Gluten Sensitivity – Prevalence & Association with Thyroid Autoimmunity

Let’s discuss prevalence of gluten sensitivity, and how often it is associated to autoimmunity, including thyroid autoimmunity. The information we will discuss will help to counter-balance the overzealous dialogue that permeates gluten discussion. Thus providing you with accurate and reasonable guidelines regarding gluten in your diet.

Dr. R’s Fast Facts

In this study Trusted SourcePubMedGo to source, with over 12,000 patients, they were looking to see if patients had Non-celiac gluten sensitivity (NCGS) or not. (They were not looking to disprove gluten sensitivity).

  • 3% of subjects were found to have NCGS
  • In the US, NCGS estimates range from 0.6-6%
  • Of the 3% that had gluten sensitivity
    • 14% of these cases had autoimmunity of some kind
    • 9% of which was Thyroid Autoimmunity

Other noteworthy conclusions:

  • 30% of NCGS cases may resolve after treating another underlying GI issue – SIBO, FODMAP, Colitis etc.
  • They found that over 90% of people had a discernible reaction within 24 hrs of reintroducing gluten.

**Full study summary available here, subscription required

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Dr. Michael Ruscio: Hi, this is Dr. Ruscio. Let’s discuss how prevalent is non-celiac gluten sensitivity or, said more simply, being gluten sensitive. And also, how commonly is being gluten sensitive associated to autoimmune conditions? And more specifically, we’ll discuss thyroid autoimmunity.

Now, we’ve discussed bits and pieces of this multicenter Italian study in the past. But I wanted to tie together a few of the more important aspects of this to help provide you with a better understanding of how prevalent gluten sensitivity is to help give you a more realistically calibrated expectation regarding, do you have a problem with gluten, or do you not have a problem with gluten?

And unfortunately, I think we’ll need to juxtapose what the science actually says, which will be somewhat contrasting to what popular belief may have you thinking.

Gluten Sensitivity – Prevalence & Association with Thyroid Autoimmunity - Tile StudySo let me start by putting the abstract up here on the screen. “An Italian Prospective Multicenter Survey on Patients Suspected of Having Non-celiac Gluten Sensitivity Trusted SourcePubMedGo to source.” In this study a group of physicians worked to ascertain if patients had gluten sensitivity or not.

This was certainly not a group of physicians who were looking to disprove gluten sensitivity. In fact, they came up with a very comprehensive, roughly 60-point examination looking at everything from lab testing to physical examination to subjective questioning to really get a good, accurate assessment. And let’s go through some of their findings.

Three percent of the subjects were found to have non-celiac gluten sensitivity. Now, this was in Italy. And one of the most quick rebukes to this comment is, “Well, it’s different in the United States. There’s more glycophosphate use. There might be more genetically modified wheat.” Okay. So that’s fine. That’s certainly an argument. It’s a speculative argument. So we want to be careful not to just take a speculative point that has no data to support it and inflate that to mean something substantial.

Gluten Sensitivity – Prevalence & Association with Thyroid Autoimmunity - Tile 001This same paper also cites that in the United States, the reported prevalence of non-celiac gluten sensitivity ranges from 0.6% up through 6%. So maybe more common in the United States.

However, even if the data in the United States was underreporting at the 6% of the population and if you wanted to be as liberal with the assignment or the prevalence of non-celiac gluten sensitivity as you could be, let’s say for argument’s sake it was 10% of the population. In this case, we have data showing 0.6 to 6%. But for argument’s sake, let’s say 10%. That is likely still far less than one has been led to believe according to things that they may read or hear on the internet.

And this may not be anyone’s fault. It may just be that the caution and the discerning language is often not used regarding conversations about gluten. We often see this very extreme language being used, or very vague language being used, leaving the health consumer to fill in the gaps in terms of, “Okay. I’ve heard gluten can be very problematic for some people. It can cause thyroid autoimmunity. It can cause inflammation. It can cause leaky gut.”

But along with that narrative, very seldom do you have delivered the information educating you on the prevalence. So again, to say it simply, if you go on the internet and perform some reading, you may easily be led to believe that the vast majority of people have a problem with gluten. And that is a stark contrast to what we’re seeing reported in this study where up to 6% of the population has a problem with gluten.

So it’s very important to keep this in mind so that you can prevent yourself from being indoctrinated to think you have a problem with gluten in absence of any experiential data that supports that.

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Okay, continuing, regarding the association to autoimmunity. So of this 3% in this study sample—by the way, this study sample was 12,225 patients. So it’s a good sample size. Of the 3% that had the gluten sensitivity, 14% of those patients had autoimmunity in general of any type. So that’s definitely significant. And of that 14%, 9% had thyroid autoimmunity.

