Saturday, July 19, 2014

Hashimoto's Thyroid and the Autoimmune Protocol Elimination Diet: What is AIP?

As I mentioned in my update post a week ago, I was recently diagnosed with Hashimoto's Thyroiditis. I was kind of relieved when I got that diagnosis, because I've had symptoms of thyroid disease for a long time, but all my TSH blood tests were coming back normal. My regular doctor ordered the TSH every year: in 2012 it was 2.13, in 2013 it was 2.03, and this year it was 2.12 (standard range is 0.45 to 5.10). But some blog readers have, in the past, tipped me off in the comments by telling me there were more detailed, accurate thyroid function tests and that many people who have thyroid disease have a normal TSH. That turned out to be true for me as well. When I finally was referred to an endocrinologist, he looked at my symptoms:

thinning hair
difficulty losing weight/weight gain
chronic fatigue
"brain fog"
dry skin
headaches
and the biggest symptom for me, cold intolerance (I spent this winter in heavy sweaters with the heat turned up to 80 degrees and was STILL cold all the time... this was new).

He ran 4 or 5 tests, and then called and told me I had Hashimoto's. Apparently with this autoimmune disease, the body develops antibodies and starts attacking the thyroid tissue. This shows up in the thyroid peroxidase antibodies blood test; I did have the antibodies, and they are quite elevated. He also told me that once you have one autoimmune disease, you are at higher risk of developing another one, like lupus or rheumatoid arthritis, because the body has learned to attack itself and this cannot be cured. I also tested positive for HLA-B27, which "suggests a greater-than-average risk for developing or having certain autoimmune disorders. An autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue." (source link).

Before we even had the results of the blood tests, the endocrinologist recommended an elimination diet (and I cringed. I have been very resistant to the idea of such a thing, like the Whole 30, because it is so restrictive and I thought I'd go off the rails). But this was different. This was no longer about weight loss. This was a recommendation for my health, because of all the symptoms I've been having. He wanted me to eliminate all traces of gluten and dairy, and possibly some other foods. Apparently the protein in gluten is very similar to the structure of thyroid tissue, so if your body is gluten intolerant and you eat gluten, your body may also start attacking your thyroid. You can read more about that here: The Gluten-Thyroid Connection.

So after the tests came back positive, I called and talked to a thyroid specialist about elimination diets and he explained the most problematic foods that may cause inflammation, such as nightshades, eggs, nuts, and processed foods. He also discussed with me the role of environmental toxins and stress in autoimmune disease (discussed more here). I bought two books to help me understand the whys and hows of these changes :Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, and The Paleo Approach: Reverse Autoimmune Disease and Heal Your Body. Both are really great books full of information, if you want to learn more about these issues.

After making a list of all the things I was told to eliminate, I started doing some research online. That's when I found that this type of elimination diet for autoimmune diseases is called the "Autoimmune Protocol" or the "Autoimmune Paleo Protocol" (because it is like Paleo on steroids). There are lots of sites dedicated to following this protocol for people who have various autoimmune diseases; here are a few that explain the details: The Autoimmune Protocol, Paleo Approaches to Autoimmune Disease, and Changing Your Diet is the First Step in Addressing Hashimoto's. But basically, I am not allowed to eat anything. Kidding... sort of.

Here's a summary of stuff I have to eliminate. First, all gluten has to go, and probably forever because of the thyroid connection. Also no grains whatsoever... no rice, barley, wheat, oats, corn, etc. You can't have any legumes, so no beans, lentils, peas, peanuts, or soy products. As the endocrinologist stated, dairy is another one that might have to be be gone forever... including milk, cheese, butter, cream and all other dairy products. No refined sugar, no processed food chemicals, no artificial colors or flavors or sweeteners (including stevia) and no modern vegetable oils (canola, corn oil, etc). I think at this point you'd be considered Paleo, right?

