Interview with Jill Grunewald, holistic nutrition coach.
Jen: What are some signs/symptoms of Hashimoto’s?
Jill: Hashimoto’s is autoimmune hypothyroidism (low thyroid function) and it’s estimated that 90 percent of people who have low thyroid function do, in fact, have Hashimoto’s. Having thyroid autoimmunity means that there are antibodies in the blood that are launching a “mission sabotage” on the thyroid gland. Whether hypothyroidism is due to Hashimoto’s or from iodine deficiency (the cause of the other 10 percent of hypothyroid cases), the telltale symptoms are the same: unwarranted fatigue (even after a full night’s rest), difficulty losing weight, gaining weight with no change in diet or exercise, hair loss and loss of hair luster, difficulty getting and staying warm, constipation, depression, brain fog, fluid retention (edema), poor ankle reflexes, and dry skin. You can read a lengthier list of symptoms here.
A significant difference between Hashimoto’s and iodine-deficient hypothyroidism is that in cases of Hashimoto’s, some people swing back and forth between hypothyroidism and hyperthyroidism — or overactive thyroid. So while the diagnosis may be low thyroid function, some experience a “push-pull” and have days where they feel hyperactive, energetic, anxious, and can have heart palpitations. This hyper state is a sign of excess thyroid hormones in the bloodstream due to increased autoimmune attack on the thyroid.
Jen: How do you get tested?
Jill: Thyroid testing includes a full range of thyroid labs (bloodwork) or an at-home BBT(basal body temperature) test, which involves taking your basal body temperature first thing in the morning for three days, then determining the average. If it’s less than 97.8, you’re likely hypothyroid. When it comes to labwork, it’s important to work with an open-minded, functional medicine doctor who isn’t TSH-happy. TSH stands for thyroid stimulating hormone and reveals very little of overall thyroid function. (See this link for the labs I recommend.) See “Testing in the Lab” in this Experience Life article for functional reference ranges, which can more readily determine an imbalance. You can also order bloodwork on your own. There are several online sources, and the one I recommend is HealthCheck USA. The Ultimate Panel includes the thyroid labs I feel are most telling of overall thyroid function.
We live in a numbers-happy society: “Numbers don’t lie.” Or, “You can’t manage what you don’t measure.” Yet some functional medicine doctors say that when it comes to managing hypothyroidism, the real litmus test of whether your thyroid is functioning optimally is how you FEEL. Hear hear!
Jen: Why did this happen (i.e., is it my fault)?
Jill: Many of my clients ask, “What did I do wrong? How did I cause myself to be hypothyroid? What did I do to myself to acquire autoimmunity?” For 10 percent of those with hypothyroidism, they’re simply iodine deficient. That’s an easy fix. (See below for dietary recommendations.) For those with autoimmunity, it’s more complex. There is a long list of autoimmune conditions, including lupus, multiple sclerosis, Type 1 diabetes, celiac, rheumatoid arthritis — the list goes on. One in twelve Americans has an autoimmune condition, making it more prevalent than heart disease and cancer. But it’s rarely talked about as an epidemic. While there are differing expert opinions on what has caused the drastic rise in autoimmune conditions, including genetic predisposition, scientists worldwide concur that the root cause is environmental — a result of our Industrial Age and 21st century lifestyles. Exposure to chemicals, toxins, pesticides, and processed foods has caused our immune cells to become confused and for some of us, to launch an attack on our own bodies. I realize this is sobering, but I don’t dwell on the doom and gloom — I like to look forward to ask what we can do today to heal and to protect ourselves. To learn more about the sudden rise in autoimmune diseases, I recommend Donna Jackson Nakazawa’s book, The Autoimmune Epidemic.
Jen: What’s the way out?
Jill: Autoimmunity or no autoimmunity, thyroid drugs or no thyroid drugs, there are several things you can do to jumpstart a sluggish thyroid and start alleviating symptoms. Diet is your first line of defense. And I don’t mean “dieting” — many people who are struggling with thyroid-related weight gain go on calorie-restrictive diets, which can backfire.
There is no pharmaceutical cure for any autoimmune disease and managing autoimmunity can be multi-faceted. Generally, it’s critical to rethink what you’re eating and to eat whole, unadulterated foods (steer clear of factory-made and factory-farmed food); eat organic as often as possible; supplement wisely; address the stressors in your life; and shield yourself as much as you can from everyday chemicals, including cleaning and bodycare products.
Jen: What foods should you avoid?
