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Hashimoto's Prescription Diet: Traditional Versus Holistic Management (Part II)

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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Part I discussed the root causes of Hashimoto's. This second article highlights the pillars of a holistic nutrition protocol that addresses root causes instead of traditional symptom management approaches.

Conventional Management of Hashimoto's

Synthroid (0,625-levothyroxine) is the primary drug that replaces the natural hormone thyroxine and is used to manage symptoms of hypothyroidism.

The thyroid gland is supposed to produce this hormone on its own but fails to do so in those with thyroid disorders like Hashimoto's.

This treatment typically slows down the effects of the disorder, such as intense fatigue, drowsiness, depression and weight gain. However, it does have some side effects, including hot flashes, headaches, mood swings, nausea, sleep problems, and hair loss.

Unfortunately, the symptoms of hypothyroidism are the same as the reported side effects of levothyroxine. Hence, it is difficult to say which are adverse effects of the drug and which are uncontrolled effects of the disease when a patient works with their doctor to find the correct dosage.

Further, there were technical glitches with its formulation in the past, causing a set of health issues of its own.

Specifically, in March 2017, the Merck laboratory removed lactose from the treatment and replaced it with citric acid and mannitol - a type of sugar alcohol - without announcing it publicly. Changing the formula has changed how the body absorbs levothyroxine, the main ingredient in the treatment.

Many people suddenly reported muscular cramps, dizziness, suicidal thoughts, memory loss, hair loss and palpitations, some of whom had been on the treatment for decades without complaint until the formula changed.

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Holistic Management of Hashimoto's

As antibodies are decreasing and hormones are slowly rebalancing, the focus needs to be on giving the body some support in the transition to coming off medication.

The strategies used include:

  • Balancing blood sugar.
  • Addressing gut health and gut infections.
  • Supporting adrenal health, so the adrenal hormones (like cortisol) are neither too high nor too low.
  • Enhancing the liver's methylation pathway.

It is essential to improve gut dysfunction (low stomach acid, malabsorption of critical nutrients, leaky gut, constipation due to slow metabolism, etc.). Addressing the areas that helped cause a permeable gut-blood-brain barrier is the best place to start restoring integrity.

Repair the Gut and Liver

Healing leaky gut is an absolute priority as it is a significant precursor for autoimmunity.

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Diet strategies to avoid leaky gut revolve around avoiding gluten-containing foods and dairy (casein). Gluten is the most significant food allergen linked to hypothyroidism because the thyroid cell tissue and the gluten molecule are very close in structure.

The similarity in protein structure - of gluten and casein - to the thyroid causes a molecular mimicry reaction and amplifies the autoimmune response. Therefore, the diet needs to be strictly void of both.

Second, stomach acid levels need to be monitored and fixed. It is common for people with Hashimoto's to have low stomach acid. Low stomach acid (HCl) inhibits digestion and can cause immense fatigue. In addition, the lack of HCl prevents the body from absorbing essential nutrients necessary for a healthy thyroid and energy.

Some common signs of low HCl include bloating, acid reflux and gas after eating. A simple fix is to consume a digestive enzyme complex supplement containing HCl.

Heal and Prevent Infections

There are five associated with Hashimoto's: herpes viruses; Epstein-Barr; hepatitis C; H. Pylori; Yersinia enterocolitica.

Hashimoto's patients need to undergo testing to treat these viral and bacterial infections to decrease thyroid antibodies further. Consuming immune-supporting foods and herbs is also indicated.

Kinesiology (muscle testing) is criticised but can be helpful feedback from your body about unique food sensitivities.

Kinesiology (muscle testing) is criticised but can be helpful feedback from your body about unique food sensitivities.

Reduce Allergenic and Toxic Load

Removing allergenic foods whilst adding selenium-rich foods the thyroid needs, and reducing exposure to toxins (mercury, perchlorate and nitrates), will benefit patients.

In addition, replacing any processed foods with whole organic produce and grass-fed organic meats or wild-caught fish is recommended. Some 60 per cent of pesticides used today have been shown to affect the thyroid gland's production of T3 and T4 hormones.

Grains should be eliminated because of their high inflammatory potential at the level of the gut lining. Again, we want to keep inflammation as low as possible to avoid TPO and TSH receptor attacks.

Other foods to minimise are vegetable oils, including canola, safflower oil, corn, sunflower oil, and all dairy.

Manage Blood Sugar

The rise and fall of insulin encourage the body to convert T4 to reverse T3 instead of free T3. Reverse T3, the inactive form of thyroid hormone, slows metabolic processes and contributes to fatigue.

Eating a low-glycemic, fat and fibre rich-diet should be the go-to diet template for all Hashimoto's patients, whether newly diagnosed or not.

Address Food Sensitivities

Foods that flare up the immunoglobulin G (IgG) system also tend to flare up thyroid antibodies. So doing a food allergy or sensitivity test is a good way to eliminate the major dietary culprits involved in the autoimmune response.

Alternatively, an elimination diet protocol would be helpful, especially for patients experiencing bloating, gas and occasional soft stools. Dairy sensitivity is a common contributor to these symptoms and is problematic in Hashimoto's patients.

Dairy is one of the worst offenders because of the cross-mimicry between casein and gluten. The proteome of cheese, for example, is made mainly of casein.

Following a short 6 to 12-week elimination diet would help determine whether other foods, such as eggs, are also provoking the immune system.

Relieve Stress

Supporting the adrenals is part and parcel of leaky gut management and thyroid hormone balance.

Incorporating one or more forms of a stress-reducing practice (like yoga, tai chi or meditation) in daily life can be extremely beneficial.

Add-ons like adaptogens and B-vitamins can also help maintain stress hormone levels in range and calm down the immune system.


Part III provides a detailed outline of the food and supplement protocol to normalise thyroid function and reduce reliance on medication.

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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