Diet, Nutrition and Exercise for the Thyroid Patient
Robyn Koumourou - 2006
A well balanced diet, adequate nutrition and regular exercise is a must for all human beings. The food we eat, the water we drink and the oxygen we breathe are the key ingredients to sustain life and keep our bodies and minds healthy. These elements become even more important for those who suffer with any chronic health condition, as they can also be the key in helping the body heal itself and restore normal function, and should be a part of any treatment protocol.
Many thyroid patients are particularly concerned with diet, nutrition, weight and exercise. They want to know what they can do to improve their situation and feel better about themselves. Dealing with a medical condition that upsets the hormonal balance and produces a myriad of symptoms can be overwhelming. Positive thoughts or antidepressants cannot control the disease process and render the patient free of illness. Thyroid conditions cause changes in metabolic rate and upset the delicate balance within the body. Patients often feel ‘out of control’, which is actually a correct assessment reflecting the fact that their body is ‘out of their control’ and needs to be given appropriate treatment to restore it to normal function. Thyroid disorders can produce a multitude of symptoms relating to any or every part of the body. The type of symptoms a person experiences depends on human individuality, which is influenced by genetics, upbringing, environment, diet and lifestyle. Therefore, when it comes to any treatment protocol, a multifaceted approach needs to be taken and a treatment program developed that is tailored for the individual. There is not just one diet and exercise regime that will work for all thyroid patients, as in the healthy community. There is not just one universal formula to treat all thyroid disorders. Overall, thyroid disease does contribute to poor health and weight problems in many patients, and plays a major role in how a person responds to diet and exercise.
Challenges Facing Thyroid Patients
To function normally, the cells of our body use thyroid hormones to convert oxygen and food into energy, heat and living tissue. When the thyroid gland becomes underactive or overactive and our metabolism either slows down or speeds up, so too does our oxygen and nutrient transport through the bloodstream. Abnormal levels of thyroid hormones at the cellular level affect how oxygen and nutrients are utilized within our cells, and this in turn affects energy metabolism and organ function.
Thyroid patients often have to deal with a multitude of symptoms that affect them emotionally, mentally and physically. Many experience overwhelming tiredness, exhaustion and generalised weakness, and it is not unusual for them to suffer with varying forms of depression, memory loss and poor concentration. As their body struggles to metabolise food properly, they often lose their appetite, develop poor eating habits, and have difficulty maintaining a healthy weight. Regular exercise can become almost impossible due to profound fatigue, poor muscle strength, and overall aches and pains. Digestive disturbances can also become more pronounced, with upset stomachs, bloating, indigestion and nausea. Stubborn constipation or diarrhoea can develop as food moves through the system at an irregular pace. These abnormalities in digestion can contribute to the poor absorption of nutrients and irritable bowel problems.
Other symptoms that thyroid patients can experience include headaches, fluid retention and shortness of breath, numbness and tingling, chest pain and heart palpitations, skin conditions and hair loss, frequent infections and sometimes imbalances with other hormones within the body. As a thyroid condition progresses more serious problems can also arise, such as changes in cardiac function, elevation of blood pressure and blood cholesterol, poorer glucose controls, and generalised congestion and inflammation throughout the body. Quality of life is often compromised when a thyroid condition is overlooked or poorly treated. It is fairly easy to understand why many thyroid patients become increasingly inactive, have poor exercise tolerance and eventually suffer from nutritional deficiencies. The earlier they are diagnosed and treated appropriately, the less likely they will develop other complications or more serious conditions.
People often associate thyroid conditions with weight problems. The most common scenario being that hypothyroidism causes weight gain and hyperthyroidism causes weight loss. The truth of the matter is that these two conditions do cause major changes in metabolism, and the more severe or long term the condition is, the more significant the changes in weight will be. The majority of thyroid patients would probably fit into one of these two categories, with a small number of individuals having little, if any, affects on their weight.
People with hyperthyroidism or Graves’ disease tend to lose weight more easily due to their body’s metabolic rate being faster than normal. Often their appetite increases and more foods are consumed to meet the body’s demand for fuel and energy. If the amount consumed is not large enough to keep up with the increased metabolism, weight loss will occur. I’ve often heard a Graves’ patient comment “I can eat whatever I like and never put on weight”, beware - you may have to eat your words. Unfortunately, around 50% of patients treated for their hyperthyroidism, with medication, RAI or surgery, tend to gain weight thereafter. Therapies for hyperthyroidism are aimed at reducing the activity of the thyroid gland and restoring hormone levels to normal. When the metabolism decreases, so too does the body’s need for fuel (food) and adjustments to dietary intake may be required. A person’s weight may only increase slightly and then stabilize at a point that ‘mother nature’ always intended. For others, the weight gain may be more significant and a healthy diet and exercise regime may need to be instigated. A further complication for people with hyperthyroidism is the loss of precious nutrients, contributing to loss of bone and muscle mass, while they are in an overactive stage. The earlier the condition is treated and brought under control the less likely this complication will occur.