Jill: It depends on the level of hypothyroidism and the adrenal fatigue that typically accompanies hypothyroidism, but more often than not, it’s a good idea to stay away from sugar and caffeine, both of which can up the ante on the overproduction of stress hormones — namely adrenaline and cortisol — that can hinder thyroid function. Goitrogens — broccoli, Brussels sprouts, cabbage, cauliflower, kale, kohlrabi, rutabaga, and turnips are the heavy-hitters — can also hinder thyroid function by causing a goiter, or enlargement of the thyroid gland. While there is some controversy about the degree to which cooking inactivates goitrogenic compounds, generally, I believe that cooked goitrogens are fine. They’re certainly not deal-breakers. You’ll also hear wildly differing opinions on soy, and my opinion is that it’s fine if it’s fermented (tempeh, for example), in moderation. Being 100 percent gluten free is non-negotiable if you have Hashimoto’s. Because the molecular structure of gluten is almost identical to the molecular structure of thyroid tissue (so weird), ingesting gluten can make the body say, “Invader! Attack! Attack!” and increase the autoimmune assault on the thyroid.
In addition, do not eat a low-carbohydrate diet, which can contribute to brain fog, hair loss, and can inhibit your body temperature regulation. It can also inhibit T3 production and increase Reverse T3, which can block thyroid hormone receptors.
Jen: OK, so what should I eat?
Jill: Here is my shortlist:
- Get protein at each meal. Protein helps boost T3, your active thyroid hormone, and helps convert T4 to T3.
- Get plenty of wholesome, dietary fat. Fat and cholesterol help build proper hormonal pathways.
- Selenium, found primarily in Brazil nuts and sunflower seeds, helps boost T3 production. Zinc, copper, and iron are also important, as is a range of B vitamins, “the anti-stress vitamins.”
- Vitamin D is particularly important, and most people are deficient. Not only does Vitamin D help transport thyroid hormone into our cells and help contribute to proper hormonal pathways (it’s actually a hormone, not a vitamin), it’s also an immune modulator, meaning that it can help modulate and regulate wayward immune function.
For more information, see “Nutritional Dos and Don’ts” in this article.
For those with non-autoimmune hypothyroidism, amp up the dietary iodine intake with seafood and sea vegetables, the best sources. Seasnax, roasted sea vegetables, are strangely addictive. (I don’t recommend iodine supplementation, unless it’s food-based, as from kelp.)
Jen: Can you work out if you have Hashimoto’s?
Jill: Absolutely. While severe fatigue is often the case for those with low thyroid function, it’s important to move. For those with more advanced fatigue, walking and yoga are sufficient. Some functional medicine doctors say that for people who have severe adrenal dysfunction and crippling fatigue, it’s best to not exercise at all during the healing phase. Later, people can transition to restorative exercise – yoga, tai chi, light pilates, walking, or the biofeedback approach you take at Movement Minneapolis. White-knuckling exercise and having a “I gotta do this because I’m overweight” attitude can be counterproductive. I’ve given many clients permission to take a break from exercise and they’ve broken through weight loss barriers. Why? Because non-restorative, “distress” exercise can induce a stress response, which can cause overproduction of adrenaline and cortisol. Cortisol, nicknamed “the belly fat hormone,” then sets up camp around our midsection and also hinders thyroid function. So it’s a vicious cycle. “Eustress” exercise, on the other hand (thank you, Jen, and the other rock stars at Movement Minneapolis for introducing me to this term) is restorative and gets people better results.
Jen: What lifestyle changes can I make to support thyroid health?
Jill: There is a significant mind-body component to thyroid health. The thyroid gland corresponds with our 5th chakra, the throat chakra, and is between the 6th and 4th chakra, which are the head and heart chakras, respectively. Chakra means “wheel” or “turning” in Hindu and our chakras are energy centers in the body. Our throat chakra is associated with the ability to communicate clearly and effectively. When there is conflict between the head and heart, we can have a thyroid imbalance. The best way to work through this conflict is to journal, meditate, pray, breathe, or practice visualization. Any spiritual practice, including yoga, which was designed to support all of our chakras, will help resolve this imbalance.
Your Dietary Defense
Making dietary changes is your first line of defense in treating hypothyroidism. Many people with hypothyroidism experience crippling fatigue and brain fog, which prompts reaching for non-nutritional forms of energy like sugar and caffeine. I’ve dubbed these rascals the terrible twosome, as they can burn out your thyroid (and destabilize blood sugar).
1. Just say no to the dietary bungee cord. Greatly reduce or eliminate caffeine and sugar, including refined carbohydrates like flour, which the body treats like sugar. Make grain-based carbohydrates lesser of a focus, eating non-starchy vegetables to your heart’s content.
