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The Mediterranean Diet and Hashimoto’s Thyroiditis

Find out how the Mediterranean diet can help improve symptoms and quality of life in Hashimoto’s patients.
The Mediterranean Diet and Hashimoto’s Thyroiditis
Last updated:
6/21/2024
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Medically Reviewed by:

In this article

Hashimoto’s thyroiditis, an autoimmune disorder where the immune system attacks the thyroid gland, presents significant health challenges. Hashimoto’s usually leads to hypothyroidism, an underactive thyroid gland, and results in continuing symptoms such as fatigue, weight gain, cold intolerance, and depression. Managing Hashimoto’s hypothyroidism requires a comprehensive approach, and diet can play a crucial role. 

Among the various dietary approaches, the Mediterranean diet has garnered attention for its potential benefits. In this article, learn more about how the Mediterranean diet can support people with Hashimoto’s hypothyroidism and positively affect thyroid function.

About Hashimoto’s thyroiditis

Hashimoto’s thyroiditis, the most common cause of hypothyroidism, involves chronic inflammation of the thyroid gland. The thyroid is a small, butterfly-shaped gland in the neck that produces hormones essential for regulating metabolism. In Hashimoto’s hypothyroidism, the immune system mistakenly targets the thyroid, leading to decreased hormone production and, consequently, a slow-down in metabolic processes.

Symptoms of Hashimoto’s hypothyroidism include:

  • Fatigue and sluggishness
  • Weight gain
  • Cold intolerance
  • Muscle weakness
  • Depression and mood swings
  • Constipation
  • Dry skin and hair
  • Memory issues and brain fog

The primary treatment for hypothyroidism involves thyroid hormone replacement therapy.

The impact of diet on Hashimoto’s thyroiditis

There is no single prescribed diet for autoimmune diseases like Hashimoto’s thyroiditis. Still, you’ll see various diets touted for their benefits, including Paleo, ketogenic, Sirtfood, low-carb, raw food, vegan, carnivore, gluten-free, and FODMAP. One size does not fit all, but it’s clear that certain dietary patterns may help reduce inflammation and manage symptoms.

For example:

  • Anti-inflammatory foods, emphasizing antioxidant-rich foods like berries, leafy greens, tomatoes, omega-3 fatty acids from fish, walnuts, flaxseeds, and olive oil, and fermented foods like yogurt and kefir
  • Elimination diets, removing potential inflammatory triggers like gluten, dairy, soy, or nightshades (tomatoes, peppers, etc.) for a while -- or permanently
  • Carbohydrate-controlled diets, limiting high-glycemic and high-carbohydrate foods, eliminating refined carbohydrates, and emphasizing protein, good fats, and healthy carbohydrates
  • Specialized diets, like the autoimmune protocol (AIP) diet, which combines various approaches to focus specifically on autoimmune issues

While no diet can cure autoimmune diseases, dietary changes can, in some cases, significantly impact the management of symptoms and improve overall health for many autoimmune patients, including those with Hashimoto’s thyroiditis.

Let’s look at one way of eating that is getting lots of buzz lately: the Mediterranean diet. 

The Mediterranean diet: an overview

The Mediterranean diet is inspired by the traditional dietary patterns of countries bordering the Mediterranean Sea, such as Greece, Italy, and Spain. This healthy diet emphasizes the consumption of whole, unprocessed foods, including:

  • Fruits and vegetables: Rich in vitamins, minerals, and antioxidants.
  • Whole grains: Such as whole wheat, oats, barley, and brown rice.
  • Healthy fats: Primarily from olive oil, nuts, and seeds.
  • Lean proteins: Including fish, poultry, beans, and legumes.
  • Dairy: Moderate consumption of cheese and yogurt.
  • Herbs and spices: Used to flavor food instead of excessive salt.

This diet is known for its anti-inflammatory properties, high nutrient density, and cardiovascular benefits.

