This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.
In the first article in this series, I showed that hypothyroidism is an autoimmune disease in 90% of cases. In this article we’re going to discuss the connection between autoimmune thyroid disease (AITD) and gluten intolerance.
Several studies show a strong link between AITD (both Hashimoto’s and Graves’) and gluten intolerance. [1, 2, 3, 4, 5] The link is so well-established that researchers suggest all people with AITD be screened for gluten intolerance, and vice versa.
What explains the connection? It’s a case of mistaken identity.
These antibodies to gliadin also cause the body to attack thyroid tissue. This means if you have AITD and you eat foods containing gluten, your immune system will attack your thyroid.
Even worse, the immune response to gluten can last up to 6 months each time you eat it. This explains why it is critical to eliminate gluten completely from your diet if you have AITD. There’s no “80/20” rule when it comes to gluten. Being “mostly” gluten-free isn’t going to cut it. If you’re gluten intolerant, you have to be 100% gluten-free to prevent immune destruction of your thyroid.
So how do you find out if you’re gluten intolerant? Unfortunately, standard lab tests aren’t very accurate. They test for antibodies to gluten in the bloodstream. But antibodies in the blood will only be found in cases where the gut has become so permeable that gluten can pass through. This is a relatively advanced stage of disease. Blood tests will miss the many milder cases of gluten intolerance that haven’t yet progressed to that stage.
Stool analysis is far more sensitive, because it detects antibodies produced in the digestive tract that aren’t yet escaping into the bloodstream. Using this method at Entero Lab, Dr. Kenneth Fine, a pioneer in the field, has found that up to 35% of Americans are gluten intolerant.
In addition to the stool analysis, Dr. Fine’s lab uses a cheek swab to test for the genes connected with gluten intolerance and celiac disease. People with HLA DQ genes are more likely than the general population to have autoimmune disease, celiac disease and gluten intolerance. Dr. Fine’s research shows that more than 80% of Americans have one of these gene types.
When I first read Dr. Fine’s research, I was astounded by the implications. It suggests that 1 in 3 Americans are gluten intolerant, and that 8 in 10 are genetically predisposed to gluten intolerance. This is nothing short of a public health catastrophe in a nation where the #1 source of calories is refined flour. But while most are at least aware of the dangers of sugar, trans-fat and other unhealthy foods, fewer than 1 in 8 people with celiac disease are aware of their condition. I would guess that an even lower proportion of people are aware they are gluten intolerant.
As much improved as Dr. Fine’s methods are, they aren’t perfect. In some patients with autoimmune disease, their immune system is so worn out they can no longer produce many antibodies.
Hashmioto’s, the most common autoimmune thyroid condition, is primarily a Th1 dominant condition. I’ll explain what this means in further detail in a future article. For now, what you need to understand is that in Th1-dominant conditions, the Th2 system is suppressed. The Th2 system is the part of the immune system responsible for producing antibodies. When the Th2 system is severely depressed, the body’s ability to produce antibodies is impaired. The levels may be so low that they won’t show up on a test. So, even if you have gluten intolerance, your test for gluten antibodies may be falsely negative if you have Th1-dominant Hashimoto’s.
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This is why I recommend that you avoid gluten if you have AITD, regardless of whether tests show an active antibody response. This is especially true if you have one of the genes (HLA DQ1,2, or 3) that predisposes you to developing gluten intolerance. In my opinion continuing to eat gluten when you have a confirmed autoimmune condition simply isn’t worth risking the immune destruction it could cause.
In fact, the more I learn about gluten and its effects on the body, the more I think we’d all probably be better off not eating it. Mark Sisson has written extensively about the dangers of gluten and gluten-containing grains, so head over there and have a look if this is new to you.
The good news is that if you have AITD and are gluten intolerant, removing gluten completely from your diet will dramatically improve your health. It’s not easy, but it’s worth it.
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Years ago, some iridologists told me I was allergic to wheat and gluten. They also told me that the pre-cursor to wheat, called SPELT, was introduced into the servant and slave diet back in ancient Egypt when the controllers began to notice that it had a soporific effect on the work force.
They discovered that a diet high in breads, biscuits and cakes effectively made man dopey, disinterested and lazy.
And now it is the staple food of the world!
Meg,
I think that’s a very important question and I really hope that Chris will respond to this question. I too have elliminated gluten, but I have had at least two accidental ingestions of gluten that I know of in th past year and am wondering what effect that has on my attempts to cure hashis. I listened to a very interesting discussion on this subject by Dr. Tom (http://www.thedr.com/index.php?option=com_content&view=article&id=27&Itemid=11) and according to him one must elliminate ALL gluten in order to stop the autoimmune attack.
