Hashimoto’s and Gluten: What the Research Actually Says
Introduction
Gluten free diets are becoming increasingly popular nowadays, with many people opting for them to manage their Celiac disease, food allergies, or out of sheer preference. In recent years, gluten free diets have also become a widely discussed approach for Hashimoto’s thyroiditis.
With so much information available at our fingertips, separating evidence-based science from popular trends can be confusing. This post will dive into the potential connection behind gluten and autoimmune conditions like Hashimoto’s, the pros and cons of a gluten free diet, and the broader picture of a nutritional approach to Hashimotos.
What Is Hashimoto’s Thyroiditis and Why Does Diet Matter?
Hashimoto’s Thyroiditis is an autoimmune condition in which the immune system attacks the thyroid, potentially causing it to become underactive. Low levels of circulating thyroid hormone can create a whole host of symptoms including fatigue, hair loss, dry skin, difficulty losing weight, constipation and cold intolerance.
Emerging research suggests that our gut microbiome directly influences our immune system, due to the large number of immune cells that live in our digestive tract. This makes diet an essential component in the management of any autoimmune disease. Prioritizing a whole foods diet can help reduce inflammation while improving both microbial diversity and intestinal barrier function. In Hashimoto’s, reduced thyroid function can reduce gastrointestinal motility, creating symptoms like constipation and bloating. This process sets the stage for disruptions in the gut microbiome, making optimal nutrition and gut supportive strategies even more valuable.
What Is Gluten and Why Does It Come Up in Autoimmune Conversations?
Gluten is a group of naturally occurring proteins found in grains like wheat, barley and rye. Although safe for many people, gluten often comes up in conversations about autoimmunity for a variety of reasons. The most common is Celiac disease- a condition where consuming gluten triggers the immune system to attack the small intestine. This process damages the tiny finger-like structures responsible for absorption, otherwise known as villi. In the absence of Celiac disease, patients can present with gluten intolerance or wheat allergies. Continued consumption of gluten despite a known intolerance or allergy can create inflammatory conditions in the body and potentially worsen autoimmunity. In sensitive individuals, gluten can trigger the release of zonulin, thereby weakening the gut lining and allowing undigested food particles into the bloodstream. This sets the stage for a process known as molecular mimicry – a phenomenon where bacteria, viruses, or proteins like gluten, share a similar structure to the body’s own tissue.
Is There a Proven Link Between Gluten and Hashimoto’s & Who with Hashimoto’s Might Actually Need to Avoid Gluten?
The relationship between gluten and Hashimoto’s is complex and requires further research to be definitive. It has been noted that patients with celiac disease are at higher risk for developing autoimmune thyroiditis. However, emerging research is reflecting more and more associations between gluten and Hashimoto’s disease.
Molecular mimicry is one potential contributor to these associations, since the molecular structure of gluten closely resembles that of thyroid tissue. In genetically susceptible individuals, this may trigger an immune response. Although some studies suggest that following a gluten-free diet may reduce thyroid antibody levels in people with both Hashimoto’s and celiac disease—and possibly in those with non-celiac gluten sensitivity—the current evidence is insufficient to recommend a gluten-free diet for everyone with Hashimoto’s.
What Are the Risks of Going Gluten-Free Without Medical Guidance?
While a gluten free diet is medically necessary for those with celiac disease, eliminating gluten without being evaluated for autoimmunity, allergies or intolerances may not always be beneficial. Eliminating gluten in the absence of GI symptoms and confirmed diagnoses can be a form of unnecessary restriction. A gluten free diet also eliminates one of the most common sources of B vitamins and fiber in most American’s diets. Removing gluten from your diet requires intentionality to ensure nutrients found in gluten-containing grains are being consumed through other dietary sources.
Additionally, if gluten has been removed from the diet before testing, serum testing and biopsies used to diagnose celiac disease may become falsely negative because your immune system is no longer being exposed to gluten. In order to gain a meaningful result, reintroduction of gluten would be required.
If you have Hashimoto’s and suspect gluten may be contributing to your symptoms, it is important to consult with your care team and ensure this approach is warranted based on your test results and symptoms.
What Does a Nutrition-Focused Approach to Hashimoto’s Actually Look Like and How Can a Registered Dietitian Help ?
A nutrition-focused approach to Hashimoto’s involves reducing inflammation, improving gut health, and optimizing the status of nutrients directly involved with the production of thyroid hormone. Iodine, selenium, zinc, copper, and iron are some of the most important nutrients in the production and conversion of thyroid hormones. Deficiencies in vitamin B12 and vitamin D are also common among people with Hashimoto’s and may worsen symptoms such as fatigue and hair loss.
A registered dietitian can assess your intake, identify potential deficiencies, and create a personalized dietary approach that accounts for your lab values, medical history, lifestyle and preferences. Registered dietitians can also help you determine whether you may be gluten sensitive and whether further testing or a gluten free diet are the right approach for you.
At Functional Nutrition RX, we go beyond just food choices. We explore lifestyle factors that influence thyroid health and overall well-being, including sleep quality, stress management, physical activity, and meal timing. We emphasize a comprehensive approach that helps you feel your best and fits your lifestyle for long-term success.
Frequently Asked Questions About Hashimoto’s and Gluten
Q: Does Hashimoto’s always lead to hypothyroidism?
Not necessarily. Hashimoto’s is indicative of elevated thyroid antibodies, but not everyone with Hashimoto’s develops hypothyroidism immediately. In some cases, Hashimoto’s and hypothyroidism go hand in hand. In others, hypothyroidism can develop over time. That’s why managing antibody levels and monitoring overall thyroid function is essential to treating Hashimoto’s.
Q: Should everyone with Hashimoto’s go gluten-free?
No- in the absence of Celiac disease or gluten sensitivity, following a gluten free diet is not universally recommended. Your medical provider and registered dietitian can help you determine how to test for gluten related conditions and whether a gluten free diet is right for you.
Q: Can I get tested for celiac if I am already gluten-free?
If you are already following a gluten free diet, testing for celiac disease can reveal a false negative. Without gluten exposure, the body may not mount an immune response. If you are already gluten free, you may need to reintroduce gluten for several weeks in order to ensure accurate test results. This can create symptoms, therefore it is not appropriate for everyone. It is important to follow the guidance of your care team as to whether the benefits outweigh the risks.
Final Thoughts: The Gluten Question Deserves a Thoughtful Answer
Research continues to explore the relationship between gluten and Hashimoto’s, but dietary changes should be guided by evidence and your individual health needs. Partnering with both your physician and a registered dietitian can help you make informed decisions that support your long-term health. If you’re recently been diagnosed with Hashimoto’s, or are interested in exploring whether a gluten free diet might be right for you, we’d love to be a part of that conversation.
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