You may have heard following a ketogenic (keto) style of eating — a low carb diet with high fat intake — could be the key to managing your hypothyroidism. A keto diet has been used therapeutically to support specific conditions, including hypothyroidism, but it may not be right for everyone. In this article, we’ll explore 12 pros and cons of the ketogenic diet in general, and whether it could help manage your hypothyroidism symptoms and improve your quality of life. 

What Is the Keto Diet?

The keto diet is a high fat diet with significant carbohydrate restrictions. A traditional keto diet aims for 60% fat, 30% protein, and 10% carbohydrates in each meal, compared to a standard American diet, which typically consists of about 30% fat, 15% protein, and 55% carbohydrates. The consumption of high dietary fats allows your body to get energy by burning ketones produced by the liver as it breaks down fat, versus getting its energy by burning glucose (sugar) from carbs. This process is called ketosis. Burning fat instead of glucose as fuel may be helpful for curbing cravings, reducing body fat, and resetting your metabolism. (Source)

To stay in ketosis, it is necessary to consume no more than 50 g of carbohydrates per day, the equivalent of 2 bananas or 1 cup of pasta. If you were only consuming between 20 g to 50 g per day of carbs before beginning keto, you might reach ketosis in 2 to 4 days, but otherwise it may take you a week or even longer to use up all your glycogen stores and reach ketosis. Other factors that will influence the amount of time it takes you to achieve a state of ketosis include:

• age
• macronutrient intake: carbohydrate, fat, and protein
• physical activity
• metabolism
• sleep hygiene
• stress

(Source)

Foods to Eat

With the keto diet, the main aspect to focus on is your fat consumption, with some protein in the mix and very little in the way of carbohydrates. The following foods are considered keto friendly:

• meats
• eggs
• avocados
• oils, especially extra virgin olive oil, avocado oil, coconut oil, and ghee
• fish, especially salmon, tuna, and scallops
• dairy (as tolerated), including high quality products such as butter and cream, unprocessed cheeses such as cheddar, gouda, Parmesan, and goat cheese
• nuts and seeds, such as walnuts, flaxseed, pecans, chia seeds, and macadamia
• low carb vegetables, such as broccoli, spinach, kale, tomatoes, and cucumbers

(Source)

Foods to Avoid

When following the ketogenic diet, there are some foods to avoid to remain in a state of ketosis without restricting calories. Even though the following may be considered healthy, whole food sources, they do not fit into a keto plan:

• beans
• high carb vegetables, such as potatoes, carrots, and some squashes
• fruits that are especially high in sugar. Berries have a lower sugar content and are a keto-friendly choice.

In addition to avoiding the foods above, alcohol and sugary drinks are also discouraged.

(Source)

What Is Hypothyroidism?

Hypothyroidism, or underactive thyroid disease, is a common autoimmune disease in which the thyroid gland does not make or release enough thyroid hormones. This thyroid condition causes your metabolism, the process in which your body converts food to energy, to slow down. Hypothyroidism can affect anyone regardless of gender or age, but women over the age of 60 and those who have gone through menopause are more susceptible to developing this condition. Proactive diet and lifestyle changes may help manage hypothyroid symptoms effectively for those who suffer. (Source)

Causes of Hypothyroidism

The two most common causes of hypothyroidism are Hashimoto’s thyroiditis, an autoimmune disease, and damage to the thyroid gland from treatment for an overactive thyroid (hyperthyroidism). Other reasons and risk factors for developing hypothyroidism may include:

• iodine deficiency
• surgery to remove the thyroid gland 
• radiation therapy
• taking medications that lower thyroid hormone levels
• having other medical conditions such as: 

• type 1 diabetes
• systemic lupus erythematosus
• pernicious anemia
• rheumatoid arthritis
• celiac disease
• Addison’s disease
• myasthenia gravis
• Down syndrome
• Turner syndrome
• anorexia or bulimia nervosa

• gender
• age
• pregnancy
• family history
• smoking

(Source)

Symptoms of Hypothyroidism

Hypothyroidism symptoms often develop slowly and may even take years to present. Possible symptoms may include:

• fatigue
• numbness and tingling in the hands
• constipation
• weight gain
• soreness or muscle weakness
• high blood cholesterol levels
• depression
• cold temperature intolerance
• dry skin and hair
• hair loss
• low libido and sexual interest
• frequent and heavy periods
• changes to facial appearance, such as drooping eyelids, puffiness
• low and hoarse voice
• brain fog

(Source)

How the Keto Diet Affects Hypothyroidism

So how can the keto diet affect your hypothyroidism condition? The butterfly-shaped gland in your throat controls your metabolism and energy. Your diet can have similar effects on these aspects of your health, and the appropriate diet can improve your thyroid symptoms. Following a clean ketogenic diet full of whole foods including healthy sources of fats is key to this diet and may be beneficial to healthy thyroid activity. 