People with hypothyroidism or Hashimoto’s Thyroiditis tend to gain weight more easily due to their body’s metabolic rate being slower than normal. They usually become more off-appetite and eat less, but at the same time tend to gain weight and have extreme difficulty losing it. This factor alone can cause considerable concern and feelings of failure. In hypothyroidism the body’s demand for fuel (food) is decreased and what is consumed is poorly metabolised, often being stored as fat particularly around the abdomen area. I often hear “I eat like a sparrow and exercise everyday, but my weight won’t budge”. It has been found that around 75% of hypothyroid patients gain weight at the same time as their thyroid condition developed and was treated. Thyroid hormone replacement therapy is aimed at restoring hormone levels to normal and the increase in metabolism will improve the way the body utilizes food and nutrients in all bodily processes. However, the excess weight gained during thyroid illness may not drop away easily and may still require a disciplined diet and exercise program. Restoring the body to a healthy state will take time and endurance.
It is easy to see how challenging it is for thyroid patients in knowing how to deal with their various complaints and tackle the issues of diet, weight and exercise. Some thyroid patients have been able to work out their own diet and exercise programs with success, while others have needed the guidance of health professionals. Before starting any diet and exercise program, thyroid patients should be encouraged to talk with their doctor and also a nutritionist or personal trainer to discuss their personal needs. Other factors will also need to be considered that may be influencing their poor health status, nutritional state and weight problems. A doctor will need to evaluate if there are any other health concerns that need addressing.
The Importance of Other Health Conditions
There are many other conditions that can be associated with thyroid disease. Some conditions are statistically more likely to occur in Graves’ and Hashimoto patients than in people who do not suffer from an autoimmune thyroid disorder. These conditions can affect nutritional balance, and cause weight changes and a whole host of other symptoms. These more serious health problems include: Anaemia (iron or B12), Depression, Hypoglycaemia, Insulin Resistance or Metabolic Syndrome, Type 1 and Type 2 Diabetes, Polycystic Ovarian Syndrome (PCOS), Irritable Bowel Syndrome (IBS), Gall bladder disease, Heart Disease, Hypertension, High Cholesterol, and Allergies/ Intolerances. Most of these conditions influence a person’s dietary and exercise needs and will certainly affect a person’s ability to lose weight and to cope with a regular exercise regime. Anyone being treated for multiple conditions will need to be regularly monitored and managed carefully.
Past Injuries and Operations
A person’s health history such as past injuries and previous operations could impact significantly on what they are able to tolerate when it comes to exercise. Injuries to the head, back, hips, knees, and feet need to be taken seriously so as to avoid further complications if an exercise program is instigated. Surgery to vital organs or bone reconstructions needs special consideration.
Medications and Nutritional supplements
Medications for other conditions may also impact upon dietary needs, exercise tolerance and even thyroxine dose. Insulin, oestrogen, beta blockers, prednisone, amiodarone, cholesterol lowering drugs, and some antidepressants and anxiety medications can strengthen or weaken the effects of thyroid hormone replacement. Many of these can also cause weight gain. Iron and calcium supplements can hinder the absorption of thyroxine and need to be taken a few hours apart from thyroxine dose. Antibiotics, pain killers and diuretics can also contribute to digestive disturbances and the poor absorption of nutrients.
Various nutritional supplements from pharmacies and health food stores contain substances that interact with thyroid medications and others drugs. Those having an antithyroid effect include bugleweed, St John’s wort, aloe vera, green tea, horseradish, kelp, soy-based foods, L-carnitine, quercetin, motherwort, lemon balm, and lipoic acid. Some of these substances would be okay in moderation, while others may have a negative effect on someone with hypothyroidism. There are also supplements that would best be avoided by those with hyperthyroidism as they have a stimulating effect or could increase thyroid hormone secretion. Celery seed extract, kelp and supplements with high iodine content, red food colouring, products containing caffeine, weight control pills, cough medicines containing pseudoephedrine, and other substances that stimulate metabolism could further aggravate an overactive condition.
Food intolerances and allergies to various substances are often found in people with thyroid conditions due to digestive and immune system changes. Any foods that create a negative reaction, or are suspicious in any way should be avoided. Wheat, gluten, diary, soy, nuts, pork and eggs are common offenders, and many thyroid sufferers have improved their thyroid function and health by eliminating these substances. Alternative food sources can be found to replace the undesirable ones, taking pressure off the digestive system and reducing inflammation throughout the body.
Metabolic Syndrome: Is excess weight a concern?
Over the past few years the term ‘Metabolic Syndrome’ has come to the fore, encompassing the problems associated with insulin resistance. A person can develop insulin resistance due to hormonal imbalances, obesity or a diet too high in saturated fats and refined carbohydrates for a long period of time. Insulin resistance refers to reduced tissue response to the normal effects of insulin on glucose metabolism. People with insulin resistance have higher than normal levels of insulin in their bloodstream in order to maintain normal blood glucose levels. Excess levels of insulin can cause sugar levels to fall too low, or simply have little effect and sugar levels remain too high. When insulin resistance is accompanied by increased abdominal fat, the person is often referred to as having metabolic syndrome. The main features that characterise this syndrome include, underlying insulin resistance, central or abdominal weight gain, elevated triglyceride fats in the bloodstream, low HDL (good) cholesterol, elevated blood pressure, and slightly elevated fasting blood glucose levels. The consequence of having metabolic syndrome is that it is associated with an increased risk of cardiovascular disease (blockages in main arteries leading to stoke or heart attack), PCOS, and the development of type 2 diabetes.
Abnormal thyroid hormone levels tend to cause changes in blood sugar controls, and it is not uncommon for many thyroid patients to experience problems with low blood sugar (hypoglycaemia), high blood sugar, and/or insulin resistance. For those who have had long term or particularly severe thyroid abnormalities, the risk of developing metabolic syndrome and type 2 diabetes increases.
