The Connection Between Non Celiac Gluten Sensitivity, Thyroid Disorders, and Autoimmune Disease
Autoimmune disorders are very common, especially autoimmune thyroid diseases. At least 10 percent of the population suffer from a thyroid disorder and an estimated 13 million people in the United States have thyroid dysfunction and don’t know it. (R)
In some populations, the prevalence is almost 25% (R)
Up to 20% of women greater than 60 years of age have subclinical hypothyroidism as well. (R)
The complex relationship between environmental, genes, gut health and diet will be explored in this blog post.
An autoimmune disease is when the body sees its own cells as a foreign invader and starts to attack itself. Some examples include diabetes, Celiac Disease, Rheumatoid Arthritis (RA), Systemic lupus erythematosus (lupus), and Multiple Sclerosis (MS).
Autoimmune diseases can attack either
A single organ or tissue (ie the pancreas in diabetes, and the joints in RA. (1)
Can wreak havoc on the entire body organs and systems like in lupus. (1)
In the case of the thyroid autoimmunity, it is defined by thyroiditis or inflammation of the thyroid gland. There are three types of thyroiditis which include Hashimoto’s, Drug-Induced Postpartum thyroiditis, and subacute thyroiditis. (2)
One autoimmune disease involving the thyroid is thyroiditis or inflammation of the thyroid cells. In this condition antibodies will attack the thyroid, leaving its cells damaged and inflamed. This is often an autoimmune disease and is caused in part by a virus, bacteria, drugs, food reactions, or pregnancy. (2)
Thyroid remedies, therefore, often benefit from concepts that help other autoimmune conditions, including lifestyle changes. Autoimmune conditions continue to be on the rise, suggesting that environmental factors are the biggest influence. Therefore, environmental factors, including food, could play a role to cure hypothyroidism and hyperthyroidism.
Hashimoto’s Thyroiditis is also known as chronic lymphocytic thyroiditis. It is the most common cause of hypothyroidism in the US. (3). This autoimmune disorder is when antibodies form and attack the thyroid leading to chronic inflammation. This disorder tends to be hereditary and runs in families. This disorder primarily affects middle-aged women, but can also occur in men, children, and women of other ages. (4)
Hashimoto’s does not have any unique characteristic symptoms. It progresses slowly over many years and will only be present as thyroid peroxidase (TPO) antibodies in the blood. Hashimoto’s causes slow and chronic inflammation which will damage thyroid cells and lead to an enlarged thyroid or (goiter). If untreated it can result in a reduction of thyroid hormone production leading to an underactive thyroid (hypothyroidism). Symptoms of hypothyroidism include fatigue, weight gain, constipation, increased sensitivity to cold, dry skin, depression, muscle aches and reduced exercise tolerance, and irregular or heavy periods. (4)
Postpartum & Painless Thyroiditis
This inflammation of the thyroid occurs after delivering a baby. It is characterized by elevated levels of thyroid hormone known as thyrotoxicosis and is followed by a temporary low level of thyroid hormone or hypothyroidism. (2)
Post-Partum thyroiditis occurs in about 5 to 10 percent of pregnant women. Some populations are at greater risk for this condition and they include those with already existing autoimmune disorders, those who test positive for antibodies, those with a history of thyroid dysfunction, and previous post-partum thyroiditis, and those who have family members with thyroid issues. (5)
Post-Partum Thyroiditis occurs after the delivery of a baby, while Painless Thyroiditis occurs in men and also non-pregnant women. There are two phases of these conditions. The first phase is known as the thyrotoxic phase which is when there is excess thyroid hormone being produced. Hypothyroidism is the second phase. About 1/3 of patients will go through both phases while one-third of patients will only experience one of the two phases. The thyrotoxic symptoms will last anywhere from one to three months and include anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. The hypothyroid phase occurs one to three months after the thyrotoxic phase and can occur over a period of 9 to 12 months. Symptoms include fatigue, weight gain, constipation, dry skin, depression, and reduced exercise endurance. About 80 percent of patients will regain normal function of their thyroid within 12 to 18 months after symptoms surface. (2)
The cause of this disorder is unknown but it is thought to be similar to Hashimoto’s. In this condition, anti-thyroid antibodies including anti-thyroid peroxidase and antithyroglobulin antibodies are formed. Women with these antibodies are more likely to develop post-partum thyroiditis. It is believed that women who develop this condition already may have a thyroid condition that just does not show any symptoms, and is triggered after pregnancy when immunity can waver. (5)