Keep going. You can't have any eggs, so forget all those egg breakfasts. No nuts either, so ditch the almond milk, nut butters, macadamias, walnuts and other nuts as snacks. And no seeds, so forget seed butters, nut and seed oils, sesame products, pumpkin seeds etc. Also included in the seeds category is (gasp) coffee AND chocolate. This has been the hardest part for me. I loved having a cup of black coffee in the morning and a square of 88% dark chocolate after dinner... no more. Nothing with coffee or cocoa at all. But there's more! You have to eliminate nightshades, so no more tomatoes, peppers of any kind, eggplant, or white potatoes. This was pretty tough too... no salsa. No delicious garden tomatoes. And this also includes spices derived from peppers, so no chili powder or paprika, curry or cayenne (in fact there is a whole list of seed-based and pepper-based spices to avoid... makes things pretty bland IMO and also meaning you have to really read labels of any meats you buy like sausages). Finally, there's no alcohol and no NSAIDS so there are probably some headaches and joint pain in your future if you frequently use NSAIDS for pain relief.

When I read all of this I was SO BUMMED OUT. Basically, I can't eat anything! No more spinach mushroom omelets. No more roasted eggplant, or spaghetti squash with marinara sauce, or chili made with beans or tomatoes. No more cauliflower pizza, or deviled eggs, or chicken salad with mayo. No Greek yogurt with walnuts and blueberries. Oh it made me mad. But then I decided to focus on what I CAN eat.

I can have most vegetables (except nightshades) in any quantity. I can have lots of meat... preferably grass fed. I can have fish! I am encouraged to try to include organ meats (like liver, heart, and kidneys... I haven't yet) for their nutrition, and also to make and drink bone broth for healing. I can have quality fats like avocado, olive oil, and coconut oil. I can use pink or grey salt instead of table salt, and I can have fruits up to 20 grams of fructose per day. I am also encouraged to eat fermented foods like real, fermented sauerkraut, kombucha, and non-dairy kefir.

I started cutting things out immediately, starting with gluten. For the first week I spent a lot of time reading labels and finding gluten in everything! I also bought some gluten free cookies and realized just how much gluten free junk is out there! Tons of it! Next I cut that junk out along with the processed foods. I was already nearly soy free but had to dump my favorite green tea because it contains soy lecithin. I then cut the eggs out and the rest of the grains, including rice. I took it slow because I was going through some stressful life stuff, and didn't think I could handle cutting it all out at once... food is an emotional thing for me. Finally, I was down to just needing to cut out the coffee, some spices, a bit of dairy, chocolate, and tomatoes. I did that last weekend and have been 100% AIP compliant since.

And I hate it so far, and it sucks. I have not been very creative with my eating, so it's basically been:
homemade sausage (pastured ground pork and AIP compliant spices)
baked wild caught salmon
grass fed ground beef
cooked cabbage, asparagus, acorn squash, broccoli, butternut squash, and sweet potatoes
local peaches, plums, berries, and apricots
coconut oil, coconut butter, avocado
fermented sauerkraut, kombucha

For a family birthday we went out to a Mexican restaurant. Really, going out to eat is not happening anymore at all because I just don't want to risk cross contamination. But for this special occasion, I sat there watching the chips and salsa being eaten (that I can't have) and people eating all kinds of yummy cheesy stuff, beans, etc. But even the meats were marinated in spices, like paprika or other pepper based seasonings. So I explained to the waiter and I got this salad. This most pathetic salad I have ever eaten... a plate of iceberg and carrot shreds topped with the most plain, boring, seasonless chicken breast you ever saw. No dressing. I did ask for some fresh sliced avocado to perk it up a bit, but no lie... eating that was depressing. If I was only doing this for weight loss I would have bailed for the chips and salsa. But I am doing this for my health, for my future, and I am too scared to eat anything off the diet. So there it is, I am 100% compliant, but not loving it, and yes it sucks.

There are a lot of websites out there with AIP compliant recipes; I bought this book: The Autoimmune Paleo Cookbook and my goal this week is to make 5 recipes from it. There are websites, too, with plenty of recipes and ideas. I just need to open my mind and branch out and start cooking in a new way. I can do this.

By the way, I don't have to eat like this forever. The doctor said "a month or two" and the standard for this elimination diet seems to be a minimum of 30 days, longer if you feel good on it. Then you slowly reintroduce each of the forbidden foods one at a time and keep a journal watching for any negative reaction or effects. Anything that has a negative reaction has to be eliminated for longer, possibly forever. And the gluten? That has to stay gone because of the thyroid issue.

