The Hashimoto’s and Gluten Connection: Do you Have to Go Gluten Free?

Do you have Hashimoto’s thyroiditis?

Are you considering going gluten-free?

Maybe you are wondering if going gluten-free will even be helpful, or if it is some sort of fad diet.

Maybe you’ve gone gluten-free and it just isn’t helping like you thought it would.

If so, you are in the right place. 

It turns out that going gluten-free may be beneficial for many patients with Hashimoto’s thyroiditis but not for the reasons you might expect.

By evaluating the research we can determine why going gluten-free may be a good idea if you have Hashimoto’s: 

Gluten and Hashimoto’s Disease

Most people have no problem making changes to their diet if they know it will help their health long term.

One question I see pop up is about Hashimoto’s and gluten.

Do you need to be gluten-free if you have Hashimoto’s?

In most cases going gluten-free is helpful for a number of reasons, but maybe not the reasons you are thinking. 

First:

Hashimoto’s disease is an autoimmune disease.

As you may already know if you have one autoimmune disease you are at risk of developing another autoimmune disease. 

This is complicated further in the case of Hashimoto’s and Celiac disease because they share a common genetic predisposition on the DQ2 allele (1).

This connection is so strong that most physicians will test patients with known celiac disease for other autoimmune diseases (in this case Hashimoto’s). 

In various studies, the incidence of patients with Hashimoto’s disease who also have Celiac disease ranges from around 4-10% (2).

This may raise some questions:

If only 5-10% of people with Hashimoto’s have Celiac disease then why should nearly EVERYONE with Hashimoto’s disease go gluten-free?

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto’s who go gluten-free notice a reduction in their symptoms almost immediately. 

So why is that?​

One of the main reasons is our limited understanding of the influence of gluten on the body. 

It turns out that gluten can cause problems independent of an autoimmune reaction (Celiac disease) which we will go over below. ​

Second:

There are two syndromes you need to be worried about when it comes to gluten.

The first is Celiac disease.

You probably are aware of this disease because it is an autoimmune disease and removing gluten is necessary to reduce the attack in your body.

Most patients with Celiac disease have antibodies in their blood to components of the gluten protein:

This usually manifests as antibodies to tissue transglutaminase and/or deamidated peptide. 

This is the condition everyone knows about.

But there is also a more sinister and more difficult-to-diagnose condition involving gluten and that is known as non-celiac gluten sensitivity. 

​This condition is indeed reported in the literature (you can read more about it in detail here) and is well established that it does exist. 

Non-celiac gluten sensitivity (NCGS for short) is most likely why so many people feel significantly better when going gluten-free, even if they don’t have Celiac disease.

It also explains why many patients may go gluten-free despite blood tests that show that they do NOT have Celiac. 

​We will discuss the difference between celiac and NCGS later in this post but you can see a list of the symptoms associated with NCGS below (many mirror Celiac disease but these patients will be antibody negative when tested). 

Third: 

Another important factor in going gluten-free is that it necessarily results in the removal of inflammatory and processed foods from the diet. 

Yes, some people who go “gluten-free” still eat gluten-free goods, sugars, and bread but patients who remove processed and inflammatory foods, notice an improvement. 

Switching to a whole-food-based diet will help improve nutrients, reduce inflammation, and support adrenal and other hormone functions. 

We will talk more about the right way to go gluten-free below (as well as the many mistakes that patients make while going gluten-free). 

Fourth:

Going gluten-free may help treat other gastrointestinal issues that you may not even be aware that you have.

One of the most under-diagnosed intestinal issues in hypothyroid patients is small intestinal bacterial overgrowth.

It is estimated that up to 50% of patients with Hypothyroidism (3) also have small intestinal bacterial overgrowth. 

Going gluten-free may actually improve SIBO (at least somewhat) by reducing the carbohydrates that feed the bacteria. 

And remember:

SIBO is an inflammatory condition, which means that the presence of this condition results in increased inflammation in the GI tract which may exacerbate autoimmune conditions.

Localized GI inflammation may also lead to increased intestinal permeability which can further increase the likelihood of developing autoimmunity through molecular mimicry (4).

• Bottom line:  Despite the fact that many patients with Hashimoto’s may not have Celiac disease, they can still improve their symptoms significantly by going gluten-free. 

