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Gluten and Autoimmune Thyroiditis

A complicated relationship

With Elena Christofides MD

Non-celiac gluten sensitivity is triggered by both the quantity and quality of baked goods you consume.

The vilification of gluten has prompted a multi-billion-dollar market in the United States, stocking shelves with gluten-free cakes, breads, and cereals. It’s also promoted a lot of confusion concerning how gluten affects different populations, how it relates to illness, and how the French seem to live off baguettes. For patients with autoimmune conditions such as autoimmune thyroiditis, the answers are a bit more clear.

Hashimoto's thyroiditis

Hashimoto's thyroiditis is an autoimmune condition that targets the thyroid gland, and often results in hypothyroidism (too little thyroid hormone). The broad nature and individuality of autoimmune thyroiditis symptoms can make the disorder difficult to treat, and to understand. Often, people with Hashimoto's are left to explore lifestyle changes such as gluten-free diets, hoping to alleviate difficult and disruptive symptoms such as:

  • Fatigue and sluggishness
  • Increased sensitivity to cold
  • Constipation
  • Unexplained weight gain
  • Muscle aches, tenderness, and stiffness
  • Joint pain and stiffness
  • Muscle weakness
  • Excessive or prolonged menstrual bleeding
  • Depression
  • Memory lapses

How exactly does gluten relate to autoimmune thyroiditis, and is all bread created equally? Endocrine Web spoke with Dr. Elena Christofides, MD, FACE, to better understand the world of gluten-free. “On a basic science level, we see a connection between gluten and autoimmune conditions,” says Dr. Christofides. Let’s break down exactly how this happens and who is affected.

Gluten, genetics, and autoimmunity

Dr. Christofides explains how the process of digesting gluten can trigger autoimmune conditions in a predisposed population.

  1. When you eat, the body recognizes the whole food, triggering a recognition of the enzymes needed to digest the food.
  2. Recognition of gluten in the gut triggers the transcription of DNA that produces the enzymes to digest gluten.
  3. This enzyme transcription is located next to a section of DNA that transcribes for the signaling of macrophages (immune cells that can initiate inflammation).
  4. The overconsumption of gluten (such as in a typical Westernized diet) can trigger the transcription of the DNA section responsible for activating macrophages in a person who is genetically predisposed to autoimmune conditions.

It is important to note that it is the genetic predisposition to an autoimmune condition that can prompt this reaction to gluten-containing foods, an epigenetic function of “turning on a switch.” Gluten-containing foods are not inherently bad or villainous. Once this switch is turned on for Hashimoto's, it cannot be turned off. Autoimmune conditions are chronic, but their symptoms and severity can be managed with diet and lifestyle.

Non-celiac gluten sensitivity

The inflammatory state experienced with gluten consumption is called non-celiac gluten sensitivity (NCGS). Celiac Disease is an autoimmune condition, whereas Non-Celiac Gluten Sensitivity is a chronic, functional digestive disorder, triggered by eating gluten-containing foods. Dr. Christofides NCGS, explains how these foods can trigger gut dysbiosis and neuroinflammation in a predisposed population such as people with hereditary markers for autoimmunity.

Gut dysbiosis describes an imbalance in your gut’s microbiota (a collection of microbes that live in your GI tract). The imbalance of these microbiota can play a role in autoimmune conditions, diabetes, obesity, cancer, cardiovascular, and central nervous system disorders. Because thyroid autoimmunity tends to be a dominant autoimmune condition, we often see autoimmunity present as a thyroid condition first.

Your GI tract works as a major immunological organ and must maintain a tolerance to dietary antigens while also being responsive to pathogenic stimuli. Both dietary antigens and pathogenic stimuli can cause inflammation. A balanced gut microbial environment is important in fighting off this inflammation and maintaining health and homeostasis.

Remember the gluten enzyme transcription site that sits next to the transcription site for macrophages? If you have a genetic predisposition for autoimmunity, excess gluten can trigger an immune response that can lead to gut dysbiosis.