So I hate it, I won't pretend it is OMG so fun and delicious. Maybe it CAN be, I will find out. I am keeping a notebook of the foods I eat and how I feel. So far: nearly constant headache and sinus drainage, but also feeling calmer. I am also working on the lifestyle parts of healing autoimmune disease, including improving sleep quality, learning to deal with stress effectively (using meditation and other skills), exercising at least 30 minutes a day, and eliminating environmental toxins. More on that in another post!

I'm thankful for those of you still here to listen to me and care how I am doing. I really appreciate your comments and positive thoughts. Hopefully the coming week will be easier!

17 comments:

FredT said...

Thanks for blogging, and sharing your diagnosis.

Some of us live that way by choice, without doctors direction. It is the paleo template or primal or 19th Century, but through out all cooking books. They cue overeating.

A can of salmon and 1/2 a head of lettuce for lunch, type simple.

Obesity is the least understood and most common modern condition brought about by development.

I have studied it for years, and now maintain a 50kg loss, but have not yet fully recovered.

Keep up the struggle

Deb Willbefree said...

Ack! I'm hating it for you.

I have an endocrinologist appt the beginning of September and I had planned on asking him about Hashimotos. (I have all of the symptoms you mention, with the latest being hair loss and the tops of my hands hurt.)

After reading this diet, I'm sure hoping all of the symptoms are from other things. Like, my hair loss could be from the water pills. And my hands could be a little arthritis. And the dry skin could be from the air conditioning. And I could be cold from too little carb in my diet... You know--something else!

Keep us posted.

Deb

heidi said...

Favorite easy meal of mine is to throw a frozen hamburger patty into a saute pan and chop it up while it cooks. Fresh garlic and/or onion is great at this point. Then I either add chopped cabbage, zucchini "noodles", or mushrooms with spinach. I do NOT drain the fat that comes off of the meat (and usually buy 73/27 ground beef frozen patties) and use the fat to saute the veggies in. It's fast and delicious and I never get tired of eating it. I usually add about 12-16 oz (raw weight) veggies when I cook this up. The vegetables of course get smaller when they cook.

Bacon, cabbage and onion saute is equally delicious and a go to meal for me. I drain however much of the fat meets my macro-nutrient goals for the day.

And lastly I make a LOT of quick salads that include a whole avocado and either chopped zucchini or finely chopped cabbage for the bulk of the salad. I made it the other day with avocado, cabbage, a little white vinegar and half a nectarine for sweetness and that was quite yummy.

For ME, the biggest part of eating "clean" in this manner is making sure to keep my refrigerator stocked full of delicious vegetables and my freezer stocked with single serving portion sizes or frozen chicken breast, frozen beef steak cut up into saute ready strips, frozen hamburger patties, frozen fish. I really seem to either succeed or fail by how good of a job I have done keeping appropriate delicious food available to whip up.

Coming up with some easy go to meals that I know I like and that I don't get tired of has been 100% responsible for me being able to keep off the weight I've lost in the last 14 months (70ish pounds).

It's tough. So's being sick. So many people who have a disease would kill to have an opportunity to vastly improve their condition with only a different diet. I have learned to be grateful that I am lucky enough to solve my health problems via the food choices I make. I still struggle all the time with off plan choices, but I keep plugging along.

CatherineMarie said...

You can get some good ideas from some of the raw cookbooks/websites as well...

Fortunately, with it being summer, you can make lots of slaws and such....

and you can make what almost amounts to a fresh chutney/relish with mango, papaya, onion. (Or peach)...because fruits can be savory too...

Once you go to just being gluten-free, maybe dairy-free, you will have a lot more options. Barbara Kafka has a really good gluten-free/dairy-free cookbook.

Karen said...

Lyn,

1. Diagnosis- glad you had the diagnosis with the right lab tests. That's key. Only about 15-20 pounds of my obesity was due to my thyroid disease, the rest, binge eating.

2. You are very, very lucky that you were told to do the elimination diet, AND that there are lots of books on AIP right now. In 1997, I was not told to remove gluten or dairy- I suffered for years.

3. This total elimination time is critical- it won't last forever, so hang in there. Auto-immune disease(s) suck- so power through and your food template will expand- do that work now. You'll know what foods don't work based on the response- when you get feeling better, likely you won't want to feel bad again.

