Hashimoto’s Thyroiditis: Should I be Gluten Free?

December 14, 2023by Cook Learn Live
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What is Hashimoto’s Thyroiditis?

Hashimoto’s Thyroiditis is an autoimmune disease that harms the thyroid gland. The presence of two types of antibodies —thyroid peroxidase antibodies (anti-TPO) and thyroglobulin antibodies (anti-TG)—in the body leads to chronic inflammation, resulting in progressive damage to the thyroid gland. The body can initially compensate for the damage by increasing thyroid-stimulating hormone (TSH) to produce an “in range” amount of the thyroid hormones T3 and T4. As the damage continues, however, the thyroid can no longer compensate and either produces an insufficient amount of hormones or none at all. Symptoms of Hashimotos may include but are not limited to fatigue, increased need for sleep, constipation, weight gain, hair loss, dry skin, muscle aches, joint pain, depression, concentration issues, cold sensitivity, puffy face, brittle nails, hair loss, and an enlarged tongue. Hashimoto’s Thyroiditis is usually treated by replacing thyroid hormone through medication.  

Nutrition & Hashimoto’s

Nutrition plays an important role in the management of Hashimoto’s Thyroiditis. Eating a balanced diet of protein, healthy fats, and complex carbohydrates aids in protecting the thyroid. It is also important to maintain an ample intake of important micronutrients such as selenium, iron, antioxidants, zinc, magnesium, vitamin D, and vitamin B12.  Eating a varied and balanced diet that includes lots of different types of vegetables, fruits, legumes (beans), nuts and seeds, lean dairy or alternatives, and lean meat and fish or alternatives will usually provide these nutrients.  However, in some cases, supplements may be recommended if a patient is unable to get what they need through diet.

Gluten & Hashimoto’s

There is a growing debate on whether eating a gluten-free diet (GFD) has benefits for Hashimoto’s patients. Hashimoto’s is frequently associated with many other autoimmune conditions, most notably celiac disease, and the two conditions share a number of similarities.. The concentration of anti-tissue transglutaminase (anti-tTG) antibodies, the marker of immune response to gluten, seems to be associated with the concentration of anti-thyroid antibodies, resulting in a possible reduction of thyroid autoimmunity. There is anecdotal evidence that avoiding gluten can help Hashimoto’s patients as it does those with celiac, but research is still being done.

Research

There are conflicting studies on the benefits of a GFD for Hashimoto’s Thyroiditis, with some finding it improves antibody concentration and others finding no influence. One study investigated antibody levels in women with thyroid autoimmunity after eating a GFD for 6 months. The women tested positive for anti-tissue transglutaminase but did not have any symptoms of celiac disease. The results showed a decrease in thyroid antibodies and an increase in vitamin D levels. One of the authors stated, “the most significant effect was observed in those whose level of antithyroid antibodies was the highest, and those patients might benefit from GFD.”

Other studies have not agreed. Researchers investigated 62 Hashimotos patients; one half on a GFD and the other not. Results showed no influence after 3 and 6 months. The authors ruled out the diet having an effect on thyroid hormone levels but said it may have an impact on thyroid antibodies. The study concluded that “gluten should only be eliminated by patients suffering from celiac disease or gluten sensitivity, which may coexist with Hashimoto’s disease. A gluten-free diet does not affect the concentration of thyroid hormones.” 

Regardless of clinical results, many patients have reported feeling better on a GFD. Izabella Wentz, Doctor of Pharmacology, has spent the majority of her career researching Hashimoto’s, publishing 3 books. In 2015, she developed a survey to find out what factors worsened or improved symptoms. She received 2,232 responses from Hashimoto’s patients, of which 3.5% were also diagnosed with celiac disease. The results showed that 86% who reported being gluten-free had improved digestive issues and mentally related-symptoms such as brain fog and anxiety.  

Gluten-Free Nutrition Risks

Following a gluten-free diet requires knowledge and attention to detail to avoid the risk of malnutrition.  Processed, packaged, gluten-free products are complex, often containing additional carbohydrates and fats, and frequently have fewer nutrients than their gluten-containing alternatives. Deficiencies of key nutrients such as B vitamins and calcium are commonly seen in people following a GFD that relies primarily on processed, packaged, gluten-free foods.

What Should You Do?

