Hashimoto’s disease, also known as chronic lymphocytic thyroiditis, is an autoimmune disorder that causes the immune system to attack the thyroid gland. This causes inflammation and damage to the thyroid tissue, leading to an underactive thyroid gland (hypothyroidism). There is a lot of debate around whether those with Hashimoto’s should adopt a gluten free diet to help manage symptoms.
What is the connection between Hashimoto’s and gluten?
There is thought to be a link between Hashimoto’s disease and gluten sensitivity or celiac disease. This is because both conditions involve the immune system attacking the body’s own healthy cells – in celiac disease the immune system attacks the small intestine when gluten is consumed, while in Hashimoto’s it attacks the thyroid gland cells.
Some research has found that people with Hashimoto’s are more likely to have celiac disease antibodies in their blood compared to the general population. This suggests there may be some shared genetic susceptibility between the two autoimmune disorders. However, having celiac disease antibodies does not necessarily mean someone will develop celiac disease.
The suspected connection between Hashimoto’s and gluten has led some to recommend a gluten free diet for managing Hashimoto’s symptoms. But it’s important to note that the evidence for this is limited and more research is still needed.
What are the potential benefits of going gluten free with Hashimoto’s?
Here are some of the theorized benefits of removing gluten from your diet if you have Hashimoto’s disease:
- May reduce inflammation – By avoiding gluten which can trigger an immune response, some people report a reduction in inflammatory symptoms.
- Could improve thyroid function – In those with gluten sensitivity, a gluten free diet may help improve thyroid hormone production and absorption.
- Might minimize antibodies – Removing dietary gluten could potentially lower thyroid antibody levels for some Hashimoto’s patients over time.
- Can relieve gastrointestinal issues – For those with celiac disease alongside Hashimoto’s, a gluten free diet should relieve symptoms like diarrhea, constipation and abdominal pain.
- May help with nutrient absorption – The damage to the intestines from gluten can hinder absorption of nutrients like iron, folate and vitamin B12.
- Can reduce fatigue and headaches – Some report gluten removal improves exhaustion and headaches associated with Hashimoto’s.
However, it’s crucial to note that evidence for many of these benefits is limited to anecdotal reports. More large-scale research is still needed.
What are the potential downsides of a gluten free diet for Hashimoto’s?
There are also some potential downsides of eliminating gluten from your diet with Hashimoto’s:
- Difficult transition – Adapting to a strict gluten free diet can be challenging at first.
- Social impacts – Dining out and traveling can become more difficult.
- Higher cost – Gluten free specialty products are usually more expensive than regular foods.
- Nutritional deficiencies – Gluten free products often lack fortification with B vitamins, iron and fiber.
- Weight changes – People sometimes lose or gain weight unintentionally on a gluten free diet.
- Doesn’t work for all – For those without gluten sensitivity, a gluten free diet may provide no benefit.
To prevent potential nutritional shortfalls, care should be taken to ensure a well-balanced gluten free diet with diverse healthy foods if trying this approach.
What are the symptoms of gluten sensitivity?
Here are some of the most common signs and symptoms that may point to an issue with gluten sensitivity:
- Gastrointestinal problems – Diarrhea, constipation, bloating, abdominal pain or discomfort.
- Fatigue – Feeling abnormally exhausted even with adequate rest.
- Headaches – Frequent headaches or migraines.
- Brain fog – Trouble concentrating, mental confusion, difficulty thinking clearly.
- Numbness and tingling – In the hands, arms, legs or feet.
- Joint pain – Unexplained muscle aches, soreness or joint pain.
- Skin issues – Rashes such as eczema or dermatitis.
- Mood changes – Depression, anxiety, irritability.
- Unexpected weight loss – Losing weight without trying.
However, it’s important to note that just because someone experiences these symptoms, it does not always mean they have gluten sensitivity. Other health conditions can also cause these signs.
Should I get tested for celiac disease before going gluten free?
It’s generally recommended to get tested for celiac disease before removing gluten from your diet if you have Hashimoto’s. This is because going gluten free can interfere with the accuracy of celiac disease testing.
To get an accurate diagnosis, doctors will usually recommend continuing to eat foods containing gluten right up until testing. This ensures any blood tests and biopsy results reflect any true gluten issues.
Testing for celiac involves both blood tests checking for specific antibodies as well as an intestinal biopsy taken during an endoscopy procedure. If celiac disease is confirmed, a strict lifelong gluten free diet is medically necessary.
Even with a negative celiac test, you can still trial a gluten free diet under medical supervision if symptoms may be pointing towards non-celiac gluten sensitivity. But confirming celiac first provides important information on the necessity of rigorously avoiding gluten.
How strict does a gluten free diet need to be for Hashimoto’s?
If you decide to go gluten free, the level of gluten restriction needed may vary depending on your individual case:
- Celiac disease diagnosis – Requires 100% strict elimination of gluten with no exceptions. Even tiny traces of gluten can trigger damage.
- Strong gluten sensitivity symptoms – May also need to be very strict, at least initially, to see if it provides improvement.