2. Up the protein. Protein transports thyroid hormone to all your tissues and enjoying it at each meal can help normalize thyroid function. Proteins include nuts and nut butters; quinoa; hormone- and antibiotic-free animal products (organic, grass-fed meats, eggs, and sustainably-farmed fish); and legumes.
Note: I’m not a fan of soy and soy products: tofu, soy milk, fake meats, energy bars, etc. Even when organic and non-GMO, soy can impede cell receptors and disrupt the feedback loop throughout your entire endocrine (hormonal) system.
3. Get fat. Fat is your friend and cholesterol is the precursor to hormonal pathways; if you’re getting insufficient fat and cholesterol, you could be exacerbating hormonal imbalance, which includes thyroid hormones. Natural, healthful fats include olive oil; ghee; avocados; flax seeds; fish; nuts and nut butters; hormone- and antibiotic-free full fat cheese, yogurt, and cottage cheese (yes, full fat, not skim); and coconut milk products.
4. Nutrient-up. While nutritional deficiencies may not be the cause of hypothyroidism, not having enough of these micronutrients and minerals can aggravate symptoms: vitamin D, iron, omega-3 fatty acids, selenium, zinc, copper, vitamin A, the B vitamins, and iodine.
A few highlights:
- It’s commonly believed that hypothyroidism is due to insufficient iodine, but this isn’t true. Dr. Kharrazian states that if you have Hashimoto’s, taking supplemental iodine is like throwing gasoline on a fire, so eschew iodine supplements and iodized salt. Primary sources of iodine: sea vegetables and seafood. Secondary sources: eggs, asparagus, lima beans, mushrooms, spinach, sesame seeds, summer squash, Swiss chard, and garlic.
- Optimal vitamin D levels are between 50-80 ng/mL; anything below 32 contributes to hormone pathway disruption.
- Omega-3s, found in fish, grassfed animal products, flaxseeds, and walnuts, are the building blocks for hormones that control immune function and cell growth, are critical to thyroid function, and improve the ability to respond to thyroid hormones.
5. Go 100% gluten-free. The molecular composition of thyroid tissue is almost identical to that of gluten. So for those with Hashimoto’s, it’s a case of mistaken identity. Eating gluten can increase the autoimmune attack on your thyroid.
6. Be mindful of goitrogens, which are foods that can interfere with thyroid function. Goitrogens include broccoli, Brussels sprouts, cabbage, cauliflower, kale, kohlrabi, rutabaga, turnips, millet, spinach, strawberries, peaches, watercress, peanuts, radishes, and soybeans. Does it mean that you can never eat these foods? No, because cooking inactivates goitrogenic compounds and eating radishes and watercress in moderation isn’t going to be a deal-breaker.
7. Go for the glutathione. Glutathione is a powerful antioxidant that strengthens the immune system and is one of the pillars of fighting Hashimoto’s. It can boost your body’s ability to modulate and regulate the immune system, dampen autoimmune flare-ups, and protect and heal thyroid tissue.
While few foods contain glutathione, there are foods that help the body produce glutathione: asparagus, broccoli, peaches, avocado, spinach, garlic, squash, grapefruit, and raw eggs. A plant substance found in broccoli, cauliflower, and cabbage, (those goitrogens), helps replenish glutathione stores.
8. Address underlying food sensitivities. Just like the body’s attack on the thyroid in the presence of Hashimoto’s, the body will also see offending or inflammatory foods as an invader and will up the ante on the autoimmune response.
9. Do a gut check. A whopping 20 percent of thyroid function depends on a sufficient supply of healthy gut bacteria, so it’s best to supplement with probiotics (friendly intestinal bacteria).
10. Address silent inflammation with whole foods nutrition. Systemic inflammation and autoimmunity often go hand-in-hand.
11. Address adrenal fatigue. There is an intimate connection between your thyroid and adrenal glands and it’s uncommon to have hypothyroidism without some level of adrenal fatigue. The thyroid and adrenals are like Frick and Frack – so tightly in cahoots that it’s not effective to address one without the other.
12. Look at your stressors and practice relaxation. The thyroid is a very sensitive gland and is exceptionally reactive to the stress response.
13. Ask for the thyroid collar. The thyroid is sensitive to radiation, so next time you’re getting an x-ray at the dentist, ask for the thyroid collar. Do not let your thyroid get zapped!