4. The good news is (based on my own experience) that all my foods that I cannot eat due to being post auto-immune are all my binge triggers. (there's a connection there) Elimination of those foods was a huge step in stopping binge/emotional eating. Good for weight loss and weight maintenance, too. One stop shopping. It takes a lot of work physically and mentally to stop binge eating. Use this diagnosis to your advantage in the long run- IMO. Putting chronic diseases in remission is helpful to feel well day -to -day.

5. Interesting what triggers us to see disease states as worth taking action. Watching people die around me triggered me taking my prior obesity and binge eating as life threatening. Auto-Immune disease was just a chronic disease to deal with. Now I consider both chronic, life long diseases to manage.

I shared my thyroid story back in May 2014. Here's the link. http://gardengirlkp.blogspot.com/2014/05/thyroid-disease-weight-loss-and-weight.html

Good luck- get support and help if you cannot stick to the elimination diet. Karen P

LHA said...

So interesting! Thanks for coming back to your blog. I always have learned a lot from reading what you write and also the readers who post. I will be following you with interest.

Lori said...

I am so sorry that the diet is so rotten. It isn't forever and I know you can power through 30 or 60 days. I'll be watching with interest to see how this works out.
Lori

Sharon said...

I've never eaten beef liver straight, but I work it in to any dish that uses ground beef or lamb. I've found that 1/4 lb liver, either chopped fine or pureed with a little water with a stick blender, pretty much is not noticeable to me once it's mixed with about 1 lb of ground meat. I've also cooked grass-fed beef tongue and "hidden" it among ground meat too. AIP is such a nutritious way to eat, I hope you start seeing improvements in your health soon.

Diana said...

Hi Lyn, I just read your last few posts. Life is certainly throwing you some curve balls. The good thing is that at least you know what's going on with your body. You were doing everything right but it's been fighting against you. I'm so sorry about the autoimmune disease. The elimination diet sounds dreadful, but I was glad to read it's only temporary and not a life long diet.

You're really good at following directions and doing the right thing. I know you'll make it through this and come out with a stronger body. Thank goodness you finally found the right doctor to help you.

Take good care of yourself. I'm very glad you're back to posting. I felt like I had lost a friend when you stopped blogging these last few months. Good to have you back. :)

Deniz said...

Oh Lyn,
I really sympathise but I know that if anyone can get this cracked, it's you. Nothing truly defeats you and I know you'll get through it. At 'em strong lady!

I'm guessing Karen over at Garden Girl may be a huge help to you.

From me, many Zen hugs headed your way... right about now.
Deniz

Susan Calderon said...

Its so good to see you posting again! I don't comment often but always read and get so much from what you share.
I went gluten free a year ago at first it was very tough but I immediately felt better once it was out of my diet. If I accidently get glutened I have a bad reaction immediately so I am vigilant to stay gfee. I hope you have finally found the answers you have been seeking for so long.

Amy said...

Thank goodness it's only a short time! If you haven't already discovered it, Braggs nutritional yeast is a lifesaver! It is a blend of B vitamins with yeast and amino acid. Tastes. Like. Cheese!

dagnykight said...

Hello! Just discovered your blog and I'm getting the lay of the land. I see where your weight has been up and down in a range for the last few years. Do you now feel that the Hashimoto's, perhaps in its early stages a few years ago, was what caused you to remain in that range? It sure wasn't for lack of effort! I appreciate your honesty in this blog and I wish you the best.

Lyn said...

dagnykight~

hard to know, but in my personal opinion I do think that was a big contributor. Since being on Synthroid, my weight has been dropping a pound a week, even though I am not counting calories and feel like I am eating about the same amounts as I was before (although different foods).

Anonymous said...

Thank you. You may have just given me a clue to some of my health issues. I don't have Hashimoto's but had post-partum thyroiditis which resolved and reoccured until my thyroid was assumed to contain cancerous tissue which turned out to be scar tissue.
I read that this is considered a variation of Hashimoto's.

Bonnie V. said...

I am in my first week of AIP. I too have hashis. I see this is an older post, and I really really hope you are doing well!! I was just wondering how things ended up for you??

Lyn said...

hi Bonnie! I am doing well. I am in reintroductions right now and have added back seed spices, cocoa, grass fed ghee, and egg yolks successfully. If you go to my home page on my blog you can read the most recent posts. I hope AIP is going well for you.