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Hashimoto's Prescription Diet: Addressing Real Root Causes (Part I)

I'm an accredited journalist working at the intersections of science, food and public health. I am also a certified nutritionist.

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What Is Hashimoto's Thyroiditis?

Hashimoto's Thyroiditis is an autoimmune condition characterised by a predominantly underactive thyroid resulting from a reduction in thyroid hormone output.

Cycling back and forth between underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid function with Hashimoto's causes various symptoms.

Common symptoms of Hashimoto's are:

  • Fatigue.
  • Dry skin and hair.
  • Brittle or broken fingernails.
  • Weight gain (though, in some cases, one is skinny).
  • Cold intolerance.
  • A pale skin colour.
  • Feelings of apathy or depression.

Sometimes, Hashimoto's patients experience additional symptoms such as disordered sleep patterns, mental challenges, poor resistance to stress, joint pain and digestive upset.

Someone may be experiencing periods of anxiety, insomnia, diarrhea and weight loss, followed by periods of depression, fatigue, constipation and weight gain.

Hashimoto's severity is measured by assaying anti-thyroid peroxidase (TPO) antibodies and monitoring the levels of thyroid-stimulating hormone (TSH) in the blood.

A typical Hashimoto patient with moderately severe symptoms but poorly managed condition will have TSH levels above 5000 mUi/l - instead of the "normal" reference range of between 0,400-3,500 mUi/l. Meanwhile, TPO antibody readings inferior to 9 UI/ml are generally considered normal.

Treatment with a gradual increase in the medication levothyroxine is the first and sometimes only strategy used to bring these levels within the normal range with varying degrees of success and not without side effects.

It is understood that unless there is a family history of thyroid issues or autoimmune conditions, a combination of environmental factors triggers thyroid issues. Therefore, a complete remission of Hashimoto's is attainable with lifestyle modifications.

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Root Causes of Hashimoto's

Viruses, stress hormones and gluten are three research-backed causes or triggers of Hashimoto's Thyroiditis. But there are other contributors.

Stress Overload

Once a stress-inducing event triggers a cascade of hormones, these hormones redirect the body's normal functions to reprioritise anything that is not necessary for overcoming the present stressor.

Functions like thyroid hormone production are temporarily put on hold or slowed down until the stress has passed.

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Chronic stress also translates into perpetually flooding the body with cortisol. Cortisol signals to the hypothalamus and the pituitary gland to slow down. Since these organs also regulate thyroid hormone production, that gets slowed down.

Stress hormones affect the enzymes that convert the inactive thyroxine (T4) thyroid hormone to its functional homologue triiodothyronine (T3). Therefore, when stress is high, we convert more of our T3 into reverse T3 (RT3) rather than free T3 (the active form of the thyroid hormone). This imbalance is what causes hypothyroid symptoms.

During the stress response, inflammatory immune molecules known as cytokines are also released, which make thyroid receptors less sensitive to thyroid hormones. So even if one is taking thyroid medication and thyroid hormone levels are normal, there still can be underactive thyroid symptoms.

Lastly, prolonged cortisol elevation causes excess estrogen to accumulate. The extra estrogen increases thyroid binding globulin (TBG) levels, which is the protein that allows thyroid hormones to travel through the bloodstream. When thyroid hormones are attached to TBG, they remain inactive, so T4 can't be stored in tissues or converted to free T3.

Immune Dysfunction

A suppressed immune system can trigger latent viral infections, some of which can trigger autoimmune thyroid disease.

The immune system fights infections with systemic inflammation, which damages tissues and triggers a stress response.

At the same time, multiple episodes of chronic stress reactivate latent infections, which creates an autoimmune response.

Separate from this vicious cycle is the fact that the gut houses most of our immune system. As a result, certain factors, like a leaky gut (discussed in the next section), can trigger the over-activation of immune cells in the gut.

The impaired immune cell activation means that one side of the immune system is trying to get to the virus if present, while the other side is incompetent. That creates a "blind" spot, and the immune system does not see the attack on the thyroid.

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Weakened Gut Barrier

A weakened gut barrier leads to a leaky gut, which can set someone on the path toward autoimmune disease. Zonulin testing can confirm or refute a diagnosis of leaky gut.

Leaky gut is an important piece of Hashimoto's. Unfortunately, researchers still do not fully understand the connection, but several theories exist.

A leaky gut lets food toxicants like gluten and casein proteins into the bloodstream, both of which can trigger attacks on the thyroid via molecular mimicry.

Repeated courses of antibiotics in infancy can predispose Hashimoto's patients to a leaky gut, among other factors. The integrity of our gut barrier is dictated in part by the microbiota composition. The microbiome controls quite a bit of our hormone levels, too. Antibiotics adversely affect it. I've written a separate article about the health of our gut and how to reclaim it here.

Interestingly, cortisol from stress also weakens our gut barrier. In addition, people with Hashimoto's often have lower pancreatic enzymes and gastrin levels, which are responsible for producing hydrochloric acid (HCl).

Low stomach acid causes further health problems such as candida and dysbiosis, messing with our microbiota. For all these reasons and more, Hashimoto's patients need to closely monitor their digestive function with precision testing as part of a nutrition program.

Hashimoto's and the Brain

Although people's TSH may be managed with synthetic thyroid hormones, part of the immune dysregulation goes unchecked. Other areas of the body are vulnerable to attack, especially the brain.

Antibodies that attack the thyroid nerve have also been seen to attack astrocytes in the brain. Astrocytes play an important role in nourishing neurons and as part of the blood-brain barrier (BBB). A blood test will detect positive antibodies to neurological tissue.

Thyroid antibodies can kill a variety of other brain tissues. Some studies have found immune cells of the thyroid attacking the cerebellum, frontal nerve, etc. Antibodies also reduce blood flow to the frontal lobe, causing brain fog.

Thyroid hormones are integral to brain health to dampen the overactivity of the microglial cells. Microglia activation is linked to neuroinflammation and neurodegeneration.

It is not uncommon to see advanced brain degeneration in long-term, unresolved Hashimoto's cases. Some symptoms indicating that Hashimoto's may be affecting the brain are severe depression, apathy, fatigue and brain fog.

Liver Toxicity

Some causes of hypothyroidism relate to the body's inability to clear certain hormones through the liver to keep the body in balance.

Heavy metal toxicity has been cited as one liver-mediated cause of Hashimoto's.

All harmful substances and toxins are cleared through the liver. So any issue with the liver detoxification pathways will impact all systems, including the immune and endocrine systems.


Part II contrasts the conventional and holistic chronic management of all Hashimoto's roots and deepest causes.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2022 Camille Bienvenu

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