A lot of patient-run websites insist that eliminating gluten is essential for treating thyroid disease. What's the evidence to support this advice?
A lot of patient-run websites insist that eliminating gluten is essential for treating thyroid disease. What's the evidence to support this advice?
Jessica writes:
“I was diagnosed with hypothyroidism several months ago. There are many websites, blogs, and Facebook groups for people with hypothyroidism that insist that you have to go gluten-free. Is this true?”
Hashimoto’s thyroiditis is the most common cause of hypothyroidism. It’s an auto-immune condition in which the body’s immune system gradually destroys the thyroid gland. As a result, the amount of circulating thyroid hormone in your body is too low. This can lead to everything from weight gain to hair loss to heart trouble.
If your doctor diagnoses you with Hashimoto’s, he or she will likely tell you it’s not that a big deal. They’ll write you a prescription for replacement thyroid hormone and send you on your way. If you ask about whether there’s anything you should be doing in terms of diet or lifestyle, they will probably tell you there isn’t.
Once you get home, of course, you’ll go straight to the Internet, where you will discover a vast community of fellow sufferers and advocates, along with tons of advice on diet and supplements for people with Hashimoto’s. You’ll read lots of stories about people who went on thyroid replacement hormone but continued to feel terrible until they went on a gluten-free diet.
It is true that people with one auto-immune disease are at elevated risk for others. People with Celiac disease are more likely to develop Hashimoto’s and vice versa. And, not surprisingly, Hashimoto’s patients who also have Celiac disease do see an improvement when they eliminate gluten. But many Hashimoto’s patients don’t have Celiac. Can they also benefit from eliminating gluten?
Unfortunately, the evidence that those with Hashimoto’s benefit from a gluten-free diet is, so far, anecdotal. That doesn’t mean that it’s not true, just that it hasn’t yet been confirmed with good science. There’s always the chance that the improvements that people feel are due to something besides the absence of gluten.
Research has shown, for example, that many people who think they are sensitive to gluten (which is a protein in wheat) are actually sensitive to the fiber in wheat, and not the gluten. When they eliminate the fiber, they have no adverse reaction to gluten.
There are other reasons that people who go on gluten-free diets might feel better. In the process, they may end up eliminating a lot of processed foods. They may end up eating more fruits and vegetables or protein to make up for the missing bread and pasta.
For better or worse, people who are attempting to manage a health condition with diet and lifestyle also tend to make lots of changes at once. They eliminate wheat but they also cut down on sugar. They start exercising or meditating. They start taking a bunch of different supplements. If they feel better, it can be awfully hard to tell which factors are responsible. There may even be a placebo effect at work.
The other tricky thing about anecdotal evidence, such as the kind you’re likely to find on a website or forum is that it tends to be one-sided. People who eliminate gluten but don’t feel any better are simply less likely to post their stories. All of that makes it hard to to gauge what percentage of people with Hashimoto’s might benefit from a gluten-free diet.
I think it depends on whether or not your low thyroid symptoms resolve once you start taking replacement thyroid hormone, keeping in mind that it can take several months to find and adjust to the correct dose.
But after getting your dosage squared away, if you still feel poorly, it might be worth experimenting with your diet to see if eliminating gluten improves your quality of life. If it does, that might not be good enough to get published in a peer-reviewed medical journal, but it’s probably good enough for you, right? But if it doesn’t seem to help, then there’s probably no need to work that hard.