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Thyroid problems are common. If you’re reading this, you may be one of the 20 million people in the United States affected by thyroid disease. (1) What you may not realize is that many thyroid problems originate in the immune system. Hashimoto’s thyroiditis is a result of the immune system mistakenly targeting and attacking the thyroid gland. This can lead to symptoms of hypothyroidism like fatigue, weight gain, hair loss, and more.
Genetics can play a role in the development of Hashimoto’s, but you are more than your genes. This article explores the role of genetics in Hashimoto’s. We’ll also discuss how nutrition and lifestyle can be used to manage Hashimoto’s and promote healthy thyroid function.
Hashimoto’s thyroiditis is one of the world’s most common autoimmune disorders. It is the top reason for hypothyroidism in the U.S. and other countries with adequate iodine intake (most developed countries). Women tend to get it more than men, at least 10 times more. (2)
The thyroid is a small hormone-producing gland that sits at the base of your neck. It is shaped like a butterfly and is often called the butterfly gland. The hormones that the thyroid makes, T3 and T4, regulate metabolism in the body. Without enough T3 and T4, the body doesn’t have enough energy to function properly.
Thyroid hormones are also essential for: (3)
Basically, without the right thyroid hormone levels in your body, you won’t have the energy to live, exercise, or function. Reduced thyroid hormone levels in children can also drastically curb growth, particularly when it comes to bone growth and brain maturation. (4)
Hashimoto’s primarily causes hypothyroidism in those it affects, so the symptom list often looks the same. The way to determine whether or not hypothyroidism is caused by an immune reaction or something else is by having your doctor perform lab testing. Thyroid antibodies including Thyroid Peroxidase Antibodies and Thyroglobulin Antibodies are produced in response to an immune attack and can help to diagnose Hashimoto’s. (5)
Common symptoms of Hashimoto’s and hypothyroidism include: (6, 7)
Other autoimmune disorders might cause similar symptoms, and it’s also possible to have more than one autoimmune disorder at a time. Hashimoto’s thyroiditis is often the first diagnosed, but can be part of multi-gland autoimmune problems including type 1 diabetes, Addison’s disease, or others. (8) Many with Hashimoto’s may have or develop other conditions, including Celiac disease. In turn, Celiac can also cause changes to the gut that may increase the risk of developing Hashimoto’s. (9)
When it comes to Hashimoto’s risk, research has found that as much as 79 percent can be due to genetic factors alone, with the remaining 21 percent associated with environmental influences and reproductive hormone triggers (e.g. why women are more prone to Hashimoto’s than men). (10)
Your risk of developing Hashimoto’s increases the older you get. This is because with aging comes more oxidative stress, less accurate cell replication, and overall increased risk factors for systemic inflammation and gut changes.
Hashimoto’s can also be triggered by infections, including hepatitis C, Epstein-Barr, and parvovirus, among others. (11, 12)
When it comes to specific genetic involvement, there are two distinctly different types of Hashimoto’s: one involves inflammation and swelling of the gland itself, often resulting in goiter; the other involves immune damage and suppression of the gland, resulting in the slow, consistent destruction of the thyroid so that it ultimately stops functioning. For the inflammatory condition, HLA-DR5 seems to be implicated, while HLA-DR3 is associated with the destructive type of Hashimoto’s. (13)
Epigenetic changes can also influence a person’s risk in developing autoimmunity. Research from 2017 in Frontiers in Endocrinology demonstrates that DNA methylation and other epigenetic-associated lifestyle factors can play a substantial role in the development of Hashimoto’s. Data is still limited and it’s not yet clear how this understanding will influence Hashimoto’s treatment. However, it’s an important baseline to show that epigenetics—the way that your genes respond to your environment—are crucial for overall health, and especially as relates to autoimmunity. (14)
Whether you’re newly diagnosed with Hashimoto’s or have been battling it for years, there are many ways to support your body. Nutrition is an essential part of healing, as gut health, inflammation, and methylation are all important for helping the body and thyroid to function optimally. Gut health and inflammation are important to address since they’re often a root cause of Hashimoto’s, too. (15) You can’t get remission from a disease if the main trigger is still a problem!
