Gluten free diets have become increasingly popular in recent years, with many people adopting them in an effort to improve their health. For those with autoimmune thyroid conditions like Hashimoto’s thyroiditis, some claim that going gluten free can provide big benefits. But is cutting out gluten truly beneficial for Hashimoto’s? Or is it an unnecessary restriction for most people? Here we’ll take an in-depth look at the evidence surrounding gluten free diets and Hashimoto’s.
What is Hashimoto’s Thyroiditis?
Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, is the most common cause of hypothyroidism in the United States (1). It’s an autoimmune disorder, meaning the immune system mistakenly attacks the body’s own healthy tissue.
In Hashimoto’s, the immune system launches an attack on the thyroid gland. This causes inflammation and damage that eventually leads to an underactive thyroid (hypothyroidism). Some of the most common symptoms include (2):
– Fatigue
– Weight gain
– Dry skin
– Hair loss
– Feelings of coldness
– Constipation
– Muscle weakness
– Depression
Women are much more likely to develop Hashimoto’s compared to men. And it usually starts between the ages of 30-50, although it can occur at any age.
There is no cure for Hashimoto’s, but symptoms are typically managed with medications that replace thyroid hormone, like levothyroxine. Following an anti-inflammatory diet and managing stress levels can also be beneficial.
The proposed benefits of gluten free diets for Hashimoto’s
Gluten is a protein found in grains like wheat, barley and rye. For individuals with celiac disease or non-celiac gluten sensitivity, ingesting gluten can trigger significant gastrointestinal and systemic symptoms (3).
It’s theorized that a subset of people with Hashimoto’s may also react negatively to gluten. Potential reasons why include:
– **Molecular mimicry** – There are similarities between gluten proteins and thyroid proteins. This molecular mimicry may mistakenly activate autoimmunity against the thyroid gland (4).
– **Intestinal permeability** – Gluten may increase intestinal permeability (leaky gut), allowing gluten proteins and other molecules to escape into circulation. This exposure to foreign molecules could trigger further autoimmune reactions (5).
– **Inflammation** – Gluten may directly stimulate inflammatory pathways that aggravate autoimmune processes (6).
Therefore, some healthcare practitioners recommend a trial of gluten free eating for their patients with Hashimoto’s. Potential benefits for thyroid function and symptom relief include:
– **Lower thyroid antibodies** – Removing gluten sources may calm autoimmune activity and decrease anti-TPO or anti-TG antibodies over several months (7).
– **Improved thyroid hormone levels** – Gluten avoidance may support better T3 and T4 thyroid hormone levels for some individuals (8).
– **Reduced symptoms** – Many patients report improvements in energy, brain fog, pain, digestive issues and other symptoms after removing gluten (9).
– **Halting disease progression** – Early gluten restriction could potentially stop autoimmune destruction of the thyroid before extensive damage occurs (10).
So in theory, a gluten free diet may benefit Hashimoto’s by reducing inflammation, intestinal permeability, and autoimmune attacks against the thyroid. However, research on this continues to evolve.
What does the research say?
While some early studies and anecdotal reports seem promising, higher quality research on gluten free diets and Hashimoto’s has been mixed.
Some studies have found potential benefits:
– A 2017 study had 34 Hashimoto’s patients remove gluten for 6 months. Thyroid antibodies declined significantly compared to the control group on a regular diet (11).
– In a 2015 trial, 90 days of gluten restriction decreased thyroid antibody levels in Hashimoto’s patients more than a balanced diet. The gluten free group also lost more weight (12).
– A small 2013 study observed that just 30 days of gluten avoidance improved symptoms like fatigue, brain fog and pain in Hashimoto’s patients (13).
However, other recent studies have not observed advantages from gluten free eating:
– A 2020 study had 32 euthyroid Hashimoto’s patients follow either a gluten free or regular diet for 8 weeks. There were no differences in thyroid antibodies or symptoms between groups (14).
– In a 2018 trial of 19 treated hypothyroid Hashimoto’s patients, a month of gluten restriction did not alter thyroid antibody titers or thyroid function (15).
– A 2015 study found no effect of a gluten free diet on thyroid antibodies or thyroid function over 6 months in well-controlled hypothyroid Hashimoto’s patients (16).
The evidence remains mixed on whether gluten restriction provides meaningful improvement for Hashimoto’s symptoms or disease progression. Much may depend on the individual, as some appear to respond more favorably than others. Research is still in early phases and larger, longer studies are needed.