Current research is indicating that insulin resistance and type 2 diabetes are due to improper lipid processing and an excess of fatty acids in the blood. As blood lipids increase, as with hypothyroidism, they interfere with insulin receptors and the cells of the body become more desensitised to insulin’s effects. Blood glucose levels then rise and are poorly controlled. Excess carbohydrates in the diet only further aggravate this cascading process, leading to more accumulated fat, higher insulin levels, insulin resistance, metabolic syndrome and possibly type 2 diabetes. The metabolic effects of hypothyroidism can cause weight gain and the accumulation of excess abdominal fat, as well as, poor carbohydrate, protein and fat processing. A slower metabolic rate can contribute to a rise in circulating blood lipids and eventually result in poor insulin/glucose controls. Another question comes to mind; does insulin resistance begin prior to weight gain, and actually cause the weight gain in the first place? This extra weight gain could further contribute to poorer glucose controls with time. The chicken or the egg theory cycles again.
With all of this in mind, what is the best treatment and dietary approach for those suffering with thyroid conditions?
Diet and Nutrition
As I said in the beginning of this article, everyone is unique and will require an individualised diet and exercise regime if it is to be beneficial and positive. If losing weight is an objective, then a correct weight loss program will need to be found that suits the individual. ‘One shoe does not fit all’. Some people with thyroid conditions have found great benefit from going to Weight Watches or Jenny Craig, while others have found that Sure Slim or a personal trainer and nutritionist worked better for them. Some thyroid patients have found it difficult to lose weight no matter what they have tried. However, some general guidelines regarding optimal treatment, nutritional foods and fat burning exercise can improve the health and fitness of the majority of people struggling with thyroid conditions.
Optimising Thyroid Hormone Levels
Regardless of what a person’s thyroid diagnosis is, whether it is hypothyroidism, hyperthyroidism, thyroid cancer or nodules, optimising thyroid hormone levels is of utmost importance. If a person’s thyroid function is still abnormal, this will affect their response to diet and exercise. Treatments for hyperthyroidism tend to cause the majority of people to become underactive, and thyroid hormone replacement therapy is then required to restore the metabolism to normal. If a person’s body is to function at its best then the fine tuning of dose is vital, especially if the person wants to lose the weight that they have gained due to their thyroid condition. Simply being within the normal reference range is not good enough. Often people are kept on too low a dose of Oroxine, or have sub-optimal levels of free T3, and wonder why they can’t lose any weight. Thyroid hormone levels need to be at the personal set-point of the individual and at the point where they feel best. This gives the person a far greater chance of responding well to dietary and exercise changes.
Evaluate Current Lifestyle, Diet and Exercise Habits
Lifestyle and work commitments have a great impact upon dietary habits and time for exercise. Assessing the types of foods you eat on a daily basis, such as keeping a daily record of everything you consume, can be quite revealing. This can give you some clues as to what to eliminate from your diet. It is also important to evaluate work commitments and schedules to see how you can manage your food intake and make better choices.
Evaluating how much exercise you do in a week can also be revealing. In some jobs it is particularly easy to do very little physical activity and driving to and from work or catching public transport can limit the amount of walking that we could do. The question you need to ask yourself is “do I want to fit some regular exercise into my daily routine?” If the answer is yes, then you need to assess your daily schedule and set aside 20 to 30 minutes a day (or 1 hour three times a week) of exercise that you enjoy. Make it happen and get moving!
Over the last few years many nutritional researchers have run studies to assess the most beneficial diets for people with various chronic conditions, such as heart disease, cancer and diabetes. The risks associated with metabolic syndrome have lead specialists to study the effects of various foods upon the body, specifically looking for foods that do not encourage the development of insulin resistance and the accumulation of blood fats.
In the early 1980’s The Glycemic Index (GI) - a numerical system - was developed to measure how much glucose different carbohydrates produced when eaten, and how high insulin levels would rise. Initially this was designed to help diabetic patients control their blood glucose levels and make wise dietary choices to improve their condition. What was found was that some foods caused a low level of circulating blood sugar with minimal insulin response, while others produced a moderate to high level of circulating blood sugar with a higher insulin response in a short space of time. The higher the spike in blood sugar, the higher the GI rating. With time it was also discovered that some complex carbohydrates caused a high blood sugar response similar to those found with simple carbohydrates. A list of carbohydrate foods with their Glycemic values was then created, and has become extremely beneficial for those diagnosed with metabolic syndrome and diabetes who want to improve their condition and also lose weight.
An article in the American Journal of Clinical Nutrition, titled ‘Glycemic index: overview of implications in health and disease’ (Vol.76, No. 1, July 2002), revealed some interesting findings:
“low-glycemic-index diets have been shown to lower urinary C-peptide excretion in healthy subjects, improve glycemic control in diabetic subjects, and reduce serum lipids in hyperlipidemic subjects. Furthermore, consumption of low-glycemic diets has been associated with higher HDL-cholesterol concentrations and, in large cohort studies, with decreased risk of developing diabetes and cardiovascular disease. Case-control studies have also shown positive associations between dietary glycemic index and the risk of colon and breast cancers. Despite inconsistencies in the data, sufficient, positive findings have emerged to suggest that the dietary glycemic index is of potential importance in the treatment and prevention of chronic diseases”.