Subacute thyroiditis is another inflammatory thyroid condition that has the same pathology as painless and post-partum thyroiditis but often will trigger thyroidal pain. Subacute thyroiditis features excess production of thyroid hormone for one to three months. But some patients with pain will not endure this thyrotoxicosis. Like in painless and post-partum thyroiditis thyroid abnormalities will subside after 12 to 18 months in about 95 percent of patients. This condition is the major cause of pain in the thyroid and usually does not reoccur after symptoms subside. (2)
Drug-Induced & Radiation Thyroiditis
Drug and radiation can cause inflammation of the thyroid. It can be caused by interferon and amiodarone. This condition is characterized by short-lived thyrotoxicosis and hypothyroidism. Symptoms usually subside once the medication is no longer taken. Effects of radiation are usually permanent.(2)
This is a sudden inflammation brought on by an infection. Symptoms include pain, illness across the organs and tissues. It also features painless enlargement of the thyroid and low thyroid function (hypothyroidism). Once the infection goes away the inflammation goes away. (5)
Unlike Hashimoto’s Graves’ disease is inflammation of the thyroid gland causing an overproduction of thyroid hormone. An increase in thyroid hormone can rev up the metabolism causing weight loss, nervousness, a fast heartbeat, and sensitivity to heat. Fifty percent of those with Graves’ disease will exhibit a symptom called exopthalmos or bulging eyes. (6)
Thyroid Remedies & the Gut
Like most disease states, the management of thyroid autoimmunity starts in the gut. This complex system is regulated by an outer intestinal tissue called the epithelium. This intestinal epithelial is a barrier that protects it from the outside environment. (7) This membrane is also linked together by channels called tight junctions (TJ) proteins.
The TJ helps to transport substances into the gut for the digestion of nutrients, water, and electrolytes. These channels should remain closed. However, If there any malfunctions in the TJ it can lead to unwanted visitors including antigens, pathogens, bacteria, and viruses leaking out into the bloodstream. (7)
When the channels are constantly open the gut will be permeable and leaking substances, hence the term “leaky gut.” (7)
Gut infections due to candida or small intestinal bacterial overgrowth (SIBO) lead to an imbalance of bacteria in the microbiome and result in leaky gut. These often occur due to nutrient-depleted diet, chronic stress, and medications such as antibiotics, steroids, and birth control pills. (7)
While this barrier is the first line of defense, the body’s immune system provides other avenues of defense when the gut is compromised. When it detects a foreign invader the immune system will produce an immune response in the form of mucus, antibodies, and immunoglobulins. (7)
Once the gut becomes compromised it can set off a chain reaction of immune responses which can lead to autoimmune diseases such as inflammatory bowel disease (IBD), celiac disease (CD), autoimmune hepatitis, type 1 diabetes (DM1), multiple sclerosis (MS), and systemic lupus erythematosus (SLE). (7)
Just like in other diseases, as TJ weaken, the intestinal barrier begins to erode, leaving the body exposed and susceptible to bacterial antigens. These foreign invaders can lead to an immune response which autoimmune conditions. (8)
Different factors can attribute to having a leaky gut.
Having a close relative who has leaky gut will give someone a great risk for having the same condition. However, when there is a genetic link it must be activated by an environmental trigger. Toxins (taken in through the skin or orally), high antibiotic use, chemicals (in food and products), or a poor diet high in processed foods and sugar and low in fiber can lead to getting an autoimmune disease. (7)
Those without a genetic link may have to look to their diet and lifestyle for the cause of their leaky gut as these habits can play a role in immune function. Environmental triggers include diet, poor stress management, smoking, alcohol consumption, and toxins such as heavy metals, viruses, bacteria, emotional stress, and drugs. (9)
In regards to the environmental triggers, there is also the “hygiene hypothesis” which assumes the cause of autoimmune disease had to do with our obsession with cleanliness and having little exposure to microorganisms as children. According to this theory, it shows there could be some protective properties from certain microorganisms while others can increase the risk of the Epstein-Barr virus (EBV). (10)
The Epstein-Barr Virus (EBV) has been associated with thyroid autoimmune disorders.