Lifestyle support is also crucial to turn genes “off” that might be working against the healing process. This can relate to many things, from toxic environmental exposures to making sure you’re getting enough sleep and exercise into your daily life. Next, let’s explore the dietary and lifestyle aspects of supporting your body through Hashimoto’s thyroiditis.
Gut health is an important part of any diet aimed at addressing autoimmunity. Research shows that many aspects of autoimmunity and thyroid health are directly tied to the health of the gut. By addressing gut health with diet, you can also address inflammation in your body. While inflammation is meant to be a healing response in the body, out-of-control inflammation is often a trigger for Hashimoto’s and other autoimmunity. (16)
Much of what we eat today—highly processed foods, elevated omega-6 fatty acids in vegetable oils, and excess sugar—are damaging to gut health integrity and highly inflammatory. (17)
Leaky gut sounds like a quack diagnosis, but that’s just the common term for how it’s clinically known: increased intestinal permeability. The intestines have tight junctions that carefully regulate what is allowed through into the bloodstream and what is passed out of the body as waste. When tight junctions break down and don’t function as they should, they let things “leak” into the bloodstream that shouldn’t be there. Hence the name of leaky gut.
Addressing leaky gut is a multi-process step, but the first factor is getting rid of foods that are impacting the integrity of gut health. The second equally important step is to focus on foods and nutrients that help the body do its own repair work for intestinal health.
Foods to remove for gut health include anything you are allergic or sensitive to, processed foods, fried foods, most grains, dairy products, vegetable oils, artificial sweeteners, refined sugars, and alcohol.
Foods to eat that help promote a healthy gut include a wide variety of fruits and vegetables, fermented foods, meats that are not processed or cured (e.g. fresh beef or salmon are better than lunch meats or smoked salmon), eggs, some grains like oats and quinoa, healthy fats (like olive oil, avocado, and coconut oil), sprouted nuts and seeds, and bone broth.
Diets should be individualized to the person, so it’s best when you’re addressing any type of health issue to work with a nutritionist or dietitian who specializes in your health needs. One-size-fits-all dietary advice on the internet can only take you so far and, at times, can be damaging. Your needs are multifaceted, based on your own complex set of genes, health conditions, and environment.
Ultimately, while the gut seems far away from an organ in your neck, the thyroid acts as a gauge for gut health. When gut health is poor or leaky gut is present, thyroid problems can be some of the first to show up. When you address gut health as part of taking care of thyroid disease, the results will be more successful.
No matter how perfect your diet is, your nutrition is only as good as the foods that you’re fully digesting and absorbing. When leaky gut or other digestive issues are present, your body may struggle to absorb all of the nutrients you provide for it. This is where nutrient dense diets become even more important.
But even the best diet might not be enough to correct some nutritional imbalances or to provide optimal levels of nutrients in the context of autoimmune disease. Targeted supplementation can help to fill gaps and support other types of optimal function. (18)
You should not take a supplement that isn’t personally recommended for you by your healthcare provider, but these are supplements that you might consider asking your doctor about, to promote health for Hashimoto’s.
Vitamin D3
One of the most crucial nutrients for all humans, not just those with autoimmunity, vitamin D3 is essential for healthy immune function, bone strength, and even strongly affects mood. Mood disorders, including depression and anxiety, commonly coexist with Hashimoto’s. (19)
Having optimal vitamin D levels—which some say ranges between 40 and 65 ng/mL—may not only decrease the risk of contracting cold or flu viruses, but can help to promote healthy immune function when it comes to autoimmunity, too. (20, 21) By optimizing vitamin D levels through targeted supplementation, you can support your immune system, overall physical health, and mental health. (22)
It’s important to work with your healthcare provider to determine the proper dose for supplementation. Vitamin D is a fat-soluble vitamin, so excess gets stored in the body. This can result in cases of toxicity when supplementation is too high. Get your blood levels tested and then work with a practitioner to determine the right supplemental dose.
