Many people with thyroid imbalances, and especially those with an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, can benefit from avoiding gluten. It’s very common for my patients who go on a gluten free trial to tell me how much better they feel. Sometimes the changes in their symptoms are dramatic, and some people even experience a dramatic reduction in their thyroid antibodies upon avoiding gluten. However, not everyone feels better when avoiding gluten. And so the goal of this blog post is to discuss what approach you should take if you don’t feel any improvement in your symptoms upon avoiding gluten.
Just as a side note, while growing up, gluten was part of my regular diet. I would have cold cereal for breakfast (i.e. Fruit Loops, Apple Jacks, etc.). I ate plenty of bread, cookies, and other foods loaded with gluten. In addition, I grew up in Queens New York, which has a bagel store on almost every corner, and there are also plenty of pizza places and bakeries. And so I had plenty of gluten as a child and teenager, and I must admit that if gluten was as healthy as vegetables I would be eating gluten-based foods all of the time! Sure, I feel great after having my green smoothie for breakfast, and I don’t mind eating steamed broccoli, but if bagels and pizza were just as healthy I’d be eating these foods every day. And yes, I know there are gluten free versions of these, but they still aren’t as healthy as whole foods.
So now that you are aware of my secret obsession with bagels and pizza (more so pizza than bagels), let’s talk about what you should expect to happen when you avoid gluten. If you are symptomatic should you experience an improvement in your symptoms within a few days or weeks of going gluten free? Should you notice an improvement in your blood tests upon removing gluten from your diet? It really does depend on the person, as if someone has a gluten sensitivity, or a condition such as Celiac disease, then they will usually feel better upon avoiding gluten. However, not everyone experiences overt symptoms even when they are gluten sensitive, and some people even have silent Celiac disease (1) (2) (3). Admittedly most of the cases of silent Celiac disease seem to be present in children and adolescents, but adults can have this as well.
How Can You Tell If You Have A Gluten Sensitivity?
There are basically two ways to tell if someone has a gluten sensitivity…by symptoms or through testing. Of course if you experience symptoms when eating gluten then this is a clear sign to avoid it. The problem is that not everyone experiences overt symptoms when consuming gluten, and so the lack of symptoms when consuming gluten doesn’t necessarily rule out a gluten sensitivity. Also, keep in mind that foods that contain gluten are typically high in FODMAPs, and so if you have problems with gluten and other high FODMAP foods then there is a chance that gluten sensitivity isn’t the issue, but you might have small intestinal bacterial overgrowth instead. If you aren’t familiar with FODMAPs then I would read the blog post I wrote entitled “Should People With Thyroid Conditions Follow a Low FODMAP Diet?”
As for testing, while this can help to detect a gluten sensitivity problem, a negative finding doesn’t rule out a sensitivity to gluten. For example, if someone gets a Celiac panel which measures the antibodies to gliadin and transglutaminase and the test results are negative, this doesn’t mean you can’t be sensitive to other proteins of gluten which aren’t tested. Cyrex Labs has the most comprehensive test for gluten that I know of, but while it tests for many of the markers of gluten, it doesn’t test for all of them. In addition, if someone has depressed immunoglobulins then this can result in a false negative result.
So hopefully you realize that it can be challenging at times to determine if someone has a gluten sensitivity, as while a positive test result usually confirms a gluten sensitivity, a negative result doesn’t necessarily rule out problems with gluten. If one has overt symptoms when consuming gluten and/or tests positive for a gluten sensitivity then there is no question that they should avoid gluten. But if they don’t experience negative symptoms, and if the testing reveals no gluten sensitivity, then it’s not clear if they should avoid gluten. And this is one reason why many healthcare professionals will have all of their patients who have a chronic health condition avoid gluten.
“Can I Get Into Remission If I Continue To Eat Some Gluten?”