The foods that we consume are classified into three main categories: carbohydrates, proteins and fats. Carbohydrates (which include fibre), fats and proteins are the primary sources of fuel for energy production and the functioning of all bodily processes. Carbohydrates, however, are the best source of energy for all bodily functions, especially the brain and central nervous system. They assist with digestion to regulate protein and fat metabolism and provide energy for muscle exertion. Carbohydrates have traditionally been broken into two categories, simple and complex. Simple carbohydrates are quickly and easily digested and converted into glucose for absorption. This causes a sudden rise in blood sugar levels (BSL) and insulin, and once inside the cells, glucose is used as fuel for energy production. Complex carbohydrates are broken down more slowly into simple sugars and then to glucose, causing a slower rise in blood glucose levels (or BSL). Glucose, whether from simple or complex carbohydrates, is mostly used as fuel by the tissues in the body, and the excess is converted into glycogen (a form of fat) which is stored in the liver and muscles. When the liver and muscles are at full storage capacity the excess glycogen (fat) is stored throughout the rest of the body and is only called upon when glucose stores are depleted. Unlike the liver, the body is able to accumulate an unlimited amount of fat that can serve as energy to all the body’s cells for as long as the reserves allow. When high glucose levels are accompanied with fat from dietary intake, the fat is immediately stored throughout the body until needed and often accumulates under the skin. Weight loss can only occur when glucose and glycogen stores have been depleted in the liver through energy expenditure (exercise), and the extra fat reserves are converted back into glucose and used for body fuel to produce energy. So as you can see sugar (carbohydrates) are used for immediate energy or stored as fat for future need. The bottom line is: excess sugar and insulin in the body will cause the body to store this extra energy as fat!
When it comes to a nutritional point of view, complex carbohydrates (starches) are in a form that contains more essential vitamins, minerals, and fibre. They are generally broken down by the digestive system slowly and help towards maintaining more stable blood sugar and insulin levels. On the other hand, simple carbohydrates often lack any substantial nutrients or fibre and are usually high in calories. They are often referred to as “empty calories”. They do provide the body with an instant energy boast, but this is short lived and the craving for more high energy foods results. Many foods have been refined or processed to such a degree that they are of little benefit to the body. These include sweets, biscuits, cakes, ice-cream, alcohol and fizzy drinks, to state the obvious. However, white flour, rice, packaged pasta, crackers, and cereals which are considered more complex carbohydrates often contain little nutritious value, have a high GI rating and are broken down into simple sugars as quickly as simple carbohydrates. Pumpkin, corn and most potatoes have good nutritional content; however they do cause an abrupt rise in blood glucose and insulin, and have a high GI rating. Overall, complex carbohydrates with a low GI are a better choice. They are usually low in calories and fat, and contain more essential nutrients, antioxidants and fibre. Low GI foods can help control appetite and encourage weight loss, by avoiding dramatic swings in blood sugar and insulin levels, and keeping you satisfied for longer. They are a wise choice for anyone wanting a healthier diet.
In ‘the CSIRO total wellbeing diet’, published in 2005, some more interesting results were revealed with regard to the balance between fats, carbohydrates and proteins in a healthy diet. The initial CSIRO dietary studies assessed the effectiveness of two low-fat diets, with a daily kilojoule count of 5600. One meal plan was higher in protein content and contained 46% carbohydrates, 34% protein, and 20% fat. The second meal plan was higher in carbohydrate content and contained 63% carbohydrates, 17% protein and 20% fat. One hundred women took part in the study and assessments were made on how much body weight and body fat they lost over a 12 week period, and then followed up after one year. For the women with no signs of metabolic syndrome with normal blood sugar control, the amount of weight lost was similar on both dietary approaches. However, the women who had signs of metabolic syndrome (poor blood sugar controls) and who were on the higher protein diet, lost twice as much excess fat around the middle compared to those on a higher carbohydrate diet. This study suggests that the type of diet that is best for an individual may depend upon how well the metabolism works in relation to the processing of carbohydrates, proteins and fats. Thyroid patients do have poor metabolic controls and many have abnormalities in processing and absorbing foods. Cravings for high sugar carbohydrates is common, and therefore a diet aimed at keeping stable insulin and blood sugar levels would be beneficial to thyroid patients and aid in weight loss. 
So what would be the best or most beneficial dietary advice for thyroid patients?
For anyone with a thyroid condition, high quality carbohydrates, proteins and fats are essential for good health and weight loss. Dietary choices should include low to moderate GI carbohydrates which are low in calories and fat, and high in fibre, nutrients and antioxidants. Thyroid friendly foods should be consumed freely, while limiting raw foods classed as goitrogens (cooking them reduces negative effects), particularly for those with an underactive thyroid gland. The following food categories contain wise choices. However, as said earlier, grains, gluten, dairy, soy and eggs may not be a good option for those with autoimmune thyroid disorders, chronic infections and other inflammatory conditions, as these food substances may hinder the body from recovering and healing.
Carbohydrates: In general, good sources of carbohydrates include: wholegrain breads and cereals (containing wheatgerm, barley, oats, rye, bran, linseeds, and nuts), fresh pasta (fettuccine, spaghetti, spirali, ravioli), rice (Basmati, or protein enriched), legumes (beans, peas, lentils and chickpeas), fruits (apples, oranges, pears, apricots, peaches, plums, strawberries and cherries), vegetables (tomato, celery, cucumber, eggplant, peppers, broccoli, cauliflower, cabbage, avocado and mushrooms), and dairy (milk, cheese, low fat yoghurt, or almond milk and yoghurt as a good alternative). These complex carbohydrates have a low to moderate GI rating and are full of essential nutrients and trace elements.