 Should you eat gluten-free if you have Hashimoto’s? With more research needing to be done and no concrete evidence, that answer is up to you. Do additional research from credible sources, weigh the pros and cons, and look at the big picture of your life, including your health and lifestyle, to determine if a GFD is feasible for you. If this is a change you would like to make, talk to your doctor, consult with a registered dietitian, and carefully implement changes that eliminate gluten while maintaining a balanced diet.  Try a GFD for a few months to see if it makes a positive difference in your thyroid labs. We will hopefully have more solid evidence on this question in the future.

Brands/Products   

 Check out these less-processed gluten-free products and brands. Remember to check that the items are gluten-free as not every brand only makes gluten-free products. You also don’t need to be gluten-free to still enjoy!       

Try These Out!

Here are a few recipes that are gluten-free to make at home to eliminate SOME (not all) processed items. If you are not going gluten-free, still give these yummy recipes a try!

Guest author Christa Vasile, Dietetic Intern, is a graduate student in Pace University’s Nutrition and Dietetics Coordinated Masters Program. 

Oatmeal Bake

Course Dessert
Cook Time 25 minutes
Total Time 30 minutes
Servings 1
Calories 450 kcal
Author Alyssa Wengrofsky

Ingredients

  • 1 egg
  • 1/2 ripe banana
  • 1/4 cup milk of choice
  • 1/2 cup oats
  • 1/4 tsp baking soda
  • 1/8 tsp salt
  • 2 tbsp chocolate chips

Instructions

  1. Preheat oven to 350F.

  2. Add ingredients into blender except chocolate chips & blend.

  3. Stir in chocolate chips.

  4. Place in oven safe pan / bowl and bake for 25 minutes.

Nutrition Facts
Oatmeal Bake
Amount Per Serving (1 g)
Calories 450 Calories from Fat 153
% Daily Value*
Fat 17g26%
Saturated Fat 8g50%
Cholesterol 201mg67%
Carbohydrates 66g22%
Fiber 8g33%
Sugar 29g32%
Protein 16g32%
* Percent Daily Values are based on a 2000 calorie diet.

 

Gluten Free Pizza Crust

Course Main Course
Prep Time 15 minutes
Cook Time 50 minutes
Total Time 1 hour 5 minutes
Servings 8
Calories 215 kcal
Author Minimalist Baker

Ingredients

  • 1 tbsp dry active yeast
  • 1 1/4 cups warm water divided
  • 2-3 tbsp sugar divided
  • 3 cups gluten free flour blend see notes - combination of white rice flour, brown rice flour, tapioca flour, and xanthan gum
  • 1 tsp salt
  • 1/2 tsp baking powder
  • 1 tbsp olive oil

Instructions

To Make Gluten Free Flour Blend

  1. To make three cups of GF flour blend: combine 1 cup white rice flour, 1 cup brown rice flour, 1 cup tapioca flour and 3/4 tsp xanthan gum.

Make

  1. Preheat oven to 350F.

  2. In a small bowl, combine yeast and 3/4 cup warm water - about 110F. Too hot and it will kill the yeast! Let set for 5 minutes to activate. Sprinkle in 1 Tbsp of the sugar a few minutes in.

  3. In a seperate bowl, combine gluten free flour blend, salt, baking powder and remaining 1-2 Tbsp of sugar depending on preferred sweetness. Whisk until well combined.

  4. Make a well in the dry mixture and add the yeast mixture. Add the olive oil and additional 1/2 cup warm water before stirring. Then stir it all together until well combined using a wooden spoon if able.

  5. If using the whole dough to make one large pizza, spread onto a generously greased baking sheet or pizza stone. Otherwise, make one smaller pizza and reserve the other half of the dough, wrapped in the fridge for several days. Using your hands and a little brown rice flour if it gets too sticky, work from the middle and work to spread/flatten the dough out to the edge. You want it to be pretty thin - less than 1/4 inch.

  6. Put the pizza in the oven to pre-break for roughly 20-25 minutes or until it begins to look dry. Cracks may appear whuch is normal anf okay.

  7. Remove from oven and spread pizza sauce, cheese, and toppings of choice. Put back in the oven for 15-25 minutes (depending on toppings), or until the crust edge beings to look golden brown and toppings are warm and bubblt.