## 5-day meal plan

Benefits of the Mediterranean diet for Hashimoto’s hypothyroidism

Anti-Inflammatory properties

Chronic inflammation is a hallmark of autoimmune diseases, including Hashimoto’s hypothyroidism. The Mediterranean diet is a diet rich in anti-inflammatory foods such as fruits, vegetables, nuts, seeds, and olive oil. These foods contain antioxidants and phytonutrients that help reduce inflammation. For instance, olive oil is high in oleocanthal, a compound with anti-inflammatory effects similar to ibuprofen.

Nutrient density

The nutrient-dense nature of the Mediterranean diet ensures that autoimmune thyroid disease patients receive essential vitamins and minerals that support thyroid function and overall health. Key nutrients include:

  • Selenium: Found in fish, nuts, and seeds, selenium is crucial for thyroid hormone production and protection against oxidative damage.
  • Zinc: Present in shellfish, legumes, and whole grains, zinc supports thyroid hormone synthesis and immune function.
  • Iodine: While often associated with salt, iodine can also be obtained from seafood and dairy, supporting thyroid hormone production.
  • Vitamin D: Found in fatty fish and fortified dairy, vitamin D is essential for immune regulation and reducing autoimmune activity.
  • B Vitamins: Present in whole grains and legumes, B vitamins are vital for energy production and combating fatigue.

Healthy fats

Healthy fats, particularly from olive oil, nuts, and fatty fish, are integral to the Mediterranean diet. Omega-3 fatty acids, found in fish like salmon and sardines, have been shown to reduce inflammation and support brain health. These fats can improve mood, cognitive function, and cardiovascular health, all of which can be compromised in individuals with Hashimoto’s hypothyroidism.

Balancing blood sugar levels

The Mediterranean diet includes low glycemic index foods such as whole grains, legumes, and vegetables, which help stabilize blood sugar levels. This is important for individuals with Hashimoto’s hypothyroidism, as unstable blood sugar can exacerbate fatigue, mood swings, and weight gain. A diet that promotes steady blood sugar levels helps maintain consistent energy levels and prevents additional strain on the thyroid and adrenal glands.

Weight management

Weight gain is a common symptom of hypothyroidism due to a slowed metabolism. The Mediterranean diet, rich in fiber from fruits, vegetables, and whole grains, promotes satiety and healthy digestion, aiding in weight management. Moreover, emphasizing healthy fats and lean proteins helps preserve muscle mass and support metabolic health, making it easier for individuals with hypothyroidism to maintain a healthy weight.

Gut health

The health of the gut microbiome is increasingly recognized as important in autoimmune conditions. The Mediterranean diet supports gut health through its high fiber content and the inclusion of fermented foods like yogurt and kefir. A healthy gut microbiome can help modulate immune responses and reduce inflammation, potentially alleviating some autoimmune symptoms.

Mood and cognitive function

Depression, anxiety, and cognitive issues such as brain fog are prevalent among those with Hashimoto’s hypothyroidism. The Mediterranean diet’s nutrient profile supports brain health and mood regulation. Omega-3 fatty acids, B vitamins, and antioxidants like flavonoids have been linked to improved mental health and cognitive function. Regular consumption of these nutrients can help mitigate the psychological symptoms associated with hypothyroidism.

The research

Medical research supports the benefits of the Mediterranean diet for people with Hashimoto’s hypothyroidism and thyroid health in general. In a study published in 2024, Egyptian researchers evaluated the effects of the Mediterranean diet on the quality of life in women with Hashimoto’s thyroiditis. They used a special research tool called the ThyPRO questionnaire, along with measurement of thyroid autoantibodies and other thyroid levels in their evaluation. The study divided the women into two groups. One group was Hashimoto’s hypothyroidism patients taking levothyroxine, a synthetic version of the thyroxine (T4) thyroid hormone. The other group had Hashimoto’s antibodies without overt hypothyroidism and weren’t taking medication. Both groups started following a modified Mediterranean dietary plan. (The modifications included a reduction in the volume of goitrogenic foods eaten.)