Symptoms of gut dysbiosis

  • Brain fog
  • Moodiness
  • Slowed thought process
  • Sleeping disturbances
  • Anxiety and depression
  • Constipation
  • Diarrhea
  • Abdominal pains
  • Abnormal thyroid levels
  • High cholesterol
  • Irregular periods
  • High blood pressure
  • High blood sugar

Clinical symptoms of gut dysbiosis may be missed or disregarded. If you believe you are suffering from this disorder, requesting lab tests for cholesterol, bloods sugars, and thyroid levels can help your physician to better diagnose your condition.

If you have an autoimmune condition, such as Hashimoto's thyroiditis, gluten can trigger inflammation, and lead to gut dysbiosis. Eliminating gluten can decrease symptoms, but it is not only gluten that causes these issues. The inflammatory state that can increase symptoms is driven by more than gluten alone.

Dietary inflammation triggers

  • Sugar
  • Highly processed foods
  • Artificial additives

Sugar is highly inflammatory and can worsen the imbalance of gut microbiota. Unfortunately, the heightened awareness of Non-Celiac Gluten Sensitivity has increased the market for gluten-free foods which are often highly processed and sugar filled.

For many people, a commercial “gluten-free” diet can increase inflammation and heighten symptoms of thyroiditis. Dr. Christofides explains, “Many people stop eating gluten, but replace it with highly processed, sugary foods, which makes it worse.” We tend to scapegoat certain foods, but the whole diet is what matters.

Healing the gut is a combination of decreasing inflammatory foods, and increasing pro- and prebiotics. When you’re in a state of extreme inflammation, you may want to avoid all gluten, sugar, highly processed foods, and alcohol. You can accompany these dietary changes with probiotics and prebiotics. Dr. Christofides recommends a supplement that includes both.

Probiotics are “good” bacteria that can help to keep your gut healthy.

Food sources of probiotics

  • Yogurt
  • Kefir
  • Kombucha
  • Sauerkraut
  • Kimchi
  • Sourdough
  • Tempeh

Prebiotics are a type of fiber that feed the healthy bacteria in your gut and can improve the balance of microbiota. 

Food sources of prebiotics

  • Dandelion greens
  • Jerusalem artichoke
  • Garlic
  • Leeks
  • Asparagus
  • Barley
  • Oats
  • Flaxseeds

Healing your gut is a bit like healing an injury or infection. Once you’re no longer experiencing symptoms of gut dysbiosis, you can slowly try to reintroduce a less restrictive and more balanced diet.

French baguettes, gluten, and the international factor

Many people report stomach distress and symptoms when consuming gluten-containing foods in the United States and wonder at their ability to eat baguettes and croissants in Europe. Is European gluten really different? Not so much. European foods, however, often are.

Remember, it is the entirety of your diet that can increase or decrease inflammation and worsen the symptoms of autoimmune thyroiditis (along with many other complications).

“In the United States, we eat a boatload of bread, mostly highly processed junk bread,” says Dr. Christofides. "In Europe, bread is part of the diet.” For example, a Mediterranean diet typically contains fresh vegetables, beans, lentils, fish meats, and fruits. Most bread in Europe is fresh and usually bought from the local bakery that morning. Compare that to an American diet comprised of many more processed foods, and it’s no surprise you feel better in France, even after eating that baguette.

Should you eat gluten if you have autoimmune thyroiditis?

Your gut health is a large determiner of your overall health. Gluten is not a villain, but for some, the overconsumption of gluten-containing junk foods can trigger and worsen an inflammatory response. The typical American diet of highly processed, artificial foods with low nutrient profiles is the predominant problem. For most people, even those with NCGS, a slice of whole grain bread is a better option than the over-processed replacement “food.” Care for your gut, and for yourself with a variety of fresh foods, and you will likely start to see and feel a difference.

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