Weight Gain

Hypothyroidism causes your metabolism to slow down, making you more susceptible to fatigue and weight gain. A ketogenic diet may be a tool to prevent and reduce weight gain, as it burns fat for fuel instead of glucose from carbohydrate sources. Simply decreasing the amount of carbohydrates you consume, while increasing your healthy fat intake, may help you better control your metabolism overall and support thyroid function. (Source)

Thyroid Hormone Production

Following a keto diet may affect the production and circulation of thyroid hormones. The thyroid gland produces two primary hormones, triiodothyronine (T3), and thyroxine (T4), with T3 being the more biologically active form. Small, short-term studies have found that a ketogenic or other low carbohydrate diet resulted in increased levels of T4 and decreased levels of T3. More research is needed to determine whether a keto diet could have a lasting effect on thyroid hormone production. (Source, Source)

Brain Fog

Brain fog can be a symptom of hypothyroidism, and studies show the keto diet has the potential to reduce it. Unhealthy weight gain and insulin resistance may contribute to foggy thinking, forgetfulness, fatigue, and mood issues, but research shows fueling your noggin with fat may improve mental clarity. A balanced diet with limited carbs but no caloric restriction may help improve blood sugar balance, avoiding spikes from nutrient-poor carb sources, and fuel your brain more efficiently. Carbohydrate sources of fuel burn out quickly, but healthy fats rich in fatty acids are capable of fueling the brain for longer periods of time. This can increase mental alertness and focus while avoiding insulin resistance that causes brain fog. (Source, Source)

Pros of the Keto Diet

Used therapeutically, the keto diet may be beneficial for managing your hypothyroidism condition, resulting in positive effects on metabolism. Though this is a restrictive diet, the many potentially beneficial health outcomes of following this plan may play a role in metabolism and include:

• weight loss
• being mindful and having an awareness of food choices, quality of ingredients, and nutrient intake, resulting in healthier eating habits
• feeling fuller and more satisfied for longer intervals of time 
• balanced and stable blood sugar

(Source, Source)

Cons of the Keto Diet

Though the keto diet may be beneficial for some conditions, this high fat style of eating may not be right for everyone with thyroid issues, especially those with liver, pancreatic, kidney, or gallbladder diseases. You may experience some uncomfortable symptoms and side effects of this diet, which may include:

• electrolyte imbalances
• quick weight loss from water that may not be an indicator of actual change in body mass
• “keto flu,” which includes symptoms of bad breath, headaches, muscle cramps, nausea and constipation
• risk of developing kidney stones, liver disease, and nutrient deficiencies
• constipation that may occur from low intake of dietary fiber
• risk of poor heart health from consuming a high fat diet over a long period of time
• difficulty sustaining the diet because it is so restrictive

Though there are quite a few cons of this diet, there are some that are temporary and may be remedied so you can safely enjoy the health benefits of this eating plan. 

• Electrolyte imbalances can be straightened out by staying hydrated with water and using electrolyte supplements, as well as ensuring you are getting enough salt in your food. 
• Transitioning to a keto diet may be a struggle for some, causing what is known as “keto flu.” This is your body’s way of adapting to using fat as fuel versus glucose from carbohydrates, and may last a few weeks. Staying hydrated and keeping electrolytes balanced can help curb the onset of keto flu. 
• Being constipated on the keto diet may mean you are not getting enough fiber, but luckily, being conscientious about staying hydrated and increasing fibrous foods will help. Keto-friendly fibrous foods include nuts and seeds, legumes, and non-starchy vegetables such as broccoli, spinach, kale, and cucumbers. 
• To fulfill your nutritional needs and balance insulin levels, be sure you are eating a balanced, whole foods diet of fresh, nutrient-dense, anti-inflammatory foods that are healthy sources of fat, protein, and carbs. This is considered “clean keto” and may help you stay on track with the micro- and macronutrients your body needs as you follow a low carb, high fat diet.
• A low carbohydrate diet like keto may seem restrictive once you begin. But after those initial first weeks of not feeling so hot your body should adapt to using fat as fuel, and it should be more sustainable for you to continue on the plan. 

(Source, Source, Source)

Is Keto the Best Diet For Hypothyroidism?

Is there a best diet for hypothyroidism? Researchers say there is no one, perfect eating plan for this chronic disease, but keto may be a low carbohydrate diet option for short-term management of thyroid function. It may improve energy levels and insulin resistance, reduce consumption of inflammatory foods, and reduce fat stores for optimal health, but it may not be a good option for all health conditions. Your age, macronutrient intake, physical activity, metabolism, sleep hygiene, and stress levels all play a role in how the ketogenic diet will affect your ability to reach and maintain ketosis. 

The Bottom Line

One of the potential pros of the ketogenic diet is that it may help manage symptoms of hypothyroidism, but this style of eating has many cons, too. You should consider all aspects of this diet — positive and negative — before deciding if it’s right for you and your condition.

If you struggle with a thyroid condition, find a health care practitioner or look into working with WellTheory’s Care Team to find an appropriate diet that works for you. Explore our high touch pathways and find out how our Nutritional Therapy Practitioners can help you find the right style of eating to suit your needs.