As the gluten free diet has gained popularity in recent years, you may hear mixed messages about this… One expert may say that gluten is toxic to humans (and all living things), and many alternative health experts recommend gluten free as a “cure-all” for various diseases. On the other hand, conventional medicine experts will say that the gluten free diet is unnecessary and even harmful, unless you have celiac disease.
So what is a person to do, if they have a thyroid condition?
My readers often ask me: what about eating gluten free for people who have thyroid issues, but do not have celiac disease?
My Personal Gluten Free Experience
When I was first diagnosed with hypothyroid, I was already working as a consultant pharmacist helping people with complicated healthcare needs in getting better health outcomes. I knew that autoimmune conditions tend to co-occur and that having hypothyroid would put me at a greater risk for other types of autoimmune conditions, including celiac disease. In fact, I came across a study that suggested gluten could be a trigger for both celiac disease and hypothyroid. (1)
Celiac disease is known for creating gastrointestinal distress… I had numerous gut-related symptoms including bloating, irritable bowel syndrome, acid reflux, and frequent stomach pains, in addition to the “typical” hypothyroid symptoms of brain fog, fatigue, hair loss, weight gain, and cold intolerance! I also had “non-typical” symptoms like anxiety, palpitations, joint pain, carpal tunnel, allergies, and panic attacks that are sometimes associated with celiac disease, so I had my doctor test me for celiac disease.
While I wasn’t exactly excited about having a second condition, I was hopeful that gluten and celiac disease would be my root cause and that getting the right diagnosis would help me feel human again. But the celiac test came out negative, and my doctor told me I didn’t need to bother with the gluten free diet.
As a result, I didn’t attempt the gluten free diet. Instead, I started thyroid medications, but continued to deepen my research into my triggers as many of my symptoms continued, despite taking thyroid medications.
The medications helped me feel less tired (my sleep went from 12+ to 11 hours per night), and I was also less cold (I no longer needed two blankets at night!), but the other symptoms remained.
Digging Deeper
About a year into my journey, I decided to dig deeper. I still had an interest in exploring whether diet could play a role in my condition. I learned about three distinct reactions a person could have to foods…
- The celiac reaction – This is a reaction specifically to gluten, the protein found in wheat, that is mediated by the IgA branch of the immune system and results in damage to the intestines.
- The allergic reaction – This is governed by the IgE branch of the immune system and results in immediate reactions like anaphylaxis, difficulty breathing, rashes, and hives (think hallmark reactions to peanuts or shellfish).
- The Type IV delayed hypersensitivity reaction – This is governed by the IgG branch of the immune system. Interestingly, Hashimoto’s is also a Type IV delayed hypersensitivity reaction.
Most research has focused on celiac disease and IgE reaction testing, while IgG testing is still considered experimental.
I had already been tested for celiac disease as well as IgE food reactions, but both of those tests came up empty for me- so I decided to try IgG food sensitivity testing.
The tests revealed that I had IgG reactions to gluten, as well as to the dairy proteins, whey and casein.
At that point, my condition was only getting worse, despite taking higher and higher doses of thyroid medications.
With nothing to lose, I decided to give the gluten– and dairy-free diet a try.
To my complete disbelief and amazement, the bloating and stomach pains (a lifelong phenomenon), the irritable bowel syndrome (with me for almost 10 years at that point), and acid reflux (an unwanted guest for more than 3 years) vanished within three days!
I had previously been symptomatic despite taking proton pump inhibitors, Pepcid, Tums, and Carafate, and yet after three days of this diet, ALL of my symptoms were gone! I made a brave decision to try and stop my acid suppressing medications and guess what! The symptoms never came back.
That is, until a couple of months later when I got hungry at work and decided to try eating something at Panera. I didn’t realize the meal I had contained gluten and dairy until I found myself having acid reflux and doubled over in the bathroom with stomach pain (just like I used to have) within hours of my meal. That convinced me to stay away from gluten and dairy for long term.
As time went on, I saw more improvements in my health- the carpal tunnel went away, my panic attacks and anxiety resolved, and my thyroid antibody numbers (a potential marker of how aggressive the attack on the immune system is) were reduced.
I know skeptics will say, “Great, but you’re only one person… what about everyone else? What about me?”
While the research for IgE food reactions is lacking, I want you to be aware of the important role of the other two types of reactions: celiac disease (IgA) and the Type IV delayed hypersensitivity reaction (IgG) reaction.
Thankfully, there is now a lot of research about celiac disease and how it relates to thyroid function.
In this article, I’ll touch on the controversial concept known as “non-celiac gluten sensitivity,” which I personally believe could be an umbrella term that may one day include the Type IV delayed hypersensitivity reaction (IgG).
What is Gluten?