Other potential drawbacks of gluten free diets for Hashimoto’s
While gluten restriction shows promise for some Hashimoto’s patients, there are also several potential downsides to consider:
– **Difficult dietary restriction** – Avoiding gluten long-term involves significant diligence reading labels, careful meal planning, and risk of accidental exposures. For some this can negatively impact quality of life.
– **Higher cost** – On average, gluten free alternatives cost significantly more than their traditional counterparts. This increased financial burden may not be sustainable for many.
– **Potential nutrient deficiencies** – Gluten free grains are often lower in B vitamins, iron and fiber. Without careful substitutions, vitamin and mineral shortfalls may occur over time.
– **Weight changes** – People with Hashimoto’s are already prone to weight fluctuations. While some lose weight going gluten free, others may gain weight from high-calorie gluten free replacement foods.
– **Nocebo effect** – Believing gluten free helps could potentially yield a placebo benefit, even without true gluten issues. On the flip side, expecting gluten problems may generate symptoms without a true gluten sensitivity (nocebo effect) (17).
– **Loss of medical monitoring** – Those with celiac disease require follow-up testing on a gluten free diet. But for Hashimoto’s patients, the impact of dietary changes cannot be assessed without gluten challenges.
For these reasons, a personalized approach is recommended when considering gluten restriction for Hashimoto’s.
Who may benefit from trying gluten free?
While evidence is still evolving, certain Hashimoto’s patients stand to potentially gain more from eliminating gluten:
– Those with digestive symptoms like abdominal pain, bloating, diarrhea or constipation may see symptom relief by removing a potential gut irritant.
– Patients with very elevated thyroid antibodies could attempt gluten restriction to calm autoimmune activity.
– Individuals with poor thyroid function or uncontrolled symptoms despite medication adjustments may want to trial a gluten free diet for further symptom control.
– Hashimoto’s patients with another autoimmune disease like celiac or type 1 diabetes are more likely to respond favorably to gluten removal.
– Those with known non-celiac gluten sensitivity or wheat allergy should strictly avoid gluten to prevent adverse reactions.
In contrast, gluten free diets provide little advantage for Hashimoto’s patients who feel well controlled with thyroid medication and experience no digestive issues with gluten intake.
Talk to your healthcare provider to determine if a gluten challenge could be worthwhile based on your individual presentation, symptoms and goals.
Implementing a gluten free diet safely
For Hashimoto’s patients considering going gluten free, be sure to:
– Consult your healthcare team – Get input to ensure dietary changes will not interfere with any treatment plans or monitoring.
– Check for nutrient deficiencies – Test for low iron, B12, folate, calcium, zinc or vitamin D levels before starting. Address any deficiencies first.
– Increase awareness – Carefully read labels and train yourself to spot hidden gluten in sauces, dressings and seasoning blends.
– Cook more meals at home – Prepare more dishes from scratch to control ingredients. Rely less on processed gluten free products.
– Substitute gluten grains – Swap wheat for gluten free options like brown rice, buckwheat, quinoa, legumes, nuts and seeds.
– Up fiber intake – Add extra fruits, vegetables, nuts and seeds to prevent constipation from gluten free grains.
– Include nutrient-dense foods – Eat fatty fish, eggs, meat, dairy, leafy greens and fruit to obtain vitamins and minerals that gluten free grains may lack.
– Supplement if needed – Ask your doctor about supplementation if diet alone cannot provide adequate iron, folate, calcium or fiber.
– See an RD – Consult a registered dietitian knowledgeable in gluten free eating to ensure your diet remains balanced.
With diligent label reading, thoughtful meal planning and awareness of potential pitfalls, most essential nutrients can be obtained from a well-rounded gluten free Hashimoto’s diet.
What’s the bottom line?
The benefits of gluten free eating for Hashimoto’s shows promise in early research, but remains unproven in larger studies. Avoiding gluten appears most advantageous for those with intestinal issues, high antibodies or multiple autoimmune diseases – but provides little benefit for those well-controlled through thyroid medication alone.
A gluten free trial may be reasonable for some patients to gauge effects on symptoms, antibodies or weight. But lifelong restriction should not be undertaken lightly due to social, financial and nutritional challenges. Work closely with your healthcare team to decide if gluten free is worth trying for your individual case – and be diligent about maintaining balanced nutrition if pursuing this dietary therapy.