The Epstein-Barr virus is also known as human herpesvirus 4, is a member of the Herpesviridae virus family. This virus can cause infectious mononucleosis (IM) better known as “mono” or the “kissing disease.” (11)
The way EBV leads to allergies and autoimmune diseases is not completely clear but it causes infections in the form of bacteria and viruses through both genetic and environmental triggers. The virus has also been seen to change how the body responds to foreign invaders. (12)
Once in the system, it can lay dormant but it that is not always the case and can result in a serious EBV-related illness later in life. That is why autoimmune diseases can be accompanied by severe symptoms. (12)
There is a link between EBV and several autoimmune disorders and is also a leading cause of thyroid autoimmune disease. Autoimmune thyroid disorders (AITDs) have occurred more frequently in those who also have been also positive with herpes virus DNA which points to the Epstein-Barr virus (EBV) infection as a cause for these conditions. Graves’ disease was also seen as more severe in those with infectious mononucleosis due to a primary EBV infection. (12)
The Epstein-Barr virus (EBV) has been shown as a cause for thyroid autoimmunity in both vitro and in vivo research. B lymphocytes infected with EBV produced an autoimmune response with a presence of thyroid antibodies in the blood of Grave’s disease patients as well as healthy subjects. This autoimmune response can increase the risk for thyroid autoimmune diseases or further intensify an already existing autoimmune condition. (13) Consistent findings have been replicated within human studies. Children with mono due to EBV infection were found to produce the same thyroid antibodies on B immune cells consistent with those found in test tube studies. These studies shed light on the production of Graves’ disease as a result of the Epstein-Barr virus. (14)
The EBV infection has also been seen in a high percentage (81%) of Hashimoto’s thyroiditis and Graves’ disease (62%) which can indicate there is a correlation between this virus and how thyroid autoimmune disorders can occur. (15)
Diet has been shown to be a big factor in setting off autoimmune as well as inflammatory responses. Two diet factors include processed sodium chloride and saturated fatty acids. These substances have been shown to be risk factors in diseases that stem from chronic inflammation including stroke, hypertension, cardiovascular diseases, and autoimmune conditions. (16)
Processed and fast food is often high in sodium chloride which causes chronic inflammation among monocytes, while macrophages were limited in their ability to prevent an autoimmune response from T cells. (9) High salt diets have been shown to enhance inflammation in MS patients. This is evidence of how diet plays a role in autoimmune conditions. (16)
Short-chain fatty acids (SCFA) have been seen to improve gut health by producing butyrate. Butyrate is a substance that feeds the intestinal membrane (17) to help calm inflammation from toxic bacteria in the bowel.
When mice were given butyrate they had an increase in the number of Treg immune cells which have been shown to prevent autoimmune disorders. The incorporation of foods with SCFA can be helpful for decreasing autoimmune responses. (16)
Other substances that help produce SCFA are inulin, fructooligosaccharides (FOS), resistant starch, and pectin. Inulin comes from artichokes, garlic, leeks, onions, wheat, rye, and asparagus. FOS is found in various fruits and vegetables, including bananas, onions, garlic, and asparagus. Resistant starch comes from rice, barley, grains, green bananas, legumes and potatoes that have been cooked and then cooled. Pectin is found in apples, apricots, carrots, and oranges. (18)
As we know, high intake of short-chain fatty acids (SCFA) help promote regular digestion and improve bowel health. However, too many medium- and long-chain fatty acids (MCFA and LCFA) found in the Standard American Diet can worsen autoimmune symptoms in disorders like MS.(16)
Therefore, part of a way to regulate the thyroid naturally may include changes in SCFA intake, which may include coconut oil, MCT oil, or supplemental butyrate. Thyroid remedies may also include a reduction in processed foods with sodium chloride.
High Fat, Carbohydrate, & Sugar Diet
High consumption of unhealthy fat, refined sugar, and simple carbohydrates can affect the intestinal barrier and lead to bacterial overgrowth and leaky gut. Mice fed a 30 percent fructose solution for 8 weeks exhibited a loss of TJ proteins and an increase in toxic bacteria in the gut.(19)
Although we don’t have clinical trials yet, limiting high-sugar and certain types of fats including transfat and hydrogenated oils are likely part of how to control thyroid levels.