Gluten Sensitivity – Prevalence & Association with Thyroid Autoimmunity - Tile 003So yes, there is legitimacy to the claim that you can have non-celiac gluten sensitivity in association with autoimmune conditions. And the thyroid seems to be the most prevalent of those.

However, it’s very important to keep in mind that this was 9%. I routinely see patients who come in being led to believe that if you have thyroid autoimmunity, you can never have any gluten ever. And I am certainly all for being progressive and trying to find dietary methods of managing any condition.

However, there is a cost to making overzealous dietary recommendations which is the psychosocial difficulty that is accompanied by a strict, 100% gluten-free diet where I think a gluten-reduced diet would be a much more practical endeavor for most people. You gain the benefit. And it seems that, again, not everyone needs to be fully gluten free as this study is supporting.

Again, I am happy to look at data showing that everyone with thyroid autoimmunity must be 100% gluten free. But if you have an honest objective look at the data, I don’t think that’s there. Yes, it is legitimate. Yes, people with autoimmunity have an increased risk of being gluten sensitive. But is it everyone? No.

In fact, it’s probably the minority of people rather than the majority. Should you go through a gluten elimination and then reintroduction? 100%. I think that is totally a viable suggestion. However, it’s important to have a reasonable outlook so that you don’t self indoctrinate yourself into thinking that you have a problem with gluten when you actually don’t. You should be looking for a discernible reaction.

Gluten Sensitivity – Prevalence & Association with Thyroid Autoimmunity - Tile 004And as this study also found, the majority—over 90% of patients—upon gluten reintroduction, will have a discernible, symptomatic reaction within 24 hours. So to the argument that you may have this thyroid autoimmunity that’s being fueled by gluten and it may never manifest symptomatically for weeks or months or years, again, I’m open. But I don’t see great data to support that.

In fact, I think that hurts more people than helps people because I see people come in who are orthorexic. They’re afraid of food. And they’re avoiding gluten strictly 100% of the time even though when we have them go into a gluten reintroduction they seem to be okay with gluten. Some people are very reactive, yes. But there’s a number of people who actually feel better when they loosen up their diet a little bit and enjoy the ease of having fewer dietary restrictions.

Gluten Sensitivity – Prevalence & Association with Thyroid Autoimmunity - Tile 005And that’s actually a nice segue to the next point which is that 30% of these non-celiac gluten sensitive patients were able to resolve their symptoms after addressing another issue in the gut. So essentially, they had another problem in the gut that was making them look or appear like they had gluten sensitivity. This includes SIBO, FODMAP sensitivity, colitis.

And again, this is likely part of the reason why in the clinic we see people able to reintroduce gluten without much of a problem. Some people never had a problem to begin with. And they were indoctrinated into thinking that they do. Other people had an underlying gut imbalance, if you will, that was leading to what looked like gluten sensitivity. But they actually were not. And when they cleaned up that problem, they were able to tolerate gluten.

So hopefully, this helps calibrate you more proximal to what the data actually shows regarding gluten sensitivity. Gluten Sensitivity – Prevalence & Association with Thyroid Autoimmunity - Tile 006And if you’re struggling with this, I would offer you the protocol that I outline in Healthy Gut, Healthy You, which is my book that walks you through a self help plan. It will help you navigate these confusing waters of rectifying your gut health.

Gluten sensitivity is definitely something to consider as part of your dietary approach. But not everyone has a problem with gluten. Not everyone has to be 100% gluten free. And some people will have an underlying problem in the gut that’s presenting as what looks like gluten sensitivity. But they actually are able to eat gluten, at least to some degree, once they rectify that problem.

So again, hopefully this is helpful. This is Dr. Ruscio. And I hope this information helps you get healthy and get back to your life. Thanks!

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

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20 thoughts on “Gluten Sensitivity – Prevalence & Association with Thyroid Autoimmunity

  1. There are no tests or biomarkers to make a diagnosis of non-gluten sensitivity. So what did these researchers actually determine? Given the above, before going back on the gluten bandwagon, I would not be wowed by studies like this one. I would perform a self study. Eliminate gluten entirely for several weeks and then reintroduce it. See how it affects your gut health and your overall health. One can eat a perfectly healthy and enjoyable diet sans gluten.

    Even if other underlying issues (dysbiosis, SIBO, colitis, etc). are revealed and treated, self test (eliminate gluten then reintroduce it) to be on the safe side -especially if you have an autoimmune disease. Dr. Ruscio likes to play devil’s advocate in these matters. Multicenter study or no, the final word is not in on this topic. Tread carefully!