But first, it’s important to understand just what gluten is. Gluten is a protein found in barley, rye, and wheat. It’s a staple in the Western diet that you’ll encounter in most breads, cereals, and pasta. However, it can also be hidden in many other food products. For example, you’ll often see wheat flour added to many sauces and even chocolates! Many foods may often be cross-contaminated with gluten as well, including oats. (Did you know? Hidden gluten is everywhere and can actually be found in personal care products such as skin care!)
It’s important to know what gluten is, as it can create a toxic response in people with autoimmune disease, including those with Hashimoto’s.
The most severe form of gluten response is seen in people with celiac disease.
Non-Celiac Gluten Sensitivity
After finding out that I had IgG reactions to gluten, as well as to the dairy proteins, whey and casein, I came across a condition known as non-celiac gluten sensitivity (NCGS).
With non-celiac gluten sensitivity, people have celiac-like reactions to gluten, yet they don’t test positive to the typical IgA celiac antibodies nor do they present the characteristic damage to intestinal cells seen in celiac disease.
However, research has shown that there are many correlations between those with thyroid disease and gluten sensitivities. For example, a 2002 study in the European Journal of Endocrinology found that 43 percent of people with Hashimoto’s showed activated mucosal T cell immunity, which is usually correlated with gluten sensitivity. (6)
While there is research to support this condition, the condition is considered controversial by conventional medical circles and conventional media. The challenge, in my opinion, is that there is not one diagnostic test, nor even one cause, for non celiac-gluten sensitivity.
There could be numerous reasons why a person may react to wheat products.
Some of them include small intestinal bacterial overgrowth (SIBO), which results in an impaired ability to break down various food particles, including fructans. In fact, a recent study found that fructan, a food molecule that may be found in wheat, is to blame for NCGS symptoms, and not gluten. (7)
Histamine intolerance has also been tied to NCGS, (8) as have other types of reactions to food particles, including nickel sensitivity.
A recent review article of the available scientific literature proposed that gluten sensitivity may occur as a result of a specific type of gut imbalance (known as dysbiosis).
Leccioli and colleagues proposed that the root cause of gluten sensitivity may be due to a decrease in the gut bacteria Firmicutes and/or Bifidobacteria, which produce the anti-inflammatory, gut healing short chain fatty acid butyrate. This is a really interesting theory, as I’ve seen low butyrate levels in many of my clients who have taken the GI MAP test from Diagnostic Solutions. (9) (I’ve used Tributyrin Supreme to help counteract this).
I will tell you that my personal and clinical experience has shown that gluten sensitivity is one of the most significant triggers in hypothyroid. I base this opinion on the severity of symptoms that thousands of people with hypothyroid have reported, as well as the health improvements they experience once they remove gluten from their diets.
Another important point to make about gluten and autoimmune disease is that studies have shown that gluten induces intestinal permeability in all individuals, regardless of whether or not they have celiac disease. (10)
Why is that important?
It’s because Fasano and researchers have found that every case of autoimmune disease needs three things present to occur:
- A genetic predisposition
- An environmental trigger
- Intestinal permeability
If one of the three things is missing, the condition will go into remission.
While we can’t change our genes (just yet), and while we don’t always have power over our triggers, we can always address the strength of our intestines and work on making them less permeable!
One obvious strategy to make intestines less permeable is to remove the substances that induce their permeability.
I find it is helpful to think of the intestinal permeability (commonly called leaky gut) reaction to gluten in terms of a spectrum.
On one side of the spectrum, some people may only experience momentary discomfort after eating gluten, such as brief bloating. On the other side of the spectrum, you will find people with celiac disease who suffer greatly, and even tiny amounts of gluten can cause significant damage to their intestines and symptoms for many weeks.
Can Other Foods – Beyond Gluten – Be Triggers?
Yes they can! Other substantial food triggers seen in survey include dairy (a large sensitivity for me!), eggs, sugar, soy, grains (corn, in particular), nightshades (tomatoes, potatoes, eggplants and peppers), alcohol, caffeine, nuts, and seeds.
In addition to cutting out gluten, the other most helpful dietary interventions were going on a sugar free diet (87 percent felt better), a grain free or Paleo diet (81 percent felt better), a dairy free diet (79 percent felt better), the Autoimmune Paleo diet (75 percent felt better), and the Low Glycemic Index diet (76 percent felt better).
It is also worth noting that many dietary interventions received higher percentages of “feeling better” results than actual prescribed thyroid medications. While 43 percent of people reported feeling better on Synthroid, and 58.9 percent felt better on Armour Thyroid*, 88 percent felt better on the gluten free diet.