Zonulin & Leaky Gut
Zonulin has been shown to increase gut permeability and lead to an immune response. Zonulin was discovered in 2000 by a team of researchers at the Maryland School of Medicine. The protein is found in the cells of the intestinal wall and has been called a “tight junction regulator” since it controls the opening and closing of channels in the intestine. (20)
Zonulin is a haptoglobin protein. This type of protein binds with hemoglobin to prevent iron loss and kidney damage during hemolysis or destruction of red blood cells. (21)
Haptoglobin 2 (HP2) has been implicated in immune conditions including Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE) and T1D. Haptoglobin 2 has also shown up more in patients with IBD (UC and CD) when compared with healthy subjects. (21)
Haptoglobin measures the amount of destroyed red blood cells. This protein also indicates infection and inflammation depending on levels of detected in the blood. (22)
When the concentration of haptoglobin increases, it is known as the positive-acute phase, which means there is inflammation. The level decreases it is a negative acute-phase protein and indicates there is no inflammation.
HP1 has an anti-inflammatory effect compared with HP2 which is why zonulin is considered a toxin and harmful for the gut. (25)
Zonulin has been compared to the toxin secreted by the pathogen cholera. (26) Zonula occludin toxin or Zot for short is an intestinal toxin that is transmitted when food contaminated with feces is digested. Zot attaches itself to the intestinal membrane and opens the tight junctions channels. Open channels make the gut permeable and exposed to harmful substances entering the body. (27)
Next, the effects of how foods affect zonulin will be discussed and how these changes may help fix thyroid naturally.
Zonulin & Gluten Consumption
Zonulin is produced when gluten is consumed. It is also released when there is a bacterial infection. When there is zonulin present in the TJ between the intestinal cells do not close and there is an opening or “leakiness” in the gut. This can lead to an inflammatory response which will over time damage the intestines and causes an autoimmune response. (20)
Zonulin has been seen in autoimmune conditions like Celiac disease, type 1 diabetes, Rheumatoid arthritis, and Multiple Sclerosis. (27)
When looking at blood levels those with Celiac disease had higher amounts of zonulin (0.033 ng/mg), compared with those who exhibited Non-Celiac Gluten Sensitivity (NCGS) (0.030 ng/mg) or diarrhea-predominant Irritable Bowel Syndrome (IBS) (0.012 ng/mg). Healthy individuals exhibited 0.007 ng/mg of zonulin. This is 78 percent less zonulin than those with Celiac, 76 percent less than those with NCGS, and 42 percent less than those with IBS. (20)
Diet also plays a role in zonulin production, specifically the consumption of gluten. Those with NCGS had decreased zonulin levels when they consumed a gluten-free diet. (20)
Findings from this research have shown the connection between zonulin production and how it can affect gut health. (20) In those with autoimmune disorders like Celiac disease, zonulin is produced so there is likely a possibility it will be produced in those with thyroid disorders. (28)
While Celiac disease can be rare, Non-Gluten Celiac Disease (NCGS) is prevalent and can often show no symptoms until there is a high amount of zonulin in the body. NCGS occurs when the gut lining is exposed to gluten-containing foods which can lead to either an immune and/or non-immune response. When consumed, gluten causes a rapid immune response that changes the gut microbiome and can upset the balance of bacteria. (29)
Reducing zonulin by reducing gluten in the diet may help regulate thyroid naturally.
Zonulin & Gliadin
Animal and human studies linked gliadin as the mechanism for both Celiac and DM1 autoimmunity due to the release of zonulin in the gut. (8)
When exposed to gliadin, mice and lab rats also experience increased intestinal permeability and a release of zonulin, which opens the epithelial channels and allowing food antigens to enter the blood stream outside the intestinal tract. (8)
Alternatively, when given a gluten-free diet the development of autoimmunity in both mice and rats was suspended. These animal models show the importance of how reducing gluten can prevent autoimmunity.(8)
Human studies showed more intestinal inflammation from gliadin antibodies in children with diabetes when compared with healthy subjects. Zonulin was also associated with the production of Glo-3A antibodies. These non-gluten storage proteins found in wheat are helping to diagnose gluten issues at an earlier stage. (31) Human studies showed a gluten-filled diet was responsible for increases in Glo-3A antibody levels in those with risk for autoimmunity showing there is a difference in the gut immune responses between those with autoimmunity and control subjects. (8)
Those sensitive to gluten are likely to be sensitive to gliadin and should stay away due to zonulin production. This substance has also been shown to activate zonulin production and increasing autoimmune response. (32)
Both gluten and gliadin removal from the diet may be part of how to improve thyroid function naturally.