Interestingly, both groups experienced significant improvements in thyroid function and other health markers after following the Mediterranean diet:

  • Thyroid peroxidase antibodies (TPOAb) levels were reduced
  • Anti-thyroglobulin antibodies (TgAb) were reduced
  • Body mass index (BMI) was lowered
  • LDL, total cholesterol, and triglycerides were reduced
  • Free T3 and free T4 levels increased
  • Both groups noted significant improvements in quality of life using the ThyPRO scale

The group receiving medication also had statistically significant reductions in their thyroid-stimulating hormone (TSH) levels. (TSH levels in the unmedicated group didn’t change significantly.)

A 2021 study found that the Mediterranean diet may also be protective against autoimmune diseases in general, and autoimmune thyroid diseases like Hashimoto’s. It’s thought that the diet counteracts the adverse effects of oxidative stress and has anti-inflammatory and immune-modulating effects.

How to follow the Mediterranean diet

The Mediterranean diet emphasizes plant-based foods like fruits, vegetables, whole grains, legumes, nuts, and healthy fats like olive oil. It limits red meat, sugar, and processed foods while allowing moderate amounts of fish, poultry, eggs, and dairy.

Here are some simple, easy-to-follow guidelines to help you implement the Mediterranean diet.

Eat more of these foods daily

  • Vegetables (broccoli, spinach, eggplant, peppers, etc.)
  • Fruits (apples, bananas, oranges, grapes, figs, etc.)
  • Whole grains (brown rice, quinoa, whole wheat bread, oats, etc.)
  • Legumes (lentils, chickpeas, beans, peas)
  • Nuts and seeds (almonds, walnuts, pistachios, chia seeds, flaxseeds)
  • Herbs and spices (basil, oregano, rosemary, garlic, etc.)
  • Extra virgin olive oil

Eat these foods weekly

  • Fish and seafood (salmon, tuna, mackerel, shrimp, etc.)
  • Poultry (chicken, turkey)
  • Eggs
  • Dairy (Greek yogurt, feta cheese, etc.) in moderation

Limit these foods

  • Red meat (have a few times per month or less)
  • Sweets and desserts
  • Processed foods
  • Refined grains (white bread, pasta, etc.)

Other tips

  • Focus on eating whole foods and avoid processed and refined foods
  • Drink water as your primary beverage
  • Have wine in moderation (1 glass per day for women, 2 for men)
  • Incorporate healthy lifestyle factors such as regular physical activity and sufficient sleep 
  • Eat meals slowly and mindfully
  • Eat meals with family and friends when possible

Remember that while the Mediterranean diet has significant health benefits for Hashimoto’s patients, some of the recommended foods may be contaminated by endocrine-disrupting chemicals. It’s important to choose foods that minimize the use of pesticides and endocrine disruptors as much as possible.

Also, remember not to overdo the consumption of raw goitrogenic vegetables, like broccoli, cauliflower, cabbage, kale, brussels sprouts, spinach, turnips, soybeans, tofu, and soy milk, among others. High levels of these foods consumed raw have the potential to slow down thyroid function.

A day on the Mediterranean diet

Here is the meal plan for a sample day on the Mediterranean diet:

  • Breakfast: Greek yogurt with fresh berries, a drizzle of honey, and a sprinkle of chopped walnuts or almonds.
  • Lunch: Mediterranean chickpea salad - mix chickpeas, diced tomatoes, cucumber, red onion, parsley, and dress with olive oil and lemon juice. Serve over a bed of greens like arugula or spinach.
  • Snack: Fresh fruit like an apple or orange with a small handful of nuts or olives.
  • Dinner: Baked salmon with roasted vegetables like zucchini, bell peppers, and onions tossed in olive oil, garlic, and herbs. Serve with a side of whole grains like quinoa or brown rice.
  • Dessert: Greek yogurt with fresh berries.
  • Drinks: Water, unsweetened herbal tea, coffee, glass of wine.