It is said that it can take up to 6 months for the body to elliminate antibodies, but if that is the case, then that would mean that just one accidental ingestion every 6 months would be enough to get the immune system to continue producing antibodies and therefor make it impossible to cure hashis or other autoimmune diseases. I have been slowly decreasing my thyroid medication since going gluten-free almost a year ago and am pretty sure it’s working, despite those two accidental ingestions. So I don’t think it’s an all or nothing thing, but I do think it’s very important to be as close to zero gluten intake as possible.
There is no cure for Hashimoto’s. Tests, elimination diets, balance in all things in life.. Sure…but no cure. Genetic autoimmune disease, especially one that is one of the highest misdiagnosed and mistreated out of all the autoimmune diseases, has no cure thus far. And unfortunately the longer you have it without being diagnosed, the less likely you will ever feel even remotely human again no matter how many things you try…thyroid meds, stress, relief, diet elimination, supplements, toxic cleansing, proper full spectrum blood testing…20 plus years and I have lost the fight with Hashimoto’s. Take note, autoimmune disease, especially thyroid is predominant and runs rampant through one side of my family. Men and women in high numbers with varied destructive symptoms. It’s a lifetime war. Some just fair better than others in this world.
Hi Chris!
Very good article!! I’m a longterm thyroid nodule patient with suspect Hashi’s (although i’m clinically euthyroid) who has gone gluten-free. I have a question about incidental gluten ingestion through cross-contamination. I am scrupulous at home in my cooking, but I do occasionally eat out. I try to investigate all ingredients used in what I may order, but I’m definitely aware that I can still get some gluten through cross-contamination in restaurant kitchens. I know that celiac patients find it necessary to avoid even this exceedingly low level of gluten in their eating. Do you feel it would be necessary for someone with an autoimmune thyroid condition as well?
Wow, thanks so much for these answers. It is interesting that we sometimes look for a direct causal link when really, it is an entire system out of whack, from how we’ve hybridized foods, grow foods and process foods to the way we eat food, what we do to the environment, the stress we live under. Clear that change needs to happen at several levels to begin regaining balance and rightness.
Do you know why there is such a high incidence of gluten intolerance now? This was not an issue at all when I was a kid–and until maybe 10 or 20 years ago (when I was diagnosed.) Does it have to do with hybridized wheat? The general unsupportiveness of our diets or the toxicity of our environment that weaken our immune systems?
Sorry if you have already answered this. I couldn’t find the answer in the string of comments.
My guess is several factors that collectively comprise the modern lifestyle: food and environmental toxins, micronutrient deficiency, chronic stress, physical inactivity, poor gut health (lack of fermented foods, antibiotic use, etc.), social isolation and alienation and disconnection from nature. All of these have the potential to dysregulate the gut and immune system and increase sensitivity to antigens like gluten.
“Wheat Belly” is a great read if you want more understanding of the changes done to wheat and how it affects our bodies. The scary part for me was how it affects our brains, but also our blood-sugar levels, thus our propensity to diabetes, leaching the calcium from our bones, and the devastation in the intestinal tract, which then leads to malabsorption. Modern wheat is also highly addictive. Chemicals from wheat are capable of crossing the blood-brain barrier in the way many drugs do. I was shocked at the things I learned in “Wheat Belly”, and I have changed the diet of my entire family as a result.
My kids have eczema and ADHD – both of which can be caused by gluten intolerance, impacting the ability to get sufficient levels of B12 and other requirements, and causing inflammation….so much to learn.
I got the opportunity to ask a wheat scientist if it was true that selective breeding had produced a wheat strain with a hundred-fold increase in gluten over the last 50 years or so. He replied indeed this was exactly the case.
Lisa,
Please, Please go to http://www.stopthethyroidmadness.com and other reputable websites to begin to find out how to help your daughter. I have lived with Graves’ Disease and now hypothyroid. I am hoping that you were referring to the celiac disease when you stated that you are glad that it is only her diet that needs revamping. I cannot even begin to imagine how it would feel for a 7 yr. old to live with Graves’ Disease. The fatigue, shortness of breath, loss of muscle mass, etc. She needs her mommy to become a warrior for her health as well as her mental health. Study up on the symptoms of both diseases and be able to show compassion in the moments when you think she is “just being overly-dramatic”. I do not mean to offend you, only to beg you to educate yourself. The doctor’s will try to get you to kill or remove all or part of the thyroid. DO NOT LET THEM DO IT! Graves’ Disease is a malfunction of the pituitary gland, not the thyroid! http://www.stopthethyroidmadness.com has lists of tests to do and also, she probaly needs a cortisol saliva test to check her levels throughout different times of the day and a test for her adrenal function. Finding out all of these factors now may save her years of agony and misery by getting her treatment started off on the right foot. Good Luck to her and your family!
