A new study shows Hashimoto’s patients with symptomless celiac disease (i.e., no digestive complaints) require 49 percent more T4 to achieve the same TSH levels as non-celiac Hashimoto’s patients.

After the patients followed a gluten-free diet for 11 months their TSH levels came down with the same T4 requirement as the non-celiac Hashimoto’s patients.gluten hypothyroidism hashimoto's thyroid hormones

Gluten sensitivity linked with Hashimoto’s hypothyroidism

This is yet another study that demonstrates the clinical association between gluten sensitivity and Hashimoto’s hypothyroidism. It is very rare to find a person with Hashimoto’s who does not have some degree of gluten sensitivity or full-blown celiac disease.

Gluten overstimulates the immune system

Gluten sensitivity is basically defined as any immune response to gluten.

Celiac disease is defined generally as an autoimmune response to intestinal tissues upon gluten exposure, as well as overall activation of the immune system Various labs classify celiac disease using different criteria, including genetic testing and intestinal biopsy.

Either way, such an immune response is never good for a person with Hashimoto’s or other autoimmune disease. The immune system is already imbalanced and overactive during an active autoimmune condition. A consistent immune reaction to a regular food in the diet only makes the immune system more volatile, further exacerbating the autoimmune condition.

This overall activation of the immune system creates inflammation and explains why symptoms of gluten sensitivity vary. For some the inflammation may target the joints, creating pain and swelling. For others skin rashes and skin disorders ensue. Many others suffer inflammation in the brain, resulting in brain fog, mood and anxiety disorders, or memory loss.

The list of inflammation-induced symptoms brought on by a gluten sensitivity goes on and depends upon the person’s genetic makeup. Needless to say such systemic inflammation also flares up an autoimmune condition.

Experience shows a gluten-free diet is a must

In my experience, most Hashimoto’s patients fall somewhere between gluten sensitivity and celiac disease. Nevertheless, almost all patients with Hashimoto’s improve on a strict gluten-free diet, even if they do not fit the established criteria of celiac disease. By strict I mean you are 100 percent gluten-free. Because the immune reaction to gluten has been shown to last up to six months after exposure, cheat days or occasionally eating gluten will derail the therapeutic benefits of a gluten-free diet.

Practitioners wrong when they say gluten OK

I have seen many patients over the years with Hashimoto’s whose health care practitioners have told them they can eat gluten because they had a normal gluten antibody test (meaning there is no sensitivity) or they did not have the gene for gluten sensitivity. This a horrible mistake and a complete disconnect with the realities of what a serious immune trigger gluten is for most people with Hashimoto’s, unassociated with celiac disease.

Problem lies with incomplete gluten testing

I am now convinced that part of the problem with negative gluten antibody tests is improper testing. The general gluten antibody test conducted by most labs today is only testing a small portion of the gluten protein, alpha-gliadin.

In reality, an individual can have an immune response to various parts of the gluten protein, including omega-gliadin, gamma-gliadin, wheat germ agglutinin, and deamidated gliadin.

In my practice the only valid and complete gluten assessment is a panel called the Wheat/Gluten Proteome Sensitivity and Autoimmunity test by Cyrex Laboratory in Phoenix, Arizona. The panel also provides testing for transglutaminase antibodies, the marker for autoimmunity against intestinal tissue. This marker strongly suggests celiac disease or at least an autoimmune reaction in the small intestine in response to gluten.

Other factors in gluten testing

If you are a thyroid patient who tested negative for alpha-gliadin antibodies and have been told it is OK to eat gluten, that advice could be harmful to your condition as you may be reacting to one of these other components of gluten.

Also, newer research shows that people may have a gluten cross-reactivity, meaning they react to other foods as if they are gluten, another scenario for which Cyrex Labs screens. Lastly, if your immune system is depressed and exhausted, you may not be able to make enough antibodies to register positive on a lab panel, even though an immune reaction is taking place. In this instance, restoring immune health will often then produce a positive antibody response to gluten on a lab test.

Both the scientific and clinical evidence linking gluten with Hashimoto’s and autoimmune disease in general is too powerful and abundant to ignore. A strict gluten-free diet is the first and most important step to managing your Hashimoto’s hypothyroidism.

17 Comments

  • Keri June 7, 2014 at 10:28 pm

    What kind of doctor tests for gluten sensitivity/intolerance, autoimmune tests? Is it an endocrinologist? Ive had my tsh, t4 and t4 free results come back “normal.” I know my thyroid is still not functioning as it should. I take Synthroid and my endomhas upped my dosage a dew times but I havent felt any different. P,ease help advise me further. Beyond frustrated.
    Thanks for your help.