- Mild symptoms or family history – A trial of a gluten free or reduced-gluten diet may be worthwhile. Being gluten-free at home while allowing occasional gluten when dining out may be an option.
- No clear symptoms or reason – Going completely gluten free may provide little benefit without an identified problem.
Work with your healthcare provider to determine the appropriate level of gluten restriction to trial, especially if you have confirmed celiac disease requiring vigilant gluten avoidance.
Are there any risks or complications from going gluten free?
For most people, removing gluten from the diet is safe and unlikely to pose any major health risks. However, there are a few things to keep in mind:
- Nutritional deficiencies – Gluten free products often lack B vitamins, iron, fiber and other nutrients. Work to replace these shortfalls with healthy gluten free foods.
- Weight changes – Losing or gaining too much weight due to dietary changes may occur. Track your weight and adjust your diet if needed.
- Cross-contamination – Those with celiac need to avoid any cross-contact with gluten. Things like shared toasters and cooking utensils can be sources of contamination.
- Other food sensitivities – Removing gluten may reveal other food intolerances like lactose, FODMAPs or eggs. An elimination diet can help identify problem foods.
Consult your doctor and dietitian to help minimize any nutritional, weight related or cross-contamination risks that can come with transitioning to a gluten free diet, especially for celiac disease.
What are some healthy gluten free foods to eat?
Focusing your gluten free diet around healthy whole foods can help provide balanced nutrition. Some nutritious gluten-free foods include:
- Fruits and vegetables – Get a rainbow of produce like greens, berries, citrus fruits, sweet potatoes, peppers, carrots.
- Lean proteins – Choose gluten-free options like skinless poultry, fish, eggs, beans, lentils, nuts.
- Dairy – Opt for plain yogurt, cheese, unsweetened milk if tolerated.
- Gluten-free whole grains – Try quinoa, buckwheat, rice, certified gluten-free oats.
- Seeds and oils – Incorporate healthy fats from chia seeds, flaxseeds, olive oil, avocados.
Focusing on these nourishing whole foods as the foundation of your meals and snacks can help maintain overall nutritional balance on a gluten free diet.
What foods and ingredients contain gluten?
Here are some of the main sources of gluten to avoid on a strict gluten free diet:
- Wheat – Bread, pasta, crackers, baked goods.
- Barley – Pearl barley, malt extract.
- Rye – Rye bread, cereals.
- Oats* – Oatmeal, muesli, granola.
- Malt – Malted milkshakes, vinegar.
- Beer – Ales, lagers and mixed drinks with beer.
*Oats are naturally gluten free but are often contaminated with gluten grains. Some brands provide certified gluten free oats, labeled gluten-free.
Always check ingredient labels carefully and look for “gluten free” certified options when buying processed foods. Soy sauce, salad dressings, seasonings and other products often contain hidden sources of gluten.
Should I see a dietitian for help with a gluten free diet?
Consulting with a dietitian knowledgeable about gluten free diets can be extremely helpful whether you have celiac disease or are just considering going gluten free for other reasons. A dietitian can:
- Provide guidance on following a gluten free diet properly, especially for celiac disease.
- Ensure you avoid nutritional deficiencies or unhealthy weight changes.
- Offer meal planning advice and gluten free food suggestions.
- Explain how to identify hidden sources of gluten in foods.
- Recommend any needed vitamin or mineral supplements.
- Tailor the diet to your individual needs and symptoms.
- Monitor your ongoing health and diet response.
Working together with both your doctor and a registered dietitian can help make transitioning to gluten free easier and more sustainable in the long run.
What are some tips for dining out gluten free?
Here are some suggested tips for safely navigating restaurant meals gluten free:
- Research the menu online first and call ahead with questions.
- Tell your server you need fully gluten free meal prep with no cross-contact.
- Check that sauces, dressings and condiments are gluten free.
- Request food be prepared in a clean skillet, not one used for gluten items.
- Ask about ingredients and preparation methods for menu items.
- Opt for naturally gluten free choices like grilled meat, fish and vegetables.
- Avoid fried food with likely cross-contaminated oil.
- Say no to croutons, bread baskets and other free gluten offerings.
- Inform staff it is due to celiac disease rather than preference.
Being well-informed and proactive when eating out gluten free is key to avoiding inadvertent exposures, especially with celiac disease.
Conclusion
Adopting a gluten free diet is a complex decision with pros and cons to weigh up. There appears to be a link between Hashimoto’s disease and gluten sensitivity, however the evidence is still evolving. Removing dietary gluten may provide symptom relief for some people with Hashimoto’s, but could provide little benefit to others without gluten issues.
Those with confirmed celiac disease require a strict lifelong gluten free diet to manage the autoimmune condition and avoid complications. For others considering going gluten free, a time-limited trial elimination diet under medical supervision can help determine if it improves your Hashimoto’s symptoms without significant risks or downsides to your health, nutrition or quality of life.
Working with health professionals experienced in gluten free diets provides the best support for transitioning and determining if this dietary change is appropriate for your individual case.