  2. There are no tests or biomarkers to make a diagnosis of non-gluten sensitivity. So what did these researchers actually determine? Given the above, before going back on the gluten bandwagon, I would not be wowed by studies like this one. I would perform a self study. Eliminate gluten entirely for several weeks and then reintroduce it. See how it affects your gut health and your overall health. One can eat a perfectly healthy and enjoyable diet sans gluten.

    Even if other underlying issues (dysbiosis, SIBO, colitis, etc). are revealed and treated, self test (eliminate gluten then reintroduce it) to be on the safe side -especially if you have an autoimmune disease. Dr. Ruscio likes to play devil’s advocate in these matters. Multicenter study or no, the final word is not in on this topic. Tread carefully!

  3. Dr. R,
    You are neglecting to address molecular mimicry between gluten and the thyroid gland. According to Kharrazian, Kresser, Wentz, Meyers, Brogan, and many more, those with autoimmune thyroid need to remove gluten from their diet d/t molecular mimicry. I have hashimotos and was an avid baker up until 2015, I made my own sourdough starter, my own bread etc. I had no GI or physical symptoms of distress from gluten, or so I thought. When I gave up gluten the stiffness in my neck went away in 30 days and I was able to go mountain biking for hours. Before I could not hold my head up for more than 20 minutes while riding.

    Another interested thing is that my TPO antibodies went from 1300 to 200 when I gave up gluten.
    I can believe that the doctors listed above, with their many hours of clinical experience and research are steering those with Hashimotos in the wrong direction. Hashimotos is not just about Celiac dz. If it hadn’t of been for these docs advising to remove gluten in my diet, I feel that my autoimmune condition would be worse.

    I feel that anyone with an auto immune dz should remove gluten from a molecular mimicry stand point.
    For molecular mimicry as well as glyphosate, which is sprayed on the wheat grain to dry it out and get it to come to head faster than traditional drying methods that our ancestors used. Gylphosate kills the good bacteria in our gut just as it kills the bugs in agriculture.

    Any one aware of certified glyphosate free grains in the US ? Organic grains cannot be sprayed while in the ground but once harvested there is no regulation against using glyphosate as a desiccant.

    One more thing, for years I was convinced that I tore something in my right knee. It hurt all the time. Doing lunges, squats, body combat and anything that applied pressure resulted in sharp pain. on May 1, 2018 I decided to give up cheese. I have known for a long time that dairy is not advised for those with Hashimotos but I loved it too much to give it up. With in 7 days that sharp pain that I have had in my knee for years disappeared. I feel like I was just given a new knee. Im back to body combat , barre, squats and lunges – with no pain. My love for no knee pain is stronger that my love of cheese. I did test this theory and sure enough, two days after eating cheese I would get that sharp pain in my knee – just like the ole days.
    So those are my clinical pearls of experience and wisdom. Hopefully what I have shared was of use to someone.
    In health,
    Veronica

    1. Hi Veronica,
      Thanks for the input.
      1. Irrespective of the mechanism, if damage is occurring, one would like notice a symptomatic change. I spoke to this in the video and tied it to the study findings.
      2. I think you are being way to broad and vague with citing others names and perspectives on gluten.
      3. I think you are missing the point – unjustified avoidance hurts people. For you, it’s justified and it’s terrific you figured this out. But, it does not mean that everyone has to avoid gluten all the time. Again, you can’t merely throw in a few names as adequate support for your position.
      4. Yes, I spoke to prevalence data in the US, this would account for glycophosphate.

      Eliminate, then reintroduce to tolerance. I think you missed this important part of the message. I also think what you don’t appreciate here is the droves of people who have misconstrewed (insent expert names here) to recommend absolute avoidance of gluten – this then leads to fear of food and pseudo eating disorders and a condition I then have to clean up on the back end.

      Please don’t fall victim to the gluten overzealousness. Yes, it is an important issue for some, but don’t make this an all-or-none-for-everyone situation. This would neglect the careful and thoughtful message I am trying to deliver to people who desperately need it. And, irrespective of what certain gurus say, this position is most validated by the actual science.

      Hope this helps.

      1. I heard on a podcast by Gluten Free Society that the ONLY way to determine if one is Gluten Sensitive is by Genetic Testing.
        Can you give me more background on this please?

    2. Thank you Veronica! I have Hashimoto and I am trying to understand if I should become gluten free… your comment was very helpful.
      Lori

  4. Dr. R,
    You are neglecting to address molecular mimicry between gluten and the thyroid gland. According to Kharrazian, Kresser, Wentz, Meyers, Brogan, and many more, those with autoimmune thyroid need to remove gluten from their diet d/t molecular mimicry. I have hashimotos and was an avid baker up until 2015, I made my own sourdough starter, my own bread etc. I had no GI or physical symptoms of distress from gluten, or so I thought. When I gave up gluten the stiffness in my neck went away in 30 days and I was able to go mountain biking for hours. Before I could not hold my head up for more than 20 minutes while riding.