Hashimoto’s and Gluten Research

While we’ve already established that there is a clear link (and increased risk) between patients who have Hashimoto’s and celiac disease, I want to direct your attention to some other research that is quite interesting.

#1. ​Many cases of Hashimoto’s and Celiac disease may be due to polyglandular autoimmune syndrome. 

Polyglandular autoimmune syndrome is a condition in which patients have a failure of multiple endocrine (hormone) glands in the body. 

Studies have shown (5) that many patients with Hashimoto’s and Celiac disease often have PAS. 

In PAS type 3, Autoimmune thyroiditis is often paired with other autoimmune conditions such as vitiligo, alopecia, and celiac disease.

Most cases of alopecia and/or vitiligo can go under-appreciated by many physicians because their presence is usually just cosmetic (compared to systemic autoimmune diseases).

But their presence may indicate the involvement of multiple glands in their autoimmune condition.

Having the combination of Hashimoto’s + vitiligo or the combination of Hashimoto’s + alopecia or Hashimoto’s + hypogonadism (6) may dramatically increase your risk of developing Celiac disease later in life. 

You can see a complete list of autoimmune diseases associated with autoimmune thyroiditis such as Hashimoto’s and which autoimmune diseases may accompany this autoimmune disease. 

#2. The incidence of Celiac disease is increasing over time. ​

This is very interesting data and should be evaluated.

Studies have shown that the incidence of Celiac disease increases over time, even in the same patient population.

This means that you may test negative in your 20-30s but then may again test positive later in life (it’s especially common in the 4th and 5th decade of life). ​

This can obviously trick some patients into believing that they don’t need to be gluten-free because they are antibody-negative, only to become antibody-positive later in life. 

For this reason, it may be a good idea to test for Celiac disease, especially if you have a Hashimoto’s flare-up. 

You can see a graph below showing the increasing incidence of Celiac disease over time. 

Most recently we are up to 2% of the population in some studies. 

It’s not clear exactly what is causing this increase in incidence over time, but it is most likely related to inflammatory conditions and increased intestinal permeability which both have been shown to increase the risk of development of autoimmune diseases (7).

Do you have to be Gluten-Free if you have Hashimoto’s?

My opinion is that most patients with Hashimoto’s stand to benefit from at least a trial of going gluten-free.

Forget about the research listed above, forget about the strong clinical correlation between celiac disease and Hashimoto’s.

If you stand to benefit from changing your diet, wouldn’t you at least give it an honest effort?​

So the bottom line is this: ​

If you have Hashimoto’s it’s absolutely worth checking for Celiac disease (even if you are not symptomatic) to see if you have elevated antibodies in the blood.

If you are antibody positive then you have your answer.

Assuming you are antibody-negative then your next step should be to consider a 3-month trial of 100% going gluten-free.

Most patients who go gluten-free notice at least some improvement in symptoms within 4 weeks.

Some patients (although rare) notice no difference in symptoms and may be just fine consuming gluten.

Tips for going gluten-free if you have Hashimoto’s: 

• Consider a trial of going 100% gluten-free for 3 months
• You should notice an improvement within 4 weeks of going gluten-free but in some cases, it takes up to 3 months
• Gastrointestinal healing may take up to 9 months to completely heal, but you should notice a difference before that
• Take care to exclude gluten (it may hide in condiments and other sources you aren’t necessarily looking at)
• Make sure to avoid gluten-free foods such as bread, pasta, cereals, etc. – exchanging junk food for gluten-free junk food will not help

​My clinical experience suggests that while removing gluten may reduce your symptoms, it is usually not enough to bring you back to 100%. 

Conclusion

Going gluten-free should be a consideration for any patient who has Hashimoto’s or autoimmune thyroiditis. 

Through various mechanisms, separate from the etiology of Celiac disease, going gluten-free may be beneficial.

Going gluten-free may treat undiagnosed NCGS, SIBO, or fructose intolerance.

It also has the potential to help with weight loss by reducing inflammation, increasing nutrient absorption, and improving thyroid function.

My recommendation is to consider a 3-month trial of going gluten-free if you have Hashimoto’s, if you don’t notice any improvement then you may be fine consuming gluten regularly. 

If you notice negative side effects upon reintroduction then you have your answer and should avoid gluten so far as you find it helpful.

Now it’s your turn:

Do you have Hashimoto’s or autoimmune thyroiditis?

Are you also gluten-free?

Did it help? why or why not?

Leave your comments below! ​