Protein: Good sources of protein include: lean red meat (beef, veal, lamb, kangaroo), lean white meat (pork, skinless chicken, turkey), fish and shellfish (various types, small oily fish, salmon and tuna), diary/soy protein (milk, cheese and yoghurt), and eggs (full of amino acids). Plant sources (nuts, seeds and legumes). These proteins contain the essential nutrients and amino acids that make up the major source of building material for the body.
Fats: Good sources of fat include: unsaturated oils (oils of vegetables, nuts, or seeds). The best options being, extra virgin olive oil, avocado, peanut, sesame seed, and rice oil. Essential fatty acids include: omega 3 and 6 (fish, flax seed and plant seeds). Unsaturated fats (monounsaturated and polyunsaturated) are usually liquid at room temperature.
Plant sterols are plants equivalent of cholesterol – good cholesterol. Plant sterols help reduce blood cholesterol. High quantities are needed to be effective within the body, so sterol-enriched margarines have been developed; 20-25 g per day can result in a 10% reduction in blood cholesterol. These could be of benefit for thyroid patients, although margarines are not usually recommended.
Saturated fats and trans-fatty acids should be limited. Saturated fats are often referred to as ‘bad fats’ and include: fats on meats, chicken skin, butter, cheese, palm and coconut oils (coconut oil, however, has health benefits in small quantities). These fats are usually solid at room temperature and tend to raise blood cholesterol levels. Trans-fatty acids have undergone a process of hydrogenation and are unsaturated fats that behave like saturated oils (in most margarine).
Over consumption of particular foods that contain isothiocyanates can lower thyroid hormone levels and create difficulties in maintaining stable hormone levels for a person with hypothyroidism. These foods are referred to as goitrogens because the substance they contain interferes with iodine uptake and can hinder the manufacture of thyroid hormones within the cells of the thyroid gland. Of course these foods are only a concern for people with a remaining thyroid gland. Goitrogens are found in the brassica/cruciferous vegetables, such as, broccoli, cauliflower, cabbage, brussel sprouts, turnips, spinach, radish, horseradish, and mustard greens. The cooking of these foods usually inactivates the goitrogens and lessens their negative effects, and therefore can be a part of a normal diet. Patients still struggling with hyperthyroidism can eat these foods raw on a regular basis and this may help reduce thyroid hormone levels slightly, although this should not be considered a cure for an overactive thyroid gland. The intake of soy products, millet, strawberries, cassava, almonds and walnuts may also contribute to an underfunctioning thyroid gland if they are consumed regularly or in large amounts. Soy, in particular, interferes with the absorption of thyroid hormones and can induce goitre, and despite its health benefits, has been implicated in the development of autoimmune thyroid disease. Generally speaking, goitrogens only become a risk factor when these foods form a major part of one’s diet, or the diet is also deficient in iodine. Eating these foods occasionally or in small amounts should pose little concern.
Thyroid friendly foods and nutrients
The essential ingredient that the thyroid gland uses to manufacture thyroid hormones is Iodine. Therefore adequate intake of this precious nutrient is vital for a normal functioning body. The easiest and safest way to obtain sufficient amounts is by regularly including fish/seafood in the diet and using a good quality iodised salt in cooking or on your food. The daily-recommended dose for the average person is around 150 mcg per day (0.05g per year). ‘The more the better’ is not the case when it comes to iodine, as taking too much iodine can aggravate existing thyroid problems and autoimmunity, and in some individuals can cause goitre. If a person is struggling with hyperthyroidism then taking iodine is like poring fuel on the fire and can cause a major flare up of overactive symptoms. Be aware that many nutritional supplements (kelp, bladderwrack or bugleweed), processed foods, cough medicines, diet pills and other medications contain iodine. Keep a careful eye on the contents included in various substances. Iodine supplementation is of no importance for those who do not have a thyroid gland any longer, however, a healthy amount from food sources is important for the breasts and ovaries and other parts of the body that use this nutrient.
Beneficial nutrients to encourage healthy thyroid function and optimal cellular response to thyroid hormones include: selenium, B group vitamins (esp. B1, B2, B6 and B12), manganese, zinc, iron, copper, calcium, magnesium, essential fatty acids, antioxidants and vitamins A, C, D and E. A supplement containing these nutrients would be better than taking them individually so that an overall balance is obtained, unless definite deficiencies are found and need correcting individually. Ginseng, withania and the Chinese herb astragalus have been shown to have a stimulating effect on thyroid function and support of the immune system. Chromium is important to improve blood glucose control and sensitivity of insulin receptors. It can also aid in weight loss as blood sugar levels stabilise. Selenium is a particularly important mineral for the thyroid gland and the metabolism of thyroid hormones. Many enzymes involved in the production and activation of thyroid hormones are selenium dependent. Sufficient selenium is critical for the conversion of T4 into active T3, however too much selenium can also hinder the synthesis of thyroid hormones and can be toxic at high levels. Therefore, the recommended daily allowance (RDA) of selenium and iodine needs to be considered carefully so that overdosing does not occur. Foods sources high in selenium include: brewer’s yeast, organ and muscle meats, fish and shellfish, grains, dairy products, brazil nuts, and broccoli, cabbage, cucumber, garlic, onions and molasses. Tyrosine, an amino acid, is required by the thyroid gland to make thyroid hormone. It combines with iodine to form a precursor hormone that the cells of the thyroid gland convert into T4 and T3. Some people have found benefit in taking a small supplement of tyrosine to improve their thyroid function; however, the body can make its own tyrosine when needed from other non-essential amino acids.