NUTRITIONAL DOS AND DON’TS
Autoimmunity or no autoimmunity, drugs or no drugs, it’s vital to treat the thyroid well by eating a thyroid-friendly diet. Here are some of the nutritional recommendations Minneapolis-based holistic nutrition coach Jill Grunewald recommends for her clients.
The big three macronutrients — fat, protein and carbohydrates — all play key roles in regulating thyroid function.
- A low-fat or nonfat diet or a diet high in nasty trans fats will weaken your immune system and can wreak hormonal havoc. But cholesterol is the precursor to our hormonal pathways, so healthful fats are necessary for energy and hormone production. Quality sources of fat include olives and olive oil, avocados, flaxseeds, fish, nuts and nut butters, hormone- and antibiotic-free full-fat dairy, coconut oil, coconut milk products, grass-fed meats, and many types of wild fish.
- Protein is required for transporting thyroid hormone through the bloodstream to all your tissues. Protein sources include meat and fish, eggs, dairy, nuts and nut butters, legumes (lentils, beans, etc.), and quinoa.
- Low-carb diets are not a good choice for those suffering from impaired thyroid function. Decreasing carbohydrate intake leads to diminished levels of T3 hormones, crucial to your metabolism. Try the complex carbs found in vegetables, legumes, fruits and whole grains.
Nutritional deficiencies play a significant role in thyroid dysfunction. While they aren’t the cause of hypothyroidism, not having enough of these micronutrients and minerals can exacerbate symptoms.
- Vitamin D — Egg yolks, fatty wild fish (salmon, mackerel, herring, halibut and sardines), fortified milk and yogurt, mushrooms, fish liver oils. It’s best to supplement with vitamin D, as since it’s nearly impossible to get everything we need from food sources. An adequate level of vitamin D is essential, as because it helps transport thyroid hormone into cells. (The standard minimum of 32 ng/mL won’t do it, as levels below this can contribute to disruption of hormonal pathways. Optimal vitamin D levels, I believe, are between 50–80 ng/mL.)
- Iron — Clams, oysters, spinach, white beans, blackstrap molasses, organ meats, pumpkin seeds, lentils
- Selenium — Brazil nuts, sunflower seeds, mushrooms, tuna, organ meats, halibut, beef
- Zinc — Oysters, sardines, gingerroot, whole grains, beef, lamb, turkey, split peas, sunflower seeds, pecans, Brazil nuts, almonds, walnuts, maple syrup
- Copper — Beef, oysters, lobster, crabmeat, mushrooms, tomato paste, dark chocolate, barley, sunflower seeds, beans (white beans, chickpeas)
- Iodine — Primary sources: sea vegetables (kelp, dulse, hijiki, nori, arame, wakame, kombu), safe seafood; secondary sources: eggs, asparagus, lima beans, mushrooms, spinach, sesame seeds, summer squash, chard, garlic
FOODS THAT WEAKEN THYROID FUNCTION
Eating right for thyroid health also means avoiding these foods:
- By definition, goitrogens are foods that interfere with thyroid function and get their name from the term “goiter,” which means an enlargement of the thyroid gland. If the thyroid is having difficulty making thyroid hormone, it may enlarge as a way to compensate for its inadequate hormone production. Goitrogens include cruciferous vegetables such as broccoli, Brussels sprouts, cabbage, cauliflower, kale, kohlrabi, rutabaga and turnips. Though research is limited, it appears cooking helps inactivate goitrogenic compounds, so don’t shun these foods, especially considering their cancer-fighting superpowers. Foods that are less goitrogenic are millet, spinach, strawberries, peaches, watercress, peanuts and soy.
- Soy is one of the most controversial foods out there. Many believe that it is not fit to consume unless it’s fermented and only then in moderation. Fermented soy includes tempeh, natto (fermented soybeans), miso (fermented soybean paste), and shoyu and tamari (both types of soy sauce). Fermented soy doesn’t block protein digestion like unfermented soy and isn’t a menace to your thyroid. Unfermented soy contains goitrogens, which can stifle thyroid function. Unfermented soy products such as soymilk, soy ice cream, soy nuts and tofu, are reported endocrine disrupters and mimic hormones. Soy blocks the receptor sites in your cells for naturally produced hormones and interrupts the feedback loop throughout your endocrine system.
- Sugar and caffeine are the terrible twosome. These rascals can do a number on your thyroid by further stressing your system. When you have compromised glands, especially hypothyroidism and adrenal fatigue, the last thing you want to do is amp your system with sugar, caffeine and refined carbohydrates like flour-based products, which the body treats like refined sugar.
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