This meal plan is an excellent example of how to incorporate core Mediterranean diet principles like vegetables, fruits, whole grains, legumes, fish, olive oil, nuts, and yogurt. It provides a balance of healthy fats, lean protein, complex carbs, and fiber from plant sources.

A note from Paloma

The Mediterranean diet’s anti-inflammatory properties, nutrient density, emphasis on healthy fats, and support for stable blood sugar levels make it an excellent dietary approach for Hashimoto’s patients.

By incorporating whole, unprocessed foods and focusing on critical nutrients, people with Hashimoto’s hypothyroidism can improve their thyroid function, reduce inflammation, manage weight, and enhance their overall quality of life. Adopting the Mediterranean diet as a complement to thyroid hormone replacement treatment is a sustainable, enjoyable way to support long-term health and vitality in the face of Hashimoto’s hypothyroidism.

If you have Hashimoto’s and want to embrace the anti-inflammatory, nutrient-rich Mediterranean diet, the expert nutritionists at Paloma Health can guide you every step of the way. They’ll craft a personalized plan that maximizes the thyroid-supporting benefits of this diet, ensuring you get the right balance of iodine, selenium, and other vital nutrients. Paloma’s nutritionists will also help you leverage the Mediterranean diet’s emphasis on gut-friendly fiber, healthy fats, and antioxidants to reduce inflammation, promote a balanced gut microbiome, and optimize nutrient absorption. With Paloma’s support, you can confidently follow this nourishing dietary pattern while managing your Hashimoto’s symptoms and achieving your wellness goals.

References:

Abushady, Manal et al. Effect of Mediterranean diet on quality of life and disease burden in patients with Hashimoto’s thyroiditis. Abstract P395. Endocrine Abstracts. May 2024. Volume 99. 26th European Congress of Endocrinology 2024. ISSN 1479-6848. DOI: 10.1530/endoabs.99.P395 https://www.endocrine-abstracts.org/media/frhpdgnp/ece2024_abstractbook.pdf

Ruggeri, RM, et al. Influence of Dietary Habits on Oxidative Stress Markers in Hashimoto’s Thyroiditis. Thyroid. Vol. 31, No. 1. 12 January 2021. https://doi.org/10.1089/thy.2020.0299 https://www.liebertpub.com/doi/10.1089/thy.2020.0299

Bellastella G, Scappaticcio L, Caiazzo F, Tomasuolo M, Carotenuto R, Caputo M, Arena S, Caruso P, Maiorino MI, Esposito K. Mediterranean Diet and Thyroid: An Interesting Alliance. Nutrients. 2022; 14(19):4130. https://doi.org/10.3390/nu14194130 https://www.mdpi.com/2072-6643/14/19/4130

Kaličanin, D.; Brčić, L.; Ljubetić, K.; Barić, A.; Gračan, S.; Brekalo, M.; Torlak Lovrić, V.; Kolčić, I.; Polašek, O.; Zemunik, T.; et al. Differences in food consumption between patients with Hashimoto’s thyroiditis and healthy individuals. Sci. Rep. 2020, 10, 10670. https://www.nature.com/articles/s41598-020-67719-7

Osowiecka K, Myszkowska-Ryciak J. The Influence of Nutritional Intervention in the Treatment of Hashimoto’s Thyroiditis—A Systematic Review. Nutrients. 2023; 15(4):1041. https://doi.org/10.3390/nu15041041 https://www.mdpi.com/2072-6643/15/4/1041

Ruggeri RM, Barbalace MC, Croce L, Malaguti M, Campennì A, Rotondi M, Cannavò S, Hrelia S. Autoimmune Thyroid Disorders: The Mediterranean Diet as a Protective Choice. Nutrients. 2023; 15(18):3953. https://doi.org/10.3390/nu15183953 https://www.mdpi.com/2072-6643/15/18/3953

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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