Selenium
Selenium is one of the nutrients required for thyroid function. Without enough selenium, the thyroid isn’t able to remove excess hydrogen peroxide from the gland. This can lead to inflammation, low thyroid output, and thyroid disease. (23)
The RDA for selenium is 55 mcg, but the tolerable upper limit (to avoid any potential toxicity) is 400 mcg for adults. (24)
Probiotics
As discussed, a healthy gut is essential for addressing Hashimoto’s. Supplementing with probiotics has been shown to support optimal thyroid hormone levels as well as the overall function of the gland. (25)
There is no specific daily intake level set for probiotics. Finding a product that works for you can come down to one that you tolerate well or one that your doctor has recommended.
Vitamin B12
Essential for many aspects of health, low levels of vitamin B12 are found in almost half of all patients who have hypothyroidism. Supporting B12 levels with a supplement can help to address common Hashimoto’s symptoms, especially depression and low energy. (26)
Taking an activated form of B12, like methylcobalamin, adenosylcobalamin, or hydroxocobalamin will help to optimize how the body puts B12 to work. Supplementing with folate (as methylfolate or folinic acid) is also recommended with B12, along with B6, since the three synergistically work together for healthy methylation and energy support in the body.
Iron
Iron is an essential nutrient for energy in the body. Without enough, red blood cells and oxygen levels in the blood may be too low, contributing to an overall fatigue load. Iron-deficiency anemia interferes with normal thyroid function, too, resulting in decreased thyroid hormone production. Women are more prone to anemia than men, and for women with Hashimoto’s, optimizing iron levels can be helpful for balancing thyroid hormones. (27)
The RDA for adult women is 18 mg, and this goes up during pregnancy. There are many iron-rich sources of food, including red meat, oysters, chocolate, beef liver, lentils, spinach, sardines, and baked potatoes. Supplementing with more than 25 mg per day can result in disruption to other mineral stores in the body, like zinc. The body will naturally regulate dietary sources of iron, so there’s less risk for iron toxicity from food alone. (28)
Iodine
While iodine is an important nutrient for thyroid function, in the U.S. and other developed countries, it serves as a trigger for autoimmunity. Very few cases in the U.S. are due to iodine shortages. Supplementing with iodine can actually lead to an autoimmune flare or the onset of autoimmune disease. (29, 30)
If you are going to supplement with iodine, it’s important to have your urine levels tested first, to ensure a true deficiency is present. A blood test or a skin patch test are not accurate enough ways to assess iodine status.
Exercise is important for overall human health. The body was designed for movement in a wide variety of ways. Exercise plays an important role in optimizing thyroid health, but it’s important to note that balance is critical. Too much intense exercise can result in suppressed T3 levels and increased levels of inflammation and stress in the body. Regular exercise that isn't intense (in length or type of movement) can help to increase T3 and T4 levels, while lowering TSH, helping the thyroid function better overall. (31)
Stress is part of life, but long-term stress is not good for anyone. When it’s short-term, the body can cope. But when stress becomes long-term and chronic, it can change how our genes respond, impact digestion, interfere with healthy sleep, and much more. Finding ways to help the body process and decrease stress levels is important for any type of wellness, but especially when it comes to Hashimoto’s.
Specifically, stress can lower the thyroid’s ability to produce hormones. (32) Finding research-backed ways to promote stress relief is important. The following are all backed by science as being beneficial for lowering stress hormone levels and supporting a healthy stress response:
Any effort to reduce stress and improve your lifestyle will be hindered if you don’t prioritize healthy sleep. It’s not only about the right amount of sleep (most adults need 7-8 hours a night), but about how well you’re sleeping. Stress can impact how well you fall or stay asleep, so implementing other stress-relieving strategies can help to support your overall ability to get high-quality sleep.
Hashimoto’s thyroiditis is an autoimmune disease that can be triggered from many factors: genetics, lifestyle, gut health, inflammation, and more. Most often, it is a combination of factors that leads to the development of thyroid disease. With nutrition and lifestyle support for gut health and nutrients, it’s possible to address Hashimoto’s and find relief from this common autoimmune disease.
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