As a pharmacist – and someone who advocates for the proper use of thyroid medication – I am obviously a supporter of physician-prescribed thyroid medications to help manage patient symptoms and their condition. But as a “detective” who works diligently to solve my own – and my clients’ – health puzzles, I also want to point out the tremendous benefits you can see by trying some of these food elimination strategies.
How to Feel Better
So what can you do today to feel better?
I hope I have convinced you (or at least tempted you to do some of your own detective work to learn more :-)) that gluten is a common trigger for those with hypothyroid.
Based on all of the research, I firmly believe that every person with a thyroid condition should try removing gluten from their diet.
Even in those who do not have celiac disease or diagnosed gluten sensitivity, gluten causes intestinal permeability and can cause significant life-affecting symptoms. You owe it to yourself to at least try eliminating it from your diet… and let subsiding symptoms speak for themselves. You can always add it back if you do not feel any improvements.
IgG Gluten Sensitivity as a Trigger in Hypothyroid
The studies of NCGS have not come up with conclusive opinions, or even diagnostic tests for gluten sensitivity on IgG reactions to gluten. However, I believe that Type IV Hypersensitivity (IgG) reactions are a critical piece of why gluten is a problem for many with hypothyroid. People with hypothyroid often present with numerous food sensitivities, and testing may show IgG antibodies to various food proteins. IgG antibodies are thought to be the same types of antibodies that target the thyroid gland in autoimmune disease. Thus, removing IgG reactive foods may attenuate the IgG response to the thyroid gland. These reactions can be tested via lab testing, as well as through an elimination diet.
Food Sensitivity Testing
Some people need to see that they react to a food “on paper” before they commit to making a change. I get it. I was one of them! If you are looking for that proof, I have found that IgG-based food sensitivity tests can be incredibly helpful in recognizing your food reactions and minimizing your symptoms!
Food sensitivities are very individualized, so you might be surprised to find some odd things you are sensitive to!
For me, I wasn’t just reactive to the usual suspects of gluten and dairy, but I had a reaction to tomatoes and peaches too! They both triggered my acid reflux. It is also worth noting that I tested borderline for gluten intolerance (although I was positive for dairy protein intolerance), but felt much better after removing both from my diet. A follow-up elimination challenge with both foods confirmed my sensitivity to both.
Why an Elimination Diet is the Best Gluten Sensitivity Test
If you can’t afford food sensitivity testing, I have some good news for you. There is a test you can do that’s absolutely free, but it does require more work and paying attention. The elimination diet is still considered the gold standard for food sensitivity testing. Your body will always tell you which foods do not agree with it, but only if you listen to it very carefully.
Why are food sensitivities so difficult to pinpoint? One reason is because we keep eating the foods that our body is sensitive to. For me, I ate dairy and bread every day, never connecting those foods to my long list of symptoms. When you eat a particular food on a daily basis, it is difficult to connect that food to any symptoms you are having.
You might have joint pain, bloating, and acid reflux every day, but how would you ever connect that to the dairy you have always had?
As you continue to consume the food you are sensitive to, your body becomes depleted in its ability to protect itself from the antigenic food. The reactions become less specific and more chronic. Additionally, your body will become sensitive to more and more things.
That is why an elimination diet helps greatly. If you remove a particular sensitizing food for a few weeks, you should feel better and experience less bloating, reflux, and other digestion-related symptoms. And when you are exposed to that food again, your body will be able to produce a stronger, more specific reaction, which will allow you to recognize which particular food is problematic.
I always recommend an elimination diet where you avoid the food in question for 2-3 weeks.
What About Non-Food Triggers? (Other Root Causes)
If gluten is the sole root cause of your condition, you will likely see a complete remission of thyroid antibodies after you eliminate it from your diet, and your thyroid function may even return to normal within 3-12 months. If you don’t see such improvements, you will need to put your detective hat back on and dig deeper for other contributing root causes.
Along with gluten or other food sensitivities, you may also need to look at infections, environmental toxins, and even how you are managing stress – but getting off reactive foods almost always helps in the healing process.
Once you find your food triggers, you will still need to help your digestive system heal by adding supportive foods and nutrients. In my survey, I found that incorporating healing foods also made people feel better. Homemade bone broth helped 70 percent of those that tried it, green smoothies helped 69 percent, and fermented foods helped 57 percent.
You may also need to focus on removing toxicity in your environment and supporting your body’s detoxification pathways. All of this is part of my 2-week Liver Support Protocol.
Is there Harm to Eating Gluten Free?
Often, people worry about missing out on essential nutrients by removing gluten-containing grains from their diet. Fortunately, in many cases people actually absorb nutrients more effectively from their food when they remove gluten from their diet! In fact, I’ve seen multiple cases of iron/ferritin deficiency resolve on a gluten free diet. That said, there are some documented deficiencies that are reported on a gluten free diet, but the good news is that you can supplement accordingly.
