Gluten Sensitivity & Autoimmune Disease

Do those with non-celiac gluten sensitivity have an increased risk of autoimmune diseases like thyroid autoimmunity? This is a controversial question but a recent study helps us cut through debate and get to the truth.

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Dr. Michael Ruscio: Hi! This is Dr. Ruscio, and let’s discuss the association between wheat or gluten, celiac disease, non-celiac gluten sensitivity, and autoimmune disease.

Now, you’ve probably heard something remarking that people who have any kind of autoimmune condition should avoid gluten. And you’ve probably heard varying levels of severity of their recommendation. On the one hand, you have people who think everyone should avoid gluten with almost as little like adherence. And there are other people that think gluten is absolutely not a problem at all. Like many issues I find that truth lies somewhere in the middle – a recent study was published that looked at the association between more specifically non-celiac wheat or gluten sensitivity and autoimmune diseases. This study did find that there was actually an increase incidence of autoimmune disease in those with non-celiac wheat sensitivity. Some specifics of this study, looking at patients with celiac disease, non-celiac gluten sensitivity, and also IBS and looking at, compared to normal controls. And looking at the levels of autoimmune disease in each group.

Well, they found that in the incidences of hypothyroid or autoimmune thyroid disease was about similar in the celiac and the non-celiac gluten sensitive. So there was an increase incidence that was equivalent for both groups there.  So, gluten seems to be a factor.

Now the other more interesting finding from this recent study was that another autoimmune marker known as ANA, or antinuclear antibodies, was actually higher in those with non-celiac gluten sensitivity than it was in those with celiac. Twenty-four percent of the subjects with non-celiac gluten sensitivity had elevations of this ANA antibody that indexes autoimmunity. Compared to only 20 percent with celiac, so only a minor variation but still a fairly marked one.

Now, why might this be? I speculate that part of the reason may be is that a gluten-free diet is less recommended for people with non-celiac gluten sensitivity. (The) gluten-free diet is more recommended for people with celiac. So there potentially may be more people eating gluten who are non-celiac gluten sensitive then who are celiac.

So what does this all mean and what should you do?

Well it means that people who have non-celiac gluten sensitivity may risk provoking an autoimmune condition by consuming gluten. Now, people with non-celiac gluten sensitivity – one of the ways this can be diagnosed is they have been screened for celiac; they were negative, but they still report they notice a negative reaction to gluten when they eat it. This is very important. Because, my clinical recommendation has always been, after an initial elimination reintroduction diet, people avoid or ingest gluten to whatever degree they noticed they have a sensitivity.

So, what does that look like in real life? Some people after we go through an elimination of gluten over a short period of time and then bring it back in, will notice they are exquisitely sensitive. And I mean just the smallest amount of gluten will cause some patients to not feel well for weeks. But it doesn’t mean that we have to lump everyone into that recommendation, because there are other patients that will notice they have a tolerance to gluten – meaning they can have gluten a couple times a week and feel OK, or maybe once a week and feel okay. Or even on most days and feel okay. So there is a spectrum there. And I recommend everyone does their own trial and error or experimentation to determine where they fall on the gluten spectrum.

Now, some will say “well it doesn’t matter because you maybe are feeling an autoimmune process” that may not manifest symptomatically for years. I don’t really buy that, to be honest with you. I’ve noticed that in looking at a number of patients and guiding them through this process, the people that don’t do well with gluten and have a negative reaction physiologically notice some sort of symptomatic response whether immediately or within a couple of days. So, I think it’s a safe rule for the vast majority of people.

So, a good way to navigate this: first thing you should do (is) try an elimination diet, where you remove most common food allergens. This would include something like the paleo or maybe the autoimmune paleo diet. Give that at least a 30-day trial. If it is working for you, great! Continue until your improvements plateau. And then try the reintroduction, should you improve to a level that you feel is satisfactory. And as you go through the reintroduction you will notice you can do some foods and you can’t do others. So avoid the ones that you can’t do, eat the ones that you can do, and every once in a while just kind of experiment to make sure you continue to be able to eat the widest array of foods possible.

Now if you try an elimination diet and you don’t notice improvement then for most people, the next best move, is to find your way to a good Functional Medicine clinician that have has a very high level of training in gastroenterology, your gut health. And it’s not the norm, so you really have to vet your clinician. Have a thorough GI work-up, remove any infections, overgrowths, any type of dysbiosis, and potentially have a screening for any kind of inflammatory or even a gut autoimmune conditions treat those. Once those are wrapped up, return to the food reintroduction and you will be able to do the reintroduction now more accurately because you wont have this confounding variable of the underlying gut issue that may have made it hard to read what your response to reintroducing a given food might be.

So, in recap: people with non-celiac gluten sensitivity seem to risk provoking autoimmune conditions when eating gluten. At least this study loosely suggests. So, it may not be….it may be a proven approach for people with autoimmune conditions to avoid gluten. Nothing incredibly new here.

And also, potentially work through this process as I’ve outlined so that you can determine your greatest dietary flexibility and not get put into a camp of needing to adhere to super-strict avoidance if you don’t have to.
So, this is Dr. Ruscio and I hope this helps. Thanks!