Could you share your thoughts on other items that most hypothyroid doctors/nutritionalist tell you to avoid. I can deal with “gluten free” however most say no nuts, no seeds, no leafy greens like kale or spinach…no brocolli or cauliflower…no soy or soy by products. I love sushi & stir frys,& salads! I work out regularly yet struggle with my weight because of the thyroid issues and so many different website say NO to items that are staples of a healthy diet. I’d really like to hear your thoughts on this Dr. Kresser.
I’ve never had a thyroid specialist tell me to not eat nuts, seeds or leafy greens. Brocolli and cauliflower uncooked I can see because of the goitrogens.
My antibody testing showed antibodies to gluten, soy and casein. After 6 months of avoiding them and restoring certain nutrients with supplements the antibodies to casein and soy disappeared. Unfortunately the gluten antibodies remain.
I would be interested to know how exactly gluten causes attacks on the thyroid. For someone with hypothyroidism (possibly Hashimoto’s), could it cause attacks that lead to hyperthyroid symptoms as well as hypothyroid symptoms? I’ve read that Hashimoto’s can cause both hyperthyroid and hypothyroid symptoms. I decided to try to cut gluten as an experiment to see if it would clear my acne, not expecting the dramatic results I noticed within days, like chronic GI symptoms disappearing. At the time, I was unsure if it was wheat or gluten, so I would kind of “challenge” myself by eating non-wheat products that may be contaminated with gluten. One night, I decided to bite the bullet and eat half a breadstick at my mom’s, and three nights later, I ate a biscuit I got at a fast food restaurant. That same night, I woke up after 2.5 hours of sleep with what felt like hyperthyroid symptoms. I didn’t sleep at all the rest of the night. The next evening, I got cold chills and started to feel really out of it. Maybe it’s what some would describe as brain fog. Could these attacks have been brought on by the gluten I’d consumed previously? I’ve been trying to go as close to 100% gluten free as possible for the last month or so, and my last exposure to gluten, NOT purposely, caused me to feel really tired the next day. I also had painful bloating before that set in. Five days later, out of nowhere, I feel really unstable and off-balance. That night, I felt like I could sink right into my couch and felt like I could only crawl along the floor to get anywhere. Could this have been another attack on my thyroid as well? This is scary stuff and enough to keep me from ever wanting to try reintroducing gluten into my diet, if gluten is truly what has done all of this.
hmmm.. well spotted
I am not sure about this sentence, “The molecular structure of gliadin, the protein portion of gluten, closely resembles that of the thyroid gland.” The thyroid gland, as such, does not have a molecular structure. It is a gland built from many different things. Is it meant that some part of the tissue of the thyroid gland or the secretions of this gland have a molecular structure similar to gliadin? Nonetheless, a very interesting article.
I was wondering about the same thing….
Me too. Read this all the time but yet to find the scientific papers that gave rise to this statement. I got the chance to check in with a wheat scientist about the claim that gliadin content in wheat has been bred to increase and he said that was true. It has increased a hundred-fold to make the product handle better in the industrial process.
Hi Chris and all,
I’m hoping somebody knows the answer to this question.
I had my thyroid removed 7 years ago because of Hashis. My Endos never told me to avoid gluten or wheat…frustrating. My understanding is that the thyroid converts T4 to T3. I’ve been on Synthroid since my thyroid was removed, so I haven’t had T3 for 7 years. Neither my primary care doc or my Endo would prescribe Armour so I ordered off of a website in the UK and can’t wait to receive my order.
Question 1: How much damage has been done by not having T3 for so many years?
Question 2: My thyroid is gone, but what happens to the Hashis? Do I still have it? Is it attacking other organs?
Thanks so much for the help. I don’t understand why medical professionals can’t help me with this.
Please can you give nutrition advise for Lichen Sclerosus et Atrophicus? Thank you in advance
Hello,
First of all I want to thank you for putting up these tremendously helpful articles online for people to read and hopefully find their way to healing or at least, leading a better life.