Autoimmune Disease & The Zonulin Connection
Research on zonulin shows it to be a predictor in autoimmune diseases like Celiac, diabetes as well as cancers and conditions of the nervous system. In addition, zonulin is found on chromosome number 16 which is the same place where these disorders originate. (8) This shows the connection between autoimmunity and zonulin production.
Rats prone to DM1 also have an increased intestinal permeability dominated by zonulin production. When given an oral zonulin inhibitor, these rats experienced no zonulin or autoantibody production. (8)
Preventing the loss of intestinal barrier cells by reducing zonulin production can help to prevent the onset of diabetes in animal studies. When replicated in human studies 50 percent of patients with T1D had exhibited leaky gut and also high levels of zonulin. This signifies that cells are sensitive to zonulin and it is very likely for it to bind to the intestinal barrier. (8)
Even 25 percent of family members unaffected by DM1 experienced increased blood levels of zonulin and compromised gut health illustrating that compromised intestinal permeability is a key component in the path of autoimmune diseases. (8)
Zonulin inhibitors administered to rats also prevented gut permeability further protecting the intestinal epithelium. A decrease in the level of antibodies produced was exhibited in animal studies. (8)
Even if you don’t have a genetic link you can still be susceptible to thyroid and autoimmune diseases. Human studies showed a gluten-filled diet was responsible for increases in Glo-3A antibody levels in those with risk for autoimmunity showing there is a difference in the gut immune responses between those with autoimmunity and control subjects. (8)
Zonulin production occurs in anyone who consumes gluten. Zonulin will damage cells and the tight junctions leading to a leaky gut. (33) After 48 hours the intestinal cells regenerate and the gut will heal. Only this doesn’t happen in those with a thyroid gluten sensitivity or Celiac disease. (34)
Thyroid disorders are often caused by leaky gut due to food sensitivities and allergies. Gluten in any quantity is damaging to the thyroid and will keep producing zonulin and perpetuating an inflammatory response. So every time someone consumes gluten they will continue to damage to their gut lining and harming the health of the thyroid. So those with a thyroid disorder are more likely to have a gluten sensitivity.(34) These sensitivities can have no physical symptoms and that is why it is imperative to get tested for gluten and wheat sensitivity NOT just Celiac disease.
Exposure to bacteria and gluten are powerful triggers to release zonulin production in the small intestine. Impairment of the intestinal wall results from food and water consumption and is a leading cause of allergies, sensitivities, autoimmune and inflammatory diseases. (35)
How to fix the thyroid naturally? Eliminating gluten appears to be a reasonable place to start the journey.
Zonulin & Bacterial Overgrowth
Zonulin’s ability to open intestinal channels contributes to the presence of bacterial overgrowth in the small intestine. Like gluten, gliadin is another protein found in wheat and has also been shown to produce zonulin leading to the breakdown of the intestinal barrier. (36) High levels of zonulin have been produced in those with Celiac disease (37) when exposed to gluten or bacteria, fungi, or viruses. (38)
Genetic predisposition has also been shown to lead to zonulin production. Specifically, genes HP2-1 and HP2-2 produce zonulin in the intestine. Having one copy of these has been hypothesized to increase the risk factor for developing Celiac disease. Two copies of these genes will result in malabsorption due to the breakdown of the intestinal barrier. Those with CD had a higher percentage of HP2 genes when compared with healthy subjects. This indicates that only 7 percent of CD patients do not have the zonulin gene. (8)
It has been hypothesized that restoring gut barrier will help to reduce leaky gut. Research of a zonulin inhibitor was used in animal and double-blind, randomized placebo-controlled human models. Those given the placebo had a 70 percent increase in gut permeability verse no changes in the group given the zonulin inhibitor. Both groups exposed to gluten experienced an inflammatory response with IFN-y antibodies increasing in 4 of the 7 patients (57.1%) of the placebo group. Only 4 of the 14 patients (28.6%) in the inhibitor group had a reaction. The placebo group also had more GI issues than the inhibitor group. This evidence points to the fact that reducing inflammatory responses is important to reduce gluten exposure. (39)
The most powerful triggers for zonulin production were gluten and bacteria exposure leading to allergies, sensitivities, and inflammatory diseases caused by a compromised gut barrier. (39)
There is also evidence that when the small intestine comes in contact with bacteria it can produce zonulin and lead to intestinal permeability. (40) This autoimmune defense against unwanted microorganisms has also been seen with gliadin when placed on the inside of the intestine (41) specifically when gliadin binds to the cell receptor CXCR3 (42) with the help of the protein MyD88 (43) zonulin will be produced.(44)
Thyroid & Gluten Intolerance
Research shows gluten-free diets are recommended for those with autoimmune disorders including Hashimoto’s and Graves’ disease. (45)
Even those with regular hypothyroid or hyperthyroid symptoms can benefit from going gluten-free. According to one study, 71 percent of patients normalized their intestinal barrier and also improved their thyroid symptoms by going on a strict gluten-free diet for one year. Removal of gluten from the diet may greatly improve thyroid abnormalities. (46)
A gluten-free diet should be considered as part of alternative treatment for hypothyroidism and hyperthyroidism.