Dietary Tips for Thyroid Patients
A healthy diet should include 30-45% quality carbohydrates, 20-35% quality protein and 20% good fats. The ratio of carbohydrates to proteins depends on the individual and their digestive health.
Choose a variety of foods from all food groups. Try new things and experiment with different food combinations.
Choose low to moderate GI carbohydrates with a good nutritional content. The larger the grain or fibre content, the more slowly digested and generally the lower in glucose release and insulin spike.
Limit your intake of processed, refined sugary/starchy foods, such as, white breads, bakery items, cakes and sweets, as they tend to be low in fibre and important nutrients, and high in fats and GI.
Eat fresh fruit and vegetables rather than packaged ones. Aim for 5 to 8 servings of vegetables every day, and 2 to 4 serves of fruit. The more variety the better!
Choose low GI rice (Basmati), pastas and potatoes whenever possible. Limit their cooking time to ensure lower glucose levels.
Limit intake of grains as these are broken down into simple sugars, and can contribute to overall inflammation within the body. If you do consume grains, choose wholegrain breads and protein enriched pastas. The larger the grain and surface area the more slowly it is digested. Fresh pastas are lower in GI than dried packaged ones.
Choose good quality protein sources, low in fat or containing good fats/oils/essential fatty acids.
Nuts are extremely beneficial, but may need to be limited if weight is a problem.
Avoid deep fried foods and fatty cuts of meats.
Eat fish at least twice a week. Try to avoid larger fish that are further down the food chain, as they are more likely to be contaminated with mercury. Smaller fish are a better option.
Choose organic foods such as eggs, fruit, vegetables and meats if you are able to or can afford them. Organic foods are higher in nutritional content and have not been contaminated with chemicals, growth hormones and preservatives.
Avoid hydrogenated vegetable oils such as margarines and spreads, and opt for high quality oils or sprays.
Limit simple sugars and sweets, and reduce your intake of fats, salt, alcohol and caffeine (caffeine can aggravate blood sugar and tends to dehydrate the body).
Use iodized salt in cooking and on food.
Be wise with portion sizes: the larger the serving, the more it will increase your blood glucose levels. Eat to be satisfied, but don’t stuff yourself to the point where you just want to sleep and not move for a week. This also helps avoid indigestion.
Do not reduce portion sizes or calorie intake too dramatically in an effort to lose weight. This will tend to slow your metabolism down and be counter productive.
Eat slowly and chew your food well to increase digestive enzymes and to avoid consuming too much.
Eat at regular intervals so as to avoid getting too hungry. It’s fine to snack in between meals as long as your snack is nutritious and has a low GI. Good choices are fruit, raw vegetables with homemade dips, cheese, yoghurt, nuts and seeds.
If weight is an issue, choose low fat diary products instead of full cream; milk, cheeses and yoghurt.
Avoid any foods that cause a negative reaction, such as an allergic or intolerant response. Common offending foods are wheat, gluten, dairy, soy, eggs, nuts, citrus fruits and fructose. Many thyroid patients have improved their health by eliminating these food sources.
If you have a diagnosed digestive condition, such as inflammatory bowel or irritable bowel problems, whole grains and seeds may be difficult to digest and may aggravate the bowel. Choose softer options such as fruit and vegetables high in fibre that are kinder to the system. This too applies to those with thyroid conditions, as digesting whole foods and raw foods can be more difficult. Lightly cooking or steaming vegetables makes them easier to digest.
For those who have had their gall bladder removed, choosing low fat options is wise as oils in the diet will be more difficult to break down and absorb, and tend to be stored under the skin and around internal organs. A digestive enzyme supplement could be beneficial when consuming a meal containing protein and fats. Please talk to your doctor.
It has been suggested that adding protein and fats to carbohydrate meals reduces the absorption rate and lowers blood sugar response. This is incorrect. Adding protein/fat to a carbohydrate meal does not slow down the absorption of glucose and reduce the spike in blood sugar levels. Protein and fats, however, do take longer to digest and keep you satisfied for longer.
If greater weight loss is desired, then only consume low GI carbohydrates (vegetables) with meals containing protein and fat. Moderate and high GI foods should be limited to stabilize blood sugar and avoid excess fat being stored. Good options are: an omelette with cheese and vegetables, or a warm lamb salad.
Occasionally, you may choose to have a meal mainly of carbohydrates. In this case choose combinations of foods with a low and moderate GI, and do not include protein or fat with this meal. This allows the body to use the glucose from the meal and not store any extra fat from high fatty foods or protein sources (e.g. vegetarian risotto or pasta).
Drink 6 to 8 glasses of water per day to keep body well hydrated and also to avoid unnecessary eating when the body actually needs more fluids. Limit sugary drinks and caffeine to maintain blood sugar and avoid dehydration.
You are less likely to suffer with indigestion if you drink plenty of water throughout the day and avoid high GI foods and meals heavy in fat content.
