing a day shouldn’t have a big effect on you. They also say that T4 is absorbed very well by the body so waiting an hour to take your medication before eating might not necessarily be required. Taking it on an empty stomach will give you a more stable TSH reading though. But since we all know that TSH should not be the gold standard, that maybe shouldn’t matter. 

The reason you usually have to wait 6 weeks to have your labs tested is because of this long half life. It takes about 6 weeks before your body has adjusted to a dose. 

However, if your digestion is not working well and we are going to talk about that in a minute, then you may have issues with absorption and of creation of T3 from your T4 only medication. 

There can be an issue in concentration of medication between manufacturers which can mess with your body. So, be proactive and let your pharmacy know that you do not want them to switch your medication without your knowledge. Remember that getting this dose right is like goldilocks- it needs to be just right. 

This same textbook also says that NDT is not a good choice for treatment and that TSH is the gold standard so- take it for what it is worth. 

A NDT like Armour has a half life of 2-7 days with the T3 having a half life of 4-6 hours. So if you take your medication with T3 in it at 8am then sometime between 12pm and 2pm you have about half of the original dose of medication in your system. Your cells will have used the rest of it. But it should last you about a day. This means half is gone in 4-6 hours, another half of the half (a quarter more ) will be used in another 4-6 hours and so on. 

T3 is used up faster because your body doesn’t have to convert it like it does T4. This is why it is a good idea to take a partial dose in the morning and a partial dose in the afternoon. 

Now let’s talk about what happens when our digestion isn’t working well because this is very important for our thyroid to work well. 

Thyroid peroxidase is an enzyme. It makes thyroid hormones by cleaving off an iodine molecule and adding it to the amino acid tyrosine on thyroglobulin which then makes T4 and T3. In order for this to happen, we need to have available to us: selenium, copper, magnesium, B vitamins, zinc, vitamin A. 

You should not just go and willy nilly supplement with these vitamins and minerals. There are many factors involved here and supplementing with some of these may make things worse in the long run. So it is a good idea to either do a lot of your own research or work with someone who knows how to work with your condition. 

Our gut or gastro intestinal tract is an important factor in our thyroid health but even before that, what we eat and how we break it down in our stomach is a key factor. 

Before we even talk about what you are eating, let’s talk about how you are eating it. Are you running through the drive through before or after your kids activities? Are you eating in the car or eating while you are doing something else?  Are you relaxed or stressed while you are eating?

Any of those scenarios will mean you are going to struggle with breaking down your meal before it even gets to your small intestine where most of the nutrients are absorbed. 

Digestion actually starts in the brain. We smell our food cooking and our brain signals the production of saliva so we can break down some of that food in our mouth while chewing. Are you chewing your food well? Like 20-30 chews per bite? Really breaking it down so the enzymes in your saliva can begin digesting the carbohydrates in your meal?

Once you have chewed well, you swallow and that ball of food goes in to your stomach and stomach acid and pepsin get to work digesting or breaking down proteins. 

Do you have acid reflux after eating? (there is more about this in the audio)

Once it is broken down in the stomach and reaches the right pH then the valve between your stomach and your small intestine opens and fats are broken down by the release of bile and nutrients are extracted in the small intestine and absorbed in to the blood stream. 

Here is where your gut health comes in to play since leaky gut or Intestinal Permeability are what contributes to autoimmunity. 

We need a balance of gut bacteria in our intestines to help us convert T4 to T3 there. If we are not eating right or digesting well then we will have an imbalance of bacteria and intestinal permeability. 

We can end up with parasites, overgrowth of candida and constipation- all with their own contributions to our failing health. 

When we have hypothyroid- we have a sluggish gallbladder which means we might struggle to digest our dietary fats and then we are making thick and viscous bile which further messes up the gallbladder function. When this is not working well, we are not detoxifying as well either. so we can’t break down hormones or toxins from our environment. 

How are you pooping? No one wants to talk about it but you must be moving stool through your body and going every 16-24 hours. Your BM should be the size of your forearm from your wrist to your elbow, it should come out with ease and you should feel relieved when you are done and not like you still have to go. 

Being constipated further contributes to the “bad guys” overgrowing in your Small Intestine and causing bacterial infections, you may experience chronic pain, inflammation, digestive issues, food intolerances and Hashimoto’s. 

With all of this happening, we can also have issues dumping estrogen and so it can accumulate. This can cause hypothyroidism that you won’t see on a blood test according to Datis Kharrazian in Why Do I Still Have Thyroid Symptoms. This excess estrogen will keep the thyroid hormones from getting to the cells- causing hypothyroid symptoms. 

So you see, taking supplements without first healing the gut is pointless. It is a band aid at best. The only supplement you may need at this point is some stomach acid- Betaine HCl so you can start to break down your food and get those nutrients to your cells, kill off some of the bad guys and bring things back in balance. 

You will see improvement in chronic inflammation from changing what you eat and the way you eat it. Start with your plate. With breakfast. Make some bone broth. That is the next recipe to go out in my newsletter so sign up for that. 

So reduce inflammation by cutting out gluten, dairy products, eggs, most other grains, soy products and yeast. Yeast can feed an already out of control candida overgrowth. These are some of the big allergens, in other grains it is best to avoid corn for sure. 

This gives your body a chance to calm down so it can properly react to foods. 

You need to be on an elimination diet for 3 weeks to 3 months depending on how sick you are, how inflamed, or how long you went untreated for Hashimoto’s. In addition to this, you can do something called a FIT test

What can you eat?  There are no notes for this. It’s only on the audio. 

Why Do I Still Have Thyroid Symptoms?

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