  8. Cut immediatly and serve. Reheats well next day in microwave or oven.

Recipe Notes

The gluten-free flour blend is highly suggested but if you prefer use an all-purpose gluten-free flour.

Nutrition Facts
Gluten Free Pizza Crust
Amount Per Serving
Calories 215 Calories from Fat 9
% Daily Value*
Fat 1g2%
Carbohydrates 48g16%
Fiber 2g8%
Sugar 3g3%
Protein 3.2g6%
* Percent Daily Values are based on a 2000 calorie diet.

 

Trail Mix

Course Snack
Prep Time 5 minutes
Total Time 5 minutes
Servings 6
Calories 403 kcal
Author Jennifer Bigler

Ingredients

  • 2 cups nuts suggestion: macadamia, almonds & pistachios
  • 1 cup dried fruit suggestion: cherries & cranberries
  • 1/4 cup chocolate chips

Instructions

  1. In a bowl, mix all ingredients together.

Recipe Notes

Optional: add in other ingredients you enjoy, such as pretzels or raisins! 

Nutrition Facts
Trail Mix
Amount Per Serving
Calories 403 Calories from Fat 234
% Daily Value*
Fat 26g40%
Saturated Fat 4g25%
Carbohydrates 37g12%
Fiber 4g17%
Sugar 24g27%
Protein 8g16%
* Percent Daily Values are based on a 2000 calorie diet.

 

Super Seedy No-Grain Crackers

Course Snack
Prep Time 10 minutes
Total Time 30 minutes
Servings 6
Calories 195 kcal
Author CLL

Ingredients

  • 1/2 cup pumpkin seeds
  • 1/4 cup psyillum husks
  • 1 cup flax seed ground
  • 1/3 cup hemp seeds
  • 1/4 cup chia seeds
  • 1 tsp cumin ground
  • 1 tsp oregano dried
  • 1/2 tsp garlic powder
  • 1/2 tsp onion powder
  • 1 tsp salt
  • 1/2 tsp black pepper
  • 1 1/2 cups water

Instructions

  1. Preheat oven to 200F and line a baking sheet with parchment paper.

  2. Add pumpkin seeds to your food processor and pulse until it is a coarse powder.

  3. Add the rest of the ingredients, except water, and pulse to combine.

  4. Place in a bowl and mix with water. Set aside to gel for 5-10 minutes.

  5. Place half the dough on a parchment sheet. Spray a second parchment sheet and lay on top.

  6. Gently roll to desired thickness, adjusting the edges as you work to keep it a rectangle.

  7. Remove the top sheet and score dough with a pizza cutter or sharp knife.

  8. Repeat for the second batch of dough.

  9. Place baking sheets in the oven and bake for about 20 minutes - carefully flip and bake an additional 5 minutes for extra crispy crackers.

Nutrition Facts
Super Seedy No-Grain Crackers
Amount Per Serving
Calories 195 Calories from Fat 95
% Daily Value*
Fat 10.6g16%
Saturated Fat 0.5g3%
Sodium 377mg16%
Carbohydrates 21g7%
Fiber 16g67%
Protein 5g10%
* Percent Daily Values are based on a 2000 calorie diet.
References

1. Ihnatowicz, P., Wątor, P., & Drywień, M. E. (2021). The importance of gluten exclusion in the management of Hashimoto’s thyroiditis. Annals of agricultural and environmental medicine : AAEM, 28(4), 558–568. https://doi.org/10.26444/aaem/136523

2. Szczuko, M., Syrenicz, A., Szymkowiak, K., Przybylska, A., Szczuko, U., Pobłocki, 2. J., & Kulpa, D. (2022). Doubtful Justification of the Gluten-Free Diet in the Course of Hashimoto’s Disease. Nutrients, 14(9), 1727. https://doi.org/10.3390/nu14091727

3. Wentz, Izabella with Nowosadzka, Marta. (May, 2013). Hashimotos Thyroiditis Lifestyle Interventions for Finding and Treating the Root Cause. Wentz LLC.  

4. Wentz, Izabella. (January 2022). Is Gluten the Root Cause of Your Thyroid Condition? Dr. Izabella Wentz, PharmMD. https://thyroidpharmacist.com/articles/gluten-root-cause-thyroid-condition/

5. (January 15, 2022). Hashimotos disease: Overview. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855