Glycemic Index Chart
Please refer to the Glycemic Index chart at the end of this article for the GI ratings of various carbohydrates. The Glycemic Index tables give a rating on how high blood glucose levels rise after consuming 50 grams of carbohydrates. A high GI rating is usually 70+, a moderate GI rating is usually 55 to 69, and low GI rating in 54 or less. The ‘Carbohydrates GI’ chart in this article has a slightly different scale range, taking into account that some foods have a borderline GI, or might have different GI levels depending on type, whether cooked or raw or ripened. Some of the foods may be moderate in GI but are a poor choice nutritionally. The chart provided here is a basic guide, and individuals can research further by visiting some of the websites listed.
Please note, that carbohydrates with a GI rating of less than 50 are considered below the level at which insulin is produced in most people, and therefore should not pose any problems.
*Bananas, Rice, Potatoes and Pasta
The GI of an unripe banana is around 43, whereas an over-ripe banana is around 75. Different brands of rice can vary in GI from around 54 up to 130. Long grain rice has the highest amylose content and is the lowest in GI rating. Short grain rice contains little amylase and is the highest in GI, such as Calrose rice. Potatoes can also vary in GI from around 56 up to 150. New potatoes usually have the lowest GI rating. Pontiac and Desiree, peeled and boiled have very high GI ratings from 88 to 110. Fresh pasta has a lower GI compared to packaged dried pasta. The longer you cook rice, potatoes, and pasta the higher the glucose content and GI rating.
It is very easy for people with overt thyroid conditions to do very little physical activity. The changes in metabolic rate of all bodily processes can profoundly affect energy levels, muscle strength, breathing and heart rate, and greatly deter a person from even trying the smallest physical exertion. It may be impossible to exercise while thyroid hormone levels are still abnormal and not optimised for the individual. However, with adequate thyroid treatment, moderate regular exercise can be extremely beneficial. Exercise increases circulation and oxygenation of the tissues, strengthening blood vessels, the lungs and heart. It encourages cellular metabolism, improves organ function, and helps the body’s detoxification processes. Exercise increases fitness levels and flexibility, develops strength and endurance, and improves brain function and mood. It helps to reduce stress and blood pressure, and can also lower blood cholesterol and insulin levels. Regular physical activity has been shown to reduce the risk of developing chronic conditions, such as osteoporosis, arthritis, type 2 diabetes, heart disease and even cancer. With regard to the thyroid gland, it stimulates thyroid hormone secretion, as well as increasing tissue sensitivity to thyroid hormones. As you can see regular exercise is highly beneficial for one’s general health and the prevention of disease.
The combination of diet and exercise together is also the most effective approach for maintaining a healthy weight. Diet alone can help towards weight loss by keeping a close eye on calorie intake and making wise food choices and keeping blood sugar levels stable. However, energy expenditure, i.e. physical activity, will increase cellular metabolism and help to burn calories and fat at an even faster rate, as well as building muscle mass. The importance of exercise is that it not only prevents weight gain and maximises loss of fat, it also minimises loss of lean muscle. Weight loss through diet alone causes a loss of fat and muscle, and when you lose muscle your metabolic rate slows down. ‘Your resting metabolic rate is largely determined by your lean muscle mass, because muscle requires a great deal of kilojoules just to sustain it’ Muscle is the most active metabolic tissue in the body. Moderate regular exercise, along with a healthy diet, builds and strengthens lean muscle, increases metabolic rate and causes the body to burn more kilojoules/calories and fat. The acceleration in metabolism keeps going even after a physical activity is stopped and further calories are burnt for an hour or two afterwards. Physically active people have a higher metabolic rate and their calorie expenditure continues even when they’re asleep. Let’s make the body work to our advantage!
The best idea is to choose a form of exercise that you actually enjoy, fits into your daily schedule and suits the time of year – indoors in winter and outdoors in summer. If you like what you are doing then it will be easier to stick to on a regular basis. Some people enjoy working out at a gym with friends or joining a team sport or walking group. Others may feel more comfortable in the privacy of their own home. Exercise at home can involve an exercise bike or treadmill, jump rope or trampoline. Walking around your property, up and down a driveway or staircase and dancing to your favourite music are all good options. Always begin slowly and work your way up gradually, especially if you have been debilitated by a thyroid condition for some time and your muscles are particularly weak. Beginning with a warm up (stretching) and ending with a cool down period (slowing pace and stretching) will also help in avoiding unnecessary injuries and post aches and pains. As mentioned earlier, consult with a health professional and personal trainer if various health problems need careful consideration, such as, diabetes, osteoporosis, obesity, or unstable joints. Those prone to exercise induced hypoglycaemia would need to regularly monitor their blood sugar levels and should be under supervision. Those carrying excessive weight would need a specially tailored program with low impact activities to avoid damage to lower limbs. Any exercise regime should be safe for the individual and not pose any dangers. Generally, the more physical activity you do, the easier it will become and greater strength and endurance will result.
A good exercise program would involve at least 20 to 30 minutes per day of low to moderate-intensity physical activity. The best time to exercise is before meals, or at least 2 to 3 hours after a main meal, so that the body burns fat and not just glucose. The best time to eat is about 30 to 45 minutes after a physical activity while the body is warm. Appetite is suppressed immediately after exercise and you will tend to eat less and be satisfied. If you wait a couple of hours after exercise before eating your blood sugar would have dropped dramatically and stimulated appetite so that you feel famished and devour everything is sight. This can often lead to overeating when you are desperately hungry. If you like to exercise first thing in the morning, only have a glass of water or juice, and then have a wholesome breakfast after your physical workout is completed.