    Another interested thing is that my TPO antibodies went from 1300 to 200 when I gave up gluten.
    I can believe that the doctors listed above, with their many hours of clinical experience and research are steering those with Hashimotos in the wrong direction. Hashimotos is not just about Celiac dz. If it hadn’t of been for these docs advising to remove gluten in my diet, I feel that my autoimmune condition would be worse.

    I feel that anyone with an auto immune dz should remove gluten from a molecular mimicry stand point.
    For molecular mimicry as well as glyphosate, which is sprayed on the wheat grain to dry it out and get it to come to head faster than traditional drying methods that our ancestors used. Gylphosate kills the good bacteria in our gut just as it kills the bugs in agriculture.

    Any one aware of certified glyphosate free grains in the US ? Organic grains cannot be sprayed while in the ground but once harvested there is no regulation against using glyphosate as a desiccant.

    One more thing, for years I was convinced that I tore something in my right knee. It hurt all the time. Doing lunges, squats, body combat and anything that applied pressure resulted in sharp pain. on May 1, 2018 I decided to give up cheese. I have known for a long time that dairy is not advised for those with Hashimotos but I loved it too much to give it up. With in 7 days that sharp pain that I have had in my knee for years disappeared. I feel like I was just given a new knee. Im back to body combat , barre, squats and lunges – with no pain. My love for no knee pain is stronger that my love of cheese. I did test this theory and sure enough, two days after eating cheese I would get that sharp pain in my knee – just like the ole days.
    So those are my clinical pearls of experience and wisdom. Hopefully what I have shared was of use to someone.
    In health,
    Veronica

    1. Hi Veronica,
      Thanks for the input.
      1. Irrespective of the mechanism, if damage is occurring, one would like notice a symptomatic change. I spoke to this in the video and tied it to the study findings.
      2. I think you are being way to broad and vague with citing others names and perspectives on gluten.
      3. I think you are missing the point – unjustified avoidance hurts people. For you, it’s justified and it’s terrific you figured this out. But, it does not mean that everyone has to avoid gluten all the time. Again, you can’t merely throw in a few names as adequate support for your position.
      4. Yes, I spoke to prevalence data in the US, this would account for glycophosphate.

      Eliminate, then reintroduce to tolerance. I think you missed this important part of the message. I also think what you don’t appreciate here is the droves of people who have misconstrewed (insent expert names here) to recommend absolute avoidance of gluten – this then leads to fear of food and pseudo eating disorders and a condition I then have to clean up on the back end.

      Please don’t fall victim to the gluten overzealousness. Yes, it is an important issue for some, but don’t make this an all-or-none-for-everyone situation. This would neglect the careful and thoughtful message I am trying to deliver to people who desperately need it. And, irrespective of what certain gurus say, this position is most validated by the actual science.

      Hope this helps.

      1. Dr. Ruscio,
        Do you believe that individuals with autoimmune thyroid need to be strictly gluten free? Casein free?

      2. I heard on a podcast by Gluten Free Society that the ONLY way to determine if one is Gluten Sensitive is by Genetic Testing.
        Can you give me more background on this please?

    2. Thank you Veronica! I have Hashimoto and I am trying to understand if I should become gluten free… your comment was very helpful.
      Lori

  5. Thanks great podcasts.
    I have had food issues for decades and have been diaged a celiac IBS sibo ncgs. But in the end I did diet modification no real base diet other than a big pot of stew that worked and then worked my way out.
    Unfortunately at the end it was 3 foods and no recovery so I did helminthic. I have a absolute gluten allergy sneezing and histamine response within 20 mins. But the bizarre thing is now I eat everything and small amounts of gluten. Asthma eczema and 90% of psoriasis is gone. xiphodynia snd macular torus also disappeared as well. The weird one was the torus as the only research indicates low notch3 activation and no cause elucidated.
    But I though I would share this as it was remarkable for me.

  6. Thanks great podcasts.
    I have had food issues for decades and have been diaged a celiac IBS sibo ncgs. But in the end I did diet modification no real base diet other than a big pot of stew that worked and then worked my way out.
    Unfortunately at the end it was 3 foods and no recovery so I did helminthic. I have a absolute gluten allergy sneezing and histamine response within 20 mins. But the bizarre thing is now I eat everything and small amounts of gluten. Asthma eczema and 90% of psoriasis is gone. xiphodynia snd macular torus also disappeared as well. The weird one was the torus as the only research indicates low notch3 activation and no cause elucidated.
    But I though I would share this as it was remarkable for me.

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