One of the most common nutrients depleted in gluten free diets is selenium, which also happens to be a common deficiency in Hashimoto’s! To counter this, I recommend this selenium supplement.
Grain free diets can also result in a deficiency of thiamine (vitamin B1), another common nutrient deficiency.
Other vitamin deficiencies that may occur on the gluten free diet include vitamin A, B2, B3, B5, B6, B7, B9, B12, vitamin D, calcium, copper, iron, magnesium, phosphorus, and zinc. If you’re also following the Paleo diet, you may be deficient in vitamin B7 and chromium as well. Again, testing for nutrient deficiencies and boosting your nutrient levels with supplements will help you maintain optimal vitamin levels!
Moving Forward… Gluten Free!
I know giving up gluten may sound daunting! It may take some work and some sacrifices to start cutting out gluten, but you are worth it. You only have your symptoms to lose and you can go back to your previous diet if the gluten free diet doesn’t help! I recommend giving it at least a month, though many people see the results in just a week. (I saw life changing results in 3 days!)
Going gluten free is really one of the best things you can try when you have a thyroid condition like Hashimoto’s, hypothyroidism, or Graves’ disease. Why not try it for a few weeks to see how you feel?
Do You Have to Stay Gluten Free Forever?
I would say generally with hypothyroid and Hashimoto’s, most people should remain gluten free for long-term. That said, I have seen some people who have been able to reintroduce foods and seemingly don’t have any adverse reactions to gluten. In other cases, some people claim not to react to gluten, but have obvious gluten-related symptoms like joint pain, anxiety and Hashimoto’s flare-ups; and are in denial that gluten could be a trigger for them.
If gluten sensitivity is indeed caused by an imbalance of butyrate-producing bacteria, in theory, replenishing the beneficial bacteria could deem gluten sensitivity reversible. Some individuals have reported no longer reacting to gluten after taking the ProbioSpore probiotic.
I’m still studying the phenomenon of reducing gluten reactions and improving digestion, and I’m hoping to get to the bottom of it.
References
- Sategna-Guidetti C, Volta U, Ciacci C et al. Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study. The American Journal of Gastroenterology. 2001;96(3):751-757. doi:10.1111/j.1572-0241.2001.03617.x.
- Lerner A, Jeremias P, Matthias T. Gut-thyroid axis and celiac disease. Endocrine Connections. 2017;6(4):R52-R58. doi:10.1530/EC-17-0021.
- Vojdani A, Tarash I. Cross-Reaction between Gliadin and Different Food and Tissue Antigens. Food and Nutrition Sciences. 2013;4(1):20-32. doi:10.4236/fns.2013.41005.
- Virili C et al. Atypical celiac disease as cause of increased need for thyroxine: a systematic study. The Journal of Clinical Endocrinology and Metabolism. 2012;97(3):E419-E422. doi:10.1210/jc.2011-1851.
- Celiac Disease Foundation. Screening. Celiac Disease Foundation. https://celiac.org/celiac-disease/understanding-celiac-disease-2/diagnosing-celiac-disease/screening/#O8ai1iT6IsODzqfu.99. Accessed December 28, 2017.
- Valentino R, Savastano S, Maglio M et al. Markers of potential coeliac disease in patients with Hashimoto’s thyroiditis. European Journal of Endocrinology. 2002;146(4):479-483. doi:10.1530/eje.0.1460479.
- Skodje G, Sarna V, Minelle I, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-reported Non-celiac Gluten Sensitivity. Gastroenterology. 2017;S0016-5085(17):36302-36303. doi:10.1053/j.gastro.2017.10.040.
- Schnedi W, Lackner S, Enko D, Schenk M, Mangge H, Holasek S. Non-celiac gluten sensitivity: people without celiac disease avoiding gluten-is it due to histamine intolerance? Inflammation Research. 2017. doi:10.1007/s00011-017-1117-4.
- Leccioli V, Oliveri M, Romeo M, Berretta M, Rossi P. A New Proposal for the Pathogenic Mechanism of Non-Coeliac/Non-Allergic Gluten/Wheat Sensitivity: Piecing Together the Puzzle of Recent Scientific Evidence. Nutrients. 2017;9(11):1203. doi:10.3390/nu9111203.
- Hollon J, Puppa EL, Greenwald B, et al. Effect of Gliadin on Permeability of Intestinal Biopsy Explants from Celiac Disease Patients and Patients with Non-Celiac Gluten Sensitivity. Nutrients. 2015;7(3):1565–1576. doi:10.3390/nu7031565.
- Mustalahti K, Catassi C, Reunanen A, et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med. 2010;42(8):587-95. doi: 10.3109/07853890.2010.505931.