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Try An Elimination Diet For Hashimoto's Disease

Learn how to use an elimination diet to identify dietary triggers to improve symptoms of Hashimoto's.
Try An Elimination Diet For Hashimoto's Disease
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The more dietary stress you put on yourself, the more likely you will experience inflammation that can worsen your autoimmune reactions or interfere with your thyroid function.

Dietary triggers can lead to increased gastrointestinal (GI) distress, chronic inflammation, and a possible elevation in thyroid antibodies that indicate the presence of Hashimoto's disease. Exposure to reactive food may cause symptoms like diarrhea, bloating, acid reflux, gas, or cramping in the GI tract. You may also experience respiratory, muscular, or skin symptoms.

Using an elimination diet may help to identify these dietary triggers and ultimately reduce uncomfortable symptoms.

What is an elimination diet?

It can be hard to connect specific foods to uncomfortable symptoms when we practice the same eating behaviors we always do. Something may be wrong, but it seems too overwhelming or confusing to pinpoint the trigger. Still, the more you eat the problematic food, the body's ability to protect itself weakens, and the reactions become less specific, more chronic. 

An elimination diet can help identify foods your body can't tolerate well to remove them from your diet. This process typically involves two stages: removing potential food triggers and then carefully reintroducing them into your diet to determine whether they're to blame for your reactions.

First, you eliminate antigenic food groups—that is, foods that may induce an immune response in the body—for a few days to a few weeks. Then, when you reintroduce the reactive food groups, the body will produce a stronger or more specific reaction to those that are particular triggers for you. This process helps identify which food or foods may be problematic. 


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Types of elimination diets

There are many different types of elimination diets, including:

Autoimmune protocol diet

The autoimmune protocol (AIP) diet helps reduce inflammation or other symptoms caused by an autoimmune disorder like Hashimoto's thyroiditis by removing common antigenic foods. 

Low-FODMAPs diet

A low-FODMAP diet removes FODMAPs (or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), short-chain carbohydrates that some people have difficulty digesting.

Specific carbohydrate diet

The specific carbohydrate diet eliminates most carbohydrates and limits products with lactose and sucrose. You do not eat wheat products, potatoes, rice, oats, or added sugars on this diet.

GAPS diet

The Gut and Psychology Syndrome Diet (GAPs diet for short) starts with a six-phase strict introductory detoxification process. Afterward, you move on to the GAPS eating regimen, incorporating fish and meats, animal fats, eggs, fermented foods, and vegetables. You avoid any processed foods in addition to a long list of GAPS-specific. This diet comes from the specific carbohydrate diet (SCD). The primary difference is that you can eat lactose-free dairy products on SCD.

Few foods elimination diet

A few foods elimination diet involves eating only a dozen or so foods that you rarely eat in your regular diet.

Rare foods elimination diet

The rare foods elimination diet is similar to the few foods diet. However, instead of eating uncommonly eaten foods, you eat rare, exotic foods.

Fasting elimination diet

A fasting elimination diet involves strictly drinking water for up to five days, then reintroducing food groups. Your doctor should approve this kind of elimination diet as it can be dangerous to your health.

Other elimination diets

Other elimination diets include lactose-free, sugar-free, gluten-free, and wheat-free diets, among others.

Ahead, we primarily focus on using the autoimmune protocol (AIP) diet to support thyroid health.

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How does the autoimmune protocol elimination diet work?

Common antigenic foods include gluten, dairy, sugar, additives, legumes and soy, eggs, seeds and nuts, nightshade vegetables, and alcohol and caffeine. On an elimination diet, you should eat a diet free of these reactive foods for several weeks. Then, after several weeks, slowly reintroduce these foods back into your diet, one by one. 

There are no firm rules on when to reintroduce foods. Ideally, you wait to reintroduce foods until you feel great and do not have any of the symptoms you had before the elimination.

Allow several days between each reintroduction to monitor for symptoms of a reaction. Don't be in a hurry to reintroduce foods! The longer you wait between each food, the more likely the elimination experiment is to be successful.

We recommend you keep a journal to identify which foods cause which symptoms. For instance, perhaps dairy causes joint pain, or eggs cause gas and bloating. This log helps locate your dietary triggers.  

As you reintroduce foods, symptoms of a reaction may not always be apparent.

Some symptoms to watch for include:

  • Gastrointestinal symptoms like stomach ache, heartburn, nausea, constipation, irregular bowel movements, gas, or bloating
  • Reduced energy, fatigue, or energy dips throughout the day
  • Food cravings for sugar, fat, salt, or caffeine
  • Difficulty falling or staying asleep or not feeling well-rested when you wake up
  • Headaches, dizziness, or lightheadedness
  • Increased mucus production like phlegm, runny nose, or postnasal drip
  • Itchy eyes or mouth, or sneezing
  • Aches and pains in muscles, joints, tendons, or ligaments
  • Skin changes like rashes, acne, dry skin, bumps or spots, or dry hair or nails
  • Mood issues like mood swings, anxiety, irritability, or feeling low or sad

It may take a few days to see a reaction from a particular food. However, if after a few days, no symptoms appear, you can assume that the food group is safe to eat and move onto the next group. 

