Is it truly Hashimoto's disease and weight loss - is it achievable?

Hashimoto's disease represents a chronic, autoimmune inflammation of the thyroid gland, which is influenced by genetic and environmental factors. The onset of Hashimoto's disease can be promoted by a combination of bacterial or viral infections, stress, smoking, pregnancy, selenium deficiency, iodine excess, ionizing radiation, and the co-occurrence of other autoimmune diseases such as type 1 diabetes, celiac disease, psoriasis, anemia, hair loss, etc. The main indications of Hashimoto's disease include: – hair loss, – dry and flaky skin, – facial swelling, – hoarseness, – weight gain, – feeling cold, – constipation, – depression, – drowsiness and fatigue, – difficulty concentrating, – goiter, – menstrual irregularities, – infertility. One of the main indications that people with Hashimoto's disease struggle with is excessive weight gain. This is due to a decrease in basal metabolic rate (BMR) of up to 30% as a result of damage to the thyroid gland, which stops producing adequate amounts of tetraiodothyronine (FT4) and triiodothyronine (FT3).

Hashimoto's disease is much more commonly diagnosed in women, particularly in their reproductive years, than in men. It is also one of the most common thyroid diseases in children and adolescents. In order to diagnose this condition, the levels of a) hormones in the blood must be determined: TSH (thyroid-stimulating hormone, a hormone released by the pituitary gland that affects thyroid function), FT3 (triiodothyronine, a thyroid hormone), and FT4 (thyroxine, a thyroid hormone); b) antibodies in the blood: Anti-TPO (antibodies against peroxidase, an enzyme of the thyroid) and Anti-TG (antibodies against thyroglobulin, a protein of the thyroid). A high level of anti-TPO antibodies is found in almost 80% of people with Hashimoto's disease. In addition, an ultrasound examination of the thyroid is also recommended. Hashimoto's disease cannot be cured, but it can be brought into a state of remission, i.e. a state of suppression. The treatment consists of a combination of medication, a balanced diet, and physical activity. The medication therapy aims to compensate for the deficiency of thyroid hormones by administering L-thyroxine. Among the most commonly used preparations containing this hormone, we distinguish: Euthyrox, which contains lactose, and Letrox, which does not contain lactose. This is an important difference between these two preparations, especially important for people with lactose intolerance. The diet should provide the necessary nutrients that are required for the synthesis of thyroid hormones. We should avoid products that can disrupt this process.

The thyroid is responsible for approximately 30% of the resting metabolism, so in the case of a deficiency of Hashimoto's thyroid hormones, the energy provided by the diet is stored in the form of fat tissue, leading to obesity and overweight. Problems with maintaining normal body weight in turn have an impact on the normalization of the hormonal economy. Studies show that people with a hypothyroidism condition have a higher BMI and waist circumference than healthy people. In addition, it has been observed that TSH in the range of 2.5−4.5 mg/dl increases the risk of obesity and metabolic syndrome compared to a lower TSH level. However, weight reduction is possible by normalizing the thyroid hormone economy and introducing an individualized diet therapy tailored to gender, age, current weight, comorbidities, lifestyle, and physical activity. The diet not only supports pharmacological treatment but also allows for the reduction of the inflammatory process. The introduction of an appropriate caloric deficit promotes weight loss in people simultaneously affected by Hashimoto's disease and overweight or obesity. However, it is important to note that excessive caloric restrictions can lead to an increase in TSH levels, which can further slow down the rate of metabolism and hinder weight loss.

Persons with Hashimoto's disease frequently suffer from deficiencies in: proteins, vitamins A, C, B6, B1, minerals such as magnesium, potassium, phosphorus, sodium, chromium. Moreover, most individuals with Hashimoto's also have low levels of vitamins B12, E, selenium, zinc, ferritin, and glutathione. Furthermore, they often have insufficient calorie intake from food (despite frequent overweight), a lack of intake of polyunsaturated fatty acids (including omega-3 fatty acids) and dietary fiber, and an excess of carbohydrates consumed in relation to dietary standards. Therefore, it is crucial to ensure an adequate amount of vitamins and minerals in meals to prevent dietary deficiencies and thyroid dysfunction.