    • Thyroid Book June 10, 2014 at 5:51 am

      Your best bet would be a functional medicine practitioner who has been educated by Dr. Kharrazian and has experience working with thyroid issues. You can find one here: http://thyroidbook.com/practitioner-locator/. You may also do better with a thyroid med that also includes T3, such as Armour.

    • Randy B. December 25, 2015 at 5:55 pm

      I would check with a Naturopathic Doctor (N.D.). Most often a endocrinologist will attribute such issues to digestive problems over the thyroid, sending you to a gastroenterologist. Even adrenal fatigue is only recognized by a medical doctor like an endocrinologist as Addison’s disease, which is a rare disease.

      I went to several MD for sleep issues only being given pills. Then I visited a ND who found I had a thyroid problem.

      Even an endro doctor I am seeing now will not attribute my dry skin to my throid, telling me to see a dermatologist.

      Keep in mind western medicine see’s your body as a puzzle treating each body part separately as if one body part will not effect another – were as Naturopathic Doctor’s including Ayurvedic medicine (from India), and Chinese medicine sees your body as a whole.

      Follow this link to find a ND near you: http://www.naturopaAyurvedic medicinethic.org/AF_MemberDirectory.asp?version=2

      I sincerely hope this helps.

      Best regards.

  • Ingrid July 14, 2014 at 1:34 pm

    My endocrinologist did order a couple of gluten tests at my request, all of which came back very decisively negative. This after I went gluten free for several months a couple of years ago, and noticed no appreciable difference, other than I was even more tired from the colossal effort involved. after about a year of the time and cost, I went back to eating as chemical free as possible, and feel no better or worse. I am a PTC cancer survivor, taking a combo of t4 and t3….the t3 helps, a lot, but I’m still not me…..

    • Thyroid Book July 15, 2014 at 6:53 am

      It’s hard to know without specifics but perhaps you are reacting to a food you still eat that cross-reacts with gluten. This is very common, especially with dairy. This is talked about more in the brain book.

    • Juan November 17, 2015 at 12:44 pm

      Tenia TSH 4.09 Anti-Tpo 1300 T4libre normal después de 50 días TSH 2.46 Anti-Tpo 189 Después de otro mes TSH 1.58 Anti-Tpo 240 mi pregunta es ?puedo comer pescado, salmón, sardinas,bacalao, pavo pollo de corral. Plátanos,uvas etc he perdido 10 kilos en vez de engordar gracias.

      • Susan (moderator) November 18, 2015 at 8:32 pm

        Juan – Sorry, but I don’t speak Spanish, and when I tried using Google Translate the text came out very confusing. Is there any chance you can re-post in English?

        • Jamie November 27, 2015 at 1:16 am

          Translation of Juan’s comments and question:
          I had TSH 4.09 Anti-Tpo 1300 Free T4 normal after 50 days TSH 2.46 Anti-Tpo 189 after another month TSH1.58 Anti-Tpo 240 My question is can I eat fish, salmon, sardines, codfish, turkey, free range chicken. Banana, grapes, etc. I have lost 10 kilos instead of gaining weight. Thanks.

          • Susan (moderator) November 29, 2015 at 1:22 am

            Hi Jamie, thanks for translating that!

            Juan – all of those foods are considered acceptable on the gut-repair diet (although grapes are very high sugar, and would best be kept to a minimum). Some people do have a hard time keeping the weight on (though more commonly, people have problems keeping it off). Make sure you are consuming plenty of healthy fats, including coconut oil, and moderate amounts of olive oil. Also make sure you are getting enough carbs in the form of squash, plantain, yam/sweet potato and root veggies.

            We are working on getting his books translated into Spanish, and hope to have that done next year. Our previous attempt at it turned out unsatisfactory, so the project was put on hold for a bit.

            Lastly, here is a Spanish-language blog about the protocol, which may have some good resources for you: http://www.lachicapaleo.com/

            Now, the Google translate version (I have no idea if this is correct!):

            todos esos alimentos se consideran aceptables en la dieta gut- reparación (aunque las uvas son muy altos de azúcar , y sería mejor mantenerse al mínimo ) . Algunas personas tienen dificultades para mantener el peso en (aunque con más frecuencia , la gente tiene problemas para mantener apagado ) . Asegúrese de que está consumiendo un montón de grasas saludables , como el aceite de coco , y cantidades moderadas de aceite de oliva. También asegúrese de que está recibiendo suficientes carbohidratos en forma de calabaza , plátano , ñame / patata dulce y raíces vegetales .

