Recently the LifeWorks Integrative Health blog dove into a few different ways to deal with autoimmune thyroid disorders. We know it was helpful, and we know it was just the tip of the iceberg when it comes to autoimmunity. Another piece of the thyroid autoimmune picture is the role food can play in further development of disease and improvements. We will dive into the implications of gluten and autoimmune thyroid, specifically Hashimoto’s disease. This is the hidden connection that often gets missed when addressing autoimmune conditions.

Intestinal Inflammation:

A crucial part of the autoimmune conversation at large is the prevalence and implications of GI inflammation on autoimmune conditions. Since gluten only exacerbates this, it is important to consider. The NIH estimates greater than 23.5 million Americans (8% of the population) have an autoimmune disorder. There is no clear etiology as the immune system in some ways, has a mind of it’s own regarding when it decides to “go rogue.” However, with 70% of the immune system in the GI tract, it would only make sense that taking care of the gut, takes care of the immune system. There is increased research interests and correlation confirming that those with GI inflammation are more likely to have autoimmune conditions. In other words, those with autoimmune conditions are also found to have underlying GI inflammation. This is not just in GI related autoimmune conditions like Celiac disease, but also in non GI related autoimmune conditions like Rheumatoid Arthritis, Multiple Sclerosis, and Type 1 Diabetes. Research shows that the balance of gut flora is crucial as there are several signaling mechanisms at play between the intestinal flora and mucosal immune system. This means that increase in or better balance of beneficial bacteria results in increased production and maturity of T cells, therefore microorganisms help regulate immune responses. This connection between gut flora and immune cells is widely proven and understood in regard to GI related issues, but the connection to autoimmune responses is becoming more widely accepted. Furthermore, studies show gut dysbiosis (unfavorable imbalance of gut bacteria) is very common in people with Rheumatoid Arthritis.

Gluten and Inflammation:

The body of research and clinical evidence of inflammation caused by eating gluten is both robust and far reaching, meaning more than we can go into in the scope of this post. However the work of Dr. Datis Kharrazian  and Dr. Tom O’Bryan  highlight and utilize this type of research well in their work. For our purposes, it simply needs to be made implicitly clear that gluten causes inflammation in the GI tract. It is estimated that the GI tract is inflamed for 2 hours after ingestion of gluten. Each individual’s ability to modulate, or handle the inflammation is causes is different.

Why is gluten a problem?

The U.S. now grows and exports drought-resistant, bug resistant, fast growing hybridized wheat, which is one reason it is so inflammatory. This new wheat also has an estimated five percent in new proteins which the body does not recognize, as it is so vastly different from the wheat our ancestors used for thousands of years. This causes systemic inflammation and the increase in gluten intolerance. This wheat is also deamidated which is linked to an inflammatory response as well. Lastly, American wheat is known to be the most aggressively sprayed crops with pesticides and herbicides. The prevalence of inflammation coming from the chemicals used on wheat is increasing. Dr. Kenneth Fine at EnteroLabs has dedicated the better part of his career to gluten related disorders and research. His findings suggest that 1 in 3 people are gluten intolerant and 8 in 10 are genetically predisposed to gluten related disorders (gluten sensitivity or Celiac disease or both). The genetic predisposition means that although a gluten related inflammatory process may not be currently active, under the right stressful circumstances (mental, physical or emotional stress) the gluten related disorder switch can be “turned on.”

Gluten and Thyroid:

What’s the deal with gluten and thyroid disorders? The issue with gluten and autoimmune thyroid disease is a case of mistaken identity – a hidden connection of sorts. The molecular structure of gliadin (one of the primary proteins in gluten containing grains) so closely resembles that of thyroid tissue that in the presence of autoimmune thyroid disorder (the body using its own antibodies to attack the thyroid tissue), if you eat gluten containing foods, the immune system responds by attacking (destroying) thyroid tissue. Although this sounds a bit sci-fi, it’s happening at alarming rates in those with autoimmune thyroid disorders who continue to eat gluten. This immune response can last from 2-6 months. That is a long time to have the thyroid tissue being destroyed and can have significant implications for how well the thyroid condition can be managed.

Research

Let’s take a look at some research that specifically shows the importance of addressing gluten related issues alongside autoimmune thyroid conditions

1. 100 patients with autoimmune thyroid condition showed decrease in their autoimmune markers after adopting a gluten free diet. Although their thyroid antibodies did not necessarily decrease, the overall autoimmune inflammatory markers improved (J Clin Gastroenterol. 2002 Sep; 35(3):245-248)
2. 150 people newly diagnosed with autoimmune thyroid showed improvement of hypothyroidism and a decrease in thyroxine medication after they began a gluten free diet. (Form Res. 1999; 51(3):124-127)
3. This study shows and increased in celiac disease in those already diagnosed with autoimmune thyroid.  Inversely, a combined study showed those with previously detected gluten intolerance had higher prevalence of autoimmune thyroid conditions. In other words, when those with autoimmune thyroid were tested for gluten related issues, most of them had one. When those with gluten related disorders were tested for autoimmune thyroid, most of them had it and did not know it. This suggests the importance of testing both ways. If gluten is the first thing detected, thyroid needs to be tested. If thyroid is the first thing detected, gluten intolerance needs to be tested or gluten free diet should be adopted with adherence of 100% gluten free 100% of the time. A 80/20 rule does not apply here. (Autoimmunity.2008 Feb; 41 (1):116-121_
4. This study used 104 people with Hashimoto’s disease, 15% were positive for Celiac disease and 95% had the HLA-DQ2 (and/or-DQ8) genetic markers for celiac disease and gluten intolerance. In another study by the same group, 184 patients with celiac disease and 21% were positive for autoimmune hypothyroid (Hashimoto’s). In the same group, others were found to have Graves disease, and one had postpartum thyroiditis. These studies confirms the same as in the study group above (3), that gluten and thyroid related issues must be screened and tested together. (World J Gastroenterol. 2007 Mar 21;13(11):1715-1722)
5. A case study from Endocrinology and Metabolism shows a person who was unresponsive to thyroid medications for autoimmune hypothyroid requiring up to 325 mcg/day of L-thyroxine (that’s a huge dose) and still with a TSH out of range. When this person was changed to a gluten free diet, the TSH normalized and required only 125mcg/day of medication. (Are Bras Endocrine Metabol. 2005 Aug49(4):599-603)
6. Similar to study 5 above, an 86 year old was resistant to treatment with levothyroxine and alfocalcidol (another medication for thyroid) which improved after gluten free diet was adopted. Both these case studies confirm that it optimal autoimmune thyroid management should include a 100% gluten free diet 100% of the time. (Thyroid.2002 Jul;12(7):633-636)

Final Thoughts:

• In the case of Hashimoto’s the goal is 100 percent gluten-free, 100 percent of the time.
• Remember 90% of hypothyroidism is Hashimoto’s, so if you are being treated for low thyroid, chances are all this applies to you
• If you want to know if you are gluten sensitive or if you have the DNA markers, we have access to the best gluten related testing available at LifeWorks.
• Blakely Page, RDN the dietitian at LifeWorks, is also very skilled in gluten related disorders and can guide people through the gluten related testing and transition to a gluten free diet.
• Contact us today to learn more about how functional medicine can assist with thyroid disorders.