At some stage during your daily program, it is wise to pick up the pace and include some vigorous exercise to increase your cardiac workout and improve muscle tone. One should train at an intensity that elevates the heart rate to a certain level above its normal resting rate. Check breathing and heart rate regularly. You should still be able to speak slightly while exercising, and heart rate should not be so great that major chest discomfort results. Please consult your doctor or personal trainer if you have any concerns. Regular resistance training or strength training can also be included a few times a week. This helps to build muscle mass, and accelerates the metabolism even further which aids in burning more calories and fat. Resistance or strength exercises include: yoga, Pilates, lifting weights, using exercise equipment, climbing stairs, push-ups, sit-ups and squats.
Overall, there is light at the end of the tunnel for thyroid patients concerned with diet, exercise and weight management. Despite the myths, carbohydrates (sugars) are not intrinsically fattening. No one food type is fattening on its own, however, the quality, quantity, and combinations of foods can in fact contribute to weight gain and poor health. The concept of calories in, calories out is still valid. The more calories you take in, from any source, the more likely you are to store them as fat, unless you burn them off with adequate physical activity. Weight gain and obesity occur when there is a sustained excess of energy foods consumed, over energy expended. We must get moving to use up the extra energy stored throughout the body. Active people have fewer concerns with sugar intake and weight problems as they draw upon their energy reserves frequently. However, inactive people and those with a slower metabolic rate need to pay special attention the type and quantity of food they consume, and choose to incorporate regular exercise into their daily lifestyle.
For anyone suffering with a thyroid gland disorder, diet, nutrition and exercise are extremely important. A person’s body works as a whole and needs to be given the right ingredients to heal itself and function at its peak potential. Some people will only experience mild symptoms with their thyroid condition and have little or no changes in weight. While others may experience more debilitating symptoms and experience significant weight loss or weight gain. A holistic approach is therefore vital, taking into account all health conditions, medications, age, dietary and exercise habits, and lifestyle. Generally, if a thyroid condition is detected early and treated appropriately, the development of more severe symptoms and other complications can be prevented. Working closely with a doctor or health professional is of utmost importance in obtaining optimal levels of thyroid hormone replacement and ensuring that a person’s nutritional status is healthy. If you have been diagnosed with a thyroid condition, make some wise choices and choose to incorporate a healthy balanced diet and a regular exercise program into your life. Then you can look forward to living a normal, long healthy life.
Websites for Glycemic Index
A Revised International Table of Glycemic Index (GI) and Glycemic Load (GL) Values – 2002, by David Mendosa. Go to: www.mendosa.com/gilists.htm
The Glycemic Index. Go to: www.glycemicindex.com
MassAttack: Individualised weight management and health programs. Go to: www.massattack.com.au
For more information on the CSIRO total wellbeing diet, go to:
Gillam, Ian, MD, ‘Weight Management for People with Slow Metabolism and Type 2 Diabetes’ Transcripts from presentation given at the 2004 Annual Seminar – Thyroid Australia Ltd, Australia, 2004
Papalia, Mary-Anne, MD, ‘Insulin Resistance’, Transcripts from presentation given at the 2004 Annual Seminar – Thyroid Australia Ltd, Australia, 2004
Hanner, Robert, MD, ‘Diet and Nutrition in Relation to Hyperthyroidism and Hypothyroidism’, Presentation notes from the 2005 Annual Seminar – Thyroid Australia Ltd, Australia, 2005.
Jenkins, David JA, ‘Glycemic index: overview of implications in health and disease’, American Journal of Clinical Nutrition, Vol 76, No. 1, 266S-273S, 2002.
TFA Questionnaire, ‘Report on Weight Control Among Thyroid Patients’, The Bridge, Vol. 19, No.1, Spring 2004.
Mendosa, David, ‘A Revised International Table of Glycemic Index (GI) and Glycemic Load (GL) Values – 2002’. Go to: www.mendosa.com/gilists.htm
Mendosa, David, ‘The Glycemic Index’. Go to: www.glycemicindex.com
Ratcliffe, John, ‘Low Carb made easy’, Hinkler Books Pty Ltd’, Australia, 2005.
Noakes, Manny, MD and Clifton, Peter, MD, ‘The CSIRO Total Wellbeing Diet’, Penguin Books, Australia, 2005.
Kirschmann, Gayla and John, ‘Nutrition Almanac’, fourth edition, McGraw-Hill books, USA, 1996.
Bilsborough, Shane, ‘The Fat Stripping Diet’, Penguin Books, Australia, 2001.
Shomon, Mary J. ‘Living Well With Hypothyroidism’, Avon Books, Inc, USA, 2000.
Shomon, Mary J. ‘Living Well With Graves’ Disease and Hyperhtyroidism, HarperCollins books, USA, 2005.
Moore, Elaine and Lisa, ‘Graves’ Disease, A Practical Guide’, McFarland & Company Inc, USA, 2001.
 Reference: American Journal of Clinical Nutrition, titled ‘Glycemic index: overview of implications in health and disease’ (Vol.76, No. 1, July 2002)
 Noakes, Manny, MD and Clifton, Peter, MD, ‘The CSIRO Total Wellbeing Diet’, Penguin Books, Australia, 2005.
 Noakes, Manny, MD and Clifton, Peter, MD, ‘The CSIRO Total Wellbeing Diet’, Penguin Books, Australia, 2005.
© 2006 by Robyn Koumourou
Thyroid Disorders | ThyroidMatters