The diet for individuals with Hashimoto's disease should consist of four or five meals consumed at regular intervals. The first meal should be eaten within an hour of waking up, but within 30 minutes of taking the medicine, and the last about 3 hours before bedtime. It is important to drink the medicine with water, preferably unsweetened, source or low-fat. Calcium and iron (containing in the meal or given as a dietary supplement) can weaken the hormone. Between taking the medication and eating meals that are rich in these ingredients, we should maintain a healthy diet for about two hours, while in the case of dietary supplements, a four-hour break should be observed. In the diet, we should also pay attention to products that can reduce the absorption of the drug, such as soy. In the diet, we should pay particular attention to high-quality protein, the supply of which should be increased and should constitute about 15-20% of the diet's energy. Thanks to this, we can prevent hair loss, which is a common symptom in people with thyroid disorders. Additionally, high-quality protein (mainly from animal products - meat, fish, eggs, milk, cheese, as well as plant products - amaranth, rice bran, algae) is a good source of tyrosine, which is a substrate for the production of thyroxine. To support the functioning of the immune system, it is worth supplementing the diet with polyunsaturated fatty acids, especially omega-3. They have anti-inflammatory properties and have a positive effect on the lipid profile.

Providing the right amount of nutrients is key to optimal thyroid function. One of the most important elements are enzymes involved in the synthesis of thyroid hormones, which are mainly found in meat, fish, liver, pumpkin seeds, and other food sources. Another important nutrient is selenium, which is necessary for thyroid hormone syntheses and inflammatory conditions. Good sources of selenium include meat, fish, eggs, dairy products, grains, and sprouts. Zinc also plays an important role in thyroid hormone synthesis, and its proper intake (through meat, eggs, and dairy products) affects normal triiodothyronine (FT3) absorption. It is also important to note that even a good diet cannot meet the need for vitamin D3, so appropriate supplementation should be considered, especially from October to April. When the TSH level is above 2 mg/dl, products containing goitrogens should be consumed a maximum of three times a week, preferably in cooked or pickled form. Goitrogens are compounds that inhibit the absorption of thyroid hormones used in the treatment of Hashimoto's disease.

Based on studies evaluating the effectiveness of a reduction diet with increased fiber intake (30 g/day) in individuals with a BMI > 25 kg/m² and Hashimoto's disease, it was found that a diet rich in dietary fiber accelerates the weight loss process, which significantly improves the efficacy of dietary treatment. Research has shown that weight loss in individuals with well-treated Hashimoto's disease (balanced hormonal system) remains within the recommended limits of the weight-loss process (on average 0,8 kg/week). It is also worth noting that unhealthy lifestyles - lack of physical activity, sedentary work - and unhealthy eating habits are environmental factors associated with the occurrence of overweight and obesity in individuals with thyroid diseases.

The prevalence of restrictive and exclusionary diets among individuals suffering from Hashimoto's disease is concerning. A considerable number of people with this chronic illness eliminate gluten, lactose, dairy products, eggs, and nightshade vegetables from their diet. However, such elimination is not essential for everyone, as there is no unequivocal scientific evidence supporting its effectiveness. In certain cases, such as when co-occurring with celiac disease or milk protein allergy, the elimination of certain products from the diet can be beneficial. However, most patients will not benefit from this type of diet but will unnecessarily expose themselves to undernourishment risks. The primary objective in the treatment of Hashimoto's disease is the normalization of hormonal balance through pharmacotherapy, and the diet should support thyroid function and improve the absorption of medication.

Individuals with Hashimoto's disease possess a five to ten times increased likelihood of developing celiac disease compared to healthy individuals. To ascertain or exclude the presence of co-existing celiac disease, intolerance or allergy to gluten, it is advisable to conduct specialized examinations. Only upon obtaining results confirming these suspicions should one consider eliminating gluten-containing products from the diet. A gluten-free diet can also assist in weight loss, but solely for individuals adversely affected by gluten, e.g., through aggravating inflammation of the thyroid gland. In people without celiac disease, allergies or intolerances, adhering to a gluten-free diet will exert no influence on weight reduction.

Individuals with Hashimoto's disease often also have issues with lactose tolerance. In such cases, it is recommended to perform a test to confirm or exclude a possible intolerance. If you experience concerning symptoms after consuming dairy products, it is worth considering undergoing such a test. Intervention in individuals with coexisting lactose intolerance and Hashimoto's disease taking L-thyroxine is necessary because lactose intolerance can hinder the absorption of the medication, which may require an increase in dosage. A holistic approach to treating Hashimoto's disease, which includes addressing hormonal deficiencies with medication, introducing a suitable diet and physical activity, and changing one's lifestyle, is the preferred solution.