I was diagnosed with Hashimoto’s in March when, after a year of being 20 pounds overweight, lacking energy and being unable to function at full capacity as I did before, I decided to take a TSH and anti-TPO test. The TSH was normal (2.2), but the anti-TPO was 54… Because the endocrinologist was a bit dismissive of my condition (“we’ll just wait until your thyroid starts to fail, then we’ll put you on hormones), I went online and researched a lot on this topic. I found your website and a few other helpful ones, so I took steps to improve my diet and lifestyle. I’ve been gluten-free since early May and since then, the extra pounds have literally melted away (though I haven’t been exercising too frequently and I’m not limiting my intake of calories).
I feel more energetic, like I’ve mostly recovered my old spark. I’m more alert, more involved, I don’t feel the need to sleep as much (it used to be 12 hours a night during the previous year) and my mind is clearer. Yet I’ve done blood tests today and my anti-TPO was up to 184….. (I don’t know the TSH, but the others were very good: T3, T4, Free T3, Free T4, antithyroglobulin).
So basically, I feel a lot better and I’ve eliminated gluten from my diet, yet the immune attack appears to have gotten stronger, despite my efforts.
I know it’s hard to offer advice based on this limited information, but would you please help me make sense of this situation? Am I doing better or worse than before? If it weren’t for the spiked blood test, I’d consider myself ”cured” (though I know this is a condition that doesn’t go away).
Thank you for your time!
I was diagnosed with papillary carcenoma and have been on mess for about 4 months. Will going gluten free help with my hypothyroid. I’m not sure I had an autoimmune disease I was never tested or it but did have some symptoms. I’m still extremely tired and my levels are ok except for my tsh that is .007 ur I was told they want it low after cancer. Any advice would be greatly appreciated.
Very insightful articles Mr. Kresser.
Question-Comment: While the logic behind attempting to be 100% gluten free seems sound, it also seems impossible. “Gluten free” means less than 20ppm, and many “gluten free” foods have been found to contain much more. Also there is hidden gluten. Since 100% is practically impossible it also may be unecessary for most?
Come on, people, if you have nothing constructive to say then please keep your counsel. It’s an abuse of the facility and of others who wish to learn to make it personal.
keri – hi again. i’ve been thinking – i don’t think i said that right when i wrote to you above. what i meant to say is: could your doctor be using too high of a tsh to indicate hyper? now that i’ve muddied up that one, too, probably, i’d just ask if you may simply need a larger dose. good luck figuring this out! you’ll get there.
“…and don’t you forget it.” Is this high school?
And I’m not here to be disrespected, undermined or chastised by you….and don’t you forget it.
paul – ummm…no. personally, i’ll take nih’s theory rather than muscletalk’s, whatever that is.
Jane, I’d appreciate if you don’t reply to any of my posts. I find some under-treated thyroid sufferers like to argue for the sake of arguing and are prone to fits of anger… been there babe!
The internet is full of fitness forums where people abuse T3 and the common complaint is T3 making them tired whether you like it or not.
http://bit.ly/MDAAiA
Paul,
Your tone is very condescending and disrespectful. Most of us here are not athletes and struggle just to get through the day, so it is difficult to identify with your experience. We’re glad you’ve seen results and found your solution, but your unsupported pseudo-science really isn’t helpful to the rest of us.
No one it trying to pass off thousands of fitness forums as science for gods sakes… but if you’d take a moment and type “T3 tired” into google you will see 2 million results many of them fitness forums posters talking about how T3 makes them tired. You don’t find that at all interesting?? It was my experience as well. Why do I have to keep my experience to myself?
Apparently you haven’t been following Jane’s posts trying to undermine my posts (or maybe you have)…. AND her promise to NOT CONTINUE TO ARGUE in one of them. She’s back and cranky. She shows me and my experience disrespect and I’ll show it back.
Its been a while since I’ve posted on a forum. I forget the ‘regulars’ get territorial and excited when a new person comes in. There’s a natural urge to troll… been there too! 😉
Jane –
I appreciate you calling Paul on his disreputable sources. 😉 Clearly a message board is not a source for reputable data.
stacy – many thanks for the kind words. you’re definitely right that message boards aren’t terribly reliable – interesting and supportive, yes – reliable, no. and it’s disheartening when some people make things even more difficult for those of us who are searching for information and help. thanks for the information that i got from your posts, and i wish you the best in trying to get to the point where you feel best. i hope we haven’t scared away anyone – the thyroid road isn’t a bad one, but it’s one that needs some pretty good navigation, and camaraderie is always welcome :).
paul – i am not your “babe,” and i have my own diagnostician, thank you.