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Should Everyone With A Thyroid Condition Follow A Gluten Free Diet?

When I attended a recent functional medicine conference, one of the presenters asked the audience the following question: “how many people attending this conference are gluten free?”  The majority of the attendees raised their hands, which probably shouldn’t be too surprising considering that it was filled with functional medicine practitioners who commonly advise their patients to avoid gluten.  However, the presenter also mentioned that approximately 30% of the general public is gluten free, which did surprise me.  Although many people reading this post avoid gluten, I’m sure there are others reading this who eat gluten on a regular basis and want to know if they should follow a gluten free diet on a permanent basis.

Before I talk about this, you might be wondering whether or not I raised my hand when the question was asked about avoiding gluten.  To be honest, I was ready to raise my hand, but although I greatly minimize my consumption of gluten, I can’t honestly say that I’m 100% gluten free.  And I’m sure some of the practitioners who raised their hands at the conference fell into the same category, as they might try their best to avoid gluten most of the time, but they don’t necessarily avoid gluten 100% of the time, or even 95% of the time.  Once again, this obviously will vary depending on the person, as I know that some people reading this are 100% gluten free.  On the other hand, some people might think they are 100% gluten free, even though this isn’t the case, as I discussed a few years ago in a blog post I wrote entitled “Are You Really Gluten Free? [1]

Avoiding Gluten When Restoring One’s Health

Although I eat some foods which consist of gluten every now and then, I encourage my patients to follow a gluten free diet while trying to restore their health.  This might seem to be hypocritical of me, as why would I tell my patients to completely avoid gluten, even though I personally don’t avoid gluten all of the time?  Well, keep in mind that I’m not in the process of restoring my health, as I’m in a state of remission.  On the other hand, if someone with a thyroid or autoimmune thyroid condition is trying to restore their health it probably is best to go gluten free.  And the reason for this is because gluten is not only a common allergen, but it can also increase intestinal permeability (1) [2], which is a fancy term for a leaky gut, and is a factor in most, and possibly all autoimmune thyroid conditions.  In other words, in some people, avoiding gluten is a necessary component to restore their health.  And in these people, consuming even a small amount of gluten can prevent them from fully recovering.

But how about those people who don’t have any type of gluten sensitivity or intolerance?  In other words, while you might understand why someone who has Celiac disease or a non-Celiac gluten sensitivity will need to avoid gluten, why should someone who doesn’t have a sensitivity avoid gluten?  The problem is that it can be challenging to determine who is sensitive to gluten.  Unfortunately one can’t always rely on symptoms, and while there is testing available, this isn’t completely accurate either.  And so there is a chance that someone can have problems with gluten, even if they don’t experience any negative symptoms when consuming it.  This can be the case even if they have a negative Celiac panel, as frequently a Celiac panel will come out negative for those in the early stages, and they might also be asymptomatic when consuming gluten, which is known as “silent Celiac disease” (2) [3] (3) [4].  There is a more comprehensive gluten sensitivity test offered by Cyrex Labs, but it’s very expensive, and even with this test it’s possible to have a false negative result.

Can Someone Restore Their Health While Consuming Gluten?

Based on what I have said so far, you might wonder if it is possible for someone with a thyroid or autoimmune thyroid condition to restore their health, even if they don’t completely avoid gluten.  The answer is “yes”, as it definitely is possible for some people to restore their health while continuing to eat gluten…if they don’t have a gluten sensitivity or intolerance.  After all, while many people do better when avoiding gluten, and although gluten can be the main factor with regards to the autoimmune response in some people with Hashimoto’s Thyroiditis and Graves’ Disease, in many people this isn’t the case.  However, as I mentioned previously, it can be challenging at times to determine if someone has issues with gluten.  And so a person with a thyroid or autoimmune thyroid condition who doesn’t experience any symptoms when eating foods with gluten can of course choose to continue eating these foods while taking a natural treatment approach, and if all goes well then that’s great.

On the other hand, if someone continues to eat gluten but isn’t showing much improvement then this makes the situation more challenging.  And the reason for this is because if someone continues to eat gluten but their health doesn’t improve, there is no guarantee that eating the gluten was responsible for their lack of progress.  Let’s put it another way…if someone is following a natural treatment protocol, is 100% gluten free, and after a few months their health isn’t improving, then we can almost definitely conclude that exposure to gluten isn’t the reason why they weren’t progressing, since they were gluten free.  On the other hand, if someone eats gluten while following a natural treatment protocol and doesn’t improve, while it is possible that the reason why they weren’t improving was due to the exposure to gluten, there is also the possibility that another factor was responsible for their lack of progress.

I know this might be a little bit confusing to some people reading this, but my point is that when trying to restore your health, initially you want to try to avoid as many factors as possible that can be responsible for triggering your condition, and this includes avoiding gluten.  While doing this will greatly improve your chances of restoring your health, if for any reason your health doesn’t improve, at the very least you won’t be able to blame your lack of progress on those potential triggers (i.e. gluten) you avoided.  And so this will allow you to focus on other factors which might be problematic.