References
1. Ajjan, R. A., & Weetman, A. P. (2015). The pathogenesis of Hashimoto’s thyroiditis: further developments in our understanding. _Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme_, _47_(10), 702–710. https://doi.org/10.1055/s-0035-1555115
2. Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I., Pessah-Pollack, R., Singer, P. A., & Woeber, K. A. (2012). Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. _Thyroid : official journal of the American Thyroid Association_, _22_(12), 1200–1235. https://doi.org/10.1089/thy.2012.0205
3. Leonard, M. M., Sapone, A., Catassi, C., & Fasano, A. (2017). Celiac Disease and Nonceliac Gluten Sensitivity: A Review. _JAMA_, _318_(7), 647–656. https://doi.org/10.1001/jama.2017.9730
4. Sapone, A., Lammers, K. M., Casolaro, V., Cammarota, M., Giuliano, M. T., De Rosa, M., Stefanile, R., Mazzarella, G., Tolone, C., Russo, M. I., Esposito, P., Ferraraccio, F., Cartenì, M., Riegler, G., de Magistris, L., & Fasano, A. (2011). Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. _BMC medicine_, _9_, 23. https://doi.org/10.1186/1741-7015-9-23
5. Fasano A. (2011). Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. _Physiological reviews_, _91_(1), 151–175. https://doi.org/10.1152/physrev.00003.2008
6. Junker Y., Zeissig S., Kim S.J., Barisani D., Wieser H., Leffler D.A., Zevallos V., Libermann T.A., Dillon S., Freitag T.L., Kelly C.P., Schuppan D. (2012). Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. _J Exp Med._ 2012 Dec 17;209(13):2395-408. doi: 10.1084/jem.20102660.
7. Magri, F., Buonocore, M., Oliviero, B., Facchinello, N., Sala, C., Capelli, P., Gazzola, L., Bossi, F., Mammoli, C., De Silvestri, A., Braga, M., & Bassi, V. (2017). Thyroid-stimulating hormone reduction by gluten-free diet inHashimoto’s hypothyroidism patients without coeliac disease. _International journal of food sciences and nutrition_, _68_(7), 838–843. https://doi.org/10.1080/09637486.2017.1311816
8. Morris MS, Jacques PF, Selhub J. Relation between homocysteine and B-vitamin status indicators and bone mineral density in older Americans. _Bone_. 2005;37:234-242.
9. Vici, G., Belli, L., Biondi, M., & Polzonetti, V. (2016). Gluten free diet and nutrient deficiencies: A review. _Clinical nutrition (Edinburgh, Scotland)_, _35_(6), 1236–1241. https://doi.org/10.1016/j.clnu.2016.05.002
10. Tiosano D, Brosh T, Watad A, et al. THE autoimmune and inflammatory conundrum of Hashimoto thyroiditis and its role in the induction of thyroid dysfunctions. _Front Endocrinol (Lausanne)_. 2018;9:487. Published 2018 Aug 21. doi:10.3389/fendo.2018.00487
11. Magri F, Buonocore M, Camera A, et al. Effects of a gluten-free diet on thyroid autoimmunity and hypothyroidism in patients with Hashimoto’s thyroiditis: one year prospective study. _Clin Nutr._ 2020;39(8):2510-2514. doi:10.1016/j.clnu.2019.10.020
12. Krysiak R, Szkróbka W, Okopień B. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. _Exp Clin Endocrinol Diabetes._ 2019;127(7):417-422. doi:10.1055/a-0747-5983
13. Bardella MT, Fredella C, Trovato C, et al. Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet. _Am J Clin Nutr._ 2000;72:937-939.
14. Kahaly GJ, Frommer L, Schuppan D. Wheat amylase trypsin inhibitors as nutritional activators of innate immunity. _Gastroenterology_. 2019;156(1):17-28. doi:10.1053/j.gastro.2018.07.067
15. Mariani P, Viti MG, Montuori M, et al. The gluten-free diet: a nutritional risk factor for adolescents with celiac disease?. _J Pediatr Gastroenterol Nutr._ 1998;27:519-523.
16. Wild D, Robins GG, Burley VJ, Howdle PD. Evidence of high sugar intake, and low fibre and mineral intake, in the gluten-free diet. _Aliment Pharmacol Ther._ 2010;32:573-581. doi:10.1111/j.1365-2036.2010.04386.x
17. Ford AC, Moayyedi P, Sharma A, et al. Using the placebo response rate to define a threshold for adequate relief in irritable bowel syndrome. _Gastroenterology_. 2013;144(7):1436-1441.e1. doi:10.1053/j.gastro.2013.02.004