Treatment For Non-Celiac Gluten Sensitivity (NCGS)
Research is underway to find additional ways to help alleviate NCGS symptoms. One study uses probiotics to see if there is a reaction when gluten is introduced to a gluten-free environment. The controlled study evaluates how patients react to two slices of bread each day for 7 days while also taking either a placebo or the probiotic Bifidobacterum longum ES1, a patented probiotic bacterial strain. (29) Another study uses the enzyme Aspergillus niger prolyl endoprotease (AN-PEP) as a therapy for NCG. It was shown to digest gluten in healthy subjects. (47) A 2017 double-blinded, placebo-controlled study showed a tablet of this enzyme taken with a meal was effective at protecting the gut zonulin degradation in those sensitive to gluten. It was able to degrade small amounts of gluten and is not intended as a digestive aid and not to replace a gluten-free diet. (48)
Another treatment option has been that of ancient diploid wheat species. They are lower in toxicity when used in celiac disease cell studies. There is a lower amount of compounds known as Amylase-Trypsin Inhibitors (ATIs) in comparison with modern wheat. These compounds cause autoimmune responses by binding to cell receptors on immune system proteins. Enzymes are no match for the toll-like receptor ATI complex that is formed (48) Further research on these ancient kinds of wheat needs to be evaluated as a positive treatment for zonulin production. (49)
Although the best remedy for thyroid disorders still needs to be elucidated, non-celiac gluten sensitivity needs to be managed for the best outcomes.
There is no known cure for hyperthyroidism or hypothyroidism. The research authors generally agree, however, that gluten elimination could benefit thyroid function.
Knowing that gluten and gliadin are responsible for zonulin production and the breakdown of the gut lining, it is imperative to receive treatment. In order to prevent zonulin production and autoimmune response gluten must be removed from the diet.
Those with celiac and NCGS should be put on a gluten-free diet.
What is a Gluten-Free Diet?
A gluten-free diet does not mean you have to have a diet that is grain free. Instead it means eating only gluten free grains and avoiding any foods with grains, wheat, gluten, and gliadin. Those consist of both whole grains and non whole grains including wheat, barley, rye and oats that are not gluten-free. This also includes any packaged food that may contain wheat or gluten proteins.
What What You Can Eat on a Gluten Free Foods Diet
Foods That Don’t Contain Gluten
- Meats, poultry, and fish
- Dairy: Check labels for ice cream, yogurts, puddings, or other flavored dairy products.
- Grains and other: Include rice & brown rice corn, teff, buckwheat, tapioca, sorghum, gluten-free oats (make sure they are labeled gluten-free)
- Starches and flours that are potato, pea, nut-based or made with the grains listed above.
- Raw nuts and seeds. If you get any flavored varieties be aware of any possible gluten containing ingredient. Be sure the label say gluten free
- Oils and fats: all single-ingredient oils and fats like butter are gluten-free
- Fresh herbs and spices are gluten free. Beware of some packaged spices may have gluten containing ingredients. Seasoning blends may have hidden gluten in the form of wheat starch, wheat crumbs or hydrolyzed wheat protein. If in doubt check the label for these ingredients
- Bone broth
- Gluten Free Drinks: Most beverages are gluten free with the exception of beer and some alcohols. Wine, Vodka made from potato or rice and Tequila made from 100 percent Agave are gluten free. Flavored beverages sometimes have gluten so make sure to check the label if you are unsure.
