For millions of women living with hypothyroidism, the journey to better health is rarely straightforward. Weight struggles, fatigue, insulin resistance, and unpredictable symptoms are common frustrations. Standard treatments often center on adjusting thyroid medication to normalize TSH levels, but this “one-size-fits-all” approach leaves many women still feeling unwell. This is why our recent study conducted by The Noakes Foundation sought to explore a different path: Could a low-carbohydrate, high-fat (LCHF) dietary intervention help women with hypothyroidism regain control over their metabolic health? Our results say: Yes, with some important nuances.
Last year, we worked with a small group of South African women diagnosed with hypothyroidism. Over the course of three months, they adopted a low-carb diet with the support of group discussions, personalized dietary advice, and continuous feedback. Women were also given access to the Nutrition Network Advisor Training and the Women’s Health Course, providing additional education tailored to their dietary needs. What set this study apart was its mixed-methods approach, which combined quantitative data (clinical outcomes like weight, blood pressure, blood glucose, thyroid markers, and dietary changes) with qualitative insights gathered through in-depth interviews and group discussions. This created a holistic understanding of how key dietary changes influenced women with hypothyroidism physiologically, emotionally, behaviorally, and socially.
Most studies on hypothyroidism, particularly those evaluating dietary interventions, tend to follow a narrow biomedical lens, focusing heavily on biomarkers like TSH, T3, and T4. While these numbers are important, they only tell part of the story. By designing this study as a mixed-methods case series, we created a more complete, human-centered understanding of how dietary change influences women with hypothyroidism. In chronic disease management, especially in conditions like hypothyroidism, which affect everyday quality of life, clinical outcomes alone don’t define success. Instead, how participants feel, how they engage with their own care, and whether they believe change is possible can be just as influential in determining long-term outcomes.
To objectively assess how dietary habits evolved, participants completed Food Frequency Questionnaires (FFQs) at the start and end of the study. The analysis showed clear shifts: participants significantly reduced their intake of high-carbohydrate foods, including bread, cereals, and grains, while increasing their consumption of non-starchy vegetables like leafy greens and healthy fats and proteins such as full-fat dairy, eggs, meat, and biltong. Participants also drastically cut back on sugar and processed foods, including sweetened beverages, desserts, and fast foods. This measurable change matched the qualitative data, where participants described a profound transformation in their relationship with food, gaining confidence, planning meals more intentionally, and reframing food as fuel rather than comfort. This convergence between dietary data and personal reflections highlights the power of combining quantitative and qualitative approaches to capture the full meaning of dietary change.
The quantitative results showed statistically significant weight loss. This aligned closely with participants’ qualitative descriptions of feeling empowered by seeing tangible progress, which reinforced their motivation to stick with the dietary changes.
“For the first time, I feel like I’m doing something right for my body.”
However, when it came to blood pressure, the story became more complex, demonstrating why mixed-methods approaches are essential. While some participants experienced marked reductions in systolic blood pressure, particularly those who reported greater adherence to the diet and a reduction in bloating, others saw small increases in systolic readings. The qualitative interviews provided crucial context: those who improved linked their success to feeling less inflamed and having more stable energy, while those with increases often reported stress, inconsistent adherence, or external life pressures (like social events or family obligations) during the study period. This convergence-divergence dynamic, where the numbers sometimes align with experiences, and sometimes don’t, illustrates why clinical data alone can be misleading. Without capturing the story behind the data, we risk oversimplifying the true drivers of health outcomes.
HbA1c changes were modest and statistically nonsignificant, but the participants themselves felt they had better energy stability and reduced cravings. This disconnect between perception and measurable glucose control highlights the importance of subjective feelings. This is a critical insight for clinicians, who often dismiss “feeling better” when lab results look unchanged. While T3 decreased significantly, changes in TSH and T4 were not significant. Participants’ perceptions of thyroid symptom relief were inconsistent, while some felt dramatically better, others reported no change or even new uncertainty about their thyroid health. This highlights a crucial gap in conventional thyroid monitoring. Focusing only on TSH often misses the real experience of patients. Individual symptoms, energy levels, and personal perceptions of health need to be factored into clinical decisions.
“My thyroid levels have improved so much that my doctor is considering reducing my medication dose.”
This study measured emotional empowerment qualitatively, but this was arguably one of the most important findings. Every participant who completed the study reported a profound shift in self-confidence, reduced fear around food, and a sense of personal agency over their health. This emotional empowerment created a self-sustaining feedback loop. Small improvements reinforced self-belief, which fueled greater adherence, which in turn produced further improvements. The final, and perhaps most valuable contribution of the mixed-methods design was uncovering the social, environmental, and financial barriers participants face when trying to sustain low-carb living in a context like South Africa. These are invisible in clinical data but dominate real life: cost of high-quality protein, social stigma around “being difficult” when requesting dietary changes at gatherings, and conflicting advice from doctors, some of whom viewed low-carb diets with skepticism.
“The world outside doesn’t cater to this lifestyle. You either eat what’s available or stick to your plan and feel like an outsider.”
While the initial 3-month study showed promising results, the real question is: Can these improvements last? And what happens over time to thyroid markers, insulin sensitivity, and dietary adherence?
We are thrilled to announce that, thanks to funding from the Fundación Ramón Areces and the Association of Spanish Scientists in Southern Africa, we are now able to extend the study. Participants will be re-enrolled for 6-month and 1-year follow-up assessments. This follow-up isn’t just about collecting data, it’s about shaping the future of thyroid care. Standard treatment relies heavily on lab results, but our study is showing that lived experience matters just as much. How women feel, what they struggle with, and what support they need is critical information that’s often overlooked. By combining quantitative data with rich personal narratives, we hope to redefine hypothyroidism care moving away from a narrow medical approach toward holistic, patient-centered solutions. Our initial findings confirm what many women with hypothyroidism have known all along that food is medicine, but only if the approach is tailored to their body, their circumstances, and their story. By securing funding for this follow-up, we’re not only advancing scientific understanding we’re also amplifying the voices of women who have too often been dismissed or ignored. We look forward to sharing updates as the extended study progresses.
Georgina Pujol-Busquets Guillén (MSc, PhD) – Postdoctoral Researcher