I’d like to give another example.  Let’s look at a scenario where someone is dealing with Hashimoto’s Thyroiditis or Graves’ Disease, and this person completely avoids gluten, dairy, corn, refined sugars, drinks purified water, and uses natural household products in order to reduce their toxic exposure.  If this person’s health doesn’t improve after a few months of following a natural treatment protocol then we can conclude that their lack of progress wasn’t due to exposure to gluten, dairy, corn, refined foods, toxins in the water, or household products.  While it might be frustrating to the person that their health hasn’t improved despite making these changes, at least we would know to focus on other factors.  On the other hand, if the same person avoided dairy, corn, refined foods, drank purified water, used natural household products, but didn’t avoid gluten, then we might suspect that gluten was the culprit, even though there is the possibility that another factor was responsible for their lack of progress.

World-Renowned Expert On Gluten-Related Disorders Doesn’t Avoid Gluten?

Dr. Alessio Fasano is one of the world-renowned experts on gluten-related disorders, and in his book “Gluten Freedom” he states the following: “I am now convinced that our immune system mistakenly interprets gluten as a component of a dangerous bacterium or bacteria.  When this happens, it unleashes an immune response similar to that triggered by bacteria to rid the body of the attackers.  This response is elicited in everyone.  It is not exclusive to people affected by gluten-related disorders”.

In other words, according to Dr. Fasano, gluten has a negative impact on everyone, and not just people who have Celiac disease or a non-autoimmune gluten sensitivity.  And the study I brought up earlier mentions that increased intestinal permeability after gliadin exposure occurs in ALL individuals (1) [2].  Based on this it would be fair to conclude that everyone should permanently avoid gluten, right?  And if this is the case, why would I choose to eat even a small amount of gluten on an occasional basis?  Well, it’s the same reason why some people choose to drink some alcohol every now and then, drink coffee, etc.

You might argue that unlike gluten, some alcoholic beverages such as red wine have certain health benefits.  However, like gluten, all alcohol can increase the permeability of the gut, including red wine (4) [5].  I personally don’t drink alcohol, don’t drink coffee, and while I do eat a pretty healthy diet most of the time and eat very little gluten, I’m definitely not perfect.

And Dr. Fasano isn’t perfect either, as if you happened to listen to the “Autoimmune Summit” conducted by Dr. Amy Myers in Fall of 2014, Dr. Fasano was interviewed by Dr. Myers and admitted that he eats gluten sometimes.  Plus, he also mentioned the following in his book: “Although I have contributed to the discoveries of some of these inappropriate immune responses elicited by gluten in humans, I do not share the position of the proponents of a ‘gluten-free world’, who often cite my work to support their position.  We engage daily in a war with many dangerous bacteria but rarely do we lose this battle, which is an event that leads to infection.  We are also engaged in a daily confrontation with gluten, but only a minority of us will lose this battle.  These are the genetically susceptible individuals who will develop gluten-related disorders”.

So even though Dr. Alessio Fasano has done plenty of research on the adverse effects of gluten (he was one of the authors in the study I mentioned earlier), he does consume some gluten every now and then.  I’m pretty sure that I don’t have Celiac disease, and I don’t think I have a non-Celiac gluten sensitivity disorder.  And I assume gluten wasn’t a trigger when I was dealing with Graves’ Disease, or else I probably still wouldn’t be in remission.  Keep in mind that I don’t freely eat gluten, as I eat mostly whole foods, try to eat as many organic foods as possible, etc.  And if someone isn’t in remission and is in the process of trying to restore their health then without question I think it is best to play it safe and avoid gluten.

Is It Wise To Reintroduce Gluten After Getting Into Remission?

Although I seem to do fine consuming a small amount of gluten every now and then, this of course isn’t the case with everyone.  And so I admit that it is a risk for someone to reintroduce gluten after restoring their health.  While many people will do fine after reintroducing gluten, some people who reintroduce gluten won’t do fine, and at times the consequences can be severe.  As a result, there are some people who choose not to reintroduce gluten after restoring their health, even if they haven’t confirmed that they have Celiac disease or a non-autoimmune gluten sensitivity.

The truth is that we don’t need to eat gluten.  But gluten is just one of numerous toxins that many people voluntarily expose themselves to.  One can make a good argument that we should all be 100% alcohol free, not consume any caffeine, not put ourselves in a position to deal with high amounts of stress, always get at least eight hours sleep, avoid any type of household cleaner or cosmetic that isn’t certified organic, etc.  But it’s rare to come across someone who is 100% gluten free, alcohol free, and caffeine free AND has low stress levels, gets at least eight hours of sleep every night without exception, uses all natural products, etc.  Keep in mind that I’m not trying to convince anyone reading this that it’s okay to eat gluten on an occasional basis. I admit that there is no good reason to consume gluten, but one can make the argument that there is no good reason to drink any alcohol, coffee, stay up late, etc.  While it’s important to do everything you can to live a healthy lifestyle, nobody is going to be perfect in all aspects of their health.

In summary, not everyone with a thyroid or autoimmune thyroid condition has Celiac disease or a non-autoimmune gluten sensitivity.  However, since gluten is a common allergen and can increase intestinal permeability, and because it can be difficult to determine if someone has a gluten sensitivity, or even Celiac disease in some cases, I think it’s a good idea to avoid gluten while trying to restore one’s health.  As for whether it’s safe to reintroduce gluten after someone has restored their health, without question there are risks involved with doing this.  However, there are also risks involved with reintroducing other foods (i.e. dairy, corn), along with drinking alcohol, caffeine, staying up late on a frequent basis, etc.  Please feel free to share your thoughts on avoiding and reintroducing gluten in the comment section below, as I’m sure there are many people reading this who feel strongly about avoiding gluten, while others reading this might have a different opinion regarding gluten.