            Estamos trabajando en conseguir sus libros traducidos al español , y esperamos tener ese año siguiente hecho. Nuestro intento anterior en que resultó insatisfactoria , por lo que el proyecto quedó en suspenso por un rato.

            Por último , aquí hay una en español blog sobre el protocolo , que puede tener algunos buenos recursos para usted : http://www.lachicapaleo.com/

  • Carolyn Minnich November 21, 2014 at 1:29 pm

    Do you recommend a strict diet for someone who has elevated thyroid antibodies as well? Even though the current thyroid numbers are ok?

    Thanks,
    Carolyn

  • Dionne Robinson April 2, 2016 at 2:06 pm

    I had a complete Thyroidectomy and feel horrible all the time. Do I still even have a metabolism? No energy, weight gain, hair loss, dry skin, brain fog, stiff joints, tingling in my arms. I just take synthroid. Not doing any other treatments. I need help. I can not continue living like this.

    • Emily May 31, 2016 at 1:05 pm

      I am sad for you, Dionne. I hope you have connected with someone who is an ‘authority’ but I can say that from what I have read, even with a CT, your immune reaction will be the same so all of the info you read about diet, T3 conversion etc. still applies and could offer some relief. Best of luck.

    • Susan (admin) June 16, 2016 at 12:13 am

      Dionne; I hope that your doctor told you that once your thyroid is removed, you’ll be hypothyroid for life. That doesn’t have to be a sentence, though. The symptoms you describe sound like classic hypothyroid symptoms. The way to make a change is to advocate for yourself; nobody else is going to do it for you. For us thyroid patients, that’s a given, but on the bright side, it can lead to good changes, self-empowerment, and a return to a vital life. Please try to get help from a practitioner who can do the right labs (not just TSH for thyroid, but Free T3 and FreeT4 and antibodies), and possibly other things like vitamin and micronutrient deficiencies) and determine what kind of help you need. Here’s a link to a list of practitioners who are highly trained in Dr. Kharrazian’s protocols. Some of them are willing to practice remotely: (http://thyroidbook.com/practitioner-locator/). Don’t give up hope.

    • Ellen-Sue July 10, 2016 at 1:20 pm

      Dionne…..I take various scripts of T4T3 as it’s a balancing act….too much T3 gives me cardiac symptoms; too little, and I’m even more exhausted, brain dead and achy than usual. I often feel like just killing myself as it is very hard living like this……gaining weight, lost all my head and body hair…..feeling like shit ALL the time…..insomnia…..dry/itchy skin….you name it. I’m 61 and don’t intend on living like this indefinitely…..I’ve been to all sorts of doctors and am trying gluten free again. The first time I did 6 months (2012) I didn’t notice a difference in any health issues. The Hashimoto’s really hit hard starting 1-13 after a bout with the Norovirus. I have taken and am taking all the recommended supplements (iodine, selenium, zinc etc.). So know you’re not alone….I know that doesn’t help much, but you’re not alone.

      • Lori October 27, 2016 at 10:02 pm

        I have started reading Dr. Kharrazian’s book and I find it unique in addressing the causes of thyroid disease and providing strategies for treating it and perhaps even other autoimmune diseases. With respect to getting your dose right, however, in addition to Dr. K’s wonderful book, have you ever considered reading Tired Thyroid by Barbara Lougheed? I appreciated what she wrote about trying to get the right amounts of T4 and T3. I am working to switching using Levothyroxine an an empty stomach along with Naturthroid 3-4 times daily. I had not realized that although Levothyroxine must be taken on an empty stomach, natural dessicated thyroid does not. If you are taking part of your meds in the form of Naturthroid or Westthroid you could order them in 1/4 grains and even split them in half and set a timer to take many times throughout the day in this way you are less likely to get as many cardiac symptoms. The Lougheed book has interesting case studies and information on dosing. Hopefully with Dr. K’s book I will need to lower my dose eventually.

        • Susan (admin) October 27, 2016 at 10:36 pm

          Lori;

          Actually, it is recommended to take natural thyroid medications away from food, as food interferes with absorption of thyroid hormone. In particular, iron and calcium can compete with it, so best to make sure it’s not near those. For patients who must take T3 dosing throughout the day, timing it can be difficult, and sometimes meal timing is more important than perfect absorption, but it’s still good to try. There are a lot of patients who take their main dose in the morning before food, then supplement it with T3 (Cytomel) during the day.

  • sekilasindonesia.com October 6, 2016 at 3:15 am

    Thаnks foг finalⅼy writing ɑbout >Gluten-Free
    Diet and Thyroid Hormones <Liked it!

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