Hypothyroidism: The Gluten Connection

When a patient comes in with fatigue and weight gain, her doctor will most likely look at some thyroid tests to see if an underactive thyroid is to blame. The trouble is that the symptoms of hypothyroidism resemble many other things, and often exist for a long time prior to the blood levels being out of the normal range. These symptoms are very common in the US, partly due to our diet (low in nutrients, high in calories), our sedentary lifestyles, and our poor ability to manage stress. It is reasonable to think that if people were convinced to eat more real food, less processed food, and move more, they may be able to reverse some of these disease processes before the really set in. Now, we have some data to link specific dietary changes to a decrease in auto-antibodies, such as those seen in Hashimoto’s thyroiditis.(1)(2)

The good news is that many times patients are told that there is nothing they can do with diet and lifestyle to reduce the number of antibodies attacking the thyroid gland. Even without a firm diagnosis of celiac disease or non-celiac gluten sensitivity, many patients with hypothyroidism will see a reduction within a few weeks to a few months following removal of gluten from the diet. This means removing all forms of wheat, rye, barley, and spelt from the diet. Oat may be allowed if it specifies gluten-free on the label. Rice, corn, tapioca, buckwheat, amaranth, and quinoa are naturally gluten free. Labels must be read very carefully to find hidden gluten-containing ingredients.(3)

It can take weeks before you really get the hang of eating a gluten-free diet, and eating in restaurants or the homes of friends or family can be challenging to say the least. It is becoming easier as more and more people face this challenge and the food industry responds with a wealth of gluten-free products in even conventional grocery stores. Still, patients should be encouraged to prepare as much food as possible at home and take the opportunity to make some overall improvements to their diets, rather than to simply find gluten-free substitutes for the things they can no longer eat.

The risk-benefit ratio of trying a gluten-free diet is largely in favor of giving it a shot, with the only drawback being the difficulty of this dramatic lifestyle change. Many people choose to continue suffering from their disease or unpleasant symptoms rather than give up some of their favorite foods.

Gluten is much more prevalent in our diets today than it was 100 years ago. It seems like every meal contains some form of gluten: cereal for breakfast, sandwiches for lunch, and pasta for dinner, with granola bars and crackers for snacks. That’s a lot of gluten, especially when you consider that we add more gluten yet to our foods to make them look better and have better consistency. Gluten is from the Latin gluten meaning glue. We use it to make things look pretty, thicken them, and hold together better. Look on the labels of many processed foods and you’ll see not only wheat listed, but also gluten or other forms of the stuff. It’s everywhere! You’ll be surprised when you start looking.

So what is the connection to the thyroid? It’s thought that a part of the gluten molecule resembles a protein found on the thyroid gland itself. When the body creates antibodies against the gluten protein, these antibodies may also attack other cells in the body, such as the thyroid gland. This is not the only organ that appears to be affected; we see a strong correlation as well with nerve tissues, sometimes resulting in neuropathy with unknown cause.(4) Certain types of chronic skin irritation are very common with gluten sensitivity. In fact, among individuals over 10 years of age, it is actually more common to have non-digestive symptoms with gluten sensitivity than the digestive upset one would expect to find with this type of a problem. This is what makes it such a challenging condition to diagnose. Clinicians have long thought it was much less common than it turns out to be, and that it would always present with severe digestive complaints and weight loss. It is now advised that primary care physicians be mindful of this possible diagnosis in what might appear to be unlikely presentations: unexplained anemia, hypothyroidism, dermatitis herpetiformis, ADD/ADHD, autism, and many more.

Special diets take hard work and lots of support to begin. If you are intrigued about the possibilities of what a gluten-free diet or other dietary interventions might be able to do for you and your health concerns, schedule a consultation with Dr. Renee. She can discuss how you can use the most up-to-date testing and evidence to inform your diet and lifestyle choices and take charge of your health care.

1) Valentino R, Savastano S, MaglioM, Paparo F, Ferrara F, Dorato, Lombardi G, Troncone G. Markers of potential coeliac disease in patients with Hashimoto’s thyroiditis. European Journal of Endocrinology (2002) 146 479–483.

2) Shomon M. About.com: The Celiac/Autoimmune Connection.  http://thyroid.about.com/cs/latestresearch/a/celiac.htm#ref. Updated October 17, 2008. Accessed March 28, 2010.

3) Adams S. Celiac.com. http://www.celiac.com/articles/182/1/Unsafe-Gluten-Free-Food-List-Unsafe-Ingredients/Page1.html. Updated November 27, 2007. Accessed March 28, 2010.

4) Hadjivassiliou M, Grunewald RA, Kandler RH, Chattopadhyay AK, Jarratt JA, Sanders DS, Sharrack B, Wharton SB, Davies-Jones GAB. Neuropathy associated with gluten sensitivity. J Neurol Neurosurg Psychiatry. Nov 2006; 77(11):1262-1266.