What to Avoid on a Gluten Free Diet
Foods that Contain Gluten or Might Contain Gluten
Meal Plans and recipes should not include any of the following:
- Wheat and wheat products: Farina, kamut, semolina, spelt, pasta, barley, rye, oats that are NOT gluten-free
- Baked goods such as bread, cakes, cookies, granola bars, pasta, and other sweets)
- Processed or flavored animal products: Beef, chicken, pork, fish, shellfish and wild game; eggs, yogurt, kefir, cottage cheese, milk (cow or goat)
- Alcohol that is made of gluten-containing grains
- Beer that is made from rye, wheat, barley, and other gluten grains
- Seasoning blends, sauce mixes, gravies and dressings
- Barley products and beer or ale made from barley
- Malt products such as malt vinegar, malted milk, malt flavor
- Soy sauce and teriyaki sauce
- Energy bars, trail mix
- Cereals, oats (unless they say certified gluten-free)
- Breaded foods: meatballs, veggie burgers, deli meat, cold cuts, imitation crab Nuts: almonds, walnuts, peanuts, cashews, pistachios, Brazil nuts
- Deli meat & cold cuts
- Imitation crab
- Veggie Burgers
- Prescription and over-the-counter medications and supplements
- Dark chocolate (70% or more cocoa) with gluten additives
- Cosmetic products and skincare products
- Wine with gluten cross-contamination from barrels sealed with wheat paste
If you are having reactions from “gluten-free” foods you may still be reacting to the trace gluten that can be present. Naturally, gluten-free foods may have gluten-containing ingredients added to them during processing, therefore it is always recommended to read labels before consuming.
Gluten-Free Food Labeling Is Voluntary
Products that are labeled “gluten-free” may still contain trace amounts of gluten. According to the US Food and Drug Administration (FDA) foods with a gluten-free label can still have up to 20 parts per million of gluten. This number was determined by the research on those with Celiac disease shown to have been able to tolerate without further symptoms or intestinal damage.
Products that included in this category are those that are even labeled “gluten-free” and may be enough to produce gluten symptoms. (50)
The “gluten-free label is not mandated by the FDA even if the product contains the “gluten-free” requirement. (51)
So What Does This Mean for Those with Celiac & NCGS
You should be aware there could still be gluten in your food. The best way to become gluten-free is to eat a high-quality diet of naturally occurring gluten-free foods.
With the rise in gluten Celiac and NCGS individuals, a whole new line of gluten-free processed foods has been developed for consumption. Note that in order for these foods to taste similar they will use binders and additives such as gums, carrageenan, xantham gum, and guar gums. These compounds have been found to damage intestinal barriers as similar to how gluten and wheat open the TJ and permeate the gut (52)
Abstaining from gluten will help to heal the intestinal wall and combat any digestive symptoms that may occur when gluten is consumed. Often for full recovery of the gut lining, those with NCGS should continue a gluten-free diet for the rest of their life. (53)
Information on the reintroduction of gluten to an NCGS individual is limited in the research (54) but it should be noted when gluten is taken out of the diet it has been shown to reduce the risk of developing type 2 diabetes and coronary heart disease. (55,56) It is important to understand that the data collected in this study was collected in 1986, much before people began following diets as a trend. (57) This likely creates a selection bias in the purported risks of a gluten-free diet because it is well-known that Celiac disease is known to increase the risk of many chronic diseases, including cardiovascular disease. (58)
Although gluten-free diets (GFD) seems to be the most important management strategy, it should be suggested only after careful examination and a definite diagnosis of NCGS. (29) The cure for thyroid disorders is likely multifactorial.
Thyroid issues, even if they are temporary are highly tied to the health of the gut. Often gluten is a pro-inflammatory food for many people with thyroid conditions. Elimination of gluten and healing of the gut are steps necessary for health benefits and improving function of the thyroid. A gluten-free diet plan is likely part of the best natural treatment for hypothyroidism and hyperthyroidism. Diets that eliminate gluten are helpful in seeing if there is any NCGS present. However, a sure fire way to know if you have a gluten sensitivity issue is to get a blood or stool test.