If you experience adverse symptoms, you can assume this is a trigger food and remove it from your diet. 

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What you can't eat on the autoimmune protocol elimination diet

As mentioned, the autoimmune protocol elimination diet involves removing gluten and grains, dairy, sugar, additives, soy and legumes, eggs, nuts and seeds, nightshade vegetables, alcohol, and caffeine. This list can feel overwhelming, so we recommend you adjust to what feels manageable for you. The more foods comprehensive your list of foods to eliminate, the more likely you will discover the primary offenders. 

Foods you should cut out on the autoimmune protocol: 

  • Gluten
  • Grains like corn, wheat, millet, buckwheat, rice, sorghum, amaranth, rye, spelt, teff, kamut, and oats
  • All dairy products
  • Beans/legumes including all beans like kidney, pinto, black, and soy in all its forms
  • Eggs
  • Nuts including nut oils like walnut and sesame seed oils
  • Seeds including flax, chia, pumpkin, sunflower, sesame, and culinary herb seeds like cumin and coriander
  • Shellfish
  • Gums - like guar gum, tara gum, gellan gum, gum arabic
  • Dried or citrus fruits
  • Nightshade vegetables like tomatoes, potatoes, peppers, eggplant, paprika, and mustard seeds
  • Culinary herbs from seeds like mustard, cumin, coriander, fennel, cardamom, fenugreek, caraway, nutmeg, and dill seed
  • Alternative sweeteners like xylitol, stevia, mannitol
  • Caffeine, alcohol, chocolate

Of course, you want to work with your thyroid doctor to ensure you still get enough nutrients and eat a balanced diet

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What you can eat on the autoimmune protocol elimination diet

So far, this elimination process may sound very restrictive or daunting. Fear not! There is still enough variety to make healthy, balanced, and delicious meals.

Foods you can include on the autoimmune protocol: 

  • Meat and fish like lamb, wild game, cold-water fish like salmon, and highly nutritious liver meats
  • Most vegetables, excluding nightshades
  • Most fruits (limit to 15-20 grams fructose/day), excluding citrus fruits
  • Coconut products including coconut oil, manna, creamed coconut, coconut aminos, canned coconut milk (no coconut sugar or nectar)
  • Fats like olive oil, coconut oil, avocados, cultured ghee
  • Fermented foods like coconut yogurt, kombucha, kefir, fermented vegetables
  • Bone and meat broths
  • Vinegars like apple cider vinegar, coconut vinegar, red wine vinegar, balsamic (no added sugar)
  • Occasional and sparse use of honey and maple syrup
  • Load up on fresh and non-seed herbs like basil, tarragon, thyme, mint, oregano, rosemary, ginger, turmeric, and cinnamon

Try experimenting with new recipes and meals during this phase! Plenty of resources out there like these recipes that are elimination diet-friendly.

Risks of an elimination diet

If followed for too long, an elimination diet can reduce the intake of essential nutrients needed for general health and thyroid health. An elimination diet should only be followed temporarily. Following a strict elimination diet for too long can cause nutrient deficiencies, which can worsen symptoms or prevent thyroid hormone replacement medication from doing its job. 

Suppose you have a known or suspected allergy. In that case, you should be under the supervision of a trusted professional while you go through the elimination process. 

Suppose you experience no change in your symptoms during the elimination phase. In that case, this may mean that the foods you removed are not the primary cause of your symptoms. Alternatively, if you find relief during the elimination phase and then notice reactions or symptoms during the reintroduction phase, you'll know to remove that food or foods from your diet. In either case, share this information with your thyroid doctor to develop a plan that addresses how food or foods impact your thyroid function.

Difference between food sensitivity and food allergy

An allergy causes an immune system reaction that may affect several organs in the body. An allergic reaction typically shows up right away and could be severe or life-threatening. On the other hand, food intolerance is generally less dangerous, though it may cause uncomfortable symptoms. An intolerance can take longer to emerge after you've been eating a type of food for a continued time. 

Immunoglobulins are proteins that are produced by the immune system in response to a perceived threat. The body makes different immunoglobulins to combat different antigens.

Immunoglobulin E (IgE) is associated with allergic responses. When an allergic person exposes to an allergen, the body produces IgE specially targeted against that allergen. These antibodies bind to white blood cells that release chemicals, causing an allergic reaction. 

Immunoglobulin A (IgA) has high concentrations in the body's mucous membranes, specifically the respiratory and gastrointestinal systems. When you eat a food to which you have an intolerance, IgA causes irritation or inflammation in the respiratory and digestive systems. These foods, then, may cause IBS, gas nausea, skin rashes or acne, asthma, or headache.

A note from Paloma Health

Many nutritional factors play a role in optimizing thyroid function. Work with a thyroid nutritionist to determine your nutritional status and develop a personalized thyroid diet plan.


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Katie Wilkinson

Katie Wilkinson, previously serving as the Head of Content and Community at Paloma Health, fervently explores the nexus between healthcare and technology. Living with an autoimmune condition, she's experienced firsthand the limitations of conventional healthcare. This fuels both her personal and professional commitment to enhancing patient accessibility to superior care.

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