At this point you might still be wondering if you can restore your health if you continue to eat gluten. The answer is “maybe”. In my experience it is possible for some people with Graves’ Disease and Hashimoto’s Thyroiditis to restore their health, even if they don’t completely avoid gluten. While some natural healthcare professionals will disagree with this, and while I do encourage my patients to avoid gluten while following a natural treatment protocol, I have had some patients continue to eat gluten and still get into remission. This doesn’t mean that they were eating large amounts of whole wheat bread and pasta on a daily basis, as they were still eating very healthy, but they didn’t completely avoid all sources of gluten.
With that being said, it does appear that gliadin, which is one of the proteins in gluten, causes an increase in intestinal permeability in everyone, even those who aren’t sensitive to gluten (4). What this means is that gluten causes a leaky gut in everyone. And while this study did show that those people with active Celiac disease and a non-autoimmune gluten sensitivity had a greater increase in intestinal permeability, those who didn’t have Celiac disease or a non-autoimmune gluten sensitivity still experienced negative effects on the intestinal barrier when consuming gluten.
However, some people are hesitant to avoid gluten if they don’t feel worse upon eating it, or if they don’t notice any positive changes in their symptoms upon eliminating it. The problem is that you can’t always go by symptoms alone, and it is impossible to predict who will do fine when continuing to consume gluten. And so there are basically two options for those who are looking to restore their health, yet don’t experience any negative symptoms when eating gluten (or don’t feel better upon eliminating it). One option is to continue to eat gluten while following a natural treatment protocol and see how you progress. If you choose this option I still would try to minimize your consumption of gluten, and if you are eating mostly whole foods then it’s easy to accomplish this.
A second option is to play it safe and completely avoid gluten. This always leads to questions such as “is it okay to have a tiny amount of gluten?”, or “what if I’m 99% gluten free?” This once again depends on the person. Some people make an effort to go gluten free, but either intentionally or accidentally get exposed to small amounts of gluten. And if they don’t have Celiac disease or a non-autoimmune gluten sensitivity then they probably will do fine. On the other hand, if they have a gluten sensitivity they will continue to have gut inflammation even when consuming small amounts of gluten, and as a result they probably won’t improve.
What Should You Do If Avoiding Gluten For A Prolonged Period Of Time Doesn’t Help?
I’ve come across people who have gone gluten free for six months or longer without any improvement in their symptoms or thyroid blood tests/antibodies. Isn’t this an obvious sign that they aren’t gluten sensitive? Well, when this is the case there is a good chance that gluten isn’t the primary trigger. However, keep in mind that there can be multiple triggers. For example, someone can have a gluten sensitivity that is causing inflammation, but the main trigger is an underlying infection. And so avoiding gluten might have helped with the inflammation, but since the main trigger (the infection) was still present, the person didn’t notice much of a difference with their symptoms when avoiding gluten.
It’s a no-win situation, and so you might as well just throw in the towel and munch on some donuts or muffins, right? The truth is that I’m not against some people eating gluten on an occasional basis…after they have restored their health back to normal. Although I try to eat a healthy diet most of the time, I’d be lying if I told you that I was completely gluten free 100% of the time. Gluten should admittedly be avoided, just like alcohol, and while I don’t drink alcohol, I do occasionally indulge in foods that contain gluten. I’m not suggesting that everyone is able to eat gluten after they restore their health, as there definitely are people who need to completely avoid it. And next week I’ll be releasing a blog post which might suggest that I should completely avoid gluten altogether, even though I feel fine when I consume it.
In summary, while many people feel better upon avoiding gluten, not everyone who eliminates gluten from their diet notices an improvement in their symptoms and blood tests. When this is the case, it is tempting to want to go ahead and eat gluten on a regular basis, but just remember that the lack of symptoms, and even a negative test result doesn’t rule out a gluten sensitivity. While some people might be fine eating small amounts of gluten while trying to restore their health, others won’t do well. As a result, I think it’s a good idea for everyone to go on a gluten free trial, although this doesn’t mean that everyone needs to